Does HRT Help Build Muscle After Menopause? What the Trials Show
On its own, menopausal hormone therapy has not been shown to preserve muscle mass, and its strength benefit is small. One small trial suggests estrogen may add to the muscle gained from lifting.
By Kymata Health Editorial Published Last checked
This guide
Midlife Strength & Creatine- Question
- Will hormone therapy help me build or keep muscle after menopause?
- Sources
- 4 cited
- Quick answers
- 2 questions
- Clinician review
- None; sources cited inline
Key takeaways
4 points- A 2019 meta-analysis of 12 randomized trials (4,474 women) found hormone therapy users lost 0.06 kg less lean mass than controls, a difference that was not statistically significant2.
- A 2009 meta-analysis of 23 studies found a small strength benefit, about 5% greater strength in women on estrogen-based hormone therapy1.
- In a 12-week Danish trial of 31 women within 5 years of menopause who did supervised resistance training, quadriceps size grew 7.9% with a transdermal estrogen patch vs 3.9% with placebo3.
- Building muscle is not an approved use: the FDA label for one combined estradiol patch, Climara Pro, lists treating moderate to severe hot flashes and preventing postmenopausal osteoporosis4.
Hormone therapy alone and muscle mass
A 2019 meta-analysis in JAMA Network Open pooled 12 randomized trials with 4,474 women (average age 59) followed for a median of 2 years. Overall, women on hormone therapy lost 0.06 kg less lean body mass than controls, a difference that was not statistically significant2. Results were similar for estrogen-only and combined therapy and across doses, follow-up lengths and time since menopause2.
The quality of the evidence was rated low, and the authors concluded that interventions other than hormone therapy should be explored for keeping muscle2.
Hormone therapy and strength
A 2009 meta-analysis compared muscle strength in postmenopausal women who were and were not on estrogen-based hormone therapy across 23 studies. It found a small benefit (effect size 0.23), equal to roughly 5% greater strength, and the thumb muscles showed the largest difference1.
A 5% difference is modest next to what training itself does; in the trial below, both groups gained strength from lifting3.
Estrogen plus strength training
A double-blind trial in Aarhus, Denmark, randomized 31 healthy, untrained women no more than 5 years past menopause to 12 weeks of supervised resistance training with either a transdermal estrogen patch (15 women) or a placebo (16 women)3. Quadriceps cross-sectional area on MRI grew 7.9% with estrogen vs 3.9% with placebo, and whole-body fat-free mass rose 5.5% vs 2.9%3.
Most strength measures, jump height and finger strength improved after training with no difference between the groups; only handgrip strength rose with estrogen and not with placebo3. The trial was small, short and limited to early postmenopausal women, and the authors declared no commercial or financial conflicts of interest3.
Whatever you decide about hormones, the training is what builds the muscle: see our guides to heavy lifting after menopause, protein after 50 and creatine for women over 40.
Who should not take hormone therapy
Hormone therapy is a prescription medicine with real risks. The Climara Pro label lists these contraindications: undiagnosed abnormal genital bleeding; breast cancer or a history of it; estrogen-dependent cancers; active or past blood clots in the legs or lungs; active or past arterial clotting disease such as stroke or heart attack; liver impairment or disease; protein C, protein S or antithrombin deficiency or other clotting disorders; and a known allergic reaction to the product4.
The label also carries a boxed warning: in the Women's Health Initiative, estrogen plus progestin raised the risks of stroke, blood clots in the legs and lungs, heart attack and invasive breast cancer, and of probable dementia in women 65 and older, and the label says hormone therapy should not be used to prevent heart disease or dementia4. It adds that when prescribing solely to prevent postmenopausal osteoporosis, clinicians should first consider non-estrogen medicines4. For how the FDA's warnings have changed, see the hormone therapy boxed warning update; for starting later in life, see HRT after 60.
What to raise with a clinician
If you are weighing hormone therapy, these are the points the evidence above makes worth discussing:
- Whether hot flashes or your risk of bone loss justify hormone therapy, since those are its approved uses4.
- Any personal history of breast cancer, blood clots, stroke, heart attack or liver disease, all listed as contraindications on the label4.
- That hormone therapy alone has not been shown to preserve muscle mass, so it should not replace strength training2.
Quick answers
Questions
2 answersShould I start HRT just to build muscle?
The evidence does not support it as a reason on its own: hormone therapy alone did not significantly preserve lean mass in pooled trials, and muscle is not an approved use24.
What about testosterone for women?
That is a separate question with its own evidence; see our testosterone for women guide.
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Menopause treatment cost3 a.m. waking in menopauseAlso in: Supplements and vitamins
References
Every study and document cited in this guide, numbered as in the text.
Sources
4 sources- 1Hormone therapy and skeletal muscle strength: a meta-analysis. J Gerontol A Biol Sci Med Sci, 2009. PMID 19561145
- 2Association Between Hormone Therapy and Muscle Mass in Postmenopausal Women: A Systematic Review and Meta-analysis. JAMA Netw Open, 2019. PMID 31461147
- 3Transdermal Estrogen Therapy Improves Gains in Skeletal Muscle Mass After 12 Weeks of Resistance Training in Early Postmenopausal Women. Front Physiol, 2020. PMID 33542694
- 4Climara Pro (estradiol/levonorgestrel transdermal system) prescribing information, revised 02/2024. U.S. Food and Drug Administration (Drugs@FDA), 2024.
Dietary supplements are not intended to diagnose, treat, cure or prevent any disease, and these statements have not been evaluated by the FDA. Prescription options need a licensed clinician. Talk to your clinician or pharmacist before starting anything new, especially if you take prescription medicines, are pregnant or breastfeeding.