Transdermal estrogen therapy and resistance training in postmenopausal women

February 22, 2021
Bob Kronemyer

Freelance writer for Contemporary OB/GYN

“Women show an accelerated loss of muscle mass around menopause, possibly related to the decline in estrogen,” wrote the authors.

Transdermal estrogen therapy (ET) significantly increased skeletal muscle mass in response to 12 weeks of supervised, progressive resistance training among early postmenopausal women, according to a study in the journal Frontiers in Physiology.

The Danish double-blinded randomized controlled study found an increase in muscle cross-sectional area of 7.9% in the ET group vs.3.9% in the placebo group (P < 0.05).

Likewise, the increase in whole-body fat-free mass was 5.5% in the ET group vs. 2.9% in the placebo group (P < 0.05).

“Women show an accelerated loss of muscle mass around menopause, possibly related to the decline in estrogen,” wrote the authors. “Furthermore, the anabolic response to resistance exercise seems to be hampered in postmenopausal women.”

The investigators tested the hypothesis that ET amplifies the skeletal muscle response to resistance training in early postmenopausal women.

The study, which was conducted at the Department of Public Health, Aarhus University, Denmark, recruited 31 healthy, untrained postmenopausal women no more than 5 years past menopause.

The primary outcome was the impact of resistance training on a cross-sectional area of quadriceps femoris measured by magnetic resonance imaging. Secondary parameters were fat-free mass determined by dual-energy X-ray absorptiometry, muscle strength and functional tests.

Transdermal 17-β estradiol or placebo patches were given to the women in a closed non-transparent envelope. The patch was placed on the skin on the lower part of the abdominal region at the start of the intervention. The patch was also renewed twice a week.

The ET patch released 00 μg 17-β-estradiol every 24 hours. After intervention, women in the ET group were offered 10 days of treatment with progesterone.

One participant did not attend the initial test and start of the intervention; the remaining 31 women (ET n = 15; placebo n = 16) completed the intervention period and tests.

The training program of 36 sessions over 12 weeks was based on the guidelines of the American College of Sports Medicine (ACSM). Each training session started with a standardized warm-up consisting of 5 minutes of light cycling, light running or light rowing, followed by six resistance exercises.

The training intervention concentrated on the lower extremities, including three leg exercises in resistance training machines: leg press, knee extension and knee flexion.

The three other exercises were dumbbell triceps extension, sit-ups and back extensions.

The program was designed progressively to avoid overload injuries and all training sessions were supervised to ensure proper load resistance during the exercises, technique and adherence to the program.

Handgrip strength increased in the ET group (P < 0.05), but did not change in the placebo group.

Muscle strength parameters, jumping height and finger strength all improved after the training period, with no difference between the two groups.

Despite the ET group receiving a somewhat substantial dose of estradiol, the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels did not reach premenopausal levels (< 15 IU/L). “Thus it can be speculated that a higher dose of estradiol would have led to even more pronounced effects on muscle mass and function,” wrote the authors.

The authors believe that future training studies should clarify if the combination of training and ET causes a greater positive effect on skeletal muscle mass and strength as opposed to training or ET alone.


Dam TV, Dalgaard LB, Ringgaard S, et al. Transdermal estrogen therapy improves gains in skeletal muscle mass after 12 weeks of resistance training in early postmenopausal women. Front Physio