Starting Strength and Starting Over: Women in Perimenopause

by Victoria Holt | June 24, 2026

woman looking at woman deadlifting cartoon on door

Did you know that some of the body’s estrogen is produced in the quadriceps? It’s true! Skeletal muscles are involved in one of the endocrine functions of synthesizing estrogen, specifically, myogenic estrogen which regulates muscle function. As some of the largest skeletal muscles in the body, strong quads could have a huge impact on the entire body system. Not only would they create leg strength, but they would contribute to crucial estrogen production in the body as it transitioned into older age.

Lower or fluctuating estrogen levels can result in the following symptoms: weight gain, brain fog, hot flashes, depression and anxiety, decreased libido, irregular periods, vaginal dryness, skin and hair changes, sleep dysfunction and fatigue, urinary incontinence, joint pain, breast tenderness and sexual dysfunction. Unfortunately, women also begin losing bone mass around the same time.

Hormone levels in anyone’s body are a complex system of balance, with a variety of factors contributing to their rise and fall. It is folly to make a blanket statement that increasing estrogen will fix a woman’s main perimenopause complaints because too much estrogen is also linked to ligament laxity (as well as other issues) that could lead to injury [1]. In fact, ideal estrogen and other hormone levels are far beyond the scope of this article. Let’s focus on the issues that stronger muscles can alleviate in perimenopausal and postmenopausal women in average health.

Many women in peri- and post menopause notice unwanted weight gain. Strength training will cause weight gain, but it’s wanted. Muscle is denser than fat, so the weight on the scale could go up, but with consistent training, the real weight that you want to go up is on the bar! Less focus on your scale at home means greater returns on self-satisfaction and confidence. I’ve found that as my strength increases, the less I care about my physical appearance. Weight training becomes more about what I can do and less about what others think about how I look. I will say that after a solid nine months of training three times a week, there are several changes in my body that are satisfying, not the least of which are solid underarm muscles and thick thighs.

Brain fog and mental health issues such as depression and anxiety often attend women in perimenopause. According to several studies, resistance and strength training alleviate moderate depression and anxiety symptoms [2]. On a personal note, I always feel grounded, centered, and calm when I walk out of the gym. And those feelings of inner peace last throughout the rest of the day, a factor that keeps me training with enthusiasm.

Focusing on the math to get the correct weight onto the bar might seem like a minor detail, but that attention coupled with counting reps and sets creates a single-focus mindset. There isn’t room to stress about dishes waiting at home or the spreadsheet due at the end of the week because you need to pay attention to your plates and your lifts. There’s also the focus required to master the form for each lift. In my case, I record my work sets so that I can send them to my coach, Bruce Trout, for critiquing. Proper technique matters in the Starting Strength program, and that is another way that your focus is required, leaving no room for outside worries. Spending intentional time with singular attention is great exercise for your brain!

Additionally, physical exertion forces the body to utilize cortisol, the familiar “stress” hormone that tons of adults have an overabundance of these days. Strength training actually causes temporary spikes in cortisol levels, but these spikes are beneficial. Cortisol is a hormone that helps the body break down carbohydrates and fat during physical exercise or stress. It also helps the body manage inflammation and provides energy for movement. Cortisol spikes during lifting make you stronger but also train your body to tolerate higher levels of cortisol, giving you resilience. Since peri- and post menopause and/or fluctuating estrogen levels can cause intense bouts of anxiety, having the ability to manage stress in a resilient way will benefit you [3].

Depression is another frequently cited symptom of low estrogen. Whether strength training boosts estrogen levels due to bigger quadricep muscles or alleviates depression symptoms as a function of exercise, the benefits are clear and well-studied. According to the Mayo Clinic, exercise releases endorphins, boosts confidence, takes your mind off troubles, offers social benefits, and provides a healthy coping skill when life is difficult [4].

An article from Harvard Health Publishing produced by Harvard Medical School explains that adults who don’t strength train can expect to lose 4 to 6 pounds of muscle mass per decade starting as early as 35 years old in some cases. This condition is called sarcopenia, and it means the steady loss of muscle mass in adults. Additionally, the fast-twitch muscle fibers deteriorate faster than the slow-twitch muscle fibers, so not only are adults weakening, but they’re literally slowing down. The lack of muscle use contributes to the decline of the nerve-signaling system that tasks muscles to engage for work, as well. Use it or lose it describes sarcopenia in a nutshell [5].

Sleep dysfunction and fatigue are two more issues that perimenopause contributes to, but they can also be alleviated by consistent strength training. In one of the largest studies of its kind of an adult population that also covered the longest period of time, researchers studied the impact of different kinds of exercises. The study, Comparative Effects of Aerobic, Resistance, and Combined Exercise on Sleep, found that weightlifting participants slept longer and better than even the cardio participants [6]. It was especially noticeable among overweight participants who also reported sleep difficulties.

For me, I find that my deadlift days and heavy volume days never fail to create a level of exhaustion that is just right for falling asleep at the end of the day. At the same time, my consistent training has helped me gain higher-overall energy throughout each day. If you had told me forty years ago that I would still be playing basketball with my kids or playing ding-dong ditch with my grandkids in my fifties, I might have given you the side-eye. One of my favorite pastimes is yardwork, and strength training gives me both the strength and energy to keep up with my grandiose yard plans.

Weightlifting doesn’t immediately address some of the common perimenopause symptoms such as vaginal dryness, incontinence, hair loss, lower libido and sexual dysfunction, but do consider the following. Gaining significant strength and muscle tone throughout your entire body as happens with the Starting Strength program contributes to stronger core and pelvic floor muscles which will positively impact incontinence and some sexual dysfunction. Additionally, a stronger body gives a woman a huge confidence boost which could impact libido in the best way. Lifting heavy also brings women more deeply in touch with their physical bodies and provides tremendous body positivity opportunities, another feather in the cap of her sexual health. Some people take collagen and creatine supplements as part of their strength training regimen, and those are said to benefit skin, hair, and joint health. Again, weightlifting may not immediately address the above issues, but it is possible that it will provide some tangential benefits.

Lastly, what is the effect of strength training on women’s bones? Similar to sarcopenia which is muscle loss, osteopenia is bone loss. After the age of 35, adults stop producing as much bone mass. People over 50 and women in post menopause are even more susceptible to losing bone mass [7]. In fact, it has been reported that over 80% of patients with osteoporosis are postmenopausal women. What this means is a higher chance of breaking bones, longer healing times, and declining health overall. The statistics on longevity after breaking a hip are dismal. However, strength training can reverse bone mass depletion. One study showed that after eight weeks, the resistance training exercise group had measurably increased bone strength compared to the control group [8].

“Strength training helps promote bone density by applying controlled stress to bones, which triggers the body to rebuild and strengthen them through a process called bone remodeling,” says Molly Ertel, CPT, in an article in Women’s Health magazine [9]. Indeed, in the aforementioned study, weight-bearing exercise was shown to promote bone and bone marrow production after eight weeks. Many studies show the same results; strength training is a clear pathway to better bone health.

While changing hormone levels for women experiencing peri- and post menopause often cause many unpleasant symptoms, it’s heartening to see that there are ways to mitigate them through consistent resistance training. Stronger and bigger muscles can’t fix every problem, but they contribute to alleviating several of the biggest headaches caused by perimenopause, menopause, and post menopause.

If you or someone you love has expressed frustration with their bodies as they transition into the perimenopause, menopause, and post-menopause years, consider the many proven benefits of strength training and commit to helping regain or build up that muscle mass. There is quite a lot to gain from having stronger muscles. While “use it or lose it” is true, a better maxim to follow might be “gain more than just your gains.” The outcome of consistent strength training is greater than the sum of its parts. Stronger, faster muscles, confidence, greater mental and emotional health, better sleep, and higher energy—while you’re aging? That is a recipe for the best years of your life. Peri- and post menopause don’t have to slow you down. You can work with your body instead of against it, and embrace your life changes while reacquainting yourself with what your body can do. Starting Strength is more than just getting stronger. It’s starting over just when you thought your best health was behind you.