More than just menopause – How muscle, fat and a simple blood test can predict midlife women’s health
Published: 20 Jun 2025
From left: Beverly Wong, Research Assistant, Department of Obstetrics and Gynaecology, NUS Medicine; Mdm Sabarina Bte Jumarudin, participant of the Integrated Women’s Health Programme; Prof Yong Eu Leong, Department of Obstetrics and Gynaecology, NUS Medicine, Head & Emeritus Consultant, Division of Benign Gynaecology, Department of Obstetrics and Gynaecology, NUH; Darren Tan, Research Assistant, Department of Obstetrics and Gynaecology, NUS Medicine.
New research from the Integrated Women’s Health Programme (IWHP) at the National University Hospital (NUH) and the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), has uncovered new insights into how muscle strength and visceral fat, and their association with menopause, can potentially lead to downstream health impacts among women in Singapore, and how physical performance assessments and a simple blood test could help predict and prevent chronic conditions before they arise.
The first study, published in Diabetes, Obesity & Metabolism in October 2024, found that women with both weak muscle strength and high levels of visceral fat had the highest risk of developing prediabetes or type 2 diabetes. Their risk was 2.63 times higher than that of women who had normal muscle strength and lower fat levels.
Having just one of these conditions also increased risk, though to a lesser degree. The risk from having high visceral fat alone is 1.78 times higher. Among those with weak muscle strength, women with high visceral fat had a 2.84 times higher risk compared to those with low visceral fat.
Professor Yong Eu Leong, Head and Emeritus Consultant, Division of Benign Gynaecology, Department of Obstetrics and Gynaecology, NUH, and the lead of IWHP, said, “This finding validates our previous research that showed women should not just focus on weight loss, but also on building muscle strength through exercise for diabetes prevention.” Prof Yong is also from the Department of Obstetrics & Gynaecology at NUS Medicine.
The study builds on an earlier 2022 IWHP paper that found midlife women with poor muscle strength had more than double the risk of diabetes compared to those with normal muscle strength.
In another recent study, published in Menopause in March 2025, the team found that a simple hospital blood test could help predict who is more likely to lose muscle mass and physical strength with age. Women with a lower ratio of creatinine to cystatin C (CCR), a marker derived from blood tests to check on skeletal muscle mass and kidney functions, had less muscle and walked more slowly later in life.
A commentary by the study team, published in Annals in February 2025, further highlighted that menopause could lead to body changes in ways that are not always visible. Declining oestrogen during menopause contributes to increased visceral fat and reduced muscle mass – changes not captured by body mass index (BMI). These shifts are linked to greater risks of diabetes, hypertension, osteoporosis, and even early mortality.
Drawing on these findings, the IWHP researchers called this phenomenon the “Janus-like effect” — named after the Roman god of transitions — to describe the life-changing shift from the reproductive period to the post-menopausal stages of life.
Read more in the press release here.
