Menopause Is a Muscle Problem, Not Just a Hormone Problem

0:00Dr. Gabrielle Lyon:Whether we like it or not, menopause is changing your body. Women lose mass. They lose lean mass. This matters way past how your clothes fit. When you lose muscle, you have less place to put carbohydrates, which ultimately creates a ton of problems. Low muscle mass is an early indication of low bone density. One thing is for sure that if you stop moving your body through space in ways that you did when you were younger, you will get to a place where you will no longer be able to move your body through space in the way that you once did. Menopause is coming and you should not wait. There is no magic pill, patch or injection that is going to solve for muscle loss with aging, but it doesn't have to change your life.

0:59So one of my girlfriends called me and she is 50 and she was like, Gabrielle, I cannot believe it. I tried to put my luggage in the overhead bin and I couldn't. No one noticed it, but holy frick, what just happened? It took me three attempts. I'm Dr. Gabrielle Lyon and today we are going to be talking about menopause. Not hot flashes, not chin hair, but muscle. Menopause arrives like tax day. On schedule for some, early for others, late for a few, but it arrives whether or not you are prepared for it. And I am telling you when it comes to research and science, we are riding with training wheels.

1:37We know a great deal about certain hormones and there is a substantial amount of evidence and hormonal input that we don't know. For women who are listening to this, I get it because you can't predict when your menopause is coming. So you spend an enormous amount of energy dreading the unknown, which of course leads to the next logical step going down the Dr. Google rabbit hole. And what you find there is so bleak and horrible that A, you would never want to become a menopausal woman. B, you would never want to hire one. Or three, you would never want to be friends with one. All of that is terrible and untrue.

2:19The truth lies somewhere in the middle.

2:23Dr. Gabrielle Lyon:And for years, the public conversation has had one fork in the road. And just think about this. So you've got some people that are a yes or no to hormone therapy, and everyone else, it's just like, I went through menopause. But we have to understand that we can't treat it as if it's a hormonal problem, a yes or no, do I treat or do I not? Because women who are going through menopause, they have to wait for an appointment, a prescription, a permission to do the thing that they've already done within their control, which is eat differently or exercise, right? So the first question is, what are you going to do for your skeletal muscle?

3:06Dr. Gabrielle Lyon:You still have to understand that we have to care for the foundation of our bodies. Muscle is a central priority, not kind of a nice to have. And I've been talking about this forever, but not in the context so much about menopause. So whether you are feeling like you have gained weight or lost muscle, something is happening. And whether it's testosterone, estrogen, progesterone, we have to understand what are they doing to your metabolism? What do we know and what do we don't? And of course, the question that everyone wants to know is whether a 50-year-old body can build new muscle. But before we start, we're going to talk about the definition of menopause.

3:49Menopause is the permanent cessation of menstruation, and that is diagnosed

3:56Dr. Gabrielle Lyon:retrospectively after 12 consecutive months without a period. The mean age of natural menopause is about 51. And by the way, women spend roughly 40 % of their life postmenopausal. That is a lot of time. Just because you're going through menopause doesn't mean your muscle mass or your strength or your body composition has to change. I look at my mom. She has gone through menopause. And I remember growing up, I mean, I don't even know when she went through menopause because I never heard anything about it. Her weight didn't change. Her training didn't change. I had no idea. Now that you have some confidence that it doesn't have to mean it's the beginning of the end, we do have to address why muscle becomes non-negotiable.

4:48Dr. Gabrielle Lyon:Now, across the menopause transition, women lose mass. They lose lean mass. And the fastest loss is in the perimenopause stages or the perimenopause time before menopause. But truthfully, I believe that the change in lean mass, if you do nothing about it, probably begins closer to 35. Our testing, it's not very sensitive. And at this time, we don't look at skeletal muscle mass directly. Typically, we use a DEXA. and it becomes challenging to understand what our muscle mass is doing and what the health of our muscle mass is doing. SWAN, which was the largest United States cohort, showed muscle dropping and fat increasing about two years before menopause.

5:43Dr. Gabrielle Lyon:So there does seem to be a narrow window where some body composition changes happen, but it just made me think about that we've got so many books on pregnancy. And we don't have a what to expect while expecting menopause. And, you know, I think it's genuinely hard to separate menopause from ordinary aging because both are happening at once. A lot of information online you will see attributes changes to menopause itself, but I would say that that's not completely established. And declining muscle is best framed as part of a broader body of discussion and a broader body composition shift due to the aging transition.

6:31Dr. Gabrielle Lyon:There are some things that happen during and around menopause, the rise in fat mass and the fall in lean tissue, but it's not like a vasomotor flush, a classic symptom, but there are changes that happen and it's totally erratic. It's kind of I was thinking about this this morning before I started recording, is that kids have their own personality, their own tendencies. No two children are alike. And the hormonal profile of a woman is kind of like that. For some women, maybe her testosterone declines slowly. For others, maybe her estrogen stays high and then it drops and then it goes high again.

7:11Dr. Gabrielle Lyon:But no two women go through menopause the same. Hormones. Testosterone. Probably my favorite hormone. I'm very interested in this. I do research with my colleagues over at Baylor. And testosterone, which is a hormone that most people relate to muscle mass, it doesn't actually crash for most people in menopause. Estrogen is the one that typically falls off a cliff, where testosterone loss, you know, seems to be a bit of an aging story. And I will tell you, none of this is in totality, but women that have and make slightly more testosterone seem to have more lean mass. Now, this is not the same as saying testosterone therapy at a female dose builds meaningful muscle or strength because the literature doesn't support that.

8:01Dr. Gabrielle Lyon:And it's not a fix for muscle and it's not an energy fix. At least that's not what we're seeing in the data yet. Testosterone and estrogen and progesterone, they all change during this menopausal transition, perimenopausal transition. Aging muscle and menopausal muscle, again, they ride along together typically. They go through something called anabolic resistance, and this is a unique change to muscle that happens. Anabolic simply means tissue building. We're thinking about this in terms of muscle building, but it really is tissue building. And anabolic resistance means your muscle becomes harder to build because it responds less and primarily less to the two inputs that normally grow it, which are protein and mechanical load.

8:59Dr. Gabrielle Lyon:Think of it the way you think of insulin resistance, because I know that you're thinking of that often, except that muscle is the currency. And what do I mean by this? In a younger body, a normal protein meal or a hard training session stimulates muscle building, the muscle building switch. Just think of it like that. With aging muscle and anabolic resistance, a few things happen. Number one, you're getting older. Estrogen deficiency appears to worsen this a little bit. and the switch gets a little sticky. The science is not definitive, but estrogen seems to play a role in changing muscle. Again, to what degree, we're not sure.

9:39But what we do know is that you need a larger stimulus to produce the same result, a larger amount of protein at one time and more input, meaning mechanical tension.

9:53Dr. Gabrielle Lyon:Research in postmenopausal women has shown in some studies a blunted response, even to the classic protein plus resistance exercise. Now, why is this so interesting? Over the years, I've been in medical practice for a very long time and the women in my practice, they all show a variable response. Some seem to struggle with putting on muscle and others don't. And I can tell you in advance, I have absolutely no way to tell you which one you are. Estrogen may support muscle building machinery. It acts on receptors in joints and tendons. So I did a wonderful podcast episode with my colleague, Dr. Jocelyn Witten, and she has done pivotal work in estrogen receptors and joints.

10:43Dr. Gabrielle Lyon:And she was talking about how the decrease in estrogen makes women more predisposed to injury because their joints are stiffer. They're not responding the same way. I definitely think that this is an episode worth your time. I will throw a link in the show notes. For those of you who are watching, we'll put a link on the screen here. Menopause isn't just a physical transition. And I think that we talk about this piece the least. It's also a mental transition. And if you've ever gone through a challenge, burnout, or a period where anxiety keeps piling up, you know how important it can be to talk to someone.

11:23The problem is finding the right therapist, especially one who takes your insurance. That's where today's sponsor Rula comes in. Rula works with more than 100 different insurance plans and the average session costs, get this, about$15 with insurance. You're getting care from a licensed therapist without an out-of-pocket cost that makes you think twice about getting help. It is not cost prohibitive. Rula also, which is incredible, helps match you with a therapist based on what you need, your goals, and your background. there's no wait list appointments can be available as soon as tomorrow they support you throughout this process it is very user-friendly if you go to their website you will see and if you have been feeling like it's time to talk to someone and you need support we all need support i have gone and used online therapy for many years, this is the time to do it and a practical place to start.

12:34Go to rula.com slash Dr. Lyon, R-U-L-A.com slash Dr. Lyon for quality therapy covered by insurance. And one more thing, I want to hear about your experience.

12:52Dr. Gabrielle Lyon:So if you shoot me a DM or you shoot me an email, I think that this is a very untapped conversation, the mental transitions of life. At the end of the day, you need to focus more on body composition until you get into a good flow at 52 versus what you did when you were 32 or even in college. I mean, in college, I don't know. I don't even know how I did the training I did and didn't hurt myself. But this matters way past how your clothes fit. Muscle is important. It's important for everyone. But as it relates to this conversation, when you lose muscle, you have less place to put carbohydrates, which ultimately creates a ton of problems, also known as carbicide.

13:40Dr. Gabrielle Lyon:No, really, I know my jokes are terrible, but less muscle means reduced glucose disposal. Reduced glucose disposal drives insulin resistance directly. What does that mean? It just means that when you eat carbohydrates, muscle is the first place you put it. And I remember years ago when I had my first post-menopausal thin woman. She showed up in my office in New York City with about 18 % body fat, and she was pre-diabetic. I was shocked. I couldn't believe it. I was like, oh my gosh, your body fat percentage is so low. This is amazing. And then I got her blood work back and I thought to myself, I don't get it.

14:19Dr. Gabrielle Lyon:And it was that she had so low muscle that she had nowhere to put the carbohydrates that she was eating. And it was a moderate carbohydrate diet for her. But again, what we missed was that she really needed to focus on training. She had very little muscle mass and her body just couldn't handle what she was eating. Loss of muscle is an important risk factor for falls and frailty fractures. We know this. We know that there is a link to osteoporosis and cardiovascular disease, according to a review in the Lancet Diabetes and Endocrinology, which we will link. Separately, higher lean mass in postmenopausal women have been associated with lower risk across multiple chronic diseases of aging.

15:06Dr. Gabrielle Lyon:One important fact, bone declines alongside muscle around the same window. And what does this mean? It means that low muscle mass is an early indication of low bone density. The European study for clinical and economic aspects of osteoporosis and osteoarthritis treats both bone and muscle as one problem with a single intervention. Can you guess what that intervention is? Beyond exercise, when you load a muscle, you also need to feed a protein. And what we're addressing here when we talk about muscle is also about bone and nobody wants osteoporosis. And I was looking at the numbers that they recommend for the baseline for bone health, and it's actually above the RDA, which is 0.8 grams per kg, which I thought was really interesting.

16:04We have to understand, are we dealing with a muscle problem, like I mentioned, or are we dealing with a fat problem? And the reality is likely it is both. As estrogen declines, there is a shift specifically towards visceral fat, which is the fat around the organs and abdominal fat. Again, this is not fat that is under the skin, but it is around the organs. The second is this drop in energy expenditure. Research in the Journal of Physiology and another recent review both point toward lower resting and sleeping energy expenditure and reduced fat oxidation across the menopausal transition. Now, this is independent of aging, but I just want to acknowledge this because when a patient tells me she's gaining weight and that she hasn't changed anything, I don't want her to think that she's crazy and I don't want you to think you are crazy because we can fix this.

17:02The data I understand is all over the place, but I just want to share some of the things that I am seeing in our clinic at Strong Medical. And one of the things that we are coming to see is that estrogen might also play a role in satiety. The data shows that it It may support both energy expenditure and fat oxidation. Therefore, when it declines, several things are changing at once. Resting and sleeping energy expenditure fall, right? Peak fat oxidation decreases, visceral fat rises, insulin resistance worsens, triglycerides go up, and HDL goes down. I mean, it's like a perfect storm. There are recent reviews that attribute these changes not only to falling estradiol levels, but this concomitant rise in something called FSH, which is follicle stimulating hormone.

17:55The field is still working out about how much independent weight FSH and estrogen together influence metabolism. Blood testing in general is extremely critical because if you do not understand where your blood levels are, you are managing processes in your body in the dark. I suggest blood testing and knowing where you are because training and eating the way that you did in your 20s might not work when you are in your 50s. But the good news is we do have levers to pull like muscle and nutrition. And those two pieces matter more when used appropriately to preserve muscle. And preserving muscle is one of the few modifiable variables.

18:44You don't have to wait for a prescription. All you have to do is start getting after it because it's just like tax day. Menopause is coming and you should not wait.

18:53Dr. Gabrielle Lyon:There is no magic pill, patch, or injection that is going to solve for muscle loss with aging. The starting protocol, obviously you check with your physician, is the following. When I think about what I'm going to be doing with my body, two or three days a week of full body training, making sure that you're going through all planes of motion with the target in mind being this. What does your body need to remain capable of throughout your life? and what are the movements that you have to do to make that happen? Because listen, you want to avoid being like my girlfriend who couldn't put her suitcase in the overhead compartment.

19:32Dr. Gabrielle Lyon:Some of the things that we have to do is we have to get down and get back up. This in my mind is the squat and the lunge and transferring your body off the floor. You know, I was talking to the Starrettes and we talked about sitting and spending more time on the floor. Pick something up with a hinge or a deadlift, push something away, reach and lift overhead, rotate your body, resist rotation, chops, throws, carries. Women will say, well, I've never lifted a weight in my life. And I will say, listen, you've lifted children, you've lifted suitcases, you've lifted groceries, you've lifted a ton of things.

20:11But one thing is for sure that if you stop moving your body through space in ways that you did when you were younger, then you will get to a place where you will no longer be able to move your body through space in the way that you once did. And

20:27Dr. Gabrielle Lyon:I feel very passionate about this topic. People think about menopause as do I go on hormonal therapy or do I not? They do not think about midlife and menopause as muscle change. And that That is where we have to get to because whether we like it or not, menopause is changing your body, but it doesn't have to change your life. Because if you are able to use training and good nutrition and really understanding what to expect, then you will be able to be forever strong. That is exactly why we are launching our menopause challenge yet again this year. This is backed by popular demand. This is our most popular challenge that we have ever done.

21:17Dr. Gabrielle Lyon:We had hundreds and hundreds of women sign up for this challenge to experience the muscle and menopause and nutrition and mindset altogether. We don't have a choice. We go through menopause. But the one thing that you can control is your experience surrounding it. Are you going to embrace it with open arms and understand, hey man, it's coming for me and take control and agency. We might as well go through it together, positive, and help develop the second half of childhood, shall we say adulthood, for the rest of our life. So till next time, stay forever strong.