Menopause, Weight Loss & HRT plus Fat Loss, GLP-1s and Muscle Over 40 with Dr. Bill Campbell

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0:47You can message a vet at any time and schedule a video visit the same day. Our vets can even prescribe medication for many ailments and shipping is always free. With Dutch, you'll get more time with your pets and year-round peace of mind when it comes to their vet care. Go to Dutch.com to get vet care that is always there for just$92 a year. I don't even like lifting. I was just telling, like, I would lift it today. I was doing squats, and I'm like, ah, I wish I enjoyed this more. If you find your groove and you like something, just lean into that because you're active. You're, you know, hopefully you're fit.

1:24You're getting all these health benefits. Because if I convince you to do something you don't want to do, you're not going to do it very long. Please lift weights if you can. You don't have to like it because I don't like it. Yeah. But again, if you hate it and you love running, run. Awesome. Hi, everyone. My name is Haley. And this is Laura. And welcome to The Body Pod. Welcome back to the BodyPod, Dr. Bill Campbell. So excited to have you back. Yes, I'm happy to be back. Thanks for inviting me. So it has been, I've had you on some of my courses, so I feel like I'm up to date. But as far as a podcast, I've actually never had you on as a podcast.

2:12We had Instagram lives and then I turned those into podcasts, but that's now been, I think three years. So a lot has changed and you've definitely shifted from that time, obviously still a master and expert in fat loss and what you've devoted your entire career to. But now as most women will know you listening to this podcast, you've kind of shifted, well, you have shifted to include the menopause females and kind of where you are spending some of your research time. So can you share how long you've been doing, like you've been in the menopause space and providing to all of the research that we know and including the largest menopause study that you are doing right now?

3:07Yeah. So I think you did add a pretty good summary. So I've, I just described myself as a fat loss researcher. That's kind of been my research agenda for most of my career. Um, also I have a big muscle component as well. So effectively my career has been, how can we help people lose body fat, but maintain as much muscle mass. And probably for the first 15 years of my career, that was focused mostly on younger metabolically healthy females. And then over the last probably two to three years, as you said, I'm not just including I, I jumped into the deep end of the pool. I'm, I am, I am swimming in menopause fitness.

3:52Like I, the whole lab focus that shifted now it's still, I'm still using the same skill set, the same building muscle, losing body fat and looking at just the population is middle aged women now. And what I love about it is it's it's opened up a whole new world for myself of learning about hormones, specifically estrogen, progesterone, testosterone therapy. and when you're studying young women that those don't those don't really come into play um really at all so yeah and then the if i were to just be a little more narrowly focused one thing that i've that i've learned from a lot of conversations from women and then from our survey there seems to be not everybody but a lot of women especially fitness women so that's another thing um i'm i I focus on women who live a fitness oriented lifestyle.

4:55And that population is completely ignored in the menopause space. Thousands of studies on menopause, thousands of studies in women. You try to merge fitness and menopause, there is a huge void. So in that space, I've learned anecdotally that a lot of women gain weight, not a lot of weight, but to them it's a lot because they've been fit their whole lives and they seem to be having a lot of trouble losing it. Or the common message is the things I used to do to lose body fat are no longer working. So I'm really focused on that area. So what I'm calling weight loss resistance. Yeah. So can you talk about exactly what are the questions that you asked the women in this survey and how many women participated?

5:50And where are you in the, are you done with this or are you still in the process of it? So we're done with the survey in terms of it's no longer open for people to respond. So it is the largest menopause fitness survey ever done. This is so exciting. Yeah. Yeah. I want to thank you because you helped spread the word. And And right now, we're about to submit our first paper from this. There will be about six different papers we're going to get from this. And let me just explain to everyone what the survey was. So you had to be a resistance-trained female to participate. That's what I was going to ask you.

6:32When you say fitness, like fitness focused, does that mean athlete or it's just a woman who trains, does resistance training? Yeah. So I'm very much a resistance training researcher. So I'm staying in that lane. Now, you can you don't have to lift weights to to say that you're a fitness, that you embrace a fitness lifestyle. But as far as I'm concerned, that's the population that I want to study. Would you say active then for listeners just wanting to understand? Yeah, yes. And then specifically to qualify for this survey, they had to be resistance training at least for the last six months on average two times per week.

7:16And then we had five broad domains. One was just, you know, income, ethnicity, like all the basic demographics. Then we had a weight loss, body composition and weight loss resistance section. Again, that's where my research is going. So I wanted to, for the first time, I wanted to get this in the research literature because there's nothing about this in the research. A lot of women struggle with this. Then we had a nutrition section. So do you track macros? How much protein? What supplements do you take? We had a fitness section, which was big. So what does your resistance training look like? What does your cardio look like?

7:54Do you do agility? Do you do sprint interval training? Pilates, yoga. So a lot of questions around fitness and then also a hormone therapy section as well. So are you on this? Why or why not? What's your dosages? Has it helped? Has it not helped? So that's the survey at large. And we're about to submit the first paper, which is just describing the sample. So pretty what we call a protocol paper, pretty boring. And then the next one will be the weight loss resistance data. Then we'll move to fitness, then nutrition, then we'll move to hormone therapy. And then the last one I was, this isn't my area, but I was working with a colleague, JC Grease from Boston University.

8:40She convinced us we should look at shame and stigma related questions because a lot of women, I mean, I'm very open up. Well, yeah, I'm almost inappropriate sometimes about it. But a lot of women have shame or stigma to talk about this. And I'm glad that we did include that because that's again, that just I didn't never cross my mind. So we have that data as well. Wow. I wouldn't have guessed that that would be in it, but I mean, it makes it makes sense. So what would you say at this point? What are some of the what has surprised you? Because here you've worked with all all ages of women, even though most of it was younger.

9:25What has carried over that you're like, oh, there's maybe not that much of a change. And what has surprised you in this older audience? um and hayley do you mean specific to what i've learned as i'm analyzing the survey data or just everything i think just everything what have been like the key moments that maybe you're like oh i thought it was going to go this way more but it didn't yeah so i'll say more broadly um there what surprises me is how many women and and just just to give context um and i think you can appreciate this. I communicate with a lot of women just on social media. Like I'm trying, I am a sponge for knowledge.

10:07I'm just, I try to, I try to help when I can, or a lot of times I say, I don't know what they're quite, you know, if they have specific questions that I don't know the answer to, but my learning curve is really just from a lot of conversations. And now of course the survey is going to validate a lot of this. And because these are, you know, this was under research conditions. But the one thing that surprised me, and then if I think about it, maybe it doesn't, but just the, how many women are reluctant to even consider hormone therapy? Like it is not an option. I don't even want to, I don't even need to talk about it.

10:43And that surprised me because it's like, I'm not, I'm not, I don't want to convince anybody they should take hormone therapy, but at least know why that you're saying that it's not an option. So that's something that surprised me. And I don't think a lot of women, I think they just want to maybe tough, tough it out. And in my for my own wife situation, we didn't I was we were very ignorant of hormone therapy. initially. It took us one to two years before we made the decision for my wife. So I get being, but, but, but there at least I was like, well, well, let's educate ourselves. Let's, and just, just for anybody that that is listening, the biggest positive change for my wife was the day she started hormone therapy in terms of her quality of life.

11:30It was, it was awesome for her. you know, let me tell you, this is, um, when you were, as you were talking, I, I had this, while there's this kind of, um, I don't know, maybe stigma around taking the HRT and, and there are women that are like, absolutely not. I feel, and I'm kind of shifting gears here, but maybe you include this too. I feel that same stigma with, with, um, women that are pro GLP ones and against GLP ones. Those are the only two, I guess, buckets that I feel like are a hard yes or a hard no. Everything else is kind of like, yeah, I need a resistance train. I can do some cardio.

12:13I need protein. None of that is really debatable. But those two subjects are really intense as far as where people align. It has that come up in your are you asking that in the study or is that a separate bucket that you might do later? No, we we definitely asked that specific question. And I will say from our survey now, we didn't publish any of this yet, but just in my conversations, specifically to women who are having a really hard time losing body weight. Now, Let's just define weight loss resistance. The way that I'm defining it is the things that used to work when I was or when a woman was premenopausal, the weight loss strategies, and those would be reducing calories or increasing exercise, mainly cardio, doing one or both of those things does not seem to cause as much weight loss as it did years ago prior to menopause transition or prior to menopause.

13:18So it's like the body is weight loss resistant. So with that definition, I would say 80 % of the women who I communicate with. Will say nothing was working, but a GLP one finally moved the needle for me and I'm glad I did it. And then 20 % of the women, they had bad side effects or it just didn't work. So they stopped taking it. So that is, again, in my world of living with body fat loss, that's something that I would always at least put on the table. Again, whether you choose to take it or not, it has helped a lot of women with the extra 10 or 15 pounds that dieting hasn't seemed to help. Yeah, I would agree with that.

14:10When we're looking at that and the research, I guess this is as a whole, maybe for what we just talked about, GLP-1s or just in general, are you seeing a difference in the perimenopause versus the postmenopause? so not yet because i haven't necessarily analyzed that data but i can speak to research on this with body composition changes the best research studies that have studied this and i'm going to define what that is the best studies are those that start tracking women before they started perimenopause So they're getting them in their early 40s. They're clearly premenopausal and they track them through perimenopause and into early postmenopause.

15:01There's not many studies that have ever done that. There's a handful. So they're the best studies. The next thing we have to know, and now this pool of a few studies gets shorter, gets even shrunk down to even fewer studies. If you're going to study these women and ask what happens during the menopause transition, you have to identify something known as the FMP, and that stands for final menstrual period. That is, that is the anchor point for when they are now considered post-menopausal. And the definition of that is they have not had a menstrual cycle for the previous 12 months. So if you don't identify that when tracking these women over time, you have no idea when when they were in perimenopause, when they started postmenopause.

15:50So the best studies are going to track from pre through peri into post, and they're going to identify the all important FMP, final menstrual period. The studies that have, or the main study that's done this, the best study comes from a large database called the SWAN studies. That's like, that is the gold line of information if you want to study menopause and the transition through this. What we learned from this data, and we know this because not only did they track them and they had them come every single year for body composition testing, identified FMP, they realized that as women start perimenopause, or let's just say about two to three years before they're officially postmenopausal, what we see is, we'll look at this through muscle and fat, body fat is increasing through their 30s and 40s at a given rate.

16:53And then when they hit perimenopause, there's an accelerated rate of body fat gain. So perimenopause seems to be the time where some women, again, this research doesn't say it happens to everyone, but majority of the women experience an accelerated rate of fat gain for about three to four years, starting in perimenopause and extending for about a year to two past postmenopause. And then these body changes start to flatten out. So you don't continually gain excess body fat. One other thing with this, it's not just that they're gaining body fat. There's also an uneven distribution of where this excess body fat is being laid down in the body.

17:40And you probably know where that is. It is the abdominal or midsection region. So a lot of other research validates that. So more visceral fat, more subcutaneous abdominal fat during this phase of life. And let's just mention muscle as well. This study did report a slight decrease in muscle at the same time that they had this accelerated rate of fat gain. And it was slight. I still have more studies that I've identified that I haven't read. And I'm at this point, I don't think all studies are reporting a loss of muscle. Now, one caveat to that, all of this research is in what we would all call a general population, right?

18:28They're not you guys. They're not my wife. They're not lifting weights. So in my conversations with this fit lifting population, is it possible that because they've built more lean mass over the years, that they are indeed losing more muscle than what this other research that there's, there's, there's no, um, there's no accounting for building muscle or, you know, lifting weights. And the other thing is all of these changes are occurring at the same time that estradiol, estrogen levels are starting to go down and very much though we're at post menopause, they're, they're essentially very little estrogen being produced from the ovaries.

19:14And we know, or from other research, estrogen appears to be pretty anabolic. So it's, to me, it's not a stretch to think if you have built muscle and you are losing estrogen, that maybe you are losing muscle. Now, I hate to keep mentioning my wife, but Haley, you know, I talk about my wife a lot. She lost a lot of muscle during the menopause. She was like, that was one of the, you know, she gained body fat, but she was like, man, I'm just, I can't, I, I, I, it bothers me how much muscle I've lost. You know, she lifted since she was a teenager and a lot of work to build it. So are you looking at bone too?

19:53That's an area that I haven't looked at now. I, I would suggest my population that I love these resistance trained women. And we can also assume in many cases, well, I have data from our survey that they're eating pretty optimal protein as well. So they're lifting weights, optimal protein or nearly optimal. That's a population where bone loss, unless there's a genetic predisposition, it's not something that we would generally be concerned with, right? Because they're doing all the things to, to, to help bone mineral density. Now, uh, I, it's not something I've studied, but somebody like my mom who never lifted weight.

20:35So if you are a general population per woman, I, I, I would be more concerned about your, I would be more aware on top of that, that health marker, but less concerned in this population. So can you review the stats of those when you talk about HRT and you did a post on this recently where 5%, I think, of the women that are not actively resistance training, what we would just call the average general population of women. Um, the women listening here are most likely resistance training and doing some of these things, but the vast difference in 5 % of women that are taking HRT versus 55%. Was that the statistic of women that are active and resistance training and kind of in this world, 55 % are taking it.

21:39Why? Yeah. So when you asked earlier, what have I been surprised about? Well, one was how many women just are anti-hormone therapy and maybe they don't know why. And the second thing was exactly what you just mentioned. It was, and this is from our survey, and we did a preliminary analysis on this. So we actually presented this and it was, yes, like you said, 55 % of the respondents of our survey were taking hormone therapy. And we define that as they're taking estrogen and or progesterone. progesterone. So those two, we also had questions about testosterone. We also had questions about thyroid hormone, but that question, hormone therapy, it's either estrogen alone, progesterone alone, or a combination.

22:24The 5 % is based on just norms that have been previously published. I will say, let's just double that. Let's say 10 % because 5 % really doesn't account the women who are getting compounded hormone therapy. And we know that that is much higher than probably what the research has reported in past years. So let's double it. So we're still looking at 10 % to over 50%. And I, again, I didn't know what to expect going into this, but that is a massive difference. Now, again, this is where I get to be the host for a second. Why do you guys think that these women who are embracing a fitness lifestyle, why are they so much more likely to take hormone therapy?

23:14Oh, 100%. I would attribute it to, they're probably on social media and they're listening, they're following Mary Claire Haver, Vonda Wright, Kelly Casperson, some of these big leaders in the space that have made it acceptable and quite honestly, just educated women on the truth about hormone therapy, you know how long it takes to turn around a ship. I mean, we're still in this day and age in 2026, having women every single day be like, well, I don't, I can't lift. It will make me bulky. And we all know that especially I post menopausal women. I'm like, they're just trying, they're lucky if they can maintain the muscle, let alone build, they for sure can build, but it is so much different than someone that's 25 or even 30, then that post-menopausal 52, 53, whatever that age is.

24:10So that's what I would say. I think also like that result-driven mindset and then you talk to the people around you too. And if the people around you are getting results and seeing this huge change in their lifestyle and quality of life, they'll start doing it too. So I think it's like what Haley said layered on. Yeah, it's like that result-driven mindset too. Yeah, I think that's what you both said is exactly my thinking. And something that I am reminded of at times, again, because menopause just comes up in pretty much every publication I have. We do live, and I forget this. I'll say I do, but I'm going to say you guys too.

24:59We do live in a bubble on our algorithms where we think, yes, and it is not. I ran into, I was visiting my parents in Pennsylvania last Christmas, and I ran into a girl that I went to school with. And she was just, you know, I haven't seen her in a couple years. So I mean, maybe even since high school. So we're both at the gym and I think she was 48 years old and her daughters were with her. I got to meet her daughters. And I was like, yeah, I'm like I said, are you are you up to date on HRT? Like, are you are you educating yourself? And she's like, oh, what's HRT? I was like, oh, that is an acronym that I just assume that everybody knows that that stands for hormone replacement therapy.

25:50So I actually like getting that feedback because it reminds me of this. We are in a bubble. And I know sometimes I'm like just with my fitness. I already said that 20 times. And let me just talk to other people that are fitness coaches. You can't say things enough that you're always going to reach somebody that maybe didn't hear you before. Or if my wife tells me something eight times, I don't really hear it the first seven. but I do on the eighth time. Absolutely. So let's talk about the hit controversy. Number one, two questions. Number one, let's talk about the studies that show that sprint interval training is more superior than zone two and the pros and cons to that study, maybe, because there's different voices in the space and different takes on the research there.

26:48But then separate to that is this interval training spikes cortisol and therefore it shouldn't be done. I don't know where those are coming from because the women that I associate with and collaborate with, we know that cortisol is going to spike when we are exercising. so but i know there's a whole world out there that's saying don't do any interval training at this age because it will spike cortisol what what do you have to say about that yeah i have a lot of thoughts on this one i was just being a jolly old researcher and came across a study and then i'm then i read a second then i'm on a third and then i was like wow there is a lot of consistency here about, we'll say sprint interval training.

27:38So I dedicated that topic to my research review, did some posts on it. And I'm pretty naive, I guess, but I don't know what was controversial. I don't know. First of all, if you don't like doing sprint interval training, don't do sprint interval training. Nobody's forcing you to do it. The research, four different studies that compared this to zone two cardio all came to the same conclusion. You lose more abdominal and visceral body fat from sprint interval training than you do zone two cardio. And some people said, I can't believe you're bashing zone two steady state cardio. I'm like, I don't think I was like zone two cardio is awesome.

28:24If you love that, please do that. Like I would never tell you to stop doing a form of exercise that you enjoy. So in terms of the controversy, and again, I got some of that. And I don't know where that comes. Well, I think I do maybe a little bit. I don't know if we want to go there. I think, I think maybe there are voices in this space. There are people are more, more focused on a voice rather than the actual topic, I guess is, is what I would say, which that. Yeah. And would you say that, that we're, we're putting sprint interval in a separate category. I put a high intensity interval and sprint interval in the same, under the same umbrella.

29:13However, with this, with these studies, you're saying that the sprint interval is slightly superior to even the hit interval or is it that is all together and zone twos. We know zone twos are different animal. I'm not aware where they compared sprint interval to high intensity interval training. So let's, yeah, that's, I'm glad you mentioned this. Let's define our term. So I look at high intensity interval training hit as a broad umbrella term. That generally means you're exercising very hard for about 30 seconds and then you're recovering and then you're going to go hard again for 30 seconds.

29:53I look at sprint interval training as a subset of high intensity where you're actually going harder for anywhere between maybe five to 15 seconds and then recovering and then doing it again. Now, some of the protocols in the studies, the most common protocol was like eight seconds sprint, 12 seconds relax. Well, that might be a horrible, um, practical application of this, but nonetheless, when they compared that protocol to steady state zone two, there was significantly more visceral and abdominal fat loss in menopause women. And again, four different studies. Um, the studies were, there weren't major limitations in the studies.

30:45They could possibly, well, you could say this, whenever somebody says, well, they didn't control for nutrition or they didn't track nutrition. Well, they did track nutrition in most of them, but it just wasn't the whole study. But if you're going to make that argument, you have to then say the same thing about every single resistance training study, because that whole field, and I live in this area, they never, almost every resistance training study does not track food or not even protein intake in most of these studies. I think that's not good, but it doesn't mean that we say, hey, if you lift heavy, you're going to get stronger.

31:25So you don't throw out all that literature because they didn't track nutrition. You just say, yeah, that's a limitation. Which again, I'm more than willing to make myself my own research. Now, I always track nutrition because I'm a nutrition person, but my own research has limitations. And let me also mention one other thing. Cortisol. So years ago, and you said this earlier, I just want to reiterate. When you are exercising, especially high intense, high with high intensity, your body will naturally release cortisol. That is a healthy, normal response. So when I was younger in my career, I was really into overtraining and overtraining syndrome.