Pilates guide
Pilates suits women at every age, and most of the people in Pilates trials are women. It builds flexibility, core and hip strength and control, and it can be adapted for pregnancy, after birth and osteoporosis.
What it doesn't do is build bone or replace pelvic floor exercises, so it works best as one part of a week that also includes strength training, brisk walking and a few minutes of pelvic floor exercises each day.
This guide covers what Pilates does in your 20s and 30s, around pregnancy and the menopause, and from 50; what the trials in women show; your pelvic floor, bones and periods; how to start; and the signs that mean you should see a GP. Our Pilates for men guide covers the same ground for men.
A UK body of women's health physiotherapists calls its Pilates-based exercises "safe and suitable for all women", with changes in pregnancy, after birth and after surgery, and the NHS counts Pilates as muscle-strengthening activity. Most of the people in Pilates trials are women.
In adult women, Pilates improved flexibility and lowered weight a little, but didn't change body fat or muscle mass. After the menopause, it improved several areas of quality of life, including bodily pain.
Pilates on its own didn't strengthen the pelvic floor, and in a 2026 trial, pelvic floor training eased leaking far more than Pilates did. NICE (the National Institute for Health and Care Excellence) recommends at least 3 months of supervised pelvic floor training first.
Pilates eased aches and pains in pregnancy in pooled trials. Avoid lying flat on your back for more than a few minutes later in pregnancy, and start gentle Pilates from about 4 weeks after birth if you have no bleeding, wound or pelvic floor problems.
Trials in women after the menopause found no change in bone density. For bone, add strength training with weights and some impact, as a UK consensus on osteoporosis advises.
Most trials in women used 2 or 3 sessions a week for 2 to 3 months. Pair Pilates with brisk walking and strength training to meet the UK guidelines.
There is no separate women's Pilates. POGP (Pelvic, Obstetric and Gynaecological Physiotherapy), the UK's pelvic health physiotherapists, describes its Pilates-based exercises as encouraging "the pelvic floor muscles to work with the deep tummy muscles to build up the strength of your trunk", with precautions after recent surgery, in pregnancy and after birth.
Much of the Pilates evidence already comes from women: in an 18-trial review of mood, only 11 of the people doing Pilates were men, and a 2026 review found 12 trials in about 540 adult women. This guide sorts that evidence by stage of life.
The NHS counts Pilates as muscle-strengthening activity. It is light work for the heart and lungs and doesn't load bone much, so pair it with brisk walking or other cardio, heavier strength work and, for bone, some impact.
Across 12 studies of about 540 adult women, from students to women in their 60s, Pilates improved sit-and-reach flexibility against no exercise (a standardised mean difference, SMD, of 0.69). In women after the menopause, 11 trials found improvements in 5 of 9 areas of quality of life, including bodily pain and physical functioning, at very low to moderate certainty, and more so with 48 sessions or more.
Against no exercise, Pilates lowered weight by about 4 kg and body mass index (BMI) by about 1.2, at very low certainty. Body fat, waist size, muscle mass, grip strength and jump height didn't change.
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In women with long-lasting low back pain, Pilates reduced pain and improved function, both before and after the menopause; the effects were unusually large, and the review rated quality with a checklist, so treat them with caution. In 18 trials, mostly in women, depression and anxiety scores fell, mostly against doing no exercise; our Pilates for stress and anxiety guide covers this.
A review of Pilates for women's health found 13 trials of mostly low quality and "a paucity of evidence". The newer review's certainty was very low to moderate. The results are promising, not proven.
This is the time to build the habit and the strength: the UK guidelines ask for strength work on at least 2 days a week and 150 minutes of moderate activity. Pilates trials in young women found less period pain, and in women with long-lasting back pain, less pain.
Pilates eased aches and pains in pregnancy, and pooled small trials found shorter labour. Lying flat on your back is best kept short later in pregnancy, and gentle Pilates can start about 4 weeks after birth if all is well. Our Pilates in pregnancy guide has the details.
The menopause usually comes between 45 and 55, and muscle and bone start to decline from about 50. Small trials found fewer menopausal symptoms with Pilates, and strength and impact work matter more now for your bones. Our Pilates for menopause guide covers this stage.
Balance and falls join strength and bone as priorities: adults over 65 are advised to do strength, balance and flexibility work on at least 2 days a week. In 110 women aged about 69, 12 weeks of Pilates improved balance confidence, sleep and mood against no exercise. Our Pilates for seniors and Pilates for balance guides cover this stage.
In healthy women, Pilates didn't change pelvic floor muscle function, and across 7 studies, Pilates and similar exercise didn't strengthen the pelvic floor unless people also did pelvic floor exercises. In a 2026 trial of women who leaked when they coughed or exercised, 6 weeks of supervised pelvic floor training cut the impact of leaking far more than Pilates did: a fall of 4.4 points on a questionnaire, against 0.7.
Reviews of other kinds of exercise, including Pilates and yoga, found results similar to pelvic floor training for leaking when you cough or exercise, and in older women both helped. These trials were small and varied.
In a Cochrane review of 63 trials, direct pelvic floor training (repeated, deliberate squeezes) improved quality of life more than exercise without squeezes, and training that adds a squeeze to body movements may be slightly better still, at low certainty. That is where Pilates fits: practising the squeeze as you move.
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In 20 women, beginner Pilates moves didn't raise the pressure inside the abdomen more than standing up from a chair did; only the roll-ups kept it high for longer. With a prolapse or leaking, the curl-ups and roll-ups are the moves to watch.
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For leaking when you cough, laugh or exercise (stress incontinence), or mixed leaking, NICE recommends at least 3 months of supervised pelvic floor training, with at least 8 squeezes 3 times a day; for a mild prolapse, at least 16 weeks. Our Pilates for the pelvic floor guide shows how.
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Across 10 studies, Pilates reduced aches and pains in pregnancy by about 2.6 points out of 10, at moderate certainty. Pooled small trials found shorter labour and less pain in labour, online Pilates eased low mood and fear of birth, and home Pilates after birth improved sleep quality.
The NHS advises avoiding lying flat on your back for more than a few minutes in later pregnancy, and POGP suggests avoiding it after 20 weeks. The American College of Obstetricians and Gynecologists suggests "modified Pilates" and says to avoid hot Pilates. POGP says gentle Pilates is safe from about 4 weeks after birth if you have no concerns about bleeding, your wound or your pelvic floor. Our Pilates in pregnancy guide has every swap.
Against no exercise, 6 to 8 weeks of Pilates lowered menopausal symptom scores in trials of 40, 30 and 74 women, though the women rated their own symptoms knowing which group they were in. Against aerobic exercise, both helped about equally. Across 11 trials, quality of life improved. All of these trials were in women after the menopause; our Pilates for menopause guide has the detail.
Across 11 trials of mind-body exercise, such as tai chi, yoga and Pilates, in 1,005 women around and after the menopause, sleep, anxiety, low mood and tiredness improved.
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Pooled trials in women after the menopause found no significant change in bone density at the spine or hip, and Pilates or yoga in 591 women showed no clear effect against no exercise. Leisure activity, including Pilates, may help keep bone density steady, but the difference from inactive women wasn't significant.
A UK consensus on osteoporosis recommends strength training at about 8 to 12 repetition maximum (a weight you can lift 8 to 12 times), building to 3 sets; about 50 moderate impacts on most days if they're safe for you; and balance and strength work, such as Pilates, at least twice a week. In 74 trials, mind-body exercise combined with resistance training did best for bone density.
In 24 trials in older adults, Pilates didn't clearly improve strength against no exercise. In women aged 60 to 80, Pilates improved hip and back strength measured in a held position, and everyday function, while resistance training gave bigger strength gains measured through movement. Heavier loads build strength best.
Strength activities "delay the natural decline in muscle mass and bone density which occurs from around 50 years of age", the UK guidelines say. Osteoporosis often causes no symptoms until a bone breaks, so build strength before you need it. Our Pilates for osteoporosis guide covers the safe swaps.
In 30 young women, 12 weeks of Pilates twice a week eased period pain and premenstrual symptoms against a waiting list, and two 2026 trials, one online, found similar results. Pilates with a messaging support programme eased premenstrual symptoms. The NHS suggests gentle exercise such as yoga, swimming or walking for period pain.
One study of 26 women with polycystic ovary syndrome (PCOS), with no comparison group, reported less period pain and more regular cycles. That is too weak to rely on; our exercise for PCOS guide covers what helps.
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We found no trial testing Pilates for "hormone balance" or matching workouts to your cycle. A 2026 review of 55 studies favoured exercise that follows how you feel over plans built around the cycle.
Start with 6 to 8 slow repetitions of each move, or 5 to 8 breaths for the breathing (our editorial starting point); the pelvic floor exercise page gives the NICE dose.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoDead bug heel tapsBeginner · No equipment
3D demoChest lift (Pilates curl-up)Beginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoBird dogBeginner · No equipment
3D demoPelvic floor exercise (Kegel)Beginner · No equipment
3D demoPelvic floor relaxation (reverse Kegel)Beginner · No equipmentTwice a week: start with the NHS's 5 slow sit-to-stands and build to 2 or 3 sets of 8 to 12 with a weight, as the UK osteoporosis consensus suggests; build heel drops towards about 50 on most days if your bones and pelvic floor allow.
Swap roll-ups, roll-downs, rolling like a ball and the teaser for head-down core work and a hip hinge with a long back: the UK consensus suggests alternatives to the Pilates roll-down and curl-up. Each move's page has its osteoporosis caution.
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Later in pregnancy, do moves that normally lie on your back propped up on pillows or on your side, and skip lying face down. Our Pilates in pregnancy guide has every swap.
Leave out moves that make you leak or feel a bulge, such as roll-ups, curl-ups and jumps, while your pelvic floor training gets going, and see a GP.
Most trials in women used 2 or 3 sessions a week of 40 to 60 minutes for 5 to 12 weeks, and quality of life after the menopause improved in more areas with 48 sessions or more. The UK guidelines ask for strength work on at least 2 days a week.
Two Pilates sessions, one or two strength sessions with weights or bands, brisk walking on most days, and pelvic floor exercises every day (our editorial starting point). In pregnancy, after birth or with osteoporosis, use our guides' versions.
The World Health Organization's guidelines, used in the US and elsewhere, ask adults for 150 to 300 minutes of moderate activity a week, plus regular muscle strengthening at every age.
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Start with the beginner workout, or the over-50 session if you don't know your bone health; add the strength or bone workout on other days, and the 5-minute pelvic floor workout every day.
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 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 30-minute Pilates strength class with dumbbells or a band: Pilates trunk work plus squats, lunges, rows and push-ups, each set taken until it is hard.
30 minIntermediate15 movesA dumbbell, A bandA 20-minute Pilates workout for your pelvic floor, built on UK pelvic health physiotherapists' booklet: squeeze as you breathe out, move, then fully release.
20 minBeginner18 movesA wall, A bench or boxA 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 Pilates workout for any trimester: seated, standing, all-fours and side-lying moves, with no lying on your back or front and no jumping.
20 minBeginner15 movesA wall, A bench or boxA gentle 25-minute routine for the first weeks after birth: pelvic floor, breathing, tummy and hip exercises on the floor, sit-to-stands and a walk.
25 minBeginner12 movesA bench or box, Cardio machineA 25-minute Pilates workout for osteoporosis and osteopenia: the Royal Osteoporosis Society's swaps for rounding moves, plus back strength and balance.
25 minBeginner16 movesA wall, A bench or boxImpact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsA gentle 20-minute routine for period pain: an easy walk, then cat-cow, cobra, supported fish, child's pose, bound angle, a twist and bridges.
20 minBeginner9 movesCardio machineStrength, cardio and bone work across the week, with a 4-week plan to build a Pilates habit.
A 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 12-week plan for women over 40: three strength days, impact for bone, cardio and recovery through the perimenopause, in a gym or at home, with a 4-day option.
3 training days45 minBeginner3 days a weekA 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 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's signs to get checked:
If period or pelvic pain is severe or worse than usual and painkillers haven't helped.
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Stop exercising and get advice if you have bleeding or fluid leaking from your vagina, regular painful contractions, tummy pain, dizziness or feeling faint, shortness of breath before you start, chest pain, a headache, muscle weakness, or calf pain or swelling (in the US, call your obstetrician). Contact your midwife or maternity unit about a change in your baby's movements, and call 999 if you think it's a life-threatening emergency, at any stage of pregnancy.
If you leak or feel a bulge during a move, stop that move and see a GP or a pelvic health physiotherapist. POGP also suggests seeing a physiotherapist if exercises hurt, or for pelvic girdle pain or a gap between your tummy muscles.
Trials in women after the menopause found no change in bone density. Bone needs strength training with weights and impact, as the UK consensus advises; Pilates helps with balance and posture alongside.
It counts as muscle strengthening, but in trials in older adults it didn't clearly improve strength, and heavier loads build strength best. Add weights or bands twice a week.
Pelvic floor training did far better than Pilates in a 2026 trial, and Pilates alone didn't strengthen the pelvic floor. NICE recommends supervised pelvic floor training first.
Across 12 studies in women, Pilates didn't change body fat, waist size or muscle mass, though weight fell a little. Muscles can't be lengthened into a new shape.
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We found no trial testing it, or testing workouts matched to your cycle; a 2026 review favoured exercise led by how you feel.
The NHS suggests gentle exercise such as yoga, swimming or walking for period pain, and small trials found Pilates eased it.
POGP says gentle Pilates is safe from about 4 weeks after birth if you have no concerns about bleeding, your wound or your pelvic floor.
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Yes, at any adult age, as part of a mix of activity. In women, trials found better flexibility, a little weight loss and better quality of life after the menopause, but no change in body fat or bone density. Pair it with strength training and brisk walking, and do your pelvic floor exercises separately.
It keeps you moving with control, builds core and hip strength, and may ease back pain and, around the menopause, symptoms and low mood. Muscle and bone start to decline from about 50, so it's a good time to add heavier strength work alongside Pilates.
Yes. Trials in women after the menopause found better quality of life, fewer menopausal symptoms and better balance, but Pilates didn't change bone density. With osteoporosis, swap deep curl-ups and roll-downs for head-down and flat-back versions, and add strength and impact work for bone if it's safe for you.
Not on its own. The NHS counts Pilates as muscle-strengthening activity, but you also need 150 minutes of moderate activity a week, and bone needs heavier loads and impact. A good week is 2 Pilates sessions, 1 or 2 strength sessions and brisk walking on most days.
Both, for different jobs. Weight training builds more strength and is what bone responds to; Pilates builds control, flexibility and core endurance. Our Pilates for strength guide shows how to make Pilates harder.
Not on its own. In a 2026 trial, pelvic floor training reduced leaking much more than Pilates did, and NICE recommends at least 3 months of supervised pelvic floor training first. See a GP about any leaking; Pilates is a good way to practise squeezing while you move once you know how.
Usually, yes, with changes. Avoid lying flat on your back for more than a few minutes later in pregnancy, and stop and get advice for bleeding, fluid leaking, contractions, dizziness or chest pain. UK pelvic health physiotherapists say gentle Pilates is safe from about 4 weeks after birth if you have no bleeding, wound or pelvic floor problems.
Yes. The NHS suggests gentle exercise for period pain, and in small trials, Pilates twice a week eased period pain and premenstrual symptoms. Ask for an urgent GP appointment or call 111 if your pain is severe and painkillers haven't helped.
There's no evidence that it does. We found no trial testing "hormone balance" or matching Pilates to your cycle, and a 2026 review favoured exercise led by how you feel. Pilates did ease menopausal and period symptoms in small trials.
Not in the way adverts suggest. Across 12 studies in women, Pilates lowered weight by about 4 kg and improved flexibility, but didn't change body fat, waist size or muscle mass. Our Pilates for weight loss guide covers what changes body composition.
Most trials used 2 or 3 sessions a week for 2 to 3 months, and quality of life after the menopause improved in more areas with 48 sessions or more. The UK guidelines ask for strength work on at least 2 days a week.
See a GP for a lump or bulge in or around your vagina, any leaking, or any bleeding after the menopause, even a small amount once. In pregnancy, follow your midwife's advice and call 999 for anything that feels life-threatening.
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.
