Muscle, Skin and the Midlife Middle: What Menopause Changes, and What Helps

You may have noticed it somewhere in your late forties. The scales say much the same as they always have, but your waistband feels tighter, your arms feel softer and the skin on your hands looks thinner than it did a few years ago.

Those changes are real, and researchers have measured them. The average Australian woman reaches menopause at 51, according to the Australasian Menopause Society, and the years either side of it reshape the body in ways a bathroom scale barely registers. Knowing what is changing, and which everyday habits push back, gives you something practical to do about it.

The scales miss most of the story

Perimenopause, the lead-up to your final period, usually starts between 45 and 55 and lasts about four to eight years, according to healthdirect.

Some of the clearest data on what happens to the body in those years comes from the Study of Women’s Health Across the Nation (SWAN), a long-running US study. In a 2019 analysis of 1,246 women who had repeated body composition scans, the rate of fat gain doubled at the start of the menopause transition, and lean mass, which is mostly muscle, began to fall. Over a transition of about three and a half years, the average woman gained around 1.6 kilos of fat.

The scales did not show it. Total weight kept climbing at the same steady pace it had before the transition, so the change was in what the weight was made of: more fat, less muscle. The researchers found both shifts levelled off about two years after the final period.

The number worth knowing is your waist

Where that fat sits changes too. Jean Hailes for Women’s Health explains that women often carry weight on the hips and thighs before menopause, and that fat storage tends to shift to the waist as oestrogen drops.

National data shows how common this is. In the Australian Bureau of Statistics’ 2022 health survey, 79 per cent of women aged 45 to 54 had a waist measurement that put them at increased risk of disease, rising to 83 per cent of women aged 55 to 64. The average waist for Australian women was 91 centimetres.

The waist matters because of what sits underneath it. The Heart Foundation describes waist size as an indicator of the internal fat that coats the heart, kidneys, liver, digestive organs and pancreas, which can increase the risk of heart disease and stroke. For women, a waist over 80 centimetres signals a health risk.

To measure yours, the Heart Foundation suggests finding the top of your hip bone and the bottom of your ribs, breathing out normally, and wrapping the tape midway between the two, in line with your belly button and loose enough to fit one finger underneath. The guide is less accurate for some groups, including Aboriginal and Torres Strait Islander peoples and South Asian, Chinese and Japanese adults. Treat the number as a reason to talk with your GP, not a verdict on you.

Muscle is the loss you cannot see

Australia’s physical activity guidelines recommend muscle-strengthening activity on at least two days a week for adults up to 64. Most of us fall short. The ABS found that in 2022 only 21 per cent of Australians aged 45 to 54 did strength or toning exercise on two or more days in the previous week, and 19.9 per cent of those aged 55 to 64. The ABS counts lifting weights, resistance training, yoga and pilates, so the bar is lower than it sounds.

Heavy lifting has traditionally not been recommended for people with osteoporosis because of a perceived risk of fracture, so researchers at Griffith University put it to the test. In the LIFTMOR trial, 101 postmenopausal women with low bone mass, average age 65, did two supervised 30-minute sessions a week of heavy lifting and impact work for eight months. Bone density in their lower spine rose by 2.9 per cent, while a comparison group doing a low-intensity home program lost 1.2 per cent. The heavy-lifting group also did better on every physical function test, with one minor adverse event, a lower back spasm.

Those sessions were closely supervised, so the lesson is to get good guidance rather than load up a barbell alone. At home, squats from a chair, push-ups against the kitchen bench and a resistance band all count as a start. If you have joint pain or have been told your bones are thin, ask your GP or a physiotherapist where to begin.

Your skin is changing as well

Skin goes through its own version of the same story. A review in the journal Menopause International reported that as much as 30 per cent of skin collagen is lost in the first five years after menopause, followed by an average decline of 2.1 per cent a year over the next 15 years. The same review describes skin becoming thinner and less elastic with age.

That is worth knowing if you are planning to lose weight in midlife. The Better Health Channel considers about half a kilo to one kilo a week a reasonable pace, and warns that losing weight too quickly costs muscle as well as fat. A slower pace helps protect your muscle, which matters more at a time when the body is already losing it.

If loose skin is one of your worries, this guide to looking after your skin while you lose weight gathers the practical steps into one checklist, from strength work and protein to sunscreen. It also covers what creams can and cannot do, and when skin folds are worth showing your GP.

Protein at every meal

Muscle needs raw material. The healthdirect website lists daily protein needs for women of 37 to 46 grams between the ages of 19 and 70, and 46 to 57 grams after 70. Many Australians already get enough, healthdirect notes, but the site suggests including protein in each of your daily meals, and older adults may need to take special care.

In practice, that can look like eggs or yoghurt at breakfast, a tin of fish or a bowl of lentils at lunch, and lean meat, chicken or tofu at dinner. Each of those is on healthdirect’s list of protein foods, and none of them needs a special shop.

Sleep makes everything harder

Broken sleep is one of the most common complaints of this stage. The Australasian Menopause Society says some studies show more than half of postmenopausal women have disturbed sleep or a sleep disorder of some kind. Hot flushes and night sweats play a part, and the society notes that snoring and obstructive sleep apnoea are more frequent after menopause.

Its suggestions start with the simple ones, such as reducing alcohol and caffeine intake in the afternoon. If the evening glass of wine has crept up over the years, it is a fair place to look first. If sleep has become a nightly battle, raise it with your GP as a symptom in its own right.

Taking it to your GP

A GP appointment is a good place to bring all of this together. Take your waist measurement, a rough note of how often you do strength work, and any symptoms you have noticed, such as hot flushes, broken sleep, low mood or changes to your periods. The healthdirect website lists weight gain among the changes of menopause that may increase your chance of heart disease, so your heart health is part of the conversation too. Your GP can look at the whole picture and talk through what suits you.

Your body still responds

The SWAN data shows the steepest shifts happen in a window of a few years around the final period, not across the rest of your life. The women in the LIFTMOR trial, with an average age of 65, still improved their spine bone density and their strength. A tape measure, two strength sessions a week, protein at each meal and a better night’s sleep are ordinary tools, and each of them has research behind it.

 

This article is general information only and is not a substitute for personal medical advice. Please speak with your doctor about your own circumstances.