Menopause Exercise: Evidence-Based Strategies for Health, Strength, and Vitality

The menopause has existed for as long as humans have. Yet until recently it was rarely discussed in public, and when the subject was raised, it was spoken about in hushed tones and often using euphemisms, such as ‘the change’. For some women it’s a time of gradual transition to the next phase in their life, with few or no unpleasant or debilitating effects. But for others, it’s a physically, mentally, and emotionally traumatic time which can be utterly life‑destroying.

Thankfully, times have changed, and now there is greater understanding of this issue and a considerable amount of guidance to help women through this important phase.

As women now spend up to one third of their lives in post‑menopause, lifestyle strategies such as menopause exercise that support long‑term health are increasingly important. Research shows that exercise is one of the most effective non‑pharmacological interventions for managing menopausal symptoms and promoting healthy ageing.

In this article, we will explore the effects of the menopause, outline the benefits of exercise during and after this stage, and provide evidence‑based guidance for effective exercise prescription.

What is the menopause?

The menopause is when the ovaries stop releasing eggs, and there is a significant reduction in the production of the hormones oestrogen and progesterone.

Clinically speaking, it’s diagnosed after a woman has experienced 12 months with no periods, known as amenorrhoea, which is not due to pregnancy, illness, or medical treatment.

For most women, the menopause occurs between the ages of 45 and 55, with the average age in the UK being around 51 years.

It’s important to understand that the menopause is one step in a broader transition, which is broken down into several phases:

• Perimenopause – hormonal fluctuations and symptoms begin
• Menopause – the final menstrual period
• Post-menopause – the years after menopause, when symptoms may continue and long‑term health risks change over time.

Menopause exercise can be beneficial across all stages, helping to manage symptoms and support physical function.

Symptoms of the menopause and perimenopause

The symptoms of the menopause and perimenopause are varied and comprise physical, psychological, and emotional issues. These include:

• Irregular menstrual cycles
• Hot flushes
• Vaginal dryness
• Sleep disorders
• Anxiety
• Irritability
• Reduced stress tolerance
• Cognitive changes (brain fog)
• Reduced self‑esteem and confidence
• Changes in libido and sexual wellbeing
• Emotional sensitivity and tearfulness
• Social withdrawal and reduced motivation

These symptoms can be experienced for several months to years before the last menstrual period and can continue for several years after.

Research shows that menopause exercise can play a key role in reducing symptom severity and improving quality of life during this stage.

The effects of menopause on health and disease risk

After 12 months without menstruation, the post‑menopause phase begins. This is accompanied by a number of changes that impact a woman’s health. These include accelerated bone loss, reduced muscle mass, and changes in cardiovascular and metabolic health. The result of these changes is an increased risk of:

• Osteoporosis and fractures
• Frailty due to sarcopenia (loss of muscle mass and strength)
• Weight gain and central adiposity
• Insulin resistance
• Cardiovascular disease

The benefits of exercise during the menopause: What does the science say?

Menopause exercise directly targets many of these risk factors, making it a vital component of menopausal health management. A systematic review and meta‑analysis examining cardiovascular and strength training interventions in women transitioning from perimenopause to post‑menopause found that regular exercise significantly improves vitality, mental health, and overall quality of life (1).

Cardiovascular exercise was found to be particularly effective in reducing general menopausal symptoms, with key benefits including:

• Reduced fatigue
• Improved mood
• Enhanced sleep quality
• Better overall wellbeing

The importance of strength training

Strength training is also extremely valuable during menopause, as it helps to counteract the loss of muscle mass, bone density, and the deterioration in metabolic health driven by declining oestrogen.

The results of a study by Capel‑Alcaraz et al. (2) showed that resistance training reduces hot flushes and improves:

• Leg and pelvic floor strength
• Bone density
• Metabolic health

Similarly, strength training has been shown to enhance hip strength, balance, flexibility, lean body mass, and insulin sensitivity in women aged 40–60 (3). Importantly, these benefits were seen across pre‑, peri‑, and post‑menopausal groups, indicating that resistance training supports physical function throughout the entire menopausal transition.

Cardiometabolic disease risk

The female gender is often cited as being protective against cardiovascular disease. This is because before the menopause, women have lower rates of heart attack and stroke than men. However, after menopause, the rate of heart disease in women continues to rise to equal that of men after the age of 65 due to changes in lipid profiles, endothelial function, and body composition (4).

The benefits of cardiovascular exercise during this time are not limited to improvements in cardiovascular fitness, but also reductions in blood pressure and enhanced metabolic health. Interestingly, evidence suggests that combining aerobic and resistance training yields the greatest cardiometabolic benefits (4).

Functional training, flexibility, balance, and mobility

A comprehensive menopause exercise programme that fully accommodates the needs of women during the menopause and beyond should not only address strength and cardiorespiratory fitness, but also the other facets of health‑related fitness.

Functional‑type resistance training using bands, ankle weights, and dumbbells has been shown to improve balance, strength, and flexibility (5). This is particularly beneficial for:

• Joint stability
• Fall prevention
• Enhanced performance of the activities of daily living

General stretching, yoga, and Pilates also support joint mobility, reduce stiffness, and improve posture. Additionally, they help to manage stress and improve sleep quality (1).

Balance tends to decline naturally with age, and the hormonal changes of menopause can make this decline more pronounced. Therefore, incorporating balance drills, single‑leg exercises, stability, and functional movements can help to reduce the risk of falls and improve confidence (6).

Exercise recommendations

Menopause exercise is recommended by numerous authorities such as the World Health Organisation (WHO) and the NHS, but specific advice seems to be lacking.

For example, the NICE guidelines (7), although recommending the use of regular physical activity to support symptom management and long‑term health, do not provide precise guidelines.

However, the physical activity guidelines for health‑related fitness (see below) are generally appropriate for most women. As with any exercise prescription, trainers should individualise the programme to fully accommodate the needs and abilities of each client based on symptoms, fitness level, and the presence of comorbidities.

ACSM guidelines for health- related fitness (6)

Cardiovascular fitness

• ≥150 min/week of moderate‑intensity or ≥75 min/week of vigorous‑intensity exercise.
• Supports cardiovascular health, weight management, mood regulation, reduced vasomotor symptoms (hot flushes, nights sweats).

Strength

• 2–3 sessions/week targeting major muscle groups, formed of 6-10 exercises, 1-2 sets per exercise, and 8-12 repetitions.
• Focus on multi-joints exercises, such as squats, lunges, deadlifts, and presses, using free weights, machines, or resistance bands.
• Preserves muscle mass and bone density, reduces fracture risk, supports metabolic health.

Flexibility

• Stretch all major muscle groups 2-3 days per week or more, with daily being optimal.
• Hold static stretches for 10-30 seconds. For older adults, 30-60 seconds may be more beneficial.
• Maintains joint mobility and posture, reduces stress.

Neuromuscular efficiency

• Balance, agility and proprioceptive activities should be performed 2-3 days per week. Examples include single‑leg balance, stability drills and functional movements.
• Reduces risk of falls and improves balance, stability and confidence.

Reducing sedentary behaviour

In addition to a programme of structured menopause exercise, a reduction in sedentary behaviour is recommended by minimising time spent sitting and incorporating movement throughout the day. This could be achieved with walking breaks, active commuting, and standing tasks. Even small, frequent interruptions, such as standing, stretching, or short walking breaks, can improve metabolic and cardiovascular health. Spending more time outdoors should also be encouraged to enhance vitamin D production and improve mood (8).

Barriers to physical activity during the menopause

It’s important for personal trainers to be aware that across the menopausal transition, women commonly experience additional barriers to exercise that go beyond those typically experienced and which will need to be addressed. These may include physical symptoms which can reduce comfort and motivation to be active, such as:

• Fatigue
• Hot flushes
• Pelvic floor issues
• Sleep disturbance
• Joint pain
• Weight gain
• Chronic health problems such as osteoporosis

Psychological factors including low mood, anxiety, reduced confidence, lack of motivation, and fear of injury further limit participation. In addition, lifestyle pressures such as work demands, caring responsibilities, and limited time are very common in midlife. Many women are also unsure about which types of exercise are safe or effective during the menopause.

These barriers may occur before, during, and after menopause, often interacting to reduce long‑term adherence to physical activity.

While it is beyond the scope of this article to provide a detailed account of strategies to overcome barriers to physical activity, presented below are a selection of useful tips:

• Select enjoyable activities
• Start all activities at a comfortable level and increase gradually
• Allow clients to self‑select exercise mode, frequency, and duration when appropriate
• Set SMART goals
• Encourage exercising with a partner or group
• Use short, manageable sessions
• Track progress to maintain motivation
• Use flexible scheduling to accommodate busy midlife routines
• Adapt exercise to symptoms rather than stop altogether
• Build social support and accountability to enhance motivation and adherence

What this means for personal trainers

Menopause exercise is one of the most effective non‑pharmacological interventions for managing menopausal symptoms and promoting healthy ageing. This puts personal trainers in the perfect position to help women during this time. To do so effectively, they need to understand that their needs, symptoms, and barriers to exercise may differ from those of other clients.

Therefore, PTs need to adopt a flexible, empathetic approach and individualise every session and the broader programme to fully accommodate each client’s needs and abilities. They also need to listen to clients’ concerns, calm their fears, and ensure their exercise prescription not only supports their fitness goals, but also enhances their motivation and long‑term adherence to a physically active lifestyle.

For PTs looking to advance their knowledge in this area, we offer a Level 3 award in supporting clients through the menopause, which explores how to support women through exercise, nutrition and lifestyle factors.

References

1. Trujillo‑Muñoz PJ, Sánchez‑Ojeda MA, Rodríguez‑Huamán EC, et al. Effects of Physical Exercise on Symptoms and Quality of Life in Women in Climacteric: A Systematic Review and Meta‑Analysis. Healthcare (Basel). 2025;13(6):644
2. Capel‑Alcaraz AM, García‑López H, Castro‑Sánchez AM, et al. The Efficacy of Strength Exercises for Reducing the Symptoms of Menopause: A Systematic Review. J Clin Med. 2023;12(2):548.
3. Stephens F, Hayes LD, Jones TW, et al. Effects of a 12‑week low‑impact functional resistance‑training programme on physical function in women aged 40–60: a randomised controlled trial. Med Sci Sports Exerc. 2024;56(1):123–132.
4. Roberts KA, Low DA, O’Donnell E. Exercise and menopause: benefits, challenges and the transition to optimal management. Front Sports Act Living. 2026;8.
5. Seymour T, Stephens F. Resistance training improves physical function during menopause. Med Sci Sports Exerc. 2025.
6. American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 12th ed. Philadelphia: Wolters Kluwer; 2026.
7. National Institute for Health and Care Excellence. Menopause: identification and management. NICE guideline NG23. London: NICE; 2015 (updated 2026).
8. UK Chief Medical Officers. UK Chief Medical Officers’ physical activity guidelines. London: Department of Health and Social Care; 2019.

Author

Paul Orridge

Paul Orridge BSc (Hons)

Paul Orridge is a graduate in the field of sport, exercise and health, and has over 30 years’ experience within the fitness industry. In this time, he has performed a variety of roles including personal training, lecturing and writing. Paul now works as a freelance technical author and subject matter expert within the fitness industry. His work is based on his practical experience gained working with a diverse range of people from very unfit, overweight individuals to highly conditioned athletes, and is underpinned by the latest research.