Building a credible menopause program, past the myths and the marketing

The number one mistake is doing more instead of doing it smarter. People hit a plateau and their instinct is to add volume when they actually need to train differently. Underfueling is a huge one, and it hides very well. Someone eating a salad and doing tempo runs shows up exhausted, not recovered, plateaued despite being in a calorie deficit, and assumes it is hormonal. A lot of the time it is just not fueling enough, and they do need to eat more. Telling someone to eat more is genuinely hard, it is a hard conversation to have. And to be clear: if there is any history of disordered eating, that conversation has to be handled clinically, not by a health coach. That means bringing in a registered dietitian, or mental health counseling.

Honestly, though, the biggest issue is not bad training, it is no training. Only 23.8% of women between 45 and 64 are meeting basic strength training guidelines. So before getting into the nuance of protein and training cycle syncing, people need to be doing the basics: progressive overload, consistently. For women who are already fit, the mistake flips. They add volume instinctively without progressive overload or real recovery, and for that group a coach’s job is often to subtract, not to add. And “I don’t have time” is often a proxy for something else, usually lack of enjoyment or support, not an actual scheduling problem.

For younger women, under one in four women between 45 and 64 are really doing strength training at all, and more women under 45 need to be doing it and building out muscle. As we get older and go through menopause, bone loss accelerates. Research from the SWAN study shows bone loss accelerates pre-menopause, starting a year before and running at roughly 2% a year for three years. So starting in your 30s to 40s does give you more leverage for strength training and progressive overload. But the bigger lever is not shifting the age everyone starts, it is closing the participation gap in the first place.

It is worth being precise about where the evidence is strong versus soft. It is solid for bone density, lean mass, strength, and functional training. It is weaker or mixed for depression, since a lot of those trials are not blinded, and for sleep, where aerobic exercise may actually beat resistance training, and for metabolic effects, where the effect on insulin resistance is small. What needs fixing is access and simplicity: short, supervised, low barrier training programs that help close the gap.

On myths, a new 2025 research study analyzing a biopsy study found no meaningful sex difference in response, on average. The field overcorrects on “women aren’t small men” rather than furthering the evidence that actually supports it. Only 12% to 13% of women have what you would call a textbook cycle, which undermines a lot of the cycle syncing programs being sold through apps and tracking devices. There is a whole list of overstated or outright invented protocols: female-specific protein timing windows, the claim that fasting destroys your hormones in four days, or sauna use for plasma volume, which actually traces back to a six-person study done on men. None of that holds up under scrutiny. What actually survives the evidence is refreshingly boring: eating enough, lifting progressively, sleep, and incorporating creatine. Creatine is a huge myth area, with women hearing it will make them gain a ton of weight or that it is not good for them, when it is actually really great to incorporate, especially alongside strength training.

For every myth there is a different product, test panel, course, or coach. To be direct: there is real deceptive marketing and financial exploitation in this space, and it is documented. TINA.org, BBC Panorama, and UCL research have all covered it. A huge market size number gets thrown around, $600 billion circulates a lot, but that is an outlier figure. Something in the $10 billion to $24 billion range is more credible, and it is better to avoid citing the bigger number altogether. On credentials, MSCP is the only certification that is clinically meaningful right now. “Menopause coach” as a title is completely unregulated and anyone can use it, which is why it shows up constantly on social media. For things like seed cycling or the Galveston diet, popular but unstudied, the honest framing matters more than a dismissive one: “no study exists” is a different claim from “this is fake.” What is actually worth spending money on is DXA bone density scans and grip strength testing. Grip strength testing is available at a lot of gyms when you sign up, and it can help gauge where you are falling and what you need to focus on. Skip the saliva panels and Dutch tests. They are not FDA cleared and they are not used in actual clinical practice.