Pilates guide
Pilates is a good way to stay active through the perimenopause and menopause, and the National Institute for Health and Care Excellence (NICE) stresses keeping your muscles strong. Small trials found lower symptom scores after 6 to 8 weeks of Pilates than with no exercise, but no exercise, Pilates included, has been shown to switch off hot flushes, and it doesn't replace pelvic floor exercises.
Bone loss speeds up and fat gain doubles through the menopause, so our suggestion is to do Pilates alongside strength training with weights, brisk activity and, if it suits you, impact for your bones.
This guide covers symptoms, hot flushes, sleep and mood, bone, body shape and "menopause belly", the pelvic floor, how to combine Pilates with strength training, and when to see a GP.
NICE says to explain the importance of keeping muscle mass and strength through physical activity. The NHS suggests regular exercise with a focus on weight-bearing exercise to build strength, and the British Menopause Society calls resistance exercise "almost non-negotiable" for women who want to lose weight and change their body shape.
Exercise in general hasn't been shown to reduce hot flushes reliably, and the North American Menopause Society doesn't recommend exercise or yoga to treat them. NICE recommends hormone replacement therapy (HRT), with menopause-specific cognitive behavioural therapy (CBT) as an option.
Against no exercise, 6 to 8 weeks of Pilates lowered symptom scores in trials of 30, 40 and 74 women, with no blinding. In the one trial against aerobic exercise, there was no difference.
Pilates trials found less anxiety and fewer depressive symptoms, but results for sleep after the menopause are mixed.
Bone loss speeds up from about a year before your last period, and Pilates hasn't been shown to build bone, so add strength training and impact.
Pilates on its own doesn't train the pelvic floor as well as pelvic floor exercises, which NICE recommends first for leaking.
Menopause is when you haven't had a period for 12 months; perimenopause is the time of changing periods and symptoms before it, and symptoms usually last 7 to 9 years, sometimes longer. It usually happens between 45 and 55, but it can be earlier.
The NHS lists:
Source 20
In 862 women followed in a US study, bone loss began about a year before the final period and was fastest until 2 years after: the spine lost about 7.4% in those 3 years. In the same study, the rate of fat gain doubled and lean mass fell from the start of the transition, though weight rose at a steady pace.
NICE recommends offering HRT for hot flushes and night sweats, menopause-specific CBT as an option, and a non-hormonal medicine (fezolinetant) when HRT isn't suitable. These start with a GP appointment.
Source 1
Three small trials found lower symptom scores after Pilates than with no exercise: 74 women after 8 weeks, 3 times a week; 30 women after 8 weeks, twice a week, against information sessions; and 40 women after 6 weeks of online Pilates, twice a week. A fourth study, of 47 women, had no comparison group.
The trials were small and short, and the women knew which group they were in while rating their own symptoms. In the largest, the groups weren't evenly matched at the start, and one trial was poorly reported.
In the one trial comparing them, 30 women did Pilates or aerobic exercise twice a week for 8 weeks. Both groups improved in mood, sleep and some areas of quality of life, with no significant difference between them in symptoms or anything else.
Source 10
None of these trials found an improvement in urogenital symptoms, such as vaginal dryness.
Across 11 trials in women after the menopause, Pilates improved 5 of 9 areas of a quality-of-life questionnaire, including bodily pain and physical functioning, at very low to moderate certainty, more so with equipment and 48 or more sessions.
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Every trial we found was in women after the menopause; our search found no Pilates trial in perimenopause.
A Cochrane review found no difference in flushes between exercise and no treatment (3 trials, 454 women, low quality). A 2022 review of 21 trials found no change in how often flushes happened (high certainty), and a small effect on how bad they were that disappeared when the most biased trials were removed. The North American Menopause Society doesn't recommend exercise or yoga to treat flushes, and the European Menopause and Andropause Society calls the evidence mixed.
No Pilates trial counted flushes in a diary. One found better scores on the hot flush questions of a questionnaire after online Pilates, and another reported lower flush scores in a trial whose groups were unequal at the start.
NICE recommends offering HRT, with menopause-specific CBT as an option alongside it or instead of it, and fezolinetant when HRT isn't suitable. The NHS still lists regular exercise among things to try, along with keeping your bedroom cool and cutting down on triggers such as spicy food, caffeine and alcohol.
In 58 women, 15 weeks of resistance training 3 times a week cut moderate to severe flushes by 43.6%, against 2.0% in women who didn't change their activity. That's one trial; our exercise for menopause guide covers it.
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In 110 women aged 60 or over, 12 weeks of Pilates improved sleep duration and disturbances more than no exercise. In 108 women, 6 weeks did no better than the comparison groups. Pooled, there was no clear effect in women after the menopause.
In pooled trials, exercise eased insomnia in menopausal women but didn't clearly improve overall sleep quality, and in women with hot flushes it made only a small difference to sleep. The British Menopause Society includes regular daytime exercise, ideally not just before bed, in its sleep advice.
In 110 women, Pilates lowered anxiety and depression scores more than no exercise, and 6 weeks of online Pilates lowered anxiety and depressive symptoms. Across 21 trials, physical activity in general eased depressive and anxiety symptoms in menopausal women.
Reviews of mind-body exercise, which includes Pilates, found less anxiety and depression too, though Pilates' own effect on mood rested on single trials.
NICE recommends considering CBT for low mood and for sleep problems linked with hot flushes.
Source 1
Bone loss starts about a year before the final period and is fastest until 2 years after.
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Pooled trials of Pilates found no significant change in bone density, and two small trials reported spine gains whose size is hard to trust. Our Pilates for osteoporosis guide has the detail.
Strength training and impact: the UK osteoporosis consensus recommends muscle strengthening on 2 or 3 days a week and about 50 moderate impacts on most days, if they suit you. The NHS suggests strength exercises where your feet and legs support your weight, and resistance exercises such as weights, and says HRT can also reduce the risk of osteoporosis.
Fat gain speeds up in the transition. In women, Pilates trials found small falls in weight (about 4 kg) and body mass index (BMI) against no exercise, but no change in body fat percentage, waist or lean mass. The British Menopause Society calls resistance exercise "almost non-negotiable" for changing body shape, and our Pilates for weight loss guide covers "menopause belly".
In healthy women, Pilates didn't change pelvic floor function. In 40 women after the menopause with leaking when they cough, sneeze or exercise (stress incontinence), 12 weeks of pelvic floor training or Pilates gave similar results except for strength, which favoured pelvic floor training, and the authors noted Pilates helped when the women squeezed their pelvic floor during it.
In a 2026 trial, pelvic floor training improved leaking more than Pilates, with or without squeezes.
In a Cochrane review of 31 trials, women with stress incontinence who did pelvic floor training were about 8 times more likely to report a cure (56% against 6%, high-quality evidence). NICE recommends at least 3 months of supervised training first, with at least 8 squeezes 3 times a day.
Do pelvic floor exercises every day as well as Pilates, and squeeze your pelvic floor during Pilates moves if you like. See a GP or a pelvic health physiotherapist about leaking that isn't improving, or a feeling of heaviness or a bulge in your vagina.
In women with long-lasting low back pain, a review found Pilates reduced pain and improved function, including in women after the menopause. Two trials in women after the menopause, of 101 and 128, favoured Pilates over physiotherapy alone or conventional exercise, but some effects were implausibly large. Our Pilates for back pain guide covers this.
UK guidelines ask for muscle-strengthening activity on at least 2 days a week and about 150 minutes of moderate activity. NICE stresses muscle mass and strength, and the UK osteoporosis consensus asks for gradually heavier loads, about the most you can lift 8 to 12 times, for bone. The International Menopause Society says programmes that mix several types of exercise give the greatest benefits.
Mat Pilates is mostly body-weight work. It counts as muscle-strengthening activity, but to keep loading muscle and bone you need gradually heavier work too (our reading). Our suggestion: one or two Pilates sessions and two strength sessions a week, for example our beginner Pilates workout and our strength and balance workout on different days.
Both if you can. If you only have time for one, our reading of the guidelines is that strength training with gradually heavier loads comes first for bone and muscle.
With osteopenia or osteoporosis, keep your head down in the hundred, or use the knee fold, and see our Pilates for osteoporosis guide for the other swaps.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoHundred (Pilates)Intermediate · No equipment
3D demoDead bug heel tapsBeginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoSwimming (Pilates)Intermediate · No equipment
3D demoKnee hover (Pilates tabletop hover)Beginner · No equipmentOur exercise for menopause guide suggests 2 sets of 8 to 12, stopping with 2 or 3 reps to spare, and adding weight in small steps.
The pelvic floor exercise's page gives its dose: start with 8 slow holds of up to 10 seconds and 8 quick squeezes, 3 times a day. The heel drop's page gives the UK consensus dose: 20 to 30 drops, building toward about 50 on most days.
Our suggestion is to pair the beginner Pilates workout with the strength and balance workout on different days, add the bone-strengthening workout once a week, and do pelvic floor exercises daily, using the over-50s Pilates session instead of the beginner one if you have osteopenia.
A 20-minute mat Pilates workout for complete beginners. It covers breathing, spine position and the foundation moves, each with an easier option.
20 minBeginner13 movesNo equipmentStrength 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 5-minute daily pelvic floor workout for women and men: slow holds and quick squeezes, three times a day, with how to find the right muscles.
5 minBeginner2 movesNo equipmentA 20-minute beginner mat Pilates session for over-50s with no deep or repeated rounding of the spine, plus back strengthening and standing balance.
20 minBeginner13 movesA wallA 45-minute session for weight loss and health: a 20-minute brisk walk, which does more for the scales, then a short-rest Pilates circuit for strength.
45 minBeginner11 movesCardio machineA 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 wallA 20-minute beginner wall Pilates workout: standing and floor moves that use a wall for support and feedback. No equipment.
20 minBeginner9 movesA wallThe plan for women over 50 suits women from perimenopause on, since the usual age of menopause is 45 to 55. The 4-week plan builds a Pilates habit.
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 minBeginner3 days a weekA free 4-week, 3-day Pilates plan for complete beginners. Two mat days and one wall day, with clear rules for when to move each exercise to its harder version.
3 training days25 minBeginnerThe NHS suggests contacting your GP if:
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See a GP about any bleeding from the vagina after your menopause, even if it's only a small amount or has only happened once. It's not usually serious, but it needs checking, and you shouldn't have to wait more than 2 weeks to see a specialist.
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See a GP if you have a lump in or around your vagina or other signs of prolapse, such as heaviness or pressure. With prolapse, the NHS advises avoiding activities that strain the pelvic floor, like heavy lifting, running and trampolining.
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If leaking isn't improving, see a GP or a pelvic health physiotherapist: NICE recommends supervised pelvic floor training for at least 3 months first.
Source 19
Call 999 (911 in the US) for sudden chest pain that doesn't go away, pain that spreads to your arm, neck, jaw, stomach or back, or chest pain with sweating, sickness, light-headedness or breathlessness.
Source 52
The NHS suggests advice from a healthcare professional, such as a GP, before starting its exercise videos if you have a health problem, an injury or any symptoms, or have had a recent heart attack or operation.
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No trial has counted flushes after Pilates, exercise in general hasn't been shown to reduce them, and the North American Menopause Society doesn't recommend exercise or yoga for them. HRT and menopause-specific CBT have the evidence.
Pilates trials showed no clear bone gain, bone loss is fastest around the final period, and strength training and impact are what the guidelines recommend.
Pilates alone didn't change pelvic floor function in healthy women, pelvic floor training did as well or better for leaking, and NICE recommends supervised pelvic floor training first.
Pilates trials in women found small falls in weight and BMI but no change in body fat percentage or waist, and fat gain speeds up during the transition itself.
The one trial that compared them found no significant difference from aerobic exercise.
Source 10
Yes, as part of staying active: the National Institute for Health and Care Excellence (NICE) stresses keeping your muscles strong through physical activity. Small trials found lower symptom scores after 6 to 8 weeks of Pilates than with no exercise, but it isn't a treatment for hot flushes.
It hasn't been shown to. Exercise in general didn't reduce flushes in a Cochrane review, and Pilates trials used symptom questionnaires rather than counting flushes. If flushes are hard to live with, see your GP: NICE recommends hormone replacement therapy (HRT), with menopause-specific cognitive behavioural therapy (CBT) as an option.
No trial has studied Pilates in perimenopause; all were in women after the menopause. The same advice applies: muscle, bone and mood all benefit from regular exercise.
Both if you can. For muscle and bone, strength training with gradually heavier weights is the priority; Pilates adds trunk control, balance and back strength, and counts toward the strength guideline.
Not specifically. In women, Pilates trials found small falls in weight (about 4 kg) and body mass index (BMI) but no change in body fat percentage or waist. Our Pilates for weight loss guide covers what works.
Results are mixed: one trial in 110 women found longer sleep and fewer disturbances, another found no difference, and pooled, there was no clear effect after the menopause. Regular daytime exercise is part of standard sleep advice.
Small trials found less anxiety and fewer depressive symptoms, and physical activity in general eases depressive symptoms in the menopause. Talk to your GP about CBT if low mood persists.
Not on its own. Pilates didn't improve pelvic floor function in healthy women, and pelvic floor training did as well or better for leaking. Do pelvic floor exercises daily, and see a GP if leaking isn't improving.
Not on its own. Bone loss is fastest from a year before your last period to 2 years after, and Pilates hasn't been shown to slow it. Add strength training and impact, and see our Pilates for osteoporosis guide if you have low bone density.
No trial has studied wall Pilates in the menopause. It's mat Pilates with the wall for support, and our suggestion is to use it as a way to start, alongside strength training.
No trial has studied reformer Pilates in the menopause. The springs add resistance, which helps muscle, but our reading is that it doesn't replace gradually heavier weights for bone.
The trials used 2 or 3 sessions a week. Fit it around strength training on at least 2 days, about 150 minutes of brisk activity, and daily pelvic floor exercises.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
