If you’re strength training, eating “clean,” and still gaining fat or losing muscle after 40, it’s not just willpower—it’s physiology. In this episode we break down what actually changes during perimenopause and menopause (lean mass, central fat gain, estrogen shifts), plus the research-backed levers that still move the needle: resistance training intensity, protein targets, smart cardio, recovery, and when HRT may help. If you feel like the old playbook stopped working, this is your reset with a real framework.KEY TOPICS Why weight loss resistance shows up in midlife even for active women How menopause shifts body composition toward central fat gain and lean mass loss HRT and estradiol research for muscle gain and inconsistent fat loss outcomes Protein targets for midlife women and how to hit them consistently Training strategy that works: heavy lifting, cardio for VO2 max, power, agility, and recoveryTIMESTAMPS[00:00] Why Bill Campbell shifted his research to menopause after his wife’s experience[00:24] Female physiology matters: women are not “small men” and body composition changes hit hard[00:57] First generation of strength-trained women entering menopause and why the research gap matters[01:40] What’s really happening: gaining fat and losing muscle isn’t just about effort after 40[09:13] Menopause vs aging debate: what the SWAN data suggests about the transition[12:40] DEXA findings: lean mass loss begins and fat gain accelerates during the transition[14:10] Why fat shifts to the middle: central adiposity, FSH rise, and estradiol decline[15:00] HRT question: what changes when women use hormone therapy during training[16:46] Estradiol and muscle: why estrogen therapy may be anabolic in trained women[18:30] Estradiol and fat loss: why results are variable and not a guaranteed solution[20:28] Hormone balance and nuance: estradiol, progesterone, testosterone, and body fat context[22:55] Estradiol target ranges discussed for bone and muscle support[27:53] Progesterone vs progestins: why older research can be misleading[29:21] Protein targets: 0.75–1.0 g/lb ideal body weight and why most women under-eat protein[33:47] Practical protein strategy: distribute evenly across meals to hit your daily target[38:17] Protein timing around workouts: why pre vs post doesn’t matter much[40:39] Supplements that matter: creatine, whey/complete protein, omega-3s[43:22] Magnesium and vitamin D: common deficiencies and bone-health relevance[45:00] Strength training minimum effective dose: 1 day for maintenance, 2+ days for best results[47:16] Training doesn’t change by decade: intensity and proximity to failure are the difference[49:46] Benchmarks: squat bodyweight and deadlift ~1.25x bodyweight as aspirational goals[54:47] Cardio after menopause: VO2 max, HIIT, and why walking isn’t the same stimulus[58:41] Stress resiliency: when pulling back is smarter than pushing harder[01:00:16] Ideal weekly structure: resistance, aerobic fitness, power, agility, plus daily movement[01:03:16] BFR/Kaatsu for joint pain and training around injuries[01:05:02] What turned it around for Bill’s wife: progesterone first, then estradiol, plus patience[01:07:46] HRT isn’t one-and-done: adjust, track, and combine with training, sleep, and recovery[01:11:26] Where to follow Bill Campbell and his menopause fitness content[01:12:00] Support the show and join the free community at optimizedwomen.comGuest: Dr. Bill CampbellWebsite: https://billcampbellphd.comInstagram: https://www.instagram.com/billcampbellphd/LET'S CONNECTHost: Orshi McNaughtonPodcast Links: https://optimized-women.captivate.fm/listenWebsite: https://www.optimizedwomen.com/YouTube Channel: https://www.youtube.com/@optimizedwomenInstagram: https://www.instagram.com/orshimcnaughton