The Impact of Strength Training on Menopause, Andropause, and Other Age-Related Changes

It should be no surprise that with age comes decreased exercise performance, energy, libido, etc., and increased risk of falls and/or fractures, poor sleep, and declining cognitive health. These changes are heavily contributed to (but not limited to) by the decline in the hormonal profile observed in both men and women. While modern medicine and pharmacological intervention can aid significantly with the symptoms associated with this next developmental stage of life, exercise (strength training in particular) has made its case as a valuable tool in the toolbelt. This is not to say that strength training should replace cardiovascular training. Rather, both can and should be used thoughtfully and intentionally to not only improve symptoms of age related changes, but potentially thrive within them.

What is Menopause and Andropause?

There are multiple stages of menopause beginning with perimenopause, the stage wherein menstruation is irregular and manifestation of a variety of symptoms may occur including but not limited to hot flashes, night sweats, sleep disturbances, and/or mood changes. These changes are in part caused by unpredictable fluctuations in estrogen from one month to the next and a steady decline in progesterone, causing variation in menstrual flow and regularity.

Menopause is defined as the moment in time a woman has gone 12 months without a period, indicating the menstrual cycle has officially ended. Even though menstruation has ceased, the symptoms associated with peri- and postmenopause vary wildly in severity and duration, with some women experiencing minimal symptoms over the course of a few years, to others with more severe experiences up to a decade or more. The general ages one can observe symptoms may range from 45-55 years old, but anywhere between 30-60 is “fair game.” While there are a variety of concerns worth addressing during these years (such as the implications with years of poor sleep), a particular limitation worth mentioning is loss of bone density. A growing collection of research indicates that women can lose up to 20% of bone density throughout menopause, with roughly 10% of women over 60 diagnosed with osteoporosis.

Andropause, “MANopause,” or late-onset hypogonadism, describes the decline of a man’s testosterone production associated with age, generally beginning around the age of 40. While men can experience similar symptoms to women including low libido, hot flashes or sweating, low energy, and sleep disturbances, the severity of said symptoms is typically much lower, which is thought to occur due to the slow (and generally steady) decline in testosterone, compared to the rapid and unpredictable changes in estrogen from month to month for women. While only 10-25% of older men fall below the “healthy,” range of total testosterone (300-1000 ng/dL), there can still be noticeable increases in body fat and decreases in muscle mass and bone density.

It is worth mentioning that while there is growing popularity and endorsement of hormone replacement therapy in the wellness space, this decision comes with both pros and cons, and should be discussed in detail with a primary care physician based on severity of symptoms and impact on quality of life.

Why Strength Training?

Strength training as an intervention for symptom prevention or even treatment of menopause has historically flown under the public radar, but has quickly become one of the more popular talking points on everyone’s favorite podcast, talk show, or review in recent years. While muscular and cardiovascular endurance is relatively maintainable with regular exercise as we age (and also incredibly important for quality of life), both muscle size and strength decrease by roughly 10% every decade, with power (how quickly you can perform a given amount of work) decreasing even faster, up to 3-5% every year after the age of 60 (Senguin & Nelson, 2003). After the age of 65, 30% of people fall at least once, with a nearly 30% mortality rate of hip fracture patients within one year of fracture (Panula et. al. 2011). Aside from the clearly documented impact on risk of heart disease, arthritis, and metabolic diseases, strength training can distinctly improve vitality and quality of life, help maintain and grow muscle mass into later years, and prevent/reduce the risk of falls and breaks through better strength, body awareness, and bone density adaptations (Senguin & Nelson, 2003; Panula et. al. 2011).

There is also ample evidence that strength training has a direct impact on hormonal regulation, including increased secretion of androgenic hormones, (including but not limited to) testosterone and growth hormone (Kraemar & Ratamess, 2005), which are known to increase muscle protein synthesis, muscle retention, and strength gains in both men and women, as well as decreased frequency and severity of symptoms associated with menopausal changes (e.g. hot flashes, night sweats, etc) (Capel-Alcaraz et. al. 2023). Interestingly, it has also been suggested by (Vingren et al., 2010; Gharahdaghi et al., 2019) that the gradual yet significant decrease in testosterone in men observed during the andropause years may be a byproduct of reduced muscle mass from poor nutrition, sedentary behavior, etc., challenging the notion that hormones are independent of behavior. On top of the distinct impact on reducing/managing menopausal symptoms, strength training provides each one of us more agency than ever over how gracefully we age, and what we are capable of.

To learn like the professionals, you can read more about all things strength and conditioning in Essentials of Strength and Conditioning, developed by the National Strength and Conditioning Association (NSCA). Otherwise, you can explore podcasts that feature trustworthy names in the science community including but not limited to Dr. Emily Dow, Dr. Alyssa Olenick, Alec Blenis, Sheridan Skye, Ben Carpenter, or Sebastian Oreb.

How to Strength Train

Strength training is one of many modalities of resistance training, each with their own host of adaptations and benefits. Additionally, there are countless strength training protocols/exercises, some claiming to be the “best,” for specific populations like menopausal women or men with low testosterone. The bottom line - the right protocol is the one that works specifically for you and your calendar, holds your interest, and allows you to push yourself hard.

That said, there are some pillars that all strength training formatting should follow, and nearly everyone can get started with very little time and equipment availability.

Mechanical tension (i.e. the amount of tensile force placed on a given tissue or muscle through muscular contraction) - Adaptations from strength training are determined heavily by the amount of mechanical tension exerted by a muscle in a given set. While many will train based on a percentage of their 1-repetition maximum (the amount of weight one can lift for just one rep), it is very possible to strength train using other gauges of intensity, particularly for beginners. Research has heavily established that positive adaptations are gained when a set is taken to or near task failure, when mechanical tension is highest. This is typically measured as a scale rating of at least an 8 on a 0-10 rating of perceived exertion (RPE) scale, or else described as 3 or less reps in reserve (RIR) (helms et. al. 2016). In other words, if one performed 10 repetitions of a squat with at least 5 extra repetitions “in the tank,” there would be less overall mechanical tension, (and less strength, muscle growth, and bone adaptation) compared to performing 10 squats with enough resistance to report 0-3 RIR, or else an RPE of 9-10.

Pro tip - everyone undersells themselves, working out is hard. You probably have more gas in the tank than you think you do, so push yourself (limitations apply). For many, quitting is easier the more repetitions done (10+) due to the accumulation of acid in the muscle, as well as the onset of fatigue from one set to the next. For this reason, some may find more success doing between 5-8 repetitions instead, although so long as the “near failure,” goal is achieved, progress is comparable.

Disclaimer - managing injuries and everyday aches and pains is a real concern for most, and high intensity/mechanical tension may not be possible for certain movements/muscle groups. This is where lower intensities (RPE 5-6, RIR 4-6) with higher volume (more sets per exercise) can play a role. Pushing through discomfort to cause adaptation is different from pushing through pain and worsening an injury.

Exercise selection - Mechanical tension doesn’t discriminate. Unless you have a specific goal in mind (e.g. back squatting 135 lbs), the correct exercise is the one wherein you can safely push yourself harder. For many, a leg press or assisted lunge pattern will cause greater adaptations sooner than a barbell squat, solely based on the ability to safely push harder.

Consistency - While there is clear evidence training a muscle group once per week is enough to cause adaptation, the general consensus is most can optimize strength by training a muscle group 2-3x/week. This allows some freedom, with individuals who enjoy lifting weights with ample time will break up specific muscle groups to allotted days (Monday:push, Tuesday:pull, Wednesday:legs, etc.), while others will consolidate to upper and lower days, and still others will do full body days. Ultimately, all approaches work assuming the schedule can be held, so it is important to be thoughtful about time and energy one is willing to allocate per week.

Progressive overload (i.e. a systematic and gradual increase in demand addressed by weight, volume, or intensity) - You won’t change if your weights don’t change. While there are other ways to address progressive overload, one way or another there must be a clear addition to the demands you are placing on your body. Looking back on your performance from weeks to months prior, there should be a gradual increase in performance (roughly 2-5% improvement every other week or so).

Rest - Work hard, but recover harder. Benefits from strength training can be substantial with as little as 2-4 hours per week, but much is left on the table without adequate recovery, namely sleep. As highlighted by a systematic review published by Stich et. al. in 2022, participants who slept only 5.5 hours on average while in a calorie deficit lost an average of 55% less body fat, and 60% more muscle mass compared to the participants who slept 8.5 hours, even though both lost roughly 7 lbs of total weight. This is particularly significant for populations like those with menopause or late-onset hypogonadism, considering the symptoms associated like low energy, sleep disturbances, and fatigue.

Along those lines, rest during a given workout must be considered. If mechanical tension is the primary driver of adaptation, adequate rest must be taken between sets to truly push to RPE 8-10 or 1-3 RIR. Resting 2-5 minutes between sets is advised to ensure termination of the set is due (primarily) to mechanical tension instead of fatigue, disinterest, or metabolic waste (excess acid in the muscle causing intense burning).

The following is an example of a simple protocol for those with limited time or energy to dedicate to the gym. While you can always add more, a bare minimum of 2-3 challenging sets of 2-3 exercises, for 2-3 days per week is enough to make substantial gains.

Weeks 1+2

Considerations:

• While there are two separate examples provided above, repeating the same protocol twice per week is completely acceptable, and may even be better for achieving specific goals.
• Tracking weights and RIR or RPE from one week to the next is imperative to success.
• Adjustments to programming (volume or intensity) can and should be made based on performance, and outcomes. If progress is not made, it’s time to change your approach
• The more comfortable the movement, the harder you can push yourself. RIR can and should be pushed closer to 0-2 as the movement competency improves.