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Menopause - Musculoskeletal Health

Jan 02, 2023

Each year, over 300,000 people over age 65 in the US are hospitalized for hip fractures. According to the CDC, three quarters of these cases occur in women. The risk of a woman breaking her hip is equal to the combined risk of breast, uterine and ovarian cancer. Osteoporosis is the weakening of bones that often becomes problematic with age.

Our musculoskeletal system, like most other systems of the body, is closely related to our hormones and is heavily affected by menopause. Menopause is a hormonal deficiency that is defined as one full year without a menstrual period. Perimenopause, however, is a transitional process of hormone fluctuation that may start up to 12 years prior to menopause.

For some women, perimenopause features a few of the same symptoms as menopause. It is important women are aware of ways to reduce these changes and prevent injury and loss of independence.


Bone building and breakdown are continuous processes that respond to calcium levels, hormone levels and compressive loading through the bones. With a steady drop in testosterone, muscles tend to lose their strength over this period as well. Bone mass peaks in our early 20s, followed by a net decline over our 30s and up until menopause, when breakdown accelerates.

In addition to faster breakdown, existing bone generally becomes weaker. Bone mineral density can decrease up to 20% in the first 5-7 years post menopause. This makes resistance training during perimenopause and beyond important in helping to prevent progression of bone breakdown.

To build more bone than is being broken down, loads need to exceed loads typically used during daily activity. This means that if you are used to lifting weights that allow you to perform multiple sets of up to 12 reps, with only minimal fatigue by the end of each set, this will not be sufficient to prevent/improve osteoporosis during menopause.

The best types of exercise during this period involve weight bearing through the bones, working all large muscle groups and, for some, considering high intensity interval training and impact exercises. A Physical Therapist is a provider who can help you build and progress an individualized training program based on where you are starting from while monitoring your response and performance.

Pelvic Health Physical Therapist will have additional resources and education specifically related to menopause, can help discuss hormonal changes and refer to other specialists if needed.


As mentioned above, Menopause is a period which affects nearly all systems of the body. Hormonal deficiency is a root cause of these changes. Research has shown that strength training at least 2x/week can improve bone and muscle mass. However, the effect of strength training alone is blunted once a peak possible level of improvement is reached with hormonal deficiency.

Strength training combined with hormone therapy has been shown to facilitate progressive building of muscle beyond that peak, to make greater gains in improving bone density and strength. If you and your provider decide that hormone therapy is not the best option for you, there are pharmaceutical options as well.

Another important consideration is nutrition. Calcium and vitamin D3 deficiencies increase bone breakdown. While calcium can be found in milk, greek yogurt and collard greens, D3 can be obtained through fatty fish, eggyolk, and short periods of exposure to sunlight. It is always best to ask your medical provider about any supplements before adding them to your regimen.

Women become less efficient at breaking down protein for muscle building  following menopause. This means the type, quality and time of protein ingestion in relation to your workout make a difference. Your medical provider or Physical Therapist should be able to help connect you with a registered dietician if indicated, to help coordinate your intake needs with your resistive training plan in order to help prevent bone loss and fracture. Don’t Pause for Menopause.

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