Sarcopenia

Sarcopenia is losing muscle mass and muscle strength at the same time. That is the definition experts from the main sarcopenia societies worldwide agreed in 2024, through the Global Leadership Initiative in Sarcopenia, adding that it affects muscles across the whole body and may be reversible. The European Working Group on Sarcopenia in Older People (EWGSOP2) links it to falls, fractures, disability and early death, and says it is common in older age but can start earlier in life.

The European Menopause and Andropause Society (EMAS) says it affects up to 10% of people over 60. When lost muscle comes with more body fat, doctors call it sarcopenic obesity. Visceral fat covers the fat side of that picture.

We found no reliable figure for Pakistan. One 2024 study near Pune, in western India, measured 745 adults with an average age of 53 and found sarcopenia in 8% of the women: about 12% of women in the villages against 3% in the city.

It creeps. EWGSOP2 says to look further when someone falls, feels weak, walks slowly, struggles to get up from a chair, or loses weight or muscle. Its five-question check, SARC-F, asks about strength, walking, rising from a chair, climbing stairs and falls.

At home it looks like help. The heavy pot goes to a daughter, the shopping to a son, the gas cylinder to whoever is around. That help is a blessing. It can also hide how much has changed.

Age is one part. Hormones are another. The Menopause Society says sarcopenia, like osteoporosis, is linked to ageing, falling estrogen and the menopause transition, and rates that evidence as limited or inconsistent (Level II). Women's Health Concern says falling estrogen during menopause causes muscle mass to decline, which slows the rate the body burns energy.

EMAS lists the risk factors: being a woman, older age, little physical activity, too little protein and a low body mass index. In the Pune study, older age, village life, a lower income and too little protein each went with sarcopenia, and only 29% of the adults ate enough protein by Indian guidelines.

• The Asian Working Group for Sarcopenia, in its 2025 update, now checks adults from age 50, not only older people, using grip strength and muscle mass, with a calf measurement among the first quick checks.
• The Pakistan Menopause Society says regular physical activity improves muscle strength and flexibility and reduces sarcopenia, and lists strength training with body weight, free weights or resistance bands as its own kind of exercise (Table 6). Strength training has the detail, including how to start at home.
• The same Pakistani recommendations ask doctors to use the menopause visit to talk about muscle strength and activity (Table 1), and to encourage adequate protein (Table 2). They give no amount. Nutrition covers protein in food.
• They also list recurrent falls among the reasons to assess fracture risk and consider a bone density scan where one is available (Table 4). Weak muscles and thin bones make a bad pair. Osteoporosis explains the bone side.

EMAS's list of ways to manage sarcopenia has two entries, strength exercise and getting nutrition right, and no medicine.

On HRT, neither NICE nor The Menopause Society promises anything for muscle (see "Does HRT stop muscle loss?").

EMAS's 2026 framework for midlife care says routine care in these years should include checking muscle strength and physical function, alongside heart risk and bone health. Asking for a check is reasonable, not fussy.

Mention a fall, or a near miss, even if nothing broke. Sarcopenia builds over years. Weakness that arrives over days or weeks is something else and needs a doctor soon.

Rising from sujood, again and again, five times a day, is its own daily strength test, and women notice when it gets harder. Whether and when to pray seated is a question for a qualified scholar. Keeping your legs strong enough to keep standing is a question for your doctor, and a good one to ask before it gets harder.