Perimenopause and Muscle Loss: What No One Tells Indian Women

There is a stage in a woman's life when the rules seem to suddenly change.

You could be consuming food in the same way you always did or possibly even exercising more than you used to. And yet, your body is behaving differently as a whole. Weight around your belly may seem like something difficult to lose. You may notice that your clothes fit differently, you recover slower, you sleep poorly, your mood varies, and strength is not what it used to be. 

Many women are told that it is aging. However, the conversation should be much deeper. 

Because for many women, the years before menopause can be crucial in terms of hormones, body composition, muscles, bones and metabolism. 

One thing we don’t talk about enough is muscles. There is plenty of information about hot flashes and hormonal changes, but the truth is, maintaining muscles in midlife is one of the things that influence the process of aging.

So let's start with what is actually happening. 

Perimenopause isn't something that suddenly arrives on one particular birthday. It is a transition. Hormonal patterns change, menstrual cycles can become irregular, and symptoms can vary enormously from one woman to another.

For some women, the changes are subtle. For others, they can be disruptive. 

You may notice changes in your menstrual cycle. 

You may sleep differently. 

You may experience hot flashes or night sweats. 

You may notice changes in mood, energy or body composition.

And sometimes the first thing a woman notices is not her period at all. She notices her waist. 

During the menopause transition, research has found changes in body composition and fat distribution, including greater accumulation of abdominal fat and changes in lean mass. These changes can also interact with cardiometabolic risk factors such as blood lipids, blood pressure and glucose metabolism.

This is why a woman can come to me and say, “Ryan, I haven't changed anything. Why does my body suddenly feel different?”

And sometimes the answer isn't simply that she has stopped being disciplined.

Her physiology is changing. But here's where I want to make an important distinction.

Perimenopause does not mean that weight gain and muscle loss are inevitable. And it certainly doesn't mean you should give up and say, “Well, this is what happens when you turn 45.”

It means the strategy may need to change.

One of the biggest mistakes I see is that women continue using the same strategy that worked for them at 25.

• They eat less.

• They do more cardio.

• They cut more calories.

• They try another restrictive diet.

And when the scale doesn't respond the way they expect, they assume they need to work even harder. But if your goal is to protect your health during perimenopause, I would rather you think about what you need to preserve.

And one of those things is muscle. Muscle isn't just about looking toned.

Your skeletal muscle is an important tissue for movement, strength and glucose handling. As we get older, losing muscle and strength can make everyday activities harder and can contribute to a cycle of becoming less active.

That is why resistance training becomes increasingly important. And when I say resistance training, I don't mean that every woman needs to become a bodybuilder.

You don't need to spend two hours in the gym.

You don't need to lift extremely heavy weights.

You need to give your muscles a reason to stay.

That might mean squats.

• Rows.

• Push-ups.

• Lunges.

• Deadlifts.

• Resistance bands.

• Dumbbells.

• Machines.

The exercise doesn't have to look impressive on Instagram. It needs to be consistent and appropriately challenging.

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The 2026 Indian Menopause Society guidelines recommend incorporating muscle-strengthening exercise along with aerobic, balance and other forms of physical activity during the menopausal years.

And I think this is a particularly important message for Indian women. Because we often talk about weight loss.

We talk about becoming thinner.

We talk about reducing calories.

But we don't talk enough about becoming stronger. A woman can lose five kilograms and still become metabolically less healthy if a large proportion of what she loses is lean mass.

So during this stage of life, the question shouldn't only be: “How much weight did I lose?”

It should also be: “How much muscle did I keep?”

That changes the entire conversation.

Next, we consider protein. With aging, the body’s ability to process and utilize protein decreases. This is one of the reasons that sufficient protein intake is so crucial for maintaining muscle mass.

However, I do not wish to suggest to women that they need to drink three protein shakes everyday.

Everyone’s protein needs are very specific.

The size of your body, how active you are, how much resistance training you do, what you eat and how healthy you are all come into play. In some cases the most suitable option may just be spreading sufficient protein consumption evenly throughout the day.

That means instead of consuming almost all your protein for dinner, focus on getting a good protein source at breakfast as well as at lunch.

• Eggs.

• Curd or Greek yogurt.

• Milk.

• Paneer.

• Dal.

• Soy.

• Fish.

• Chicken.

• Lean meat.

• Legumes.

And for women following vegetarian or vegan diets, planning becomes even more important because protein quality and total intake need to be considered together.

This is not about following a “menopause diet.” There is no single food that fixes perimenopause.

What matters is the overall pattern.

I would want your diet to contain enough protein, plenty of vegetables and fruits, adequate fiber, healthy fats and mostly minimally processed foods. 

And please don't forget calcium and vitamin D, particularly because bone health becomes increasingly important around and after menopause.

Your bones need attention too. This is another reason why resistance and weight-bearing exercise matter. The body responds to physical stress. When you challenge your muscles and bones appropriately, you give them a reason to adapt.

But nutrition alone cannot replace exercise. And exercise alone cannot replace nutrition.

You need both.

Then there is sleep. This is the part that can become frustrating. You may be doing everything “right,” but your sleep suddenly becomes unpredictable.

• You wake up at night.

• You struggle to fall asleep.

• You wake up feeling exhausted.

• And then the next day, everything becomes harder.

• Exercise feels harder.

• Food choices become harder.

• Your appetite may feel different.

• Your patience becomes shorter.

This is why I don't want women to treat sleep as an optional part of their health plan.

If your sleep is consistently poor, talk to your doctor about it. Don't simply accept months or years of disrupted sleep as something you have to tolerate because you're entering menopause.

And there is another important piece of the puzzle: metabolic health. 

The menopause transition is associated with changes in abdominal fat and cardiometabolic risk, although the relationship is influenced by ageing, lifestyle, body composition and other factors.

So this is a good time to know your numbers.

• Your blood pressure.

• Your fasting glucose and HbA1c when appropriate.

• Your lipid profile.

• Your waist circumference.

• Your body composition is clinically useful.

Not because I want you to become obsessed with numbers. Because numbers can sometimes give us an early warning. And this is where I want to make another important point about Indian women.

We often wait until something is clearly wrong before we take action.

Don't wait for the diagnosis. 

Use this stage as an opportunity to become more proactive. Build muscle before you lose significant muscle. Protect your bone health before you have a fracture. Improve your diet before your metabolic markers become abnormal. Improve your sleep before exhaustion becomes your normal. And get appropriate medical advice when symptoms are affecting your quality of life.

What about menopause hormone therapy? This is an area where there is a tremendous amount of confusion.

Hormone therapy is not a magic anti-ageing treatment. 

It is also not something that every woman needs. And it is certainly not something you should start simply because someone on social media told you that it will keep you young. Menopausal hormone therapy can be an appropriate medical option for some women with menopausal symptoms, but the decision needs to be individualized with a qualified healthcare professional, taking into account symptoms, age, timing, medical history, risks and benefits.

So, what can you actually do about all of this? 

I don't want you to finish this article thinking, “Okay, my hormones are changing, my muscles are disappearing and there's nothing I can do about it.”

Quite the opposite. There is a lot you can do.

And I would start with your food.

It is common that for some women there are specific foods or beverages that trigger problems such as hot flashes, night sweats, insomnia or gastrointestinal disorders. Most frequently cited foods include alcohol, caffeine and hot spices although this is very personal and different from person to person. Thus, when learning the pattern it is better to avoid an unnecessary elimination of some major food groups from your diet.

Once you notice that a certain food causes difficulty on a regular basis, experiment with limiting or cutting it out. Keeping a very simple log of what you eat is enough for you. You do not need to track the exact number of calories you consume or weigh each meal. Simply write down each food item consumed and how it affected you.

And remember that the goal is not to create another restrictive diet. The goal is to understand your body. 

If there is one nutritional area I don't want women to ignore as they move through midlife, it is protein.

Your muscles are constantly being broken down and rebuilt. Yes, resistance training of-course provides the stimulus but your body also needs amino acids from protein to repair and maintain that muscle tissue.

Now, this is particularly important as we get older because our muscles become less responsive to smaller amounts of protein. That means simply eating the same way you did when you were 25 may not be enough (b wwww) to support the muscle you want to maintain at 45 or 55.

So look at your meals. Where is the protein? 

You can get it from eggs, fish, chicken, dairy, paneer, soy, tofu, legumes, dals and other protein rich foods. If you take protein powder, that can also be a convenient tool. But remember it is a tool and not a requirement. I would rather see you build a good protein rich meal pattern than become obsessed with a single supplement.

The third thing is something we should talk about more in India: plant diversity in your meals. 

Grains derived from plants such as flaxseeds, soybeans, sesame seeds, and legumes feature phytoestrogens which are natural compounds found in plants that have the potential to bind with estrogen receptors in the body. A lot of literature has been published regarding phytoestrogens and their possible effects on menopause particularly on products containing soy isoflavones. 

However, it should not be assumed that phytoestrogens are replacements for estrogen.

Phytoestrogens should be seen as one aspect of a healthy dietary regime. Soy, for example, can be consumed for its protein. Flaxseeds, sesame seeds, beans, fruits, and vegetables are some other sources of dietary fiber. 

The most important thing now is not to seek a "miracle food" for menopause but to improve your eating habits. And this is what brings us to something that is even more crucial than every single item of food. 

It is essential to remain physically active as we age. Getting older makes it hard not only to keep a healthy weight but also to stay functional and active. Walking, biking, and swimming are proven to be effective forms of exercise.

But I don't want resistance training to disappear from the conversation. Because if you want to maintain muscle, you have to give your muscles a reason to stay. 

You can use dumbbells.

You can use resistance bands.

You can use machines.

You can use barbells.

You can even start with body-weight exercises.

The equipment isn't the most important part.

The important part is progressive challenge.

If ten squats are easy today, eventually you need to make the exercise harder. Maybe you add resistance. Maybe you increase the number of repetitions. Maybe you improve the range of motion. Maybe you progress to a more challenging variation.

Your body adapts to the demands you place on it. And this is where I want to change the way we think about exercise during perimenopause.

Don't exercise only because you want to burn calories. Exercise because you want to build a body that can carry you through the next 20, 30 or 40 years.

• You want strong legs.

• You want strong hips.

• You want a strong back.

• You want enough muscle to get up from the floor.

• You want enough strength to carry your luggage through an airport.

• You want to climb stairs without thinking twice.

• You want to remain independent.

That is a much bigger goal than simply fitting into a particular dress size.

And resistance training also becomes important for bone health. Bone density naturally changes with age and around menopause, so weight-bearing activity and resistance exercise are important parts of a broader strategy for maintaining skeletal health. If you have particular bone health concerns, speak with your doctor about the right exercise and screening approach for you.

There is another reason I want women to exercise. Your brain.

When you exercise, you're not just training your muscles. Physical activity is associated with benefits for mood, sleep and overall mental well being. And during a stage of life when sleep disruption, hormonal changes and life stress can all pile up together, that matters.

So don't underestimate a 30 minute walk.

Don't underestimate a strength session.

Don't underestimate getting outside and moving.

It all counts. 

But I also want to say something about weight. 

During perimenopause, you may notice changes in where your body stores fat. The scale may move differently than it used to. Your waist may change even when your overall body weight doesn't change dramatically.

Don't panic. And don't respond by starving yourself.

If you lose weight but lose a significant amount of muscle along the way, that isn't necessarily the outcome we're looking for.

Instead, think about body composition.

• Think about waist circumference.

• Think about strength.

• Think about fitness.

• Think about your blood pressure, blood glucose and lipid profile.

• Think about how you feel.

And think about your body's abilities.

And finally, avoid trying to deal with symptoms by yourself.

If you deal with lots of hot flashes, issues with sleep, mood swings, abnormal bleeding or anything that affects normal functioning, consult a doctor about it.

Hormone therapy can work for some women but it is not universal and not considered a means of overcoming aging. 

Whether it is okay for any woman to use hormone therapy depends on the symptoms, medical history and associated risks. It is a topic that an individual woman should discuss with a health professional, not decide based on media platforms.

Perimenopause is not your body failing you. Your body is changing.

And when the physiology changes, your strategy needs to change too

Maybe at 25 you could get away with skipping breakfast, eating whatever was available and doing a little cardio when you had time.

Maybe that doesn't work anymore.

• That's not failure.

• That's information.

• Listen to your body.

• Feed it properly.

• Give it enough protein.

• Eat a diverse diet.

• Move regularly.

• Lift something.

• Protect your sleep.

• Look after your bones.

• Keep an eye on your metabolic health.

And don't be afraid to ask for medical help when you need it.

You don't have to fight aging. You have to prepare for it.

Because the goal of health isn't to remain 25 forever.

The goal is to make sure that when you are 50, 60, 70 and beyond, you still have the strength, mobility, confidence and independence to enjoy your life.

And if we can build that foundation during perimenopause, then perhaps this transition doesn't have to be something we fear.

It can be the point where we finally start investing in the body we want to carry into the next chapter of our lives. 

A qualified dietitian or nutritionist can look at your gyno health, lifestyle, food preferences, sleep goals and nutritional needs and help build a plan around you, rather than asking you to fit into a generic diet.

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