Dr Jen Pfleghaar explains why muscle is more important than ever in midlife and how best to build it to stay strong and healthy
I had my last son at age 37. By the medical textbooks, that put me in a category I didn’t like seeing on my own chart: advanced maternal age. I knew what the phrase was meant to warn me about, but it wasn’t the truth about my health.
My body told a different story. I was in the best health of my life. The autoimmune disease I had spent years managing had gone quiet. My energy held steady while I ran a business and still picked up night shifts in the emergency room.
I did not feel like a risk factor. I felt capable.
For years I had been taught that autoimmune disease is something you manage, not something you reverse. My own labs disagreed. Between the way I ate, the way I slept, and the way I moved, my body had done something the textbooks never promised me. It made me wonder what else it could do if I gave it a real reason to.
So, I made a decision. I was going to get strong.
Not smaller. Not toned for a photo. Strong. I wanted to lift heavy and build real muscle while my body was still willing to give it to me, because I already knew what was coming for it.
Muscle is not something you keep by default. Sometime in our 30s, it starts slipping away, and by the time most women reach menopause, the losses are already underway.
I would rather build muscle now, while it’s still easy, than spend my 50s trying to win it back. And I want the same head start for you.
Here’s why building muscle is so crucial in midlife and how to do it effectively.
Most of us were told that women should stay on the cardio machines and never go to the part of the gym with the weight machines. Or that if we do lift, it should be to “tone,” and we should use only 5 lb hand weights. That framing has cost women dearly.
Muscle is not decoration on the body. It is living metabolic tissue, and it may be the most protective thing a woman can build for the second half of her life.
Muscle keeps you upright and steady on your feet. It protects your bones and helps you catch yourself instead of falling.
It burns through the sugar you eat. It gives your metabolism somewhere to put fuel other than fat storage. Pound for pound, it’s more metabolically active than fat, so a stronger body quietly burns more even while you sit still.
Women who carry more muscle stay independent longer, recover from illness faster and hold their ground against the frailty that steals so many good years at the end of life.
Muscle loss is real, and it is measurable. Beginning around age 30, we shed roughly 3–8 percent of our muscle mass every decade.1
Strength slips even faster than size, on the order of 3 percent a year as women get older.2 Menopause pours fuel on the fire because the hormones that once guarded your muscle are walking out the door.3
None of that is a reason to despair. It’s a reason to start now, while starting is still easy.
A big piece of the answer is a hormone most women never think about: growth hormone.
It does exactly what its name suggests. It signals repair and rebuilding, including the daily upkeep of muscle. In your 20s, it runs high. After that it falls by about 15 percent every decade.4
Physicians even have a name for this slow fade. We call it somatopause, the quieter sibling of menopause.
Less growth hormone means a weaker signal telling your body to hold onto muscle. Layer on the natural drop in testosterone, which women carry in smaller but important amounts, and the repair crew your muscles depend on shows up short-staffed.
This is ordinary aging, not a disease. But left alone, it has a predictable destination, and that destination is weakness.
What my patients find most maddening is that the very season of life when muscle matters most is the season when it’s hardest to build.
Estrogen is a major reason. Estrogen is not only a reproductive hormone. Your muscle cells carry receptors for it, and it plays a genuine role in muscle repair and quality.5
When estrogen drops during the menopause transition, muscle becomes harder to build and quicker to fade. Recovery drags. A workout that used to leave you sore for a day can leave you sore for three.
There’s also something researchers call anabolic resistance. As we age, muscle grows a little deaf to the signals that normally tell it to build, including the protein in a meal. Younger muscle responds to a modest amount of protein. Older muscle needs a louder knock on the door.
It appears the deck is stacked against you: lower growth hormone, lower estrogen, lower testosterone and muscle that responds less. But that’s not an argument for giving up. It’s an argument for being intentional.
You won’t drift into muscle in midlife the way a teenage boy does during puberty. You must work for it, on purpose, with real, heavy weights in your hands.
Women ask me where to start almost every day, and the honest answer is simpler than the internet makes it look.
First, the encouraging part. Muscle answers back. Even well past menopause, women who train with resistance reliably build lean tissue and get stronger.6
Lift weights that are genuinely heavy for you. Build your training around the big movements first.
Squat down and stand back up. Pick things up off the floor. Press weight overhead. Pull and carry heavy loads across the room. These train the most muscle at once and carry straight over into real life, from hoisting a toddler to steadying yourself on the stairs.
Focus on these resistance training concepts: fatigue and progression.
Training to fatigue means taking a set close to the point that you couldn’t manage many more clean repetitions. You don’t need to grind every set to total failure. In fact, you shouldn’t.
The research is clear that working close to failure drives the growth, while pushing all the way to failure mostly piles on fatigue without adding much reward.7 For most women, stopping one or two solid reps short is the sweet spot.
Progression means the work must get harder over time. If you lift the same 5 lb dumbbells for a year, your body has no reason to change, so it won’t.
You add a little. A heavier weight, one more repetition, an extra set, cleaner form. Small and steady, week after week. That upward pressure is the entire game.
Two or three focused sessions a week is plenty to begin. You don’t need two hours in a gym. If you have only 20 minutes to move your body, lift weights for those 20 minutes. You need to show up, lift with intention, rest enough to recover and increase the weights.
A simple week can look like this:
That’s the whole method, and it works at age 40, age 60 and well beyond.
Supplements won’t save you. Training does the real work.
But a supplement that can genuinely help is creatine. It’s the supplement I recommend most for strength training.
Creatine monohydrate is one of the most studied supplements we have, and the old idea that it belongs only to young male bodybuilders was never true.
For women in midlife, taken alongside strength training, creatine supports muscle and strength, and it may offer added benefits for bone structure and even brain health.8 The dose is not complicated: 5–10 g a day, taken every day. I usually mix mine with electrolytes and take it after my workout.
Protein matters just as much, and most women eat far too little of it in midlife. Build your meals around a real serving of protein, and remember that aging muscle needs more of it, not less, to answer the call.
As a rough target, many women do well aiming for about a gram of protein for each pound of their goal body weight, spread across the day. Start with a solid serving at breakfast, which is when women most often fall short. I like to recommend 30 g of protein each meal, and eat your protein first.
As we age, we become more insulin resistant, meaning we don’t process sugar as well. Muscle is where your body handles sugar.
After you eat, your skeletal muscle pulls in most of the glucose that insulin clears from your blood, somewhere in the range of 70–80 percent of it.9 Muscle is the sponge. The more muscle you carry, and the more you use it, the bigger and thirstier that sponge becomes.
When muscle shrinks, the sponge shrinks with it. Sugar lingers in the bloodstream. Insulin must climb higher and higher to force it into storage. Over time, that is the road to insulin resistance, prediabetes and type 2 diabetes.
There’s a bonus worth knowing: A working muscle can pull glucose out of the blood even when insulin is low, simply by contracting. That’s part of why a short walk after a meal or a few sets of squats can blunt the insulin spike so well. Trained muscle does this job better than untrained muscle, which means every workout is buying you steadier blood sugar for days, not just for the hour you spent lifting.
This is why strength training does something no diet on its own can match. It doesn’t burn glucose only while you sweat. It builds and preserves the very tissue that keeps your blood sugar steady for the rest of your life.
Resistance training has been shown to improve insulin sensitivity and blood sugar control,10 and for many of the women I treat, it’s the missing piece they never knew to look for. You can’t supplement or peptide your way around that truth. You must build the muscle.
I think often about the choice I made at age 37, the choice to get stronger. It has protected my metabolism, my mood, my energy and my ability to keep pace with four children and a full life. It’s some of the best medicine I’ve ever given myself.
Muscle pays a woman back in nearly every currency that matters in midlife. Strength. Steady blood sugar. Bones that hold. Independence. Years that feel like living instead of slowly declining.
You don’t need to become a bodybuilder. You need to start, stay consistent and keep asking your body for a little more than it gave you last week. Build it now, while it’s still easy to earn. Your future self will be standing on everything you build today.
The GLP-1 medications that everyone is talking about, like semaglutide and tirzepatide, deserve a clear warning when it comes to muscle.
They work. People lose significant weight on them. The question no one asks loudly enough is what that weight is made of. In the major trials, a real share of the loss was not fat but lean tissue, muscle included. In one large semaglutide study, close to a third of the total tissue lost was lean mass.1
Some loss of lean mass comes with any serious weight loss. But picture a midlife woman already fighting age-related muscle decline who then sheds still more muscle on a medication. She can end up smaller on the scale and weaker in every way that counts.
Thinner was never the goal. Metabolically strong is the goal. A drug that quietly turns down your appetite should never be allowed to quietly carry off your muscle.
1. Squat
Strengthens your thighs, glutes and core
Standing with feet shoulder-width apart, hold a dumbbell at your chest or one in each hand by your sides. Push your hips back and bend your knees as if sitting into a chair. Keep your heels on the floor. Lower as far as feels comfortable, then push through your heels to stand.
2. Hinge (Romanian deadlift)
Strengthens your glutes, hamstrings and lower back
Stand with your feet hip-width apart, holding a dumbbell in each hand. Keeping your back straight and knees slightly bent, push your hips backward and lower the weights down the front of your legs. Squeeze your glutes to return to standing.
3. Overhead press
Strengthens your shoulders, arms and core
Hold a dumbbell in each hand at shoulder height, palms facing forward or toward each other. Brace your core and press the weights overhead until your arms are nearly straight. Lower slowly back to the start, avoiding arching your back.
4. Bent-over row
Strengthens back muscles and improves posture
With a dumbbell in each hand, hinge forward from your hips. Pull the weights toward your ribs, keeping your elbows close to your body and squeezing your shoulder blades together. Lower with control.
5. Loaded carry (farmer’s carry)
Improves grip strength, core stability and real-life strength
Hold a dumbbell in each hand and stand up straight. Keeping your core engaged and shoulders relaxed, walk forward steadily for 20–30 seconds without leaning, slouching or swinging the weights.
Beginner tip: Start with a light weight that allows you to keep good form, then gradually increase the weight as the moves get easier.
Dr Jen Pfleghaar, DO, is double board-certified in emergency medicine and integrative medicine and speaks nationally on hormones, metabolic health and longevity. She is the founder of Healthy by Dr. Jen and practices root-cause medicine focused on women’s health. She lives in Tennessee on a mini farm with her husband and four children. Follow her work at @integrativedrmom and healthybydrjen.com.
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