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Common mistakes in women's health and longevity, and how to avoid them: Part 3

Thinking you will 'bulk up' with strength training

If you haven't read the earlier Part 2 of this series on body weight and body composition, please read this before you proceed on to help you understand the background to this topic. The section titled "One day weight gain equals fat gain" of Part 2 blog explains the science behind body weight and body composition.

Muscle is an active tissue that declines with age. There are gender differences in that women are more susceptible to this from mid-age with declining levels of estrogen and testosterone. Muscle strength and mass are correlated with lower risk of chronic disease, quality of life and lifespan. Apart from looking 'toned', having good muscle strength and mass are important to long term quality of life and health. As we age, both bone and muscle mass and strength decline which can result in a condition called osteo-sarcopenia that leads to frailty in old age. A combination of declining physical activity (especially strength based movement), falling levels of anabolic hormones (growth hormone, sex hormones) and inadequate protein intake contributes to this. However, we can prevent and slow down this process with appropriate exercises to stimulate muscle growth and repair, even with declining hormones.

Women have estrogen and testosterone receptors in every cell, including bone, brain and heart tissues. Premenopause women actually have higher testosterone levels than estrogen. These hormones are involved in nerve transmission, muscle contraction and repair.

But a misconceptions around strength or resistance training and the idea that women will appear too 'bulky' may have prevented may women from optimising their progress or achieving their potential. Firstly, hormonal levels for testosterone are different between men and women - women make approximately 10% of testosterone as men. Just having testosterone doesn't automatically grow muscle, you still have to give this enough stimulus through resistance or weight training. Unless exogenous use of anabolic steroids or testosterone taken above and beyond physiological levels are involved, it is very unlikely that 'bulking' will occur.

This is also another reason why I like the whole body DEXA scan because this is a gold standard for tracking the changes in muscle tissue and fat. It is not something you do daily, and you cannot compare this with a BIA, but I recommend at least doing this one time to know your baseline and compare this to your age and gender to see where you rank in terms of muscle mass and determine what is your level of risk for diseases and death. This can be done yearly to track your progress. If you are interested in assessing your progress in a strength or nutrition program then you may want to do this more regularly to understand how the strategy is working for you and make adjustments.

Building muscle tissue is not easy, this is a very metabolic and energy consuming process and requires not only sufficient intensity and load but also adequate nutrition for the repair and growth process. While strength will improve quickly for someone who has just started out, the actual progress the body goes through to build this energy demanding tissue is not an overnight outcome. It takes weeks, months and years depending on your training age.

It is never too late to start and even post-menopausal women can build lean muscle and improve their strength according to a meta-analysis in 2021 on women ages 50-80 identified small to moderate benefits. Another smaller RCT study of 26 sedentary elderly women, after 12 weeks of strength training, had a mean increase of 4kgs of fat-free mass and more importantly muscle strength in upper body increased by 4.4kgf (kilogram-force) and lower body by 7kgf.

Finally, I also want to illustrate to you the differences in what the volume of the same weight of fat vs muscle actually looks like.

As you can see, the volume is much larger for 2kg of fat for the same 2kg weight of muscle. It is unlikely from the above understanding of natural physiology and anatomy, that being over-muscled is the issue, but whether the issue lies with fat tissue or fluid shifts or both.

I suggest tracking your food intake for a week and if you are not in surplus then work out if you are experiencing 2 other pitfalls in Part 1. If non of those apply to you, then consider finding a health provider to do some targeted labs to rule out metabolic, hormonal and chronic inflammatory issues.

Believing that women have to suffer through hormonal symptoms

Every woman living long enough with go through menopause. Many will have no symptoms while others may have a variety of symptoms that may range in frequency and severity. Menopause associated symptoms are not just hot flashes or night sweats, each woman has their own pattern of symptoms, and women who still have periods may experience symptoms related to their hormones. Lifestyle changes can be beneficial for managing symptoms and also reduce future health risks. But despite this, some women may still struggle daily and this impacts on their quality of life. And even if they want to make changes to their lifestyle, the low energy, exhaustion and poor sleep quality all impact on the ability to make these changes.

Menopause and perimenopause affects various parts of the body from joints, bladder, memory, heart and emotions and sometimes at different periods of time and with variable severity. There is no one medical specialty that predominantly addresses this and undergraduate training in medical school is insufficient in providing knowledge around menopause care. Currently, it is still a siloed and reactive approach. In addition, cultural perceptions in some countries are negative about menopause and the media reporting of the risks around hormone therapy are inaccurate, missing much of the nuances that came out of the Women Health Initiative and the Nurses Health Study. This leaves many women who are otherwise healthy but experiencing bothersome symptoms in the dark about what their actual options really are. There are medically accepted guidelines for gold-standard care and also recommendations on evidence-based informed complementary treatments.

If you are a health care professional, interested in the guidelines and evidence around menopause care, a free online course provided by the Newson Health Research and Education in the UK has an abundance of resources, videos and case studies you can go through at your own pace. Menopause care can involve any medical specialty, raising awareness amongst health professionals will also open the conversation more broadly.

Whilst hormone therapy is not for every woman, recognising symptom patterns for each women allows tailoring of the advice, management and monitoring options so that women can make informed personal choices.

The first step, for women, is to fill in a free menopause or perimenopause symptom questionnaire to track your symptom experience and share this with your health care professional for further discussion. You can contact us here or submit an enquiry here for the questionnaire.

If you have found this information helpful please comment, share or subscribe to our blog for updates on the launch of our new online self-paced course on Women's Hormone Health and Longevity coming soon where you can receive evidence-based and informed, fad-free, gimmick-free information.


  1. Thomas, E., Gentile, A., Lakicevic, N. et al. The effect of resistance training programs on lean body mass in postmenopausal and elderly women: a meta-analysis of observational studies. Aging Clin Exp Res33, 2941–2952 (2021).

  2. Gambassi, B.B., Rodrigues, B., Feriani, D.J. et al. Effects of resistance training of moderate intensity on heart rate variability, body composition, and muscle strength in healthy elderly women. Sport Sci Health12, 389–395 (2016).

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