Menopause and Perimenopause: How To Optimize Exercise And Lifestyle.
- Dan Raynham
- 2 days ago
- 14 min read
The hormonal shifts of menopause and perimenopause can have far-reaching effects on women's health and wellbeing. In my previous article on training and periods, I highlighted the shortcomings of traditional fitness advice for women. The historical neglect of menopause research and the dismissive treatment of women seeking support has been shameful. However, things are changing rapidly, it's time to fully address and end this neglect. As a health professional, I stress the importance of preparing for menopause to my younger female clients and anyone who will listen. It resonates with them once they grasp its significance, even though they may have 30 or more years to go! This issue concerns everyone: men, too, should read on to become informed allies. Given the prevalence of menopause-related queries I receive, I believe a biopsychosocial model works best: hormones (for some) + therapy + lifestyle + social support + education + exercise can make a tangible difference. I'll cover the basics of menopause, exploring exercise and lifestyle options and their implications, also busting some myths aiming to provide clarity and support where it's needed most. [1] [2]
What occurs at menopause?
1. Estrogen Decline:
Estrogen's (the most potent form is Estradiol or E2) drop affects more than just muscle mass, bone density, and body composition. It also impacts:
- Skin health (thinning and dryness)
- Vaginal health (dryness and pain during sex)
- Mood regulation (mood swings and anxiety)
- Sleep patterns
- Metabolism and fat distribution (increased belly fat)
2. Testosterone Changes:
Declining testosterone in women (and men, to some extent) can lead to:
- Decreased libido and sexual satisfaction
- Fatigue and decreased energy
- Loss of muscle mass and strength
- Mood changes (depression and irritability)
3. Cortisol and Insulin Sensitivity:
Increased cortisol can:
- Promote belly fat storage
- Disrupt sleep
- Increase blood pressure
- Affect bone density
- Impact mood and cognitive function
4. Other lesser-known changes:
- Leptin: A hormone regulating appetite and metabolism, often disrupted during menopause, leading to increased hunger and weight gain.
- Ghrelin: A hormone stimulating appetite, may increase during menopause, making weight management more challenging.
- Adiponectin: A hormone involved in glucose regulation and fat breakdown, often decreased in menopause, contributing to insulin resistance.
- Serotonin: A neurotransmitter regulating mood, appetite, and sleep, often imbalanced during menopause, contributing to mood swings and depression.
- Melatonin: A hormone regulating sleep-wake cycles, often disrupted during menopause, leading to insomnia or sleep disturbances.
[3]
What is perimenopause?
Perimenopause = the menopausal transition. It’s the years leading up to your last period when hormones start misfiring.
Ages & timeline
Early perimenopause 40-45, but can start late 30s: 4-8 years avg.
Late perimenopause Mid-late 40s to early 50s: 1-3 years.
Menopause 45-55 (51 avg in UK/US) Range 1 day: 12 months after the final period.
Postmenopause 51+: Rest of life.
5% hit menopause before 45, and 1% before 40 = premature ovarian insufficiency. Smoking, genetics, and chemo/radiation can shift it earlier.
What’s happening biochemically: 3 key shifts
1. Your ovaries become erratic: estrogen swings wildly, not just a decline, this is a big myth. Estrogen does not smoothly drop. In early perimenopause:
- FSH spikes: Brain pumps out more Follicle Stimulating Hormone because fewer follicles are left.
- Estradiol (E2, biggest estrogen) rockets + crashes: You can have higher estrogen than in your 20s some cycles, then near-zero others. Swings of 10-1000+ pg/mL in the same month!
- Inhibin B drops: Your small follicles make less of this, so FSH isn’t held back.
- AMH plummets: Anti-Müllerian Hormone tracks ovarian reserve. <0.39 ng/mL = likely final period within 2 years.
Result: 60+ day cycles, skipped periods, heavy bleeding, or 2 periods/month. All “normal” for perimenopause.
2. Progesterone tanks first
You stop ovulating reliably in your late 30s/40s. No ovulation = no corpus luteum = no progesterone that cycle.
- Estrogen unopposed: Without progesterone to balance it, estrogen dominates: heavy periods, breast tenderness, anxiety, sleep issues.
- Luteal phase defects: When you do ovulate, progesterone may be low/short, PMS worsens.
3. Neurotransmitters & inflammation change
Estrogen & progesterone aren’t just sex hormones. They regulate brain chemistry:
- Serotonin drops: Estrogen boosts serotonin. Swings = mood/anxiety dips. This is the reason why SSRIs serotonin increasing antidepressants are prescribed to help VMS (vasomotor symptoms: hot flashes night sweats).
- GABA tanks: Progesterone metabolizes to allopregnanolone, a GABA-A agonist. Low progesterone = worse anxiety, poor sleep.
- Norepinephrine increases: Estrogen withdrawal narrows the thermoneutral zone in hypothalamus resulting in hot flashes triggered by tiny temp changes.
- Inflammation increases: Estrogen is anti-inflammatory. As it fluctuates, IL-6, TNF-α rise leading to joint pain and brain fog.
- Insulin resistance increases: Muscle becomes less sensitive. The same calories results in more belly fat.
Late perimenopause clues you’re close:
1. Periods ≥60 days apart = late stage. Happens ∼1-3 yrs before final period
2. FSH >25 IU/L + missed periods
3. VMS peak: 80% of women get hot flashes/night sweats here. Driven by that shrunken thermoneutral zone.
Why symptoms are worse than menopause itself
Postmenopause = low but stable hormones. Perimenopause = hormonal chaos. Your brain/body can’t adapt because the target keeps moving. That’s why anxiety, rage, insomnia, and heavy bleeding often peak before periods stop.
Blood tests: useful or not? Hormone levels on a single day is useless data in perimenopause because they change hourly. Doctors should diagnose by age, symptoms and cycle changes. AMH (Anti-Mullerian Hormone) test is best for predicting time to final period, not symptoms. [4]
Exercise during perimenopause and menopause
Obviously any form or exercise activity will have a positive effect on anyone in perimenopause, menopause or in any stage of life. Most exercise studies have focused on early menopause or post menopause, however in the last two years a few studies have emerged specifically for perimenopause. In general, the optimum exercise is much the same for both, but even more intense and “jumpy” for perimenopause.
Optimised training
Most of the research shows the best training for menopause is basically the same as for overall health in the general population. Timed sequences encompassing resistance, cardio and plyometrics that cover all bases can have an effect on imbalances caused by menopause. The main thing to be mindful of during menopause is not overdoing it and getting good solid rest and sleep. With perimenopause, train harder and faster! Check with your doctor if you have heart problems or osteoporosis or any other underlying condition or have never done advanced training before. Start slowly.
The basic 3
1. Resistance Training:
- Helps maintain muscle mass and strength
- Supports bone, ligament and tendon health (weight-bearing exercises like squats, lunges)
- Improves insulin sensitivity
2. Cardio:
- High-intensity training can be beneficial for cardiovascular health, fat loss, increasing estrogen levels, improving and enhancing insulin sensitivity.
- Moderate-intensity cardio (e.g., brisk walking) also supports overall health. But it is not enough to combat perimenopause and menopause.
3. Plyometrics:
Plyometrics can be especially useful during perimenopause and menopause for bones, muscle power, and fall prevention. It’s the “high-impact” piece that’s often missing from walking/yoga and the usual inadequate prescribed activities. It’s one of the few exercises with direct “osteogenic” loading (bone density increasing). Pair it with resistance training for best results.
Bone mineral density (BMD) – a big win
Postmenopausal women lose 1-2% bone mass density (BMD) per year, mostly in the first 5-10 years. High-impact jumping directly loads the hip and spine to slow or reverse that.
Jumping works best, before menopause, to build density. But after menopause it mainly prevents loss. Power training/jumping has been shown to be more effective than slow strength training for maintaining BMD at lumbar spine and total hip in postmenopausal women.
Muscle power & function
Menopause causes fast-twitch muscle fiber loss which equals less power and worse balance. Plyometrics are “power training” by definition. It increases those fast-twitch muscle fibres.
Body composition
Meta-analyses show exercise increases fat-free mass in postmenopausal women. Plyometrics alone or combined with resistance training can boost lean mass in just a few months.
[5] [6] [7] [8] [9]
Caveats & how to do it safely
1. It’s dose-dependent: More isn’t always better — tendons take longer to adapt after menopause. Shorter intense optimised exercise could be best.
2. Landings matter: Barefoot on hard surfaces was used in many studies to maximize impact. But start on forgiving surfaces if you have joint issues or feel nervous.
3. Build to it: If you have osteoporosis, prolapse, or incontinence, don’t start with max jumps. Work with a professional if possible.
4. Combine with resistance training: Best bone density results appear to come from mixed training e.g. weight-bearing jumps + dynamic resistance training.
5. Menopause limits gains: Postmenopausal women don’t gain BMD as easily as premenopausal. Expect maintenance or small increases, not big jumps. Still massively worth it, you’re fighting 1-2% annual loss. You could stop this in its tracks.
What science exists for perimenopause specific training?
There has been a key 2024-2025 shift acknowledging perimenopause behaves differently to menopause. Most pre-2023 studies used postmenopausal women. But perimenopause has those wild estradiol swings, so the response to exercise is different.
What’s different vs general health guidelines
General adult guideline from GPs and health services | Perimenopause-specific tweaks from studies |
150 min moderate cardio | Add 1-2 HIIT sessions. E2 swings impair fat oxidation interval training restores it |
2x/week light resistance training | Go heavier and harder. Peri women need higher mechanical load to stimulate muscle due to anabolic resistance |
Walking is enough for bones | Not in perimenopause or anywhere! Need impact: jumps, hops, jumping push ups stomping. 50-100 impacts 3x/week prevents peri bone loss |
Flexibility/yoga/stretching | Maybe good for stress, but does not touch VMS, lean mass, or strength. Can’t be the main plan, it will achieve almost nothing. |
Mechanisms experts are targeting
1. Anabolic resistance: Fluctuating Estradiol makes muscle less responsive to protein and normal loads. Solution = heavier weights and body weight training.
2. Thermoregulation: HIIT (high intensity interval training) resets hypothalamic thermoneutral zone. Steady cardio doesn’t.
3. Insulin resistance: Peri-specific belly fat shift responds better to sprints + weights than walking or normal exercise, yoga, pilates etc.
4. Bone: Impact loading (jumping) 3-4x bodyweight needed. Walking = 1x bodyweight. Hence jump training wins in perimenopause.
The knowledge most people + NHS/GP services are lacking:
1. “Lift weights” isn’t optional — it’s the primary intervention for perimenopausal body composition + VMS.
2. Jump training is safe if you build up. 40% of bone loss across menopause happens in the late perimenopause. Impact now matters more than postmenopause. [10]
HRT and exercise: a winning combo?
HRT experiences vary, but if it works for you, great! Exercise and healthy living can achieve similar benefits, and combining them with HRT seems to be the best approach for some people. Meds often have costs or side effects, but exercise and healthy living = fitter humans, no downsides!
When it comes to managing menopause symptoms and improving overall health, there are several approaches to consider: fitness alone, fitness combined with Hormone Replacement Therapy (HRT), or HRT alone. Here's a breakdown of what some of the science says:
Fitness alone:
Exercise is a great way to manage menopause symptoms, improve bone density, and reduce cardiovascular risk. Weight-bearing and resistance training exercises are particularly effective in maintaining bone health and muscle mass.
HRT alone:
HRT can be effective in managing menopause symptoms, improving bone density, and reducing cardiovascular risk when initiated in women under 60 or within 10 years of menopause. However, HRT may not be suitable for everyone, and its benefits can vary depending on individual health factors. As with all medications there are always possible side effects.
Fitness and HRT combined:
Combining HRT with exercise may offer the best of both worlds. HRT can help alleviate symptoms, while exercise can enhance cardiovascular benefits, improve muscle mass, and support bone health. Research suggests that HRT combined with exercise can lead to greater improvements in bone density and muscle function compared to either approach alone.
Key considerations:
- Timing is everything: HRT is most effective when initiated in women under 60 or within 10 years of menopause.
- Individualized approach: HRT and exercise plans should initially be tailored to each woman's specific needs and health status. Ultimately leading to a uniform peak fitness program.
- Risks and benefits: Weigh the potential benefits of HRT against individual risk factors, such as blood clots or breast cancer.
Ultimately, the best approach depends on your unique life situation, health goals, and preferences. If an individual can find success purely with exercise this in my opinion should always be favoured. [11] [12]
Diet, supplements and menopause: let's bust some myths!
The biggest drivers of health are exercise quality first, total food intake second, and specific food choices third. Still, it’s worth checking the evidence on food types to stop people wasting time and money on supplements. Eat food you enjoy, not because you expect a miracle cure. Put more energy into training than into obsessing over diet details. If you’re gaining fat, the main lever is eating less overall. You absolutely do not need to spend money on anything fancy. Most, if not all of it is a money making con.
Menopause diet myths and bad practices are everywhere! Let's separate fact from fiction:
- Myth: Menopause weight gain is inevitable: Hormonal changes play a role, but diet as in volume of calories eaten and exercise are huge factors. You can manage weight with healthy habits.
- Myth: Red wine helps with menopause: Just no.
- Myth: Caffeine worsens hot flashes for everyone: Some women may be sensitive; try reducing or switching to herbal teas if it triggers symptoms.
- Myth: Menopause means you need more protein: Protein needs do not drastically change.
Supplements are a waste of time, money and they are not tasty!
- Calcium and Vitamin D: Essential for bone health, but supplements aren't always necessary. Get calcium from dairy, leafy greens, and fortified plant milk. Vitamin D from sunlight, fatty fish, and supplements (if needed).
- Phytoestrogens: Plant-based estrogens in soy, flaxseeds, and legumes may help with hot flashes, but evidence is mixed. I wouldn't waste valuable exercise time on this. Whole foods are better than supplements.
- Omega-3s: Anti-inflammatory benefits, found in fatty fish, flaxseeds, and walnuts. Supplements may help with hot flashes, but food sources are preferred.
- Herbal Supplements: Black cohosh, red clover, and evening primrose oil are popular, but evidence is terribly limited. Avoid! [13] [14]
Mental health during menopause and perimenopause
Yes, menopause can hit mental health hard, but there’s solid science on what actually helps. The drop in estrogen and progesterone directly affects serotonin, norepinephrine, dopamine, and GABA systems, plus sleep and hot flashes make it worse. About 15-50% of peri/postmenopausal women report anxiety, depression, or insomnia. Here are some evidence-based countermeasures:
1. Exercise: strongest non-drug evidence
Exercise cuts depressive symptoms significantly in menopausal women
What type works best (based on SUCRA ranking system):
- Aerobic exercise ranked #1 for depression: SUCRA 78.7%
- Multi-mode/resistance training nearly tied: SUCRA 78.1%
- Mind-body exercises(yoga, pilates, tai chi, qigong): SUCRA 45.4%
Exercise also improves anxiety, sleep quality, and fatigue.
2. Cognitive Behavioral Therapy (CBT) – best psychological tool
CBT appears effective in reducing negative moods in group settings for menopausal women. It also can improve vasomotor symptoms, sexual dysfunction, and recurrent depression after 24 weeks of treatment.
Why it helps: Menopause disrupts emotional regulation circuits. CBT gives coping strategies for hot flashes, sleep, and catastrophic thinking about symptoms. It addresses the “straw that breaks the camel’s back” effect: midlife stress, hormones and role changes.
3. Mind-body therapies
Mindfulness, music therapy, dance therapy, and Reiki showed greater psychological benefits than yoga/qigong for sleep, depression, and anxiety. Overall MBTs gave moderate-to-large effects.
4. Hormone therapy and antidepressants – when appropriate
Estrogen has neuromodulatory effects. Transdermal estradiol 0.1mg/day gave 68% remission vs 20% placebo for perimenopausal depressive symptoms. It works best in perimenopause before prolonged hypoestrogenism. For women with depression and hot flashes, SNRIs like venlafaxine are often first-line.
5. Sleep + stress targeting
Perceived stress was the only factor linked to memory complaints. Poor sleep, daytime hot flashes, and night sweats all drive anxiety/depression. So treating VMS and sleep often lifts mood.
Key risk windows & who’s vulnerable
- Late perimenopause shows spikes in depression, tied to hormone variability and psychosocial factors. Suicide Risk: Studies have identified an increase in suicide risk among women of perimenopausal age.
- Previous major depressive disorder (MDD) is the biggest predictor of MDD during menopause. Women with previously diagnosed mood disorders are at a higher risk.
- Severe VMS, long transition, poor sleep, life stressors = higher risk.
- Social support drops in early perimenopause. Psychosocial factors are a recognised risk factor. [15] [16] [17] [18]
Important reality check
There is no compelling evidence menopause universally raises risk of depression/MDD. Many women don’t get mood disorders. But if you do, it is real, in no small part because of fluctuating estradiol/progesterone affecting brain chemistry, inflammation, and neurotrophic factors. Misattributing all distress to “just menopause” can delay treatment. The biopsychosocial model works best: hormones + therapy + lifestyle + social support. I cannot stress enough. SOCIAL SUPPORT! That includes you men!
In conclusion
Perimenopause and menopause aren’t a steady decline. They are chaos first, then a new baseline. The research is finally catching up to what women have known for decades: the old “gentle walking, yoga and rest” script doesn’t cut it.
The data is clear. Heavy resistance training, HIIT, and impact work aren’t extreme. They’re the minimum effective dose to offset anabolic resistance, bone loss, and metabolic shifts. Food quality matters, but total calories and training quality drive results. Supplements won’t save you. Jumping squats might.
This isn’t just women’s business. Partners, GPs, trainers, and health services need to update their playbook. We’ve ignored female physiology for too long, and the cost is fractures, depression, and preventable decline.
So here’s the ask: Start lifting heavy in your 30s. Jump before your bones demand it. Talk to your daughters, your patients, your mates. Menopause prep should start 20 years before the final period, not 20 minutes after hot flashes begin.
The myths are busted. The neglect is ending. Exercise isn’t optional medicine for this transition, it’s the foundation. HRT can help, therapy can help, but you still have to do the reps. Evidence-based protocols now exist. The next step is implementation across healthcare and fitness. That starts with education, today. This transition is tough, but you’re not powerless. With the right tools, community, and barbell, you come out stronger. Literally.
Your body isn’t broken. The advice was. Now we fix it.
I have received no sponsorship or payment for this article. There are no conflicts of interest.
Let's Connect!
Got questions or need more references about training during perimenopause and menopause, biohacking or just wanting to boost your fitness? I'm here to help - whether it's for you or your organisation. At The Fitness Scientists, we cut through the noise with science-backed methods for a clear path to better health.
Hit me up on: Instagram, LinkedIn, Email, WhatsApp, Phone
Photo: Ryan Stefan
[5] Holloway-Kew KL, Morse AG, Anderson KB, Kotowicz MA, Pasco JA. Patterns of Bone Mineral Density Loss at Multiple Skeletal Sites Following Recent Menopause in Users and Non-Users of Menopausal Hormone Therapy. Calcif Tissue Int. 2025;116(1):80. Published 2025 Jun 4. doi:10.1007/s00223-025-01392-8
[6] von Stengel S, Kemmler W, Kalender WA, Engelke K, Lauber D. Differential effects of strength versus power training on bone mineral density in postmenopausal women: a 2-year longitudinal study. Br J Sports Med. 2007;41(10):649-655. doi:10.1136/bjsm.2006.033480
[7] Manaye S, Cheran K, Murthy C, et al. The Role of High-intensity and High-impact Exercises in Improving Bone Health in Postmenopausal Women: A Systematic Review. Cureus. 2023;15(2):e34644. Published 2023 Feb 5. doi:10.7759/cureus.34644
[8] Menzies C, Bowtell R, Shur N, Brook MS. Menopause, Female Sex Hormones, Skeletal Muscle Mass and Muscle Protein Turnover in Humans. J Cachexia Sarcopenia Muscle. 2026;17(1):e70232. doi:10.1002/jcsm.70232
[11] Sánchez-Delgado JC, Jácome-Hortúa AM, Uribe-Sarmiento OM, et al. Combined effect of physical exercise and hormone replacement therapy on cardiovascular and metabolic health in postmenopausal women: A systematic review and meta-analysis. Braz J Med Biol Res. 2023;56:e12241. Published 2023 May 15. doi:10.1590/1414-431X2023e12241
[12] Platt O, Bateman J, Bakour S. Impact of menopause hormone therapy, exercise, and their combination on bone mineral density and mental wellbeing in menopausal women: a scoping review. Front Reprod Health. 2025;7:1542746. Published 2025 May 12. doi:10.3389/frph.2025.1542746
Comments