In this episode, Dr. Bill Campbell returns to the show to discuss a major pivot in his research from building muscle and optimizing fat loss to understanding menopause and its effects on women's body composition. After watching his wife struggle through a severe perimenopause transition that resisted every traditional fat loss strategy, Campbell uncovered a massive blind spot in the scientific literature: almost no research exists on fit, resistance trained women going through menopause. His public comments sparked hundreds of messages from women describing the same struggles including unexplained weight gain, muscle loss, energy crashes, and sleep disruption highlighting how poorly understood this phase of life truly is.
Dr. Campbell breaks down what the best research does show. Menopause accelerates fat gain, shifts fat distribution toward the midsection, and produces measurable declines in muscle and bone mineral density. Many women experience weight loss resistance where standard diet and training approaches no longer produce results. He also digs into the nuance of hormone replacement therapy how progesterone and estrogen can dramatically improve sleep, anxiety, and energy, why estrogen appears anabolic for middle aged women, and why HRT's effect on body fat varies widely. Campbell clarifies the long standing confusion created by the 2002 Women's Health Initiative study, how its flawed interpretation suppressed HRT use for two decades, and why today's evidence supports earlier intervention under an evidence based physician.
The conversation closes with clear, practical guidance for women entering perimenopause. Maintain a consistent fitness lifestyle, lift weights to protect muscle and bone, prioritize sleep, get annual bloodwork and DEXA scans, and consider HRT early if medically appropriate.
Campbell emphasizes that lifestyle habits do not replace hormone therapy and hormone therapy does not replace lifestyle. Together they help women navigate the most dramatic physiological transition since puberty. Whether you're a coach, practitioner, or someone approaching this stage of life, this episode provides a much needed framework for understanding, preparing for, and managing menopause with strength and agency.
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