Muscle and the Menopause

Key Content Sarcopenia and osteoporotic fractures are major contributors to frailty and falls in post‐menopausal women, and they are also highly preventable. Despite this, structured strategies to preserve muscle mass are often neglected in post‐menopausal care. Menopause is associated with a gradual decline in muscle mass, strength and function, secondary to decreasing levels of sex hormones. These hormonal changes affect mitochondrial health and muscle protein synthesis, ultimately leading to sarcopenia, frailty and reduced quality of life. Hormone replacement therapy has a limited role in maintaining muscle mass, especially in sedentary individuals. Conversely, lifestyle modifications such as resistance training, adequate protein intake and supplementation with creatine and vitamin D are more effective in supporting and maintaining muscle function and mass. Exercise not only helps prevent muscle loss but may also alleviate other symptoms of menopause. Learning Objectives To explain the pathophysiology of muscle loss during the menopausal transition. To evaluate the evidence assessing the use of HRT (oestrogen with or without progesterone), testosterone, resistance training, and nutrition in preserving muscle mass. To interpret the clinical relevance of muscle loss in relation to menopausal symptoms, frailty, and long‐term health outcomes. To develop a framework for counselling postmenopausal women on lifestyle strategies to support musculoskeletal and metabolic health. Ethical Issues There are no direct ethical concerns related to discussing menopause and musculoskeletal health in this article. However, recommendations regarding HRT must be patient‐centred and consider individual risks and benefits, as well as informed consent. Additionally, the equity of access to exercise facilities and nutritional support remains a significant public health concern, particularly for socioeconomically disadvantaged populations or those with physical disabilities. The review also recognises the importance of avoiding weight‐centric language and promoting inclusive interventions for women at all stages of the menopausal transition.