Menopause and Exercise: Why Movement Matters More Than Ever
Perimenopause and menopause are natural stages of life that every woman experiences, yet they often bring changes that can make staying active feel more challenging. You may notice that exercises which once felt easy now require more effort, your joints feel stiffer in the morning, or you're finding it harder to maintain your strength and fitness.
The good news is that while menopause does bring changes to the body, regular exercise remains one of the most effective ways to support your health and wellbeing during this stage of life. It can help maintain muscle and bone strength, improve balance, support heart health, boost mood and confidence, and help you continue doing the activities you enjoy.
As a Chartered Physiotherapist and Pilates instructor, one of the questions I'm asked most often is, "What is the best type of exercise during menopause?" The answer isn't about finding one perfect exercise. It's about building a balanced routine that keeps you strong, mobile and confident for years to come.
In this article, we'll look at why exercise becomes even more important during menopause, the different types of exercise that offer the greatest benefits, and how you can create a routine that works for you.
Understanding the stages
The terms perimenopause, menopause and postmenopause are often used interchangeably, but they describe different stages of the menopause transition.
Perimenopause is the time leading up to menopause when hormone levels begin to fluctuate. It can last several years, and many women start noticing symptoms during this stage while they are still having periods.
Menopause is confirmed when you have gone 12 consecutive months without a menstrual period.
Postmenopause refers to the years after menopause. Although hormone levels stabilise, changes to muscle, bone and cardiovascular health continue, making regular exercise just as important.
What changes during menopause?
Before looking at exercise, it's helpful to understand why your body may feel different during and after menopause.
Menopause is associated with a decline in the hormone oestrogen, which affects many tissues throughout the body—not just the reproductive system. As a result, many women notice changes in their muscles, bones, joints and overall energy levels.
Some of the most common physical changes include:
A gradual loss of muscle mass and strength.
Reduced bone density, increasing the risk of osteoporosis and fractures.
Changes in body composition, with fat more likely to be stored around the abdomen.
Increased stiffness or joint aches.
Reduced balance and stability for some women.
An increased risk of cardiovascular disease as protective hormone levels decline.
Not every woman experiences these changes to the same extent, and symptoms vary widely. However, understanding what is happening can help explain why the way we exercise may need to evolve.
The encouraging news is that many of these changes respond well to regular, appropriately challenging exercise. While exercise can't stop menopause, it can help reduce some of its effects and support long-term health and independence.
Why Exercise Matters More Than Ever During and After Menopause
Exercise has always been important for good health, but during and after menopause it takes on an even greater role. Regular physical activity won't stop the hormonal changes associated with menopause, but it can help reduce some of their effects and support your health both now and in the years ahead.
Current evidence suggests that regular exercise can help women during and after menopause by:
Maintaining muscle mass and strength.
Supporting bone health and reducing the risk of osteoporosis.
Improving balance and reducing the risk of falls.
Helping to maintain a healthy body composition.
Supporting cardiovascular health.
Reducing joint stiffness and improving mobility.
Boosting mood and overall wellbeing.
Improving sleep quality and reducing fatigue.
Helping you remain independent and continue doing the activities you enjoy.
Perhaps most importantly, exercise helps maintain your physical function. Whether it's carrying the shopping, climbing stairs, gardening, playing with grandchildren or enjoying an active holiday, staying strong and mobile can make everyday life easier and more enjoyable.
The key is recognising that different types of exercise provide different benefits. Walking, Pilates, strength training and balance exercises all have an important role to play, and combining them is likely to provide the greatest overall health benefits.
The Five Types of Exercise Every Woman Should Include
There isn't one perfect exercise for women during and after menopause. Instead, the greatest health benefits come from including a variety of different types of movement throughout the week.
Each type of exercise supports your body in a different way, and together they help build strength, protect bone health, improve fitness and maintain independence as you get older.
1. Strength Training
If there is one type of exercise that deserves to be prioritised during and after menopause, it is strength training.
As oestrogen levels decline, women naturally begin to lose muscle mass and strength. This age-related muscle loss, known as sarcopenia, can make everyday activities more difficult over time if it isn't addressed.
Strength training challenges your muscles to work against resistance, encouraging them to become stronger and helping to counteract age-related losses in muscle mass and strength. It can also improve bone health, balance, posture and confidence while making everyday tasks feel easier.
Strength training doesn't have to mean lifting heavy barbells in a gym. It might include:
Free weights or resistance machines.
Resistance bands.
Bodyweight exercises such as squats, lunges or press-ups.
Challenging Pilates exercises that progressively load the muscles.
The important principle is progressive overload. To become stronger, your muscles need to be challenged a little more over time, whether that's by increasing the resistance, the number of repetitions or the difficulty of the exercise.
In practice: If every exercise feels easy every time you do it, your body has very little reason to adapt. Feeling that an exercise is becoming challenging towards the final few repetitions is often where strength gains begin.
2. Weight-Bearing Exercise
Weight-bearing exercise is any activity where your feet and legs support your body weight while working against gravity.
These activities place gentle stress on your bones, encouraging them to maintain their strength. This becomes increasingly important during and after menopause when declining oestrogen levels can accelerate bone loss.
Examples include:
Brisk walking.
Stair climbing.
Dancing.
Hiking.
Tennis.
Low-impact jogging (where appropriate).
It's worth remembering that not all exercise is weight-bearing. Activities such as swimming and cycling have many health benefits but don't provide the same stimulus for bone health because your body weight is supported.
If you're living with osteoporosis or have been told you have low bone density, some exercises may need to be modified. You can read more in my article, Pilates and Osteoporosis: Can You Still Do Pilates?
The good news is that there is often overlap between strength training and weight-bearing exercise. Squats, lunges and step-ups strengthen your muscles while also placing healthy stress on your bones, making them some of the most beneficial exercises during and after menopause.
3. Pilates
Pilates is an excellent form of exercise during and after menopause, helping to improve posture, flexibility, balance, coordination and core strength. It encourages controlled, mindful movement and can help you feel stronger, more confident and more connected to your body.
Many women also find that regular Pilates helps reduce stiffness, improves movement quality and makes everyday activities feel easier. For those experiencing joint aches or reduced confidence with movement during perimenopause or menopause, it can be an enjoyable and sustainable way to stay active.
However, it's important to recognise that Pilates is just one piece of the puzzle.
While Pilates develops many aspects of fitness, current evidence suggests that it works best when combined with progressive strength training, regular weight-bearing exercise and cardiovascular activity. Together, these different types of exercise provide the broad range of benefits needed to support muscle, bone, heart and overall health during and after menopause.
The good news is that many modern Pilates classes now incorporate resistance equipment such as hand weights, resistance bands and weighted balls. When used progressively, these can increase the challenge to your muscles and complement a well-rounded exercise programme.
The best exercise programme is the one you'll continue to do. Finding activities you enjoy is one of the strongest predictors of long-term success. Whether that's Pilates, strength training, walking, dancing or a combination of several activities, consistency is far more important than perfection.
4. Cardiovascular Exercise
Cardiovascular exercise, often referred to as aerobic exercise, is any activity that raises your heart rate and keeps your heart and lungs working harder than usual.
During and after menopause, cardiovascular exercise becomes increasingly important. As oestrogen levels decline, the risk of cardiovascular disease gradually increases, making regular aerobic activity an important part of maintaining long-term health.
Regular cardiovascular exercise can help:
Improve heart and lung health.
Support healthy blood pressure and cholesterol levels.
Increase energy levels and stamina.
Help maintain a healthy body weight.
Improve mood and reduce stress.
Promote better sleep.
The good news is that cardiovascular exercise doesn't have to involve running or high-impact workouts. Brisk walking, cycling, swimming, dancing, hiking and many sports all count towards your weekly activity.
Current UK guidelines recommend aiming for at least 150 minutes of moderate-intensity aerobic activity each week, alongside strength training on at least two days per week. Moderate intensity means you should feel warmer, breathe a little harder and be able to hold a conversation, but not sing comfortably.
5. Balance Training
Balance is something many of us take for granted until it begins to decline. However, maintaining good balance is an important part of healthy ageing and becomes increasingly valuable during and after menopause.
Good balance depends on several systems working together, including your muscles, joints, vision and inner ear. Like strength, balance can be improved with regular practice.
Improving your balance can help:
Reduce the risk of falls.
Increase confidence with everyday activities.
Improve coordination and stability.
Support independence as you get older.
Many activities naturally challenge your balance, including Pilates, yoga, tai chi and certain strength exercises. Even simple activities such as standing on one leg while brushing your teeth or practising tandem walking can help improve balance over time.
The key is to include balance exercises regularly, rather than waiting until balance becomes a problem.
In Summary
There isn't one perfect exercise for perimenopause or menopause. Instead, aim to include a mixture of strength training, weight-bearing exercise, Pilates, cardiovascular activity and balance work throughout the week.
You don't need to start everything at once. Small, consistent changes are far more effective than trying to completely transform your routine overnight.
Whether you're just beginning to exercise or have been active for years, it's never too late to become stronger, improve your fitness and invest in your long-term health.
What Does a Balanced Week of Exercise Look Like?
One of the questions I'm asked most often is, "How much exercise should I be doing?"
There isn't a single routine that's right for everyone, but a balanced week might include a mixture of strength training, cardiovascular exercise, Pilates and activities that challenge your balance.
For example:
Day | Activity |
Monday | Pilates class |
Tuesday | Strength training |
Wednesday | Brisk walk |
Thursday | Pilates class |
Friday | Strength training |
Saturday | Walk, cycle or another enjoyable activity |
Sunday | Rest or gentle mobility |
Remember, this is just one example. The best routine is one that fits your lifestyle and is realistic to maintain over time.
If you're just getting started, begin with what feels manageable and build gradually. Consistency is far more important than trying to do everything at once.
Common Myths About Exercise and Menopause
Myth 1: Cardio is the best way to lose menopausal weight.
While cardiovascular exercise is excellent for heart health and fitness, strength training plays an important role in maintaining muscle mass and supporting long-term metabolic health. A combination of both is likely to provide greater overall benefits than relying on cardio alone.
Myth 2: I should avoid lifting weights because I'll get bulky.
Building large amounts of muscle requires years of dedicated training and specific nutrition. For most women, strength training simply helps maintain muscle, improve strength and support bone health.
Myth 3: Joint pain means I should stop exercising.
Not necessarily. While some conditions require specific advice, appropriately prescribed exercise is often recommended for common joint problems such as osteoarthritis (see my post on Exercise for Osteoarthritis for more information). The key is choosing the right type and amount of exercise for your individual circumstances.
Myth 4: I'm too old to start exercising.
It's never too late to benefit from becoming more active. Research shows that people can improve strength, balance and fitness well into later life.
Myth 5: Pilates is just stretching.
Pilates certainly improves flexibility, but it also develops strength, balance, coordination and body awareness. Modern Pilates classes can be surprisingly challenging, particularly when resistance is progressively increased.
Final Thoughts
Menopause is a natural transition, but it doesn't mean giving up on feeling strong, capable and confident.
Exercise is one of the most powerful tools we have to support our health during and after menopause. By combining strength training, weight-bearing exercise, Pilates, cardiovascular activity and balance work, you're investing in your future health as well as your wellbeing today.
Remember, you don't need to do everything perfectly. The most important step is to keep moving and find activities you genuinely enjoy, because the best exercise programme is the one you'll still be doing months and years from now.
Frequently Asked Questions
Can I exercise if I'm taking HRT?
Yes. Hormone replacement therapy (HRT) and regular exercise work well together. While HRT can help manage menopausal symptoms and support bone health, exercise provides additional benefits for muscle strength, cardiovascular fitness, balance and overall wellbeing. If you have concerns about exercising with a medical condition or while taking medication, speak to your GP or another appropriately qualified healthcare professional.
Should I exercise if I'm experiencing hot flushes?
For most women, yes. Regular physical activity is safe during menopause, although some women find that exercising in a cooler environment, staying well hydrated and wearing lightweight clothing makes exercise more comfortable. If you feel unwell, dizzy or have symptoms that concern you, stop exercising and seek medical advice.
When should I seek professional advice before starting a new exercise programme?
If you have significant joint pain, osteoporosis with previous fractures, heart or lung disease, uncontrolled medical conditions, or you're unsure which exercises are appropriate for you, it's sensible to seek advice from your GP, Chartered Physiotherapist or another appropriately qualified healthcare professional before beginning a new exercise programme.
Disclaimer:
This article is intended for general educational purposes only and should not be taken as individual medical advice. Exercise recommendations should always be tailored to your personal circumstances. If you have concerns about your health, are experiencing new or worsening symptoms, or are unsure which exercises are appropriate for you, seek advice from your GP or an appropriately qualified healthcare professional before starting a new exercise programme.
References
UK Chief Medical Officers. UK Chief Medical Officers' Physical Activity Guidelines. Department of Health and Social Care; originally published 2019, updated 2026.
National Institute for Health and Care Excellence (NICE). Menopause: Identification and Management (NG23). NICE.
World Health Organization. WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020.
British Menopause Society. Menopause: Nutrition and Weight Gain. BMS Tools for Clinicians; 2023.
The North American Menopause Society Advisory Panel. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022;29(7):767–794.
Brooke-Wavell K, Skelton DA, Barker KL, et al. Strong, Steady and Straight: UK Consensus Statement on Physical Activity and Exercise for Osteoporosis. British Journal of Sports Medicine. 2022;56(15):837–846.
American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription. 11th ed. Wolters Kluwer; 2021.
Money A, MacKenzie A, Norman G, et al. The impact of physical activity and exercise interventions on symptoms for women experiencing menopause: overview of reviews. BMC Women's Health. 2024;24:399.
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