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Your Secret Weapon for Perimenopause and Menopause? Regular Exercise

by , | June 4, 2026 | Articles, Hormone Health

women doing yoga

Regular physical activity is one of the most powerful tools available to women navigating perimenopause and menopause. Personally, when I exercise, I am in a better mood, I’m better equipped to deal with stress, and I feel stronger, agile and more flexible. If I miss exercise or simply don’t move enough one day, I feel it. My body feels stiffer and my energy levels may be lower. There is no shortcut: no supplement or peptide, no iv drip that will replace the benefits of exercise – we simply have to invest the time and effort to feel the rewards. 

Exercise in Perimenopause and Menopause

Many women reduce their physical activity during perimenopause. Observational data suggest that women in this stage experience up to a 40% decline in exercise levels, influenced by factors such as low energy, reduced stress resilience, and disrupted sleep patterns. 1 

It’s not a surprise – women in perimenopause are often navigating busy careers, raising children, managing a household and taking care of aging parents. Responsibilities often don’t allow the time or energy for a regular exercise routine. We hear this in our practice all the time. The competing demands are legitimate and challenging. That being said, if we don’t prioritize exercise, we are increasing the risk of metabolic dysfunction, including insulin resistance, prediabetes and diabetes, as well as inflammation, cancer and cognitive decline –which are heightened due to drop in hormones and the aging process. 

The Case for Exercise 

Women who maintain consistent exercise habits during menopausal transition demonstrate lower body mass index (BMI), reduced fat accumulation, greater lean muscle mass, and higher bone mineral density compared with sedentary peers. 2  Structured exercise interventions have been shown to improve sleep quality, reduce insomnia, and alleviate depressive symptoms. Data demonstrates that just 12 weeks of moderate-intensity exercise significantly improved sleep and mood outcomes. Exercising regularly can be a powerful antidepressant! (While there is absolutely a role for medications, when indicated, there are many cases where a healthy lifestyle can eliminate the need for medications.) Additionally, moderate-intensity cardiovascular and resistance exercise has been associated with reductions in hot flashes and night sweats.3  Regular exercise also supports self-worth, quality of life, and psychological well-being, which is especially important during this period in our lives when we may feel more vulnerable.4

Strength Training: Preserving Muscle, Bone, and Metabolic Health

Resistance training is necessary. Period. There is no way around it. It promotes lean muscle development, enhances body composition and benefits bone health. It can improve insulin sensitivity, and reduce the risk for heart disease, hypertension, anxiety, depression, and certain cancers. 5 

Resistance training should be performed 2 or more times per week and incorporate progressive overload, gradually increasing resistance, repetitions, or training volume. Training is generally done to near muscle fatigue with 8–15 repetitions per set, 2-4 sets, targeting all muscle groups. 6 

For those new to resistance exercise, beginning with bodyweight movements, resistance bands, or light free weights allows for proper form and injury prevention. Over time, advancing to heavier resistance or compound lifts enhances muscle mass, joint stability, and balance – critical components for reducing fracture risk, preserving independence, and supporting overall metabolic and cardiovascular resilience in postmenopausal years. 7 8  

We encourage supervised workouts to anyone starting out to ensure proper form, reduce the risk of injury and provide the greatest benefit.

High-Intensity Interval Training (HIIT) for Visceral Fat Reduction

High-intensity interval training (HIIT) alternates short bursts of vigorous activity with periods of rest or lower-intensity exercise. HIIT has emerged as particularly effective for reducing visceral fat (fat wrapped around the organs of the abdomen, associated with inflammation and metabolic dysfunction), which tends to accumulate during perimenopause due to estrogen decline.9 .Research indicates that HIIT supports fat loss in both normal-weight and overweight perimenopausal women, with benefits exceeding those observed in postmenopausal women.

Additionally, HIIT has been shown to outperform continuous moderate-intensity aerobic exercise in promoting visceral fat reduction, with three sessions per week generally recommended. Even brief sessions of 5–10 minutes can confer meaningful metabolic benefits, making this accessible for women on a tight schedule.10

Exercise: What, How Often and for How Long?

  • Engage in regular exercise encompassing cardiovascular activity, strength training, flexibility, and balance-focused modalities such as yoga, pilates, or dancing. Aim for at least 150 minutes (ideally, closer to 300 minutes) of moderate-intensity aerobic activity per week.11 An alternative is 75-150 minutes per week of vigorous-intensity activity. 
  • Strength train 2–3 times per week, progressively targeting all major muscle groups. Begin with bodyweight or light resistance and increase as strength improves. Learn proper technique with a trainer and/or a physical therapist. 
  • Interrupt prolonged sitting with frequent movement “snacks,” such as short walks or mobility exercises. Step counters or smartwatches can support tracking and motivation, but are not necessary. I will sometimes get up from my desk and do squats or practice a simple latin ballroom move, or stretch. 
  • Consider incorporating HIIT 2–3 times weekly for targeted fat loss and cardiovascular benefit.

Exercise Safety

Novice programs may begin at lower volume and intensity and progress as tolerated. To optimize bone health, include short bouts of impact/weight-bearing loading (such as stair-climbing, hopping, skipping, low-level jumps or dance) in combination with resistance training; supervised high-intensity resistance plus impact programs have shown meaningful improvements in lumbar spine and femoral neck bone mineral density in postmenopausal women. 12 

Balance and functional training, such as single-leg stands, tandem walking or tai chi, performed 2-3 times per week, reduce falls risk in older adults. Prior to initiating higher-intensity or impact programs, safety screening is important– we recommend that our menopausal patients have an assessment of bone density, fracture history and cardiovascular status–to ensure suitability and reduce risk. 12 

Women with prior vertebral fractures, multiple fragility fractures, or very low bone mineral density (BMD) require individualized support under specialist supervision (physical therapist, exercise physiologist, and/or osteoporosis clinician, such as endocrinologist or rheumatologist).13  International guidance from bone health societies explicitly advises caution with high-risk spinal flexion and recommends exercise prescriptions that prioritize trunk-extension strength, safe loading mechanics, and supervised progression for those at elevated fracture risk. 14

Individuals with active cardiorespiratory conditions, recent major surgery or fractures, or other conditions that can compromise safety, should consult with their specialist. They would typically start low-dose, supervised activities and progress conservatively as tolerated.15  Supervised or partially supervised exercise programs improve adherence, technique, and clinical outcomes while reducing adverse events during the introduction of heavy or impact loads; systematic reviews and randomized trials show greater functional gains and safety with supervision compared with unsupervised approaches in older adults.16

Key Takeaways

  • Consistent exercise during menopause reduces BMI, adiposity (fat), and vasomotor symptoms while improving mood, sleep, and bone density.
  • Resistance training 2–3x/week with progressive overload is essential for muscle and bone preservation.
  • HIIT 2–3x/week is particularly effective for visceral fat reduction.
  • Aim for 150–300 minutes of moderate aerobic activity per week; safety screening is recommended before starting high-intensity programs.
  • With all of this being said, meet yourself where you are and commit to what you are actually going to do. If this means starting with group dance classes, walking your dog around the block, or going for a walk with your neighbor, that’s a great start! For building healthy habits, I highly recommend James Clear’s Atomic Habits. 

Seeking Personalized Care

We encourage all women experiencing menopausal symptoms to speak to their doctor, or qualified menopause specialist about symptom management and available treatment options.

Our team is here to guide and support our patients every step of the way.

Dr. Bojana Jankovic Weatherly is a certified menopause practitioner. We are committed to providing the personalized care you deserve, helping you move forward with confidence and strength. You have the power to take charge of your health during perimenopause and menopause. We are here to partner with you to achieve your goals. To learn more about our medical, nutrition and health coaching services, contact us at 646.627.8000, fill out this form for a complimentary discovery call, or email Bridget@drbojana.com.

References: 

  1. https://www.mdpi.com/2072-6643/15/2/444
  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC3858421/
  3. https://pmc.ncbi.nlm.nih.gov/articles/PMC9886316/
  4. https://pmc.ncbi.nlm.nih.gov/articles/PMC2728615/
  5. https://pmc.ncbi.nlm.nih.gov/articles/PMC3715578/
  6. https://link.springer.com/article/10.1186/s13018-025-05890-1
  7. https://journals.lww.com/menopausejournal/abstract/2023/01000/resistance_training_for_postmenopausal_women_.15.aspx
  8. https://pubmed.ncbi.nlm.nih.gov/26300634/
  9. https://www.mdpi.com/2072-6643/15/2/444
  10. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2828487
  11. https://onlinelibrary.wiley.com/doi/10.1002/jbmr.3284
  12. https://cdnsciencepub.com/doi/10.1139/h11-037?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
  13. https://pmc.ncbi.nlm.nih.gov/articles/PMC10345999/
  14. https://pmc.ncbi.nlm.nih.gov/articles/PMC11258164/
  15. https://emedicine.medscape.com/article/330598-guidelines
  16. https://pmc.ncbi.nlm.nih.gov/articles/PMC11258164/

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