Exercise guide
Exercise through the perimenopause and menopause protects muscle, bone, heart and mood. It is much less likely to switch off hot flushes: the largest trials found no clear reduction, and this page says so. If flushes or night sweats are hard to live with, talk to your GP about HRT and menopause-specific CBT, which have the evidence.
The core is strength training on 2 to 3 days a week, about 150 minutes of brisk walking or cycling, impact for bone if it suits you, and pelvic floor exercises every day. Check with a GP before you start if you have heart disease or another medical condition, osteoporosis or a past spinal fracture, or a feeling of heaviness or a bulge in the vagina.
Strength training keeps muscle and strength, which NICE now asks doctors to explain at this stage of life. Strength and impact exercise are the exercise answer to faster bone loss around the last period. Exercise also helps the heart and blood pressure, lifts mood a little, and may ease insomnia.
Mostly not. In the largest trials, women who exercised had about as many flushes as women who didn't, and a Cochrane review found no clear difference. If flushes or night sweats are hard to live with, see your GP: NICE recommends HRT, and menopause-specific CBT as an option alongside it or instead of it.
A mix, with strength training at the centre: strength moves on 2 to 3 days a week, about 150 minutes a week of brisk walking or cycling, impact such as heel drops if it suits you, and pelvic floor exercises every day.
No exercise burns fat from the belly on its own. More total activity does: in postmenopausal women, 300 minutes of aerobic exercise a week reduced belly fat more than 150. The menopause shifts fat to the middle more than it adds weight, so a waist measurement is a fairer guide than the scales.
Women in their 50s and 60s gain strength well. Interval training and heavier lifting are not harmful for healthy midlife women, and the claim that HIIT raises cortisol and causes "menopause belly" has no trial behind it. Build up gradually.
The menopause usually happens between 45 and 55, and the same plan works from your 40s. Bone loss speeds up from about a year before the last period, which is one reason to start strength and impact work in perimenopause rather than wait. Energy and sleep can vary from week to week: swap a hard session for a walk on a bad day rather than stopping (our suggestion).
NICE asks clinicians to explain the importance of keeping muscle mass and strength through physical activity during the menopause. An American College of Sports Medicine review of 137 reviews found that strength training improves strength, muscle size, power, balance and everyday function in adults; heavier loads and 2 or more sessions a week build more strength. In pooled trials of people over 50, women gained more lower-body strength than men relative to where they started.
Bone loss starts about a year before the final period and is fastest until two years after it. In the SWAN study of 862 women, 7.4% of spine bone density was lost in that three-year window, out of 10.6% over ten years. A UK consensus recommends progressive strength training on 2 to 3 days a week and about 50 moderate impacts on most days. Our osteoporosis guide has the detail.
The American Heart Association describes the menopause transition as a time of rising heart and circulation risk, with less favourable changes in body fat, cholesterol and blood vessels. In postmenopausal women, strength training lowered resting blood pressure and heart rate across 60 studies, and three months of high-intensity aerobic training reduced waist size, fat mass, diastolic blood pressure and cholesterol.
Across 21 trials with 2,020 women, exercise reduced depressive and anxiety symptoms in the menopause, at low as well as moderate intensity. The trials varied a lot, so the size of the effect is uncertain.
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In pooled trials, exercise reduced how severe insomnia was in menopausal women, more so in women with sleep problems, but did not improve overall sleep quality. In women with hot flushes, physical activity made only a small difference to sleep. Exercising in the daytime, ideally not just before bed, is part of standard sleep advice.
Exercise is worth doing for everything above. It is not a reliable treatment for flushes.
A Cochrane review found no difference in flushes between exercise and no treatment (3 trials, 454 women, low-quality evidence). The two largest trials agreed. In the UK, 261 women given 6 months of support to exercise had no fewer flushes, and the authors say women should not be told that exercise will relieve them. In the US, 248 inactive women did 12 weeks of aerobic training 3 times a week or carried on as usual: flushes fell by about the same amount in both groups (by 2.4 and 2.6 a day).
NICE recommends offering HRT for hot flushes and night sweats, and menopause-specific CBT as an option alongside HRT or instead of it. The North American Menopause Society recommends CBT, clinical hypnosis and some medicines, and does not recommend exercise, yoga or paced breathing to treat flushes. These are treatments to talk through with your GP.
In a Swedish trial of 58 women, 15 weeks of strength training 3 times a week cut moderate to severe flushes by 43.6%, against 2.0% in the comparison group. The difference held at 6 months but not at 2 years, and the trial was small and unblinded. Pooled analyses of strength training and flushes are small and low certainty. A 21-woman trial of supervised aerobic training also reported fewer flushes, but the larger trials above did not.
No trial has shown that exercise makes flushes more frequent over time, though heat can set one off during a session. The NHS self-help advice for flushes fits here: light layers, a fan, a cold drink and a cool room. It is fine to stop and cool down.
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In the SWAN study of 1,246 women, weight rose steadily through midlife, about 0.25 kg a year during the transition, with no speed-up at the menopause. What changed was the body's make-up: the rate of fat gain doubled, adding about 1.6 kg of fat over the three and a half years of the transition, and lean mass fell by about 0.2 kg. These changes levelled off about two years after the last period.
An expert review links the hormonal change to more total and abdominal fat, and the weight gain itself to ageing and lifestyle.
In 384 inactive postmenopausal women, 300 minutes of aerobic exercise a week for a year reduced total body fat by 1% more than 150 minutes, and reduced more of the fat under the skin of the belly. Weight and the deeper belly fat did not differ between the two doses.
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In pooled trials of adults (not only women in menopause), interval training reduced total, abdominal and deep (visceral) fat, with no difference between men and women. In early postmenopausal women, three months of high-intensity training reduced waist size and fat mass as much as in premenopausal women.
Six weeks of abdominal exercises 5 days a week did not reduce belly fat in a small trial, though abdominal endurance improved. Fat comes off the whole body with more total activity and changes to eating.
Because the change is in fat and muscle more than in weight, your waist measurement and your strength are fairer guides than the scales. Strength training is how you hold on to muscle.
No trial shows it. Hard exercise raises cortisol for a short time, as all hard effort does: in a small study of 12 men, cortisol rose about 40% after 30 minutes at 60% of maximum aerobic capacity and 83% at 80%, while light exercise didn't raise it. A short rise is not the same as cortisol that stays high. In 34 postmenopausal women, six months of aerobic training plus weight loss did not change resting cortisol, and interval training reduces abdominal fat in trials.
In the LIFTMOR trial, 101 postmenopausal women with low bone density, average age 65, did supervised heavy lifting (5 sets of 5 at over 85% of their maximum) plus impact, twice a week for 8 months. Spine bone density rose 2.9%, against a 1.2% fall with low-intensity home exercise, with one minor adverse event, a back spasm. The lifting was supervised: with osteoporosis, get advice first and avoid deep loaded forward bending.
Pick what you enjoy and will repeat, and build up. A run of hard sessions on too little sleep is hard to keep up, so mix harder and easier days (our suggestion). If you have heart disease or high blood pressure that isn't controlled, check with your GP before hard intervals.
No guideline sets a separate dose for the menopause. These are the adult guidelines, with the UK osteoporosis consensus for bone.
WHO: 150 to 300 minutes of moderate activity a week, or 75 to 150 minutes of vigorous activity, or a mix. The NHS suggests spreading it over 4 to 5 days, or every day. Moderate means you can talk but not sing; vigorous means you can only say a few words without pausing for breath. For fat loss, more helps: 300 minutes beat 150 in a year-long trial.
NHS and WHO: work all the major muscle groups on at least 2 days a week. For bone, the UK osteoporosis consensus advises 2 to 3 days, working towards the most you can lift 8 to 12 times and building up to 3 sets per exercise, with good technique at lower weights first. Strength rises more with heavier loads and 2 or more sessions a week.
About 50 moderate impacts on most days, for example 5 sets of 10 heel drops (UK consensus). With spinal fractures or several low-trauma fractures, keep impact to brisk-walking level. If you leak when you land, start pelvic floor training first.
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WHO advises balance and strength work on 3 or more days a week from 65. In your 40s and 50s, a few minutes of single-leg work at the end of each strength session keeps the habit going (our suggestion).
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NICE: at least 8 contractions 3 times a day, and a supervised course of at least 3 months if you have stress or mixed incontinence.
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Our suggestion for a woman new to training without warning signs: two full-body strength sessions of 6 to 8 moves (2 sets of 8 to 12, stopping with 2 to 3 reps to spare), three brisk 30-minute walks or rides, heel drops on most days if they suit you, and pelvic floor exercises daily. For strength, add reps before weight, then weight in small steps; for walks, add about 5 minutes a session. The 8-week plan for women over 50 below has this shape and suits perimenopause too.
Train in layers with water and a fan to hand, and avoid hot rooms if heat sets off flushes. If late hard sessions upset your sleep or night sweats, move them earlier: daytime exercise is standard sleep advice. HRT doesn't change any of these doses; the British Menopause Society calls good nutrition and an active lifestyle the cornerstone of a healthy menopause, whether or not HRT is part of it.
Stop exercising and call 999 for:
2 to 3 days a week. Start with 2 sets of 8 to 12, stopping with 2 to 3 reps to spare, and work towards the most you can lift 8 to 12 times, up to 3 sets (UK osteoporosis consensus). Use the same range for the overhead press, lighter than its own page suggests (our suggestion), and press seated if you feel unsteady. Sit-to-stands come before goblet squats, wall push-ups before incline push-ups, and the band row is the home version of the dumbbell row. Move slowly in back extensions and supermans if you have osteoporosis.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoDumbbell goblet squatIntermediate · A dumbbell
3D demoDumbbell Romanian deadliftIntermediate · A dumbbell
3D demoStep-upBeginner · A step
3D demoWall push-upBeginner · A wall
3D demoIncline push-upBeginner · A bench or box
3D demoBand rowBeginner · A band + An anchor point
3D demoSupported single-arm dumbbell rowIntermediate · A dumbbell + A bench or box
3D demoStanding overhead pressIntermediate · A barbell + A dumbbell
3D demoFarmer's carryBeginner · A dumbbell + A kettlebell
3D demoBack extension on a 45-degree benchIntermediate · A bench or box
3D demoSupermanIntermediate · No equipmentHeel drops come first: 20 to 30 at first, building to about 50 on most days (UK consensus). Move on to skipping only once heel drops are easy and you don't leak. For balance, 2 holds of 20 to 30 seconds on each leg and 2 lots of 10 heel-to-toe steps at the end of a strength session, beside a counter or wall.
Brisk walking is weight-bearing and counts towards your 150 minutes; cycling and rowing are kinder to sore joints and if you leak. Pelvic floor: 3 sets of 8 a day, mixing slow holds of up to 10 seconds with quick squeezes; the 3D figure can't show these internal muscles, so follow the written steps. Crocodile breathing is for winding down before bed: slow breathing has not been shown to reduce flushes.
Pelvic floor muscle training made women with stress incontinence (leaking with coughs, sneezes, jumps or lifting) about 8 times more likely to report a cure: 56% against 6% (4 trials, 165 women, high-quality evidence). Cure or improvement: 74% against 11%.
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A supervised course of pelvic floor muscle training lasting at least 3 months as the first treatment for stress or mixed incontinence, with at least 8 contractions 3 times a day.
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With a prolapse (a feeling of heaviness or a bulge in the vagina), the NHS advises pelvic floor exercises and avoiding heavy lifting, running and trampolining. See a GP before going back to them.
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You don't have to stop. Switch to lower-impact exercise such as cycling or swimming while you build up, and see a GP or pelvic health physiotherapist if it isn't improving after about 3 months.
Nothing on this page is off-limits for a healthy midlife woman. These are the situations that change the plan.
The UK consensus advises avoiding high degrees of spinal flexion, such as sit-ups and deep loaded forward bends. With spinal fractures or several low-trauma fractures, keep impact to brisk-walking level, and get individual advice. Our osteoporosis guide covers this in detail.
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Joint and muscle aches are a recognised menopause symptom, and they arrive at the age when osteoarthritis becomes common. There is no specific treatment; reviews encourage exercise, weight management and simple painkillers. Keep moving, and change the range or the load of a move that hurts rather than stopping altogether. For a diagnosed problem, our knee, hip, hand and shoulder pain guides have their own plans and warning signs. See a GP if the pain isn't settling or stops you doing everyday things.
Train your pelvic floor daily, and use walking, cycling or rowing rather than jumping while it improves. Bring heel drops and skipping back gradually.
Keep breathing on every effort and build intensity gradually. Our high blood pressure guide covers weights, wall sits and which readings need a GP first.
The plan for women over 50 suits women from perimenopause on: the usual age of menopause is 45 to 55. If you are under 50 and already train, the plan for women includes a note on menopause and bone. New to exercise? Start with the beginner plan.
A weekly plan for women over 50: strength, bone-loading and balance on 3 days plus walking, built on UK osteoporosis consensus advice.
3 training days45 minBeginner3 days a weekA weekly workout plan for women: three strength days, cardio and pelvic floor training, with the evidence on periods, pregnancy and menopause.
3 training days45 minBeginner2 days a weekYour first four weeks: two, then three short strength sessions a week at home plus walks, building gently to a full routine.
2 training days20 minBeginnerStrength and balance twice a week, the bone workout once, cardio on two days and pelvic floor exercises every day. If you leak during the heel drops, build up the pelvic floor exercises first and keep impact low for now. The breathing routine is for winding down, not for flushes.
Strength and balance in one session: squats, Romanian deadlifts, push-ups, rows, step-ups, back extensions, carries and single-leg balance.
45 minBeginner14 movesA wall, A dumbbellImpact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallPelvic floor exercises in 5 minutes: slow holds and quick squeezes, three times a day, with how to find the right muscles.
5 minBeginner2 movesNo equipmentBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxA gentle 20-minute beginner home workout with a chair, a wall and a band: sit-to-stands, wall push-ups, band rows, step-ups and dead bugs.
20 minBeginner11 movesA bench or box, A wallA 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentThe best trials say it mostly won't. The NHS still lists regular exercise among things to try, and exercise is good for you in many other ways, but it is not a treatment for flushes. One small strength-training trial is the exception worth watching.
This popular claim has no trial behind it. Hard exercise raises cortisol briefly, as all hard effort does, which is not the same as cortisol that stays high. Aerobic training did not change resting cortisol in postmenopausal women, and interval training reduces abdominal and deep belly fat. Mix intensities and keep the sessions you enjoy.
Women in their 60s with low bone density did supervised heavy lifting for 8 months in the LIFTMOR trial; their spine bone density rose, with one minor adverse event. Build up with good technique and, with osteoporosis, get advice first.
In the SWAN study, weight climbed slowly through midlife, about 0.25 kg a year in the transition, with no speed-up at the menopause. What changed was more fat, about 1.6 kg over the transition, slightly less muscle, and more fat around the middle.
Six weeks of abdominal exercises 5 days a week did not reduce belly fat, though they did improve abdominal endurance. More aerobic minutes reduced belly fat more in postmenopausal women.
Strength training is what keeps muscle and strength, which NICE now stresses, and women over 50 gain strength well. The British Menopause Society calls resistance exercise "almost non-negotiable" for women who want to change their body shape. Bulk takes years of targeted training and eating.
It is common, but treatable: pelvic floor training cured stress incontinence in about half of women in trials, against 6% without it. See a GP if it isn't improving.
A mix, with strength training at the centre. Lift weights or do bodyweight strength moves on 2 to 3 days a week, walk or cycle briskly for about 150 minutes a week, and add impact and balance work if they suit you. NICE asks doctors to explain why keeping muscle strength matters at this stage of life, and strength and impact work are what the UK osteoporosis consensus recommends for bone. Pelvic floor exercises every day round it off.
Probably not much, and it is better to know that up front. In the largest trials, women who exercised had about as many flushes as women who did not, and a Cochrane review found no clear difference. The North American Menopause Society does not recommend exercise as a treatment for flushes. One small Swedish trial of strength training found fewer flushes, which is worth watching. HRT is the most effective treatment, and NICE recommends menopause-specific CBT as an option, so talk to your GP if flushes are hard to live with. Exercise is still worth doing for everything else it protects.
There is no exercise that burns fat from the belly on its own: six weeks of daily abdominal exercises did not shift belly fat in a trial. What reduces belly fat is more total activity, alongside eating habits. In postmenopausal women, 300 minutes of aerobic exercise a week reduced belly fat more than 150 minutes, and interval training reduces abdominal fat in trials. The menopause itself shifts fat towards the middle, so a waist measurement is a fairer guide than the scales.
No good evidence says so. Hard exercise raises cortisol for a short time in everyone, and that is normal. No trial shows that interval training raises cortisol long term or causes belly fat in menopausal women; in fact, three months of high-intensity training reduced waist size and fat in early postmenopausal women. If you enjoy HIIT, keep it, build up gradually, and balance it with easier days and good sleep. If you have heart disease or high blood pressure that is not controlled, check with your GP first.
For most women, yes, if you build up gradually with good technique. In a trial of women in their 60s with low bone density, supervised heavy lifting improved spine bone density and physical function, with one minor adverse event. If you have osteoporosis or a spinal fracture, get advice from a physiotherapist first, and avoid deep loaded forward bending.
In a large US study, weight rose slowly through midlife with no sudden jump at the menopause. What did change was the body's make-up: fat gain sped up and muscle dipped slightly during the transition, and these changes levelled off about two years after the last period. Ageing, sleep, activity and eating all play a part. Strength training helps you keep muscle, and more activity helps with fat.
Walking is a good base: brisk walking counts towards your 150 minutes a week and helps your heart and mood. On its own it does little for muscle strength, and bone needs more than walking can give. Add strength training on at least 2 days a week, and impact such as heel drops or skipping if they suit you. If you have spinal fractures, keep impact to brisk walking and get advice.
A little. Across 21 trials, exercise reduced depressive and anxiety symptoms in menopausal women, at low as well as moderate intensity. Trials found modest improvements in insomnia, but in women with frequent flushes the effect on sleep was small. Exercising in the daytime, ideally not just before bed, is standard sleep advice. If sleep or mood is a real problem, see your GP: NICE recommends menopause-specific CBT, and HRT can help too.
You don't have to stop exercising. Daily pelvic floor exercises cure or improve stress incontinence in many women, and NICE recommends a supervised course of at least 3 months as the first treatment. Switch to lower-impact exercise such as cycling or swimming while you build up, and see a GP or pelvic health physiotherapist if it isn't improving. If you feel a bulge or heaviness in the vagina, see a GP before going back to running or heavy lifting.
Not in any guideline we read. The advice on strength, aerobic, impact and pelvic floor work is the same whether or not you take HRT. HRT is a treatment for menopause symptoms to discuss with your GP; exercise adds strength, fitness and heart benefits of its own.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
