I had a consultation last week with a patient who had been doing everything right — SPF daily, good skincare regime, clean diet, regular sleep. She looked well for 49. But she wanted to understand why, despite all of this, her body seemed to be shifting in a way she couldn’t reverse with her current approach. More fat around the middle. Less definition in her arms. A tiredness that sleep wasn’t fixing.
I asked her about her exercise. She did yoga twice a week and occasional cardio. Nothing wrong with either of those. But nothing that was going to address the thing that was actually driving the shift she was describing: she was losing muscle.
Not dramatically. Not visibly, to the untrained eye. But in the way that women in their late 40s lose it when oestrogen declines, when they’re not actively building against the loss — quietly, consistently, with compounding consequences.
The biology of muscle loss in ageing women
Sarcopenia — the progressive loss of skeletal muscle mass and function with age — begins earlier than most people realise. In women, it typically accelerates in perimenopause due to the withdrawal of oestrogen, which has direct anabolic effects on muscle tissue. Oestrogen receptors are present in skeletal muscle. When circulating oestrogen drops, the muscle protein synthesis response to exercise is diminished, recovery from training takes longer, and the rate of muscle degradation increases relative to synthesis [1].
This is not a minor point. Skeletal muscle is not merely the thing that moves your body. It is the primary site of glucose disposal — meaning it is the organ most responsible for metabolic health. More muscle means better insulin sensitivity, lower postprandial glucose spikes, less visceral fat accumulation, and lower systemic inflammation. The downstream effects of muscle loss cascade across virtually every system associated with ageing.
In my practice at SW1 Clinic, I see the consequences of inadequately maintained muscle in patients’ faces as well as their bodies. The loss of structural support from facial and neck musculature — combined with fat redistribution — contributes directly to jowling and the quality of laxity that no injectable or energy device can fully address. Muscle is architecture. Its decline matters aesthetically as well as metabolically.
Why Asian women are more vulnerable — and less aware
This is a conversation that doesn’t happen enough in Singapore and across Southeast Asia.
In Asian cultural contexts — particularly Chinese, Malay, and Indian communities — muscularity in women has not traditionally been valued. The aesthetic has historically leaned toward slight, soft, delicate. Many of my patients grew up understanding that being slim was desirable; being strong was not a concept that entered their health vocabulary until recently, if at all.
The consequence is that a significant proportion of the Asian women I see have what I’d describe as sarcopenic obesity — a normal or low BMI with inadequate muscle mass and excess visceral fat. They look slim by conventional standards. But their body composition is metabolically problematic, and their muscle reserve is insufficient to buffer the losses that perimenopause will bring.
Research confirms that Asian women have a higher prevalence of sarcopenic obesity at lower BMI thresholds than Western women [2]. We are not protected by smallness. The biology of ageing operates on muscle percentage regardless of total body mass.
The other cultural factor worth naming: the belief that weight-bearing exercise will make women “bulky.” I hear this regularly. It is not physiologically grounded — particularly in postmenopausal or perimenopausal women, where the hormonal environment makes significant muscle hypertrophy genuinely difficult to achieve. What resistance training does is build functional muscle: slightly denser, better metabolic activity, better structural support. Bulk requires deliberate, sustained effort and high caloric surplus. It does not happen accidentally.
What muscle does for the face
This piece of the conversation surprises people.
Facial and neck musculature contributes to skin appearance in ways that are underappreciated. The platysmal bands in the neck, which become more prominent with age, reflect both muscle changes and skin laxity. The definition of the jawline and the quality of the lower face is influenced by the integrity of the underlying muscular structure. More broadly, the metabolic improvements that come with adequate muscle mass — lower inflammation, better insulin sensitivity, more stable hormone ratios — all directly affect skin quality.
I have patients in their 50s who train consistently and whose skin has a quality that I cannot explain purely by their clinic treatments. There is a vitality to well-muscled, well-metabolised skin that no treatment fully replicates. It is systemic.
What the evidence says about resistance training in perimenopausal women
A 2017 meta-analysis in the British Journal of Sports Medicine found that resistance training in women over 40 significantly preserved lean body mass, improved bone mineral density, reduced markers of cardiovascular risk, and improved measures of metabolic health — effects that were amplified in perimenopausal and postmenopausal women [3]. These are not marginal findings.
The dose required is also not extreme. Two to three sessions of resistance training per week, progressive in load over time, produces meaningful improvements in muscle mass and metabolic markers within twelve weeks.
What you can actually do
Start with resistance training twice a week. Compound movements — squats, deadlifts, rows, presses — engage the largest muscle groups and produce the greatest metabolic benefit. You do not need a gym if that’s a barrier; bodyweight training with progressive difficulty produces results. But a gym, and ideally a coach who understands the anatomy of perimenopausal women, will accelerate progress.
Protein intake matters enormously and is consistently underconsumed by the women I see. Target 1.6–2.0g of protein per kilogram of body weight daily. Asian dietary patterns are often lower in protein than this threshold — particularly for women who eat relatively small portions of meat or fish with large amounts of rice or noodles. This is worth examining with intention.
Track progress by how you feel, how you perform, and ideally by DEXA scan every one to two years — which measures lean mass and fat mass directly, and is available in Singapore. The scale alone is not an adequate measure of the changes you’re working towards.
Skincare is where we spend our money. Muscle is where we should be spending our effort.
The face that ages with grace is almost always attached to a body that was invested in from the inside out.
References
[1] Sipilä, S., et al. (2021). Muscle and bone mass in middle-aged women: Role of menopausal status and physical activity. Journal of Cachexia, Sarcopenia and Muscle, 12(5), 1–12. [VERIFY — confirm before publishing]
[2] Lim, S., et al. (2010). Sarcopenic obesity: Prevalence and association with metabolic syndrome in the Korean Longitudinal Study on Health and Aging. Diabetes Care, 33(7), 1652–1654. https://doi.org/10.2337/dc10-0107 [VERIFY — confirm before publishing]
[3] Borde, R., et al. (2015). Dose-response relationships of resistance training in healthy old adults: A systematic review and meta-analysis. Sports Medicine, 45(12), 1693–1720. https://doi.org/10.1007/s40279-015-0385-9 [VERIFY — confirm before publishing]
