Exercise and Peri/Menopause

May 01, 2024
3 women working out in a studio each holding barbells on their shoulders
If you grew up in the 1980s, exercise was all about cardio, with the goal of burning calories and being thin. Now that hormones are changing with perimenopause, you may notice that the exercise that’s helped you maintain your weight during your younger...

years no longer works.

If you feel like you haven’t changed a thing with your lifestyle, but you’re gaining weight and experiencing symptoms, it might be time to change your exercise routine.

Perimenopause, the years marked by hormonal changes leading to menopause, is an important window of change that not only shapes your menopause experience but also your health for the rest of your life.

You could spend 40% of your life post-menopause. How you exercise now can help you preserve muscle mass, improve metabolic health, and prevent diseases that tend to increase after your last period.

Today’s article will dive into how exercise supports perimenopausal hormonal changes, builds resiliency, and prevents disease. Keep reading to discover:

  • How aging and perimenopause affect your health
  • Exercise benefits for women in perimenopause and beyond
  • An important look at strength training and HIIT
  • Exercise recommendations (hint: it’s probably not as hard or complicated as you think!)
  • Tips for getting the most out of your new exercise habits

Aging, Perimenopause, and Your Health

Perimenopause, the transition from the reproductive years to no longer having a menstrual cycle, is marked by a dramatic decline in estrogen (primarily estradiol) and progesterone. Estrogen is metabolically protective; the loss of estrogen promotes insulin resistance and changes in body composition, including more visceral fat accumulation around the midsection.

Additionally, we begin to lose lean body mass (muscle) at a rate of around 1% per year starting in our 30s. Less muscle means lower energy expenditure. Many women notice weight gain in midlife, corresponding to this muscle loss and increased body fat.

The metabolic changes in midlife, intensified by hormone decline, not only lead to an unfavorable body composition, but also increase inflammation and the risk of cardiometabolic diseases, bone loss, and more. Even if body weight doesn’t change in perimenopause, the same underlying shifts occur, which increases metabolic risk in the post-menopause golden years. Meaning, your scale weight can stay the same but because muscle weight tends to go down in this stage of life and fat increases, weight can stay steady (or even decrease) but body composition shifts to an unhealthy bias towards excess visceral fat and low muscle mass.

Many women in perimenopause tend to exercise less, not more. Some research suggests a 40% decline in physical activity. Additionally, other perimenopausal symptoms like decreased stress resilience, low energy, and poor sleep can make exercise more challenging during this time.

Benefits of Exercise for Women in Perimenopause

Exercise during perimenopause helps mitigate the metabolic dysfunction – insulin resistance, changing body composition, and inflammation – discussed above. It also helps maintain health through perimenopause and into the post-menopause years.

Women who are active through perimenopause tend to have:

  • Lower body mass index (BMI)
  • Less body fat
  • Greater muscle mass
  • Higher bone density

Exercise helps reduce perimenopausal symptoms. One randomized controlled trial found 12 weeks of moderate exercise improved sleep quality, insomnia, and depression in sedentary women. Another study suggests that regular, moderate exercise (both cardiovascular and resistance exercise) can reduce hot flashes.

Further, exercise supports mood, self-worth, and quality of life.

Strength Training

If you love cardio and the exercise messaging from the 1980s and 90s has shaped your routine for decades, you may have shied away from strength training. Contrary to the idea that lifting weights will make you bulky, it helps you to build lean muscle and improve body composition.

Strength training, also called resistance training, helps to offset the declines in muscle mass related to aging and hormone decline. As muscle mass decreases, so does strength and power, as well as balance, which are also essential muscle functions to maintain.

Other benefits of strength training and maintaining or improving muscle health include:

  • Improved insulin sensitivity
  • Improved bone mineral density
  • Reduced risk of cardiovascular disease
  • Reduced risk of hypertension
  • Reduced risk of anxiety and depression
  • Reduced cancer mortality
  • Reduced all-cause mortality

In perimenopause, it’s helpful to prioritize strength training, which may mean less time for cardio. If this sounds scary, give it a try; it’s incredibly supportive for those in their 40s and beyond.


High-intensity interval training (HIIT) involves alternating periods of high-intensity exercise with short rest periods. This type of training in perimenopause may be the most effective option for weight loss (fat loss), especially the tricky visceral fat that’s hard to lose.

A meta-analysis of 38 studies looked at HIIT training in perimenopausal and postmenopausal women. The data suggests HIIT training supports fat loss in both normal and overweight women, with more benefits in perimenopause vs. post-menopause. Additionally, it helped overweight women lose visceral fat. After menopause, HIIT was found to be more effective than running and the authors suggest three HIIT sessions weekly.

With HIIT, a little goes a long way. Start with 5- to 10-minute sessions.

Exercise Recommendations for Women

Let’s put this information together into practical suggestions for women in perimenopause. The North American Menopause Society recommends the following:

  • Exercise regularly, including various types of exercise, such as walking, cardio, yoga, Pilates, dancing, HIIT, and other joyful exercise. The CDC recommends 150 minutes per week.


  • Strength train 2 to 3 times weekly, working all major muscle groups. Increase resistance (with bands or weights) as you get stronger, so you fatigue between 8 and 15 repetitions of each movement or until you are a rep or two shy of failure. You do not need to train until failure to get results. If you are new to strength training, begin with bodyweight exercises and learn proper form to avoid injury. It’s important to progressively overload your muscles to keep the training effective.


Additionally, it’s helpful to break up sitting through the day, especially if you have a sedentary job or sedentary habits. Consider movement like snacks. Exercise “snacking” involves small bouts of movement throughout the day. Counting steps with a smartwatch or pedometer can be a helpful tool for increasing movement.

Exercise Tips

As you look at these recommendations, you might feel that they are very doable. Or you may feel overwhelmed. Every woman will be different, and you can take the time to experiment to find the best approach for you. Whether you are new to exercise or ready to shift exercise to support your perimenopause journey, here are some helpful tips:

  • Eat enough protein! As you focus on strength training to build or maintain muscle mass, your diet provides the protein building blocks for muscle, and it’s important to have enough. You may need 2 to 1.6 grams of protein for every kilogram of (ideal) body weight daily. For a 150-pound woman, this translates to 82 to 110 grams per day. Your TārāMD nutritionist can support you with a personalized recommendation and all the details.


  • Choose whole foods. Modifying or adding exercise may affect hunger levels. You may find you need more food to fuel activity. Ensure you meet your nutrient needs by choosing whole, unprocessed foods. Fill half your plate with veggies, a quarter with protein, and a quarter with starch (like starchy veggies or beans) or fruit. Finally, add some healthy fats to support satiety and balanced energy.


  • Prioritize sleep. Sleep is when your body recovers from exercise and builds new muscle and bone. If you aren’t sleeping well, this could affect your energy for exercise and the benefits you receive. Read How to Get Better Sleep for Women’s Health for strategies to improve sleep.


  • Mind your mindset. Exercise that comes from a place of body shame isn’t going to be enjoyable or as effective as exercising from self-love. Mindset may take more work for some than others, but in perimenopause, an important shift is away from the goal of being thin and towards the goal of being strong and metabolically healthy. Focus on how you feel after a good exercise session and use that as motivation for the next.


  • Support estrogen receptors. Many of the metabolic shifts in midlife have to do with declining estrogen, so it makes sense that supporting estrogen receptors can help mitigate these effects. You have estrogen receptors throughout the body, including the brain, muscles, and bones. Support receptors with phytoestrogen foods (like flax and soy), phytoestrogen herbs (like black cohosh or Pueraria mirifica), and bioidentical hormone replacement therapy. Read more about HRT here.


Setting goals around exercise and building new habits during this critical life phase of perimenopause will help you feel better (and experience fewer symptoms). Exercise also helps improve how you feel, your quality of life, and your risk for chronic disease after menopause. Remember, more isn’t always better; something is better than nothing, and it’s not too late to get started.

At TārāMD, we provide comprehensive perimenopause support, including gynecological issues, nutrition, supplements, bioidentical hormone replacement, and more – all personalized to your unique needs and lifestyle. You don’t have to go through it alone!


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