The number on the scales tells you what you weigh. It cannot show how much is fat or lean tissue. During perimenopause, that distinction matters: research shows that body composition can change without a corresponding acceleration in weight gain. [1]
What changes during perimenopause
Perimenopause covers the transition around the final menstrual period and ends one year afterwards. Natural menopause is recognised after 12 months without menstruation when no other cause explains it. Declining estrogen is part of this transition, which happens alongside ageing. [2]
What the scales can miss
In the Study of Women’s Health, researchers tracked 1,246 women. Fat gain accelerated and lean mass began declining around two years before the final period. Across the transition, average lean mass fell about 0.5%. Weight continued rising, but its rate of increase did not accelerate. The scales therefore missed part of the change. Lean mass includes water and organs as well as muscle. [1]
A Finnish study followed 234 women aged 47–55 from perimenopause into early postmenopause, averaging about 15 months. Arm and leg lean tissue declined by 1.1%; thigh muscle area fell about 1% in a smaller CT-scanned subgroup. Higher physical activity was associated with better maintenance of several muscle-related measures. These are group averages across the observation period, not annual loss rates or a forecast for every woman. [3]
These observational findings describe associations, not proof that estrogen alone caused the changes. SWAN included Chinese- and Japanese-American women, and patterns differed across ethnic groups. The findings inform the conversation, but are not precise predictions for Filipino women. [1]
Muscle health is also about strength
Muscle health also involves strength. The Asian Working Group for Sarcopenia’s 2025 consensus requires both low muscle mass and low strength for diagnosis, with criteria extending to adults aged 50–64. Menopause itself is not a diagnosis of sarcopenia. If everyday activities become persistently harder, seek assessment. [4]
Strength can improve with training
Strength can improve with training. A randomised trial enrolled 72 women aged 40–60; 70 were analysed. Twelve weeks of supervised resistance exercise improved hip strength across premenopausal, perimenopausal and postmenopausal groups. The study was small. Its authors disclosed support from the University of Exeter and Pvolve, and an advisory role with Pvolve for one author. This supports an active approach to muscle health during the transition, while longer studies are needed to establish lasting benefits. [5]
Keep nutrition alongside training
Keep nutrition alongside training. In another 12-week randomised trial, completed by 55 postmenopausal women, resistance training improved strength and muscle measures. A high-protein diet added no clear benefit over training alone. Review your usual protein intake with a qualified dietitian to identify what you need. [6]
Putting it into practice
Start with a routine you can sustain. WHO recommends muscle-strengthening activities at moderate or greater intensity, involving all major muscle groups, on at least two days weekly. Build up gradually from your current abilities. [7]
This is the Strengthen step of the SecondSpring Method™: Move for Your Future Self. Choose two days this week to begin building a strength routine. Pay attention to what you can do, alongside what you weigh. Make those sessions a regular appointment with yourself, and adjust as your confidence grows.
Sources
1. Greendale GA, et al. Changes in body composition and weight during the menopause transition. JCI Insight, 2019. Link
2. World Health Organization. Menopause. 2024. Link
3. Juppi HK, et al. Role of Menopausal Transition and Physical Activity in Loss of Lean and Muscle Mass: A Follow-Up Study in Middle-Aged Finnish Women. Journal of Clinical Medicine, 2020;9(5):1588. Link
4. Chen LK, et al. A focus shift from sarcopenia to muscle health in the Asian Working Group for Sarcopenia 2025 Consensus Update. Nature Aging, 2025;5:2164–2175. Link
5. Svensen E, et al. A Novel Low-Impact Resistance Exercise Program Increases Strength and Balance in Females Irrespective of Menopause Status. Medicine & Science in Sports & Exercise, 2025;57(3):501–513. Link
6. Ioannidou P, et al. Analysis of combinatory effects of free weight resistance training and a high-protein diet on body composition and strength capacity in postmenopausal women — A 12-week randomized controlled trial. Journal of Nutrition, Health & Aging, 2024;28(10):100349. Link
7. World Health Organization. WHO Guidelines on Physical Activity and Sedentary Behaviour. 2020. Link