A common areas of discussion when talking to women about the perimenopause is what sort of exercise should I be doing now?
It is an important subject. The perimenopause is a time of significant hormonal, physical and psychological change, yet advice about physical activity is often vague or overly simplified. The evidence suggests something more nuanced: different types of exercise appear to support different aspects of perimenopausal health.
I must admit to not knowing much about this area so, as one of my topic investigations for my Menopause Professional Certifcate, I looked at the evidence and did a ‘mini’ literature review. This post aims to distil what I found about how a range of physical activities can help manage perimenopause symptoms — not in an optimisation-driven way, but in a way that works with a changing physiology rather than against it. This blog is an AI assisted summary of my topic investigation.
A Brief Physiological Context
The perimenopause is characterised by fluctuating and eventually declining ovarian hormone production, particularly oestradiol and progesterone. These hormones influence far more than the menstrual cycle. Oestrogen receptors are found throughout the body — including bone, muscle, brain, cardiovascular tissue and connective tissue — which helps explain why symptoms can be so varied.
Common experiences include fatigue, low mood, anxiety, sleep disturbance, joint pain, changes in body composition, and reduced exercise tolerance. For many women, there is also a sense that what used to work no longer does. Understanding how different forms of exercise interact with these physiological changes can be empowering.
Strength Training: Supporting Muscle, Bone and Confidence
If I had to choose one form of exercise with the strongest evidence base for perimenopausal health, it would be resistance training.
As oestrogen levels fluctuate and decline, women experience accelerated loss of muscle mass and bone density. Strength training directly counters both. It improves muscle protein synthesis, helps preserve lean mass, and provides the mechanical loading needed to maintain bone strength.
Beyond the physical effects, strength training has been shown to improve insulin sensitivity, reduce central fat accumulation, and support functional capacity. Clinically, many women describe feeling stronger, more stable, and more confident in their bodies — outcomes that are often underestimated but deeply important.
Crucially, strength training does not need to be extreme. Two to three sessions per week, focused on progressive but manageable loading, appears sufficient for meaningful benefit.
Cardiovascular Exercise: Heart, Brain and Metabolic Health
Cardiovascular risk increases across the menopause transition, partly due to the loss of oestrogen’s protective effects on vascular function and lipid metabolism. Regular aerobic exercise remains a key protective strategy.
Moderate-intensity activities such as brisk walking, cycling or swimming improve cardiorespiratory fitness, blood pressure and metabolic health. There is also consistent evidence for improvements in mood, anxiety and cognitive function, likely mediated through neurochemical pathways including endorphins and brain-derived neurotrophic factor (BDNF).
However, the dose matters. High volumes of prolonged, high-intensity endurance exercise can exacerbate fatigue, sleep disturbance and stress responses in some perimenopausal women. Shorter bouts, interval-based approaches, or lower-impact steady activity are often better tolerated and more sustainable.
Mind–Body Exercise: Regulating Stress and Sleep
Yoga, Pilates, tai chi and similar mind–body practices are sometimes viewed as secondary to “proper” exercise, but the evidence suggests they play an important role during the perimenopause.
Hormonal fluctuations can increase sensitivity of the stress response system, making anxiety, poor sleep and emotional lability more common. Mind–body exercise appears to support autonomic regulation, reducing sympathetic overactivity and enhancing parasympathetic tone.
Studies suggest benefits for sleep quality, perceived stress, anxiety and depressive symptoms. Many women also report that these practices help them reconnect with their bodies at a time when bodily signals may feel unfamiliar or unreliable.
A Blended Approach Works Best
Rather than asking “Which type of exercise is best?”, a more helpful question may be:
“What combination of movement supports my body and brain right now?”
The evidence supports a blended approach — incorporating strength training, cardiovascular activity and mind–body exercise — tailored to the individual and adaptable over time. Needs and capacity may change from month to month, and flexibility is not a failure but a feature of effective self-care in this phase of life.
Exercise during the perimenopause is not about chasing previous performance or forcing compliance with rigid routines. It is about maintaining function, protecting long-term health, and supporting psychological wellbeing.
Final Thoughts
One of the most striking features of the perimenopause is how often women blame themselves for changes that are entirely physiological. Physical activity can be a powerful tool — but only when it is framed as support rather than correction.
When movement is aligned with evidence, context and lived experience, it becomes not just a health intervention, but a way of rebuilding trust in a changing body. And that matters just as much as any measurable outcome.
Further Reading
British Menopause Society. Tools for Clinicians: Lifestyle and the Menopause
NICE Guideline NG23: Menopause: diagnosis and management
Daly RM et al. Resistance training and musculoskeletal health in menopausal women. Journal of Bone and Mineral Research
Elavsky S. Physical activity and mental health during the menopause transition. Menopause
McNeil J et al. Exercise, stress regulation and sleep in midlife women. Sports Medicine
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