Are You Losing Muscle Mass Due To Menopause?

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM

Losing muscle can be avoidedWe often talk about menopause when what we are really referring to is perimenopause – also considered the menopause transition. Perimenopause is the period during which a woman’s body undergoes changes and it stops functioning as it did previously, losing muscle. This usually starts during a woman’s forties and is over by her fifties. It differs from one woman to the next. Surprisingly, the term menopause actually refers to the exact time and day her body has completely adjusted and these changes are completed.

Losing Muscle Mass

Perimenopause can last anything between four and ten years. There are many symptoms associated with this perimenopausal period. They include losing muscle mass, unaccounted for weight gain, hormonal imbalances, dry skin, thinning hair, sleeping problems, hot flashes, and irregular periods, to name but a few.

One of the most alarming but seldom talked about effects of the menopause transition is the loss of muscle. The effects increase when a woman becomes postmenopausal.

Why Losing Muscle When Menopausal?

The aging process brings about a decline in the body’s physiological functions. The body’s muscle mass shows a steady decline starting from around the age of twenty. When a woman hits menopause, however, the rate at which she loses muscle mass increases.

Studies have concluded that this increased rate of muscle loss is due to a deficit regarding the production of the estrogen hormone. The decrease in estrogen production also contributes to the loss of bone mass density, an increased risk of cardiovascular disease, and the redistribution of fat to the visceral area, which includes the body’s organs such as the lungs, heart, liver, or pancreas. To make matters worse, it has a direct effect on muscle tissue.

Muscle loss is mainly the result of an imbalance regarding protein synthesis in muscles and muscle protein breakdown, as well as increased catabolic factors. These include inflammation and oxidative stress. A decline in hormone levels, which is associated with menopause, is also involved. Additionally, new studies have shown that vitamin D also plays a role; a low level of vitamin D contributes to muscle loss.

Vitamin D plays an important part regarding the body’s ability to regulate calcium as well as in the development and maintenance of bones. Evidence also suggests vitamin D plays a role in muscle function. Research has shown that older people with a vitamin D deficiency were more at risk of losing muscle, falling, which is largely due to a lowered muscle mass ratio. Research has also shown that a deficiency in vitamin D is implicated in the atrophy of muscle fibers.

The Vitamin D-Endocrine Connection

Avoid losing muscle by supporting your liverVitamin D is actually considered a ‘precursor hormone’. This means that it is a building block of an immensely important hormone in the body called calcitriol. This process takes place in one of the major organs in the endocrine system – the liver.

From there the kidneys take over and the results are transported to the different target organs in the body, with muscles being included.

The body is not able to create vitamin D by itself. It has, instead, been designed to create it by being exposed to the sun. Only a few hours per week are necessary. It could also be consumed by means of certain foods, such as fatty fish.

The problem, however, is that people are not exposed to the sun enough to acquire sufficient vitamin D. The negative side of this is seen in certain symptoms – such as losing muscle mass in women in menopause.

A Deficiency in Vitamin D Contributes to Adrenal Gland Fatigue

One of the contributing causes of adrenal fatigue is a deficiency in certain nutrients. Because it is a major contributor towards the functioning of the body, Vitamin D also happens to be one of these:

  • It helps to maintain a balance with regards to phosphorous and calcium.
  • Research suggests it plays a role in the countering of the effects of sustained cortisol production. The risk of osteoporosis increases when the adrenal cortex is forced to produce higher levels of cortisol over a period due to stress.
  • A Vitamin D deficiency has been related to the development of certain heart problems.
  • A low level of vitamin D is linked to the ability of adrenal glands to produce hormones.
  • A deficiency in vitamin D has been linked to the inability of your immune system to fight infection. It has been linked to chronic disease and constant inflammation.
  • Anemia is linked to a deficiency in vitamin D.

Adrenal Fatigue and its Complications

Adrenal fatigue usually occurs when the adrenals are exposed to a prolonged period of stress due to either physiological or psychological factors. Diet usually plays an important role as well.

Although a vitamin D deficiency is not the cause of adrenal fatigue, it contributes towards the problem. Vitamin D is necessary because it aids in the production of adrenaline and noradrenaline. These two hormones are both produced by the adrenal gland.

Stress, whether of a physiological or psychological origin, depletes the body of vitamin D. The body then has to choose what it needs most when it goes into survival mode, which would be to manufacture another hormone called cortisol. Cortisol is the hormone a body needs in order to protect itself during long periods of stress. The prolonged production of this hormone, in ever-increasing amounts, perpetuates adrenal fatigue.

Prolonged stress, finally, leads to the NeuroEndoMetabolic (NEM) stress response kicking in. The burden of coping with stress falls onto the hypothalamic-pituitary-adrenal (HPA) hormonal axis, the primary neuroendocrine highway. This is the path the brain receives stress signals from, interprets them, and then by means of neurotransmitters and hormones sends instructions to the different organs of what they should do about the situation.

Avoid becoming fatigued and losing muscleOnce adrenal fatigue reaches stage three or stage four, the production of cortisol, as well as other related hormones, is negatively impacted. Advanced symptoms of adrenal gland fatigue set in, most of which are the direct result of a dysregulated HPA axis.

Where a healthy metabolism is able to detoxify itself and govern the body’s response to inflammation, a weakened metabolic system experiences an imbalance. It also reduces the delivery of nutrients needed for optimum respiration in cells, thereby retarding the body’s recovery rate from trauma, whether physical or psychological in nature.

The organs that are part of the neuroendocrine circuit are the adrenals, heart, autonomous nervous system, thyroid, GI tract, and brain. The liver, pancreas, immune, microbiome and extracellular matrix form part of the anti-stress metabolic circuitry.

When the body goes into stress overload, both systems are called into action simultaneously. Their activation is automatic.

Once this system’s proper functioning is completely disrupted, certain consequences result. One of these is an imbalance in hormones.

Part of the metabolic cycle’s process is the building up of muscle tissue. This is usually accomplished due to the actions of certain hormones, such as testosterone, insulin, and growth hormones that facilitate the process. However, when the body no longer has the energy to synthesize these hormones, the opposite takes place. In other words, instead of building muscle, the body actively starts losing muscle.

The Aging Process

Age is the process where the body unfortunately stops working optimally. Added to this, lifestyle and diet also play a role. People are no longer getting enough of the essential nutrients they need in order to keep the body functioning at optimal level. Vitamin D plays a role in the metabolic process and the manufacturing of different hormones, and symptoms as a result of adrenal fatigue could be exacerbated in the case of a deficiency. One of these, especially in the elderly, is the loss of muscle and its implications which can include a tendency to fall regularly due to not being able to balance correctly.

Although a loss in muscle mass is usually attributed to women that are menopausal, it is not only reserved for this group. Losing muscle tone, as well as less muscle mass can also occur in older men. In fact, it is possible in people of all age groups. Most of those with this particular problem, however, seem to have lowered levels of vitamin D as well.

Research on Vitamin D Supplementation and Menopausal Women

A recent study was conducted on postmenopausal women between the ages of fifty and sixty-five. The aim was to evaluate the effect that vitamin D has on the rate of falls experienced by these women. This study took place over a period of nine months. All women who took part in the study had a history of falling within the twelve previous months. All had amenorrhea for the past twelve months at least. Amenorrhea is the absence of a woman’s menses or period.

Losing muscle can be avoided by eating foods with Vitamin DNo women were included in the study who experienced musculoskeletal disorders, neurological disorders, or who were on medication(s) that could affect either the occurrence of recurrence of falls. Also excluded from the study were women with osteoporosis or vestibulopathy.

In this study, the women were divided into two groups. The study group each received a daily oral vitamin D supplement. The other group received a placebo.

The result, after this nine-month period, was quite conclusive. It found that, of those in the vitamin D group, there was a marked reduction regarding body swaying and in the number of falls these women had. Those on the placebo showed the same result before and after the study.

Vitamin D deficiency is a problem encountered the world over in postmenopausal women. losing muscle creates muscle weakness and along with it, an increased chance of falling. The study, undertaken in Sao Paulo, Brazil, has documented how vitamin D supplementation actually increased muscle strength while reducing the loss of body muscle mass in women. This includes women who had undergone menopause twelve and more years previously.

Interesting gatherings which arose from the study also show that while those on the supplement showed an increase in their muscle strength, those that had been on the placebo showed a loss in muscle mass during the nine-month period of the study.

According to Dr. L.M. Cangassu, one of the lead authors of the study from the Botucatu Medical School at Sao Paulo State University in Sao Paulo, Brazil, “We concluded that the supplementation of Vitamin D alone provided significant protection against the occurrence of sarcopenia, which is a degenerative loss of skeletal muscle.”

How to Address the Issue of Muscle Loss Due to Menopause

Losing muscle due to menopause is not only due to the natural aging process. It is a combination of factors. Most predominant of these, are lifestyle and nutrition. They play a large role in the correct functioning of the adrenal system and the production of necessary hormones for the optimum functioning of human metabolism.

When the body does not get access to the nutrients needed in order to allow the neuroendocrine system to function at an optimum level, a number of symptoms are observed. One of these is sarcopenia (muscle loss), which is associated with a vitamin D deficiency. Although conventional medicine strives to address these problems individually, practitioners of natural medicine see the body as an entire organism and address it as such.

What you can do to help yourself:

  • Exercise strengthens muscles and addresses muscle loss. The exercise undertaken should be gentle and aimed at strengthening the core. Any aggressive form of training should be curtailed until the muscle strength is stabilized and the adrenal glands have recovered to a certain extent.
  • Those whose muscles have atrophied over a long period could investigate other avenues, such as electromyostimulation, for example. The low-level stimulation introduced by electrical impulses stimulates the muscles. Whole-body vibration techniques are also beneficial as it aids with building muscle strength while improving balance.
  • Avoid losing muscle by supplementing with Vitamin DTaking vitamin D and other supplements are beneficial, as has been explained. However, you can overdo it with vitamin D supplements, so you should only take the recommended dosage unless under a medical professional’s supervision.
  • Up the protein intake. Do keep in mind that a protein overload could be harmful in those who are suffering from an adrenal crash. The body has problems, during this time, in digesting protein. Whey and pea protein supplementation, however, have shown to increase protein synthesis.
  • Follow the adrenal fatigue diet. This means small, consistent meals and snacks spread out over the day. It keeps energy levels on an even keel while causing the least amount of stress to the body.
  • Keep hydrated. Dehydration is one of the signs associated with adrenal fatigue. Remember to stay away from caffeine and sodas. Sodas contain sugar or artificial sweeteners that compound the problems associated with adrenal fatigue.
  • Get enough rest throughout the day and go to bed early.
  • Discuss the possibility of hormone therapy with a certified practitioner if you have been diagnosed with adrenal fatigue and its related issues.

© Copyright 2017 Michael Lam, M.D. All Rights Reserved.

Losing muscle can be avoided


  • morag hunter says:

    Thank you so much for explaining in such detail how Vitamin D deficiency can contribute to so many problems.
    My body is low in this and I have been prescribed them to help me. Since reading your article which I shall read again, I will now remember to take these daily, as I had been forgetting. At 64yrs I am in such a state of imbalance, tired and very overweight, finding it hard to move around due to pain from Fibromyalgia. Have the symptom you have explained, pasted the menopause.

  • Alex Boorman says:

    Dear Dr Lam
    I was diagnosed with hyperemesis gravidarum during both my pregnancies and was hospitalized and put on a drip. This enabled me to eat small meals. After being taken off the drip I would get steadily worse until, after about 2 weeks I would need to be hospitalized again. Using logic, I then started drinking electrolytes daily and this helped enough to keep me out of hospital. I didn’t vomit much at all but the nausea was completely overwhelming, I couldn’t even function properly. Between hospitalizations I ate a balanced diet and drank enough so it wasn’t caused by dehydration or something else dietary related.
    Now, many years later, I have been suffering from chronic nausea for a year and by chance drank a sports drink the other day which gave me complete relief. The electrolytes in the drink were sodium and potassium so I have concluded I must be deficient in one? I am 42 years old so haven’t gone through menopause yet. Recently I went to the doctor as I thought I had some serious illness causing the nausea but after many expensive blood tests and an abdominal ultrasound he concluded there was nothing seriously wrong and put me on antidepressants. It was after that that I discovered the electrolyte thing so I’ve stopped taking the antidepressants (I’m definitely not depressed). I have also since discovered that I’m allergic to msg which causes a period of intense nausea about 6 hours after eating, but this appears to be unrelated to the chronic nausea. Do you have any advice for me? Have you heard of this before? I thought of this while reading about hormonal change during menopause, and I also can’t take any form of estrogen (pill or contraceptive patch) as I become too ill, so I thought maybe you would have come across something like this before…
    Kind regards

    • Dr.Lam says:

      Your clinical picture is quite complex. There is a lot of detailed to be filled in and that can only be done by conducting an interview over the phone. Obviously something is going on in the body that needs to be investigated further with a more detailed history to find clues to the problem.

      Dr Lam

  • Robin says:

    Dr. Lam,
    Do you suggest bio identical hormones for adrenal fatigue patients? I feel less anxiety when I’m on them.

    • Dr.Lam says:

      bHRT has its place but has to be timed properly and done right and for short term, if possible, due to long term issues in a setting of AFS. The weaker you are, the more careful you have to be. Short term benefit can often lead to long term problems with hormone manipulation.

      Dr Lam

  • Danielle Reynolds says:

    This is a great article. Thank you Dr. Lam for continuing to place such helpful information on your website. About 7 years ago, I was diagnosed with Sheehan’s Syndrome (Panhypopituitarism due to massive hemorrhage during childbirth). I was fully replaced on hydrocortisone, HGH injections, thyroid, estrogen, progesterone and testosterone. I also supplement daily with Vitamins D3-5, 2000mg Vit C with Rose Hips, Vitamin A – low dose, DHEA, and Turmeric for pain. In January 2016, we lost the insurance we had had for years, so was forced to be start from scratch on my diagnosis for insurance to continue paying for the medications. As a result, I have seen 3 endocrinologist’s, all of whom say that my pituitary has started functioning again, and to go off all medications. I still have a 0 TSH (along with a low/normal t3 and t4), so am on 240mg porcine thyroid. I am still on 20mg hydrocortisone daily. I am trying to titrate down on the HC, but whenever I do I become so weak, nauseous, extreme diarrhea and bone tired that I cannot function. I have told the doctors this, but they still insist that I must go off the meds. I have not taken HGH since October of 2015, nor have I taken testosterone for 6 months. My question, at 53 years of age, I have BMI of 40… and continue to gain wait regardless of what I do. Since going of HGH, I have gained 35 pounds. After a one month trial of an anti-inflammatory diet (No sugar, breads, white anything) and about 100 calories per day, for a month, I actually gained 2 pounds. I cannot seem to exercise as this causes my blood sugar to dip very low, and I spend days in bed after attempting anything strenuous. Do you have any suggestions for a woman of my health situation to lose weight and try to gain some muscle back? Any suggestions on how to titrate down on HC? I am at a loss as the doctors that I have seen are of no help.

    • Dr.Lam says:

      You need to proceed very slowly and very carefully with a comprehensive plan in place and a body that is strong first, or you will not have the support to sustain you. Your case is very complex. You need to either write to me or contact my office for more detailed advice.

      Dr Lam