The Best Exercise for Perimenopause & Menopause

Origin Physical Therapist and women's health specialist Alison Molnar, PT, DPT, contributed research to this post.

If there was ever a time in your life to make exercise a priority, it’s in perimenopause and menopause. The benefits are just too good to miss out on. Research shows that physical activity can make the notoriously uncomfortable transition through perimenopause and menopause infinitely easier to deal with.

Regular workouts can help calm vasomotor symptoms (think: fewer hot flashes), boost bone health, and even reduce chronic disease risk. Physical activity also helps boost the therapeutic effect of other menopause treatments.

Read on for detailed info about the benefits of exercise in this transitional time of your life, plus insight into which exercises are likely to lead to the best results.

7 Reasons to Exercise in Perimenopause & Menopause

1. You'll reduce vasomotor symptoms.

Exercise may help reduce the severity of hot flashes and night sweats, which are among the most common and uncomfortable symptoms of menopause. A systematic review and meta-analysis examined 10 different studies and found that exercise was able to help reduce the severity of the vasomotor symptoms of menopause compared to no treatment.

A randomized controlled trial showed that resistance training 2 to 3 times a week, over a 15-week period, helped to improve the quality of life for those experiencing vasomotor symptoms associated with menopause.

2. You'll boost your mood and mental health.

Physical activity is a natural mood booster. It stimulates the release of endorphins, aka the “feel-good” hormones, which may improve feelings of depression and anxiety that many women experience during menopause.

For example, this randomized controlled trial found that both walking and yoga were effective in enhancing positive affect, reducing negative affect, and improving menopause-related quality of life (QOL). Plus, exercise can also support good sleep hygiene which is beneficial for your mental health (more on this below).

3. You'll sleep better.

For the all-too-common sleep disturbances that happen during menopause, exercise can be a wonderful tool to help you get better sleep. Exercise is well known to improve sleep by helping to regulate the body's internal clock, reducing stress and anxiety, and increasing energy expenditure during the day so that you can sleep better at night.

Research shows that these benefits are likely to carry into menopause. A systematic review and analysis of 10 different studies, found that exercise was helpful for reducing sleep problems and insomnia in people who had menopause-related sleep disruption.

4. You'll gain less weight.

It’s fairly common for your body to change during menopause. This may include gaining weight, or a change in your body composition (or how adipose tissue is distributed on your body). While menopause isn’t solely to blame — there is a lot of physical, psychological, and social factors that occur at this same point in your midlife — regular exercise may be helpful in keeping your moving in a pain-free way, building muscle mass, and boosting mood metabolism, which can help you achieve or maintain a weight and appearance that is comfortable for you.

To support a comfortable weight in menopause and beyond, it is generally recommended to incorporate at least 150 minutes of moderate-intensity cardio (walking, running, cycling, etc) each week, as well as some resistance training 2-3 times a week.

This meta-analysis found that high-intensity interval training (HIIT) was helpful in reducing total fat mass for all individuals in the study (regardless of BMI), but that the biggest impact was seen in those prior to “postmenopausal” status. It also found that cycle-based HIIT was preferred by the postmenopausal individuals, as it may be more easy to tolerate when compared to running-based HIIT.

5. You'll have healthier bones.

The decline in estrogen during menopause can lead to bone density loss, increasing the risk of osteoporosis and fractures. Weight-bearing exercises such as walking, jogging, or strength training have long been recommended as a means to help maintain bone density and overall skeletal strength.

For postmenopausal people, this study suggests that exercise is the most effective treatment (when compared to pharmaceuticals) for improving the modifiable risk factors for fractures including bone strength, and the risk and impact of falls. This systematic review and meta-analysis found that a combination of high intensity weight bearing and progressive resistance training exercise was the most beneficial for bone health.

6. You'll reduce your risk for chronic disease.

By improving physical, mental, and overall health, exercise is a great way to both prevent and manage chronic diseases for anybody impacted. It’s also likely to still be helpful in menopause.

Various studies have shown that exercise was helpful in managing many chronic conditions for people in menopause including Type 1 diabetes, Type 2 diabetes, dementia and cognitive decline, and cardiovascular fitness.

7. You'll improve your strength and balance.

Exercise is a critical tool in improving strength, balance, and movement of individuals regardless of age or hormone changes. And during menopause these strength, balance, and movement benefits are critical for maintaining quality of life and reducing the risk of falls and other common health complications.

This study shows that exercise was most effective for reducing sarcopenia in postmenopausal people when combined with hormone therapy. And in their review of the research, scientists in a study recommend both aerobic exercise and strength training as a tool to minimize the musculoskeletal declines that are associated with estrogen deficiency.

The Best Exercise for Perimenopause & Menopause

While any exercise that you enjoy and stick with over time is likely to be beneficial, the research cited above focuses on these specific workouts:

• Swimming
• HIIT (try cycle-based HIIT workouts)
• Running
• Walking
• Resistance training
• Yoga

Consistency is the key to reaping the menopause-calming benefits of exercise, but that doesn’t mean you have to pick only one workout. Mixing it up will help prevent boredom and challenge your body in new ways.

Tips for Exercising in Perimenopause & Menopause

Below are some important guidelines to consider when starting an exercise program to support your body and health during menopause. If you have injuries or chronic pain that makes exercise challenging, see a women’s health PT (we've got you!) before you start.

Aerobic Exercise: Start with 5 minutes, 4 to 5 days per week.

Aerobic or cardio exercise incorporates sustained movement that increases heart and breathing rates, and enhances the body's use of oxygen. Aerobic exercises engage large muscle groups in a rhythmic way and include activities like:

• Walking
• Jogging
• Running
• Cycling
• Swimming
• Dancing
• Rowing
• Playing sports

According to the CDC you should include at least 150 minutes of moderate-intensity aerobic activity each week. So, if you want to exercise 4 to 5 days a week, aim for 30 to 45 minutes of cardio on your exercise days.

If you haven’t been doing much cardio, start with 5-minute strolls, 4 to 5 days a week. Schedule it on our calendar. And, yes, just 5 minutes! The goal is to create a habit, where you get used to putting on your sneakers and going for a walk. That’s the hardest part.

Once you get used to taking very short walks, you can start extending your time and increasing your effort level. Raining outside? Too cold or dark to walk? Spend 5 minutes marching in place while watching a show or listening to a podcast.

Resistance Training: Focus on form.

Strength training or resistance training can increase muscle power, increase bone density, and help improve hormone levels and metabolism.

You can use all of the following to create resistance:

• Your body weight (for example a squat, pull-up, or push-up)
• Hand weights, or dumbbells
• Resistance bands, or loops
• Kettlebells
• Cables or weight machines
• Medicine balls or sandbags
• Weighted household (like a water bottle, laundry detergent, or even your dog!)

The CDC recommends performing strength training at least 2 days a week, and it’s best to target all of the major muscle groups in your arms, legs, hips, back, and core.

Making sure you're using proper form is always important, as is adjusting your form to account for muscle imbalances and any past or current injuries. A physical therapist who specializes in menopause and perimenopause can help create a strength training program for you that not only builds strength but is also safe and sustainable for you.

Flexibility and Balance Exercises: Add them to any workout.

Flexibility exercises are stretching activities aimed at improving muscle elasticity and range of motion in the joints. Balance exercises are exercises designed to improve your stability and prevent falls by strengthening core muscles, and sharpening the sensitivity of the balance-sensing mechanisms in your joints.

Stretching and balancing activities can be incorporated daily, especially on the days you already plan exercise. Some examples include yoga or tai chi, or you can stretch and practice single-leg balancing or heel-to-toe walking on your own after your cardio or strengthening routine.

Get Started with Exercise in Perimenopause or Menopause

Beginning an exercise program can be intimidating, and it’s hard to balance knowing where to start with avoiding injury and having fun while staying active. But with a little more information and the right guidance, it will be totally worth it.

Menopause is a significant transition in life that can bring about many physical and emotional changes. Exercise, particularly strength training and cardio exercises, has been shown to improve many menopausal symptoms, from hot flashes and mood swings to improving your sleep and risk for chronic health issues. And it can improve your overall quality of life.

If you're navigating through menopause and seeking ways to manage symptoms more effectively, consider reaching out to us at Origin Physical Therapy. Our pelvic health physical therapists are dedicated to understanding your unique needs and will collaborate with you to create a personalized exercise program that supports your body and health during this transformative time.

The Overlapping Impact of Aging & Menopause

As you start or continue exercising in perimenopause and menopause, it can help to understand how aging is impacting your body at this stage of life.

Physical changes that come with aging:

• Changes in your musculoskeletal system lead to a reduction in your muscle size, and its ability to generate force (sarcopenia). Aging also causes your ligaments and muscle tendons to have reduced biomechanical function.
• Changes in your cardiovascular system including, thickening and stiffening of the muscle in your heart and vessels throughout your body, can affect the flow of blood and the exchange of oxygen and nutrients with tissues.
• Age-related changes in your nervous system, such as the loss of neurons and the slowing of nerve signal transmission, lead to decreased cognitive function and a reduction in the nervous system's ability to repair itself after injury.

Perimenopause and menopause, which are primarily driven by a decline in your body’s level of estrogen, can impact your body in several additional ways.

Physical changes of perimenopause and menopause:

• Your musculoskeletal function, contributing to conditions such as osteoporosis, and osteoarthritis, and speeding up the decline in your muscle function.
• Your risk for developing cardiovascular disease and dementia due to the loss of estrogen’s protective effects.
• Your reproductive and urinary health. In what is known as the genitourinary syndrome of menopause (GSM), low estrogen can affect the supportive tissues of the pelvic floor, urethra, vulva, and vagina, reducing their resilience and exacerbating urinary and sexual symptoms.
• Your pelvic floor health, by exacerbating pelvic floor dysfunction.

Symptoms of Perimenopause, Menopause & Postmenopause

Like puberty, menopause is a process of physical, hormonal, and emotional changes. There are actually three stages that we go through during the menopausal transition each with their own set of circumstances and symptoms that can impact our body, and how we feel during each one. Let's go through them one by one.

Perimenopause Symptoms

This is the period of time before actual menopause when our hormones start to change and our menstrual cycles start to become less regular. This can begin as early as age 35, and can last between 4 and 8 years.

During menopause you can experience any combination of the following new-to-you symptoms:

• Heavy and/or longer menstrual flow
• Shorter cycles (less than 25 days)
• Sore, swollen, or lumpy breasts
• Mid-sleep waking
• Increased menstrual cramps
• Night sweats, which may be more significant right before your period
• Migraine headaches (new or more intense)
• Menstrual mood swings (new or more intense)
• Weight gain without changes in exercise or eating

Menopause Symptoms

This is the actual point in which you have gone an entire year (aka 12 consecutive months) without your period, and finally you are done menstruating. Menopause typically occurs between the ages of 45 and 55.

Symptoms associated with our hormonal changes during this time include:

• Weight gain
• Vaginal dryness and urinary and sexual dysfunction (also known as genitourinary syndrome of menopause)
• Hot flashes, and increased sweating
• Mood changes including irritability
• Problems with concentration
• Joint pain

And because menopause does not just impact our reproductive systems, you are at an increased risk of developing cardiovascular disease including high blood pressure, diabetes, and osteoporosis.

Postmenopause Symptoms

This is defined by your life after menopause. Because estrogen is still low, you may continue to experience vaginal dryness, and hot flashes after menopause as well as increased risk for chronic health conditions like osteoporosis.

Because the average age of menopause is 51, we are spending decades in this postmenopausal phase. This makes choosing positive lifestyle changes, including regular exercise of paramount importance.

At Origin, our women’s health physical therapists specialize in supporting you through every stage of menopause and helping you stay active, against all odds. Don’t hesitate to book an in-person or virtual visit and start planning your ideal workout to keep you moving and feeling your best.