Menopause exercise: how to train through perimenopause and beyond

The honest version of menopause exercise advice is less exciting than the internet's and more useful: keep lifting, keep doing weight-bearing work like walking or running, and don't expect a workout to switch off hot flushes. The NHS and NICE both put strength and bone health at the center. The evidence that exercise treats symptoms is weaker than the marketing.

This post covers what the official guidance says about training through perimenopause and after menopause, what the research on lifting and bone shows, where the evidence is thin, and how to build a week that holds up. If you'd rather not plan it yourself, exrsz builds the plan. Either way, the principles are below.

A note before the training part: the line this site uses for every women's health post applies here too: check with your doctor, midwife or a pelvic health physiotherapist before changing your training around a health question. For menopause that's mostly your doctor, plus a pelvic health physiotherapist for any leaking, heaviness or pelvic pain. Nothing here is medical advice, and training is something you do alongside treatment decisions, not instead of them.

What perimenopause and menopause mean for training

The NHS defines perimenopause as when your periods become irregular, and menopause as not having a period for 12 months (when you're not using hormonal contraception). It usually affects women between 45 and 55, but can happen earlier (NHS).

NICE's menopause guideline lists symptoms that can range from minor to severe and from short to long-lasting, including hot flushes and sweats, mood changes, and musculoskeletal symptoms such as joint and muscle pain (NICE NG23). Any of those can make a training week feel very different from the same week five years ago.

None of that changes what good training looks like. It changes how much flexibility the plan needs. A women's lifting and running schedule with hard days, easy days and room to swap sessions handles a bad night's sleep the same way it handles a work trip.

For the full case for lifting in this decade, including the research on postmenopausal women, start with strength training for women over 40 explained. This post goes deeper on the menopause-specific side.

What the official guidance says about menopause exercise

Three sources, one direction.

• ›NICE recommends that clinicians explain to people experiencing menopause the importance of maintaining muscle mass and strength through physical activity, and give advice on bone health (NICE NG23).
• ›The NHS lists exercising regularly, "with focus on weight-bearing exercises to build strength as this can help protect against weakening bones", among the things you can do. For protecting bones, it names strength exercises where your feet and legs support your weight, such as walking, running or dancing, and resistance exercises such as using weights (NHS).
• ›The WHO 2020 guidelines recommend 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic activity a week for adults, plus regular muscle-strengthening activity (Bull et al., 2020).

So: lift, do weight-bearing aerobic work, and do enough of both. Running counts. So does a loaded carry, a hike, or a squat.

Lifting and bone: what the research shows

A 2024 meta-analysis of 12 randomized trials in healthy postmenopausal women confirmed the benefits of resistance training on physical fitness, while noting more debate about its influence on bone mineral density and body composition (González-Gálvez et al., 2024). The authors suggested three sessions a week of about 60 minutes as a starting point for future programs.

The LIFTMOR trial is the study most people cite on heavy lifting and bone. In 101 postmenopausal women with low bone mass, a brief, supervised program of high-intensity resistance and impact training improved lumbar spine and femoral neck bone density and all measures of functional performance compared with a home-based low-intensity program, with one minor adverse event (Watson et al., 2018). The authors stress it was done under highly supervised conditions.

What that means in practice:

• ›Heavy-for-you lifting isn't automatically off-limits after menopause.
• ›If you have osteoporosis or osteopenia, talk to your doctor before starting, and learn the heavy lifts with a qualified coach. LIFTMOR was supervised, and that detail matters.
• ›"Toning" is not a training goal. Light weights for high reps forever isn't what the bone research tested. Progressive loading is.

What exercise can't promise

This is where most menopause content gets loose with the truth.

A Cochrane review of exercise for hot flushes and night sweats found the evidence was insufficient to show whether exercise is an effective treatment for these vasomotor symptoms, and that one small study suggested hormone therapy was more effective than exercise (Daley et al., 2014). The evidence was rated low quality.

The NHS does list exercising regularly among things you can try for hot flushes, night sweats and mood changes (NHS). Both statements can be true: worth doing, not proven as a treatment. If symptoms are affecting your life, that's a conversation with your doctor about treatment options, and your training plan should work around whatever you decide. The same honesty applies to body weight, which is its own question: whether menopause causes weight gain, and what training can and can't do about it.

How to train through perimenopause, week to week

The fundamentals are the same as at any age. What changes is flexibility. If you want sets and reps rather than principles, lifting through perimenopause lays out a starter program.

Keep strength as the anchor

Two sessions a week is the official floor for muscle-strengthening work, and three is where the postmenopausal meta-analysis suggested starting. Compound lifts (squat, hinge, push, pull, carry), enough hard sets, a little more over time. If you're starting from zero, the beginner approach in the over-40 hub applies unchanged.

Run, walk or hike for the weight-bearing part

The NHS names walking and running as weight-bearing exercise for bones. For runners, the usual rules apply: mostly easy, a little hard, no heavy leg session the day before intervals or a long run. Harder conditioning is a separate question, and hiit workouts for women over 50 is its own subject. If you have a heart condition, high blood pressure or other health concerns, check with your doctor before adding hard intervals.

Adjust for symptoms, not the calendar

Perimenopause often means irregular periods, so cycle-based planning stops being predictable. The approach from more on workout with menstruation still holds: track how sessions feel, adjust the session when a day is rough, and don't rearrange your whole plan around a pattern you haven't seen yet.

A rough-night playbook:

• ›Swap, don't skip. Move the heavy session a day and do an easy run or light lift today.
• ›Lower the target. Keep the session, aim for the bottom of your rep range.
• ›Keep the week's shape. Two strength sessions and enough weight-bearing work still count if they land on different days.

Earlier chapters, same principles

Plenty of women reach perimenopause with years of training behind them, and some still have young kids. The same evidence-first approach runs through exercise during pregnancy explained, the questions that come with being a pregnant woman running, and a gradual postpartum running plan after birth. Lifting after birth gets the same careful treatment, and there is more on postpartum strength training as its own topic.

The thread through all of them: official guidance first, your care provider second, and a plan flexible enough to survive real life.

How exrsz handles training through menopause

exrsz builds a periodized plan from your goal, schedule, level and equipment, balances running and lifting in one plan, adapts each week to how you actually trained, and reshuffles missed sessions instead of stacking them. It doesn't give medical advice. Check with your doctor, midwife or a pelvic health physiotherapist about the health side, and let the plan handle the training side.

FAQ

What is the best menopause exercise?

The NHS recommends regular exercise with a focus on weight-bearing activity such as walking, running or dancing and resistance exercise such as using weights, which can help protect against weakening bones (NHS). Most women benefit from both lifting and weight-bearing aerobic work.

Does exercise help hot flushes?

The evidence isn't clear. A Cochrane review found insufficient evidence to show whether exercise is an effective treatment for hot flushes and night sweats (Daley et al., 2014). Talk to your doctor about treatment options.

Should I lift heavy weights during menopause?

Heavy for you, built up gradually, is where the bone research points. The LIFTMOR trial found supervised high-intensity resistance and impact training improved bone density in postmenopausal women with low bone mass (Watson et al., 2018). If you have osteoporosis, check with your doctor and learn the lifts with a qualified coach.

How often should I exercise during perimenopause?

The WHO recommends 150–300 minutes of moderate aerobic activity a week plus regular muscle-strengthening activity (Bull et al., 2020). A 2024 meta-analysis suggested three resistance sessions a week as a starting point for postmenopausal women (González-Gálvez et al., 2024).

Is running good during menopause?

The NHS lists running among the weight-bearing exercises that can help protect bones during menopause (NHS). Pair it with strength training and keep most runs easy.