The latest ACSM Position Stand confirms what I see in clinic every week: muscle is one of the most important tissues women can protect as hormones begin to shift.
Muscle is one of the most important tissues a woman can protect as her hormones begin to shift – and the latest evidence backs it up.
Most women walk into perimenopause bracing themselves for the hormonal side of things. They know to expect irregular cycles, hot flashes, and disrupted sleep. What tends to catch them off guard are the physical changes that arrive more quietly – strength that seems to fade, recovery that drags on longer than it used to, a body composition that starts to shift, and activities that once felt effortless now requiring noticeably more effort.
In my practice, women almost always attribute these changes to hormones alone. Hormones absolutely play a role. But when we focus only on estrogen, we tend to overlook something equally important: muscle. And a recent piece of evidence has made that point impossible to ignore.
What the New ACSM Position Stand Actually Found
The American College of Sports Medicine recently published a Position Stand that reviewed 137 systematic reviews involving more than 30,000 participants. The goal was to evaluate how resistance training influences muscle function, hypertrophy, and physical performance. The findings were remarkably consistent across the literature.
Resistance training improved muscle strength, muscle size, and power. It also improved balance, gait speed, mobility, and multiple measures of physical function. For women moving toward menopause, that combination matters enormously – and not for the reasons fitness culture usually emphasizes.
Muscle Is a Longevity Tissue, Not an Aesthetic One
Most conversations about resistance training still revolve around appearance. Building muscle, toning, changing body composition. Those outcomes may matter to some women, but they are not the most important reason to train. Muscle is one of the body’s most valuable reserve tissues. It supports movement, balance, and independence, and it contributes to physical resilience during illness, injury, and aging.
The ACSM review found that resistance training improved not only strength and muscle mass, but also balance, gait speed, chair stand performance, and timed up and go performance. Those measurements sound clinical, but they translate into something much more human. Can you climb stairs confidently? Can you get off the floor without help? Can you react quickly enough to catch yourself before a fall? Can you carry luggage, lift grandchildren, or stay active as the decades pass? Those are not fitness outcomes. Those are healthspan outcomes.
Why Perimenopause Changes This Conversation
Perimenopause is a neuroendocrine transition, but it is also a musculoskeletal one. This is often the decade when women first notice changes in body composition and physical capacity. Muscle becomes harder to maintain, recovery is less predictable, fat distribution shifts, and strength may quietly decline if it is not intentionally preserved.
The ACSM Position Stand was written for healthy adults broadly, but its findings become especially relevant here because muscle loss and functional decline rarely begin abruptly in older age. The trajectory typically starts much earlier. The women I see maintaining strength, balance, and independence in their seventies and eighties are frequently the same women who invested in those qualities in their forties and fifties. Perimenopause offers a real opportunity to influence that trajectory.
The Most Reassuring Finding: Many Approaches Work
Fitness culture often gives the impression that results depend on finding the perfect program – the ideal split, the ideal exercises, the ideal periodization. The ACSM review suggests otherwise. One of the strongest themes throughout the paper is that many forms of resistance training produce meaningful results.
- Traditional resistance training works
- Elastic band training works
- Home-based resistance training works
- Circuit training works
The body appears remarkably responsive across a wide variety of approaches. For women who feel intimidated by complicated programming, this is important. The goal is not perfection. The goal is participation.
What Actually Improves Strength
The review identified several variables that consistently supported strength development. Women who want to preserve or improve strength should consider:
- Training at least two times per week
- Using challenging loads
- Performing exercises through a full range of motion
- Completing two to three sets per exercise
- Progressively increasing training demands over time
Strength matters because it underpins nearly every aspect of physical function. And it is far easier to maintain function than to rebuild it after it has been lost.
What Matters for Muscle Mass
Muscle mass becomes increasingly important through midlife. The review found that hypertrophy was enhanced primarily through higher training volume. For women aiming to build or preserve muscle, accumulating roughly ten or more sets per muscle group per week appears to be a useful target. That volume does not have to be crammed into a single session – it can be distributed across multiple training days. The broader message is that consistency and adequate stimulus matter more than complexity.
Do Women Need to Train to Failure?
This is one of the most common questions I get. The answer from this review is genuinely reassuring. Training to complete muscular failure did not consistently improve outcomes compared with stopping short of failure. That does not mean effort is unimportant. It means women do not need to exhaust themselves during every workout to experience meaningful benefits. A challenging but sustainable approach is often sufficient – and that feels especially relevant during perimenopause, when recovery capacity can be different than it was ten years earlier.
Do Not Overlook Power
When most people think about aging, they think about strength. Clinically, power may be just as important. Power reflects how quickly force can be produced, and it influences balance recovery, fall prevention, reaction time, and overall physical performance. Notably, power tends to decline earlier than strength. The review found that power adaptations were enhanced by moderate loads moved with speed and intention during the lifting phase of an exercise. This does not mean every woman needs to take up Olympic lifting. It does suggest that moving with purpose remains important as we age.
A Practical Starting Framework
Based on the findings of the ACSM Position Stand, a realistic starting framework for women in perimenopause could look like this:
- Resistance training two to three days per week
- Training all major muscle groups regularly
- Two to three sets per exercise
- Progressive increases in resistance over time
- Full range of motion whenever safely possible
- Approximately ten or more weekly sets per muscle group for women prioritizing muscle growth
Most importantly, choose a training style that is realistic and sustainable for your life. The best program is the one you will still be doing a year from now.
What This Does Not Mean
This does not mean every woman needs to become a serious lifter. It does not mean resistance training prevents aging, and it does not mean hormones suddenly become irrelevant. It also does not mean every woman requires the same program. Individual goals, injuries, preferences, and life circumstances all matter. What the evidence does suggest is that resistance training remains one of the most effective ways to preserve muscle function and physical performance across the lifespan.
A Grounded Takeaway
The conversation around perimenopause often centers on what women are losing – declining hormones, changing metabolism, shifting body composition. The ACSM Position Stand offers a different perspective. Muscle remains remarkably adaptable. Strength remains trainable. Physical function remains improvable.
For women entering midlife, resistance training is not simply exercise. It is a long-term investment in independence, resilience, and future quality of life. The goal is not to stop aging. The goal is to age with as much strength, capability, and freedom as possible – and few interventions influence those outcomes as consistently as resistance training.
Listen next
If you want to go deeper into how muscle, metabolism, and hormones interconnect during this life stage, you’ll find “Muscle, Metabolism, and Hormones: What Every Woman Should Know” explores exactly the framework you need to understand why resistance training matters so much in perimenopause. 100. Muscle, Metabolism, and Hormones: What Every Woman Should Know.
Lexi Yoo
Lexi Yoo, NP is a functional medicine nurse practitioner and national speaker specializing in hormones, gut health, and longevity. She helps women understand what their bodies are telling them - and turn it into a plan that actually works.
