What changes in your 40s and early 50sStrong evidence
Periods usually change first, becoming more or less frequent, heavier or lighter, and hot flushes, poor sleep, mood changes, joint aches and weight gain around the middle are common. The NHS says symptoms usually last 7 to 9 years, sometimes longer.
Bone loss speeds up from about a year before your last period until two years after it: in a large US study of 862 women, about 7% of spine bone density was lost in that window, about 70% of the loss over ten years. In 1,246 women in the same study, the rate of fat gain doubled and lean mass dipped slightly through the transition, while weight rose slowly and steadily, by about 0.25 kg a year, with no speed-up at the menopause. In 234 Finnish women followed through the transition, muscle fell, and physical activity helped hold on to it.
Sources 16, 17, 18, 19
Strength training is the centre of the weekStrong evidence
NICE asks doctors to explain the importance of keeping muscle mass and strength through physical activity at this stage of life. Strength training improves strength, muscle size, balance and everyday function at any age, and pooled trials in women after the menopause found better function with no serious adverse events, though the evidence was low certainty.
In a 10-week trial in 31 women around 52, free-weight training twice a week raised squat and bench press strength in everyone, with no injuries; muscle grew only in the women who hadn't reached the menopause, at 6 to 8 sets a muscle a week, and the authors think more sets are needed afterwards. Women gain muscle at a similar rate to men relative to where they start. Heavier sets from week 9 build more strength.
Sources 20, 1, 21, 22, 23
Bone: what the guidelines advise, and what the trials showMixed evidence
The advice: the UK consensus on exercise for osteoporosis and the Royal Osteoporosis Society advise strength exercise on 2 to 3 days a week with a day's rest between, building to 3 sets of 8 to 12, and about 50 moderate impacts, such as jumps, skips, jogs or hops, on most days. That's guidance on what to do, not proof of what it does at 40.
Before the menopause, the trials are mixed. In pooled trials of 24 weeks or more, exercise improved hip and spine density a little (small effects of 0.34 and 0.20), and programmes mixing impact with heavy resistance did best; but a 2026 analysis found no significant effect in its two premenopausal trials, of 112 women. After the menopause, harder programmes did more for the spine across 53 trials, and supervised heavy lifting with impact raised spine density by 2.9% against a 1.2% fall in 101 women with low bone mass. So start the habit now, without expecting a big change on a scan.
Sources 24, 25, 26, 27, 28, 29, 30, 31
Train your pelvic floorStrong evidence
Leaking when you jump or lift is common: across 8 studies, about a third of female athletes reported it. It's treatable: in trials, pelvic floor training made a cure 8 times more likely in stress incontinence (56% against 6%), and NICE recommends a supervised course of at least 3 months, with at least 8 squeezes 3 times a day. This plan adds 5 minutes a day.
If you leak when you lift or jump, keep exercising, lighten or change what sets it off, and see a GP or pelvic health physiotherapist; if you feel a bulge or heaviness, get checked before heavy lifting or running.
Sources 32, 33, 34, 35
Heavy lifting and the pelvic floor: one small studyEmerging evidence
In one study of 47 young women who lifted regularly and hadn't given birth, an hour of heavy squats and deadlifts didn't change pelvic floor strength or endurance. That's one study in women unlike most women over 40, so it can't tell you how your pelvic floor will respond.
Reviews find the evidence on whether hard exercise harms the pelvic floor inconsistent, and the UK osteoporosis consensus notes that leaking can be a barrier to impact. Build the pelvic floor work first and bring impact in gradually. With a prolapse, the NHS advises avoiding heavy lifting, running and trampolining.
Sources 36, 37, 24, 38
Your heart and cardioStrong evidence
The American Heart Association describes the menopause transition as a time of rising risk to the heart and circulation, with less favourable changes in body fat, cholesterol and blood vessels. Aim for 150 minutes of moderate activity a week.
Strength training lowered resting blood pressure in women after the menopause across 60 studies, and three months of high-intensity aerobic training improved blood pressure, cholesterol and fitness just as much in women after the menopause as before it. For body fat, more minutes did a little more: in a year-long trial, 300 minutes a week cut total fat by about 1% more than 150.
Sources 39, 15, 40, 41, 42
Hot flushes: what exercise can and can't doStrong evidence
Exercise hasn't been shown to reduce hot flushes reliably: a Cochrane review of 3 trials, a UK trial of 261 women and a US trial of 248 found no difference, and the UK trial's authors say women shouldn't be told exercise will relieve them. One Swedish trial is the exception: in 58 women after the menopause, 15 weeks of strength training cut moderate to severe flushes by 44% against 2%, a difference still there at 6 months but not at 2 years.
NICE recommends hormone replacement therapy (HRT) for hot flushes, and menopause-specific cognitive behavioural therapy (CBT) as an option: talk to your GP. During sessions, light layers, a fan, a cold drink and a cool room help, and stopping to cool down is fine.
Sources 43, 44, 45, 46, 47, 20
Sleep, recovery and bad daysMixed evidence
In pooled trials in menopausal women, exercise reduced insomnia severity but didn't clearly improve overall sleep quality. Exercise in the daytime: the NHS advises no exercise in the 4 hours before bed, and the British Menopause Society suggests avoiding it just before bed. NICE suggests menopause-specific CBT for sleep problems with night sweats.
We found no trial showing that women in their 40s need more rest days. On a bad day, do the lighter-week dose or a walk rather than skipping the week.
Sources 48, 49, 50, 20
MoodEmerging evidence
Across 21 trials, exercise reduced symptoms of depression and anxiety in women in the menopause transition and after, at low as well as moderate intensity, though the trials varied a lot.
Source 51
Joint achesMixed evidence
Joint and muscle aches are a recognised menopause symptom, and they arrive at the age osteoarthritis becomes common. There's no specific treatment, and reviews encourage exercise and a healthy weight. Change the range or load of a move that hurts rather than stopping, and see our knee, hip and shoulder pain guides.
Sources 16, 52, 53
Your periodsEmerging evidence
On average, your cycle makes a trivial difference to performance, an umbrella review found no clear effect of cycle phase on strength or muscle growth, and in a 2026 trial in 24 women, timing training to cycle phases built no extra muscle or strength. In the perimenopause cycles become irregular, so go by how you feel.
Periods can get heavier approaching the menopause. See a GP if heavy periods are affecting your life: they're a common cause of iron-deficiency anaemia, which makes you tired and breathless.
Sources 54, 55, 56, 16, 57, 58
HRT doesn't change the planEmerging evidence
We found no guideline that changes these doses for people taking HRT. 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, and the NHS notes that HRT can also reduce the risk of osteoporosis. Whether to take it is a decision for you and your GP.
Sources 20, 59, 60
Food: carbohydrate, protein, calcium and vitamin DEmerging evidence
Don't cut carbohydrate when you're training more: the British Menopause Society warns that exercising on too little carbohydrate costs muscle. Protein of about 1.6 g per kg of body weight a day is enough for strength training; our protein calculator works it out.
The British Menopause Society suggests 700 mg of calcium a day, or 1,200 mg with osteopenia or osteoporosis, and a daily 10 microgram vitamin D supplement; the NHS also lists vitamin D supplements among the ways to protect your bones.
Sources 59, 61, 60
No promises about weight or shapeStrong evidence
This plan is about strength, bone, heart and how you feel. Through the transition, body fat tends to rise even when weight barely changes; no exercise burns fat from one area (in one trial, six weeks of abdominal exercises didn't reduce belly fat), and more total activity helps a little. If you want a measure, your lifts, your walking pace and how you feel are better guides than the scales.
Sources 18, 42, 62
Hard sessions and cortisolEmerging evidence
Hard exercise raises the stress hormone cortisol for a short time in everyone: in 12 men, by about 40% after 30 minutes at a moderately hard pace and 83% at a hard one. That isn't a hormonal problem. In women after the menopause, aerobic training didn't change resting cortisol, and interval training improved heart risk factors in women around the menopause. Mix harder and easier days and sleep well.
Sources 63, 64, 41
How much training this isStrong evidence
Counting direct sets in the build phase, this plan gives about 5 hard sets a week for the chest, 9 for the back, 6 for overhead pressing, 11 for the quads and 13 for the glutes and hamstrings, plus Wednesday's impact and kettlebell swings; the 4-day option gives about 6 for the chest, 15 for the back and 15 for the shoulders (presses, raises and face pulls).
More weekly sets build more muscle, with diminishing returns that arrive sooner for strength than for size. The 2026 ACSM position stand saw extra growth from about 10 or more sets per muscle a week, and a review of time-efficient training suggests about 4 hard sets a week as a reasonable floor for busy people.
That clears the 4-set floor for every muscle and reaches about 10 for the legs and back. In the trial in women around 52, 6 to 8 sets a muscle a week built strength in everyone but muscle only before the menopause, so if muscle is your goal, the 4-day option adds sets.
Sources 1, 65, 66, 8, 21
Cardio doesn't cancel your strength gainsStrong evidence
Adding cardio doesn't reduce muscle growth or maximal strength. One meta-analysis found a small blunting of lower-body strength gains from combined training in men that wasn't seen in women, a less certain finding.
Sources 67, 68
Check firstStrong evidence
Answer the Physical Activity Readiness Questionnaire (PAR-Q+) before you start. A yes to any question (a heart condition or high blood pressure, chest pain, dizziness or fainting, another long-term condition, a bone or joint problem) means checking with your GP or a qualified exercise professional first, and if you're over 45 and not used to hard efforts, check before the intervals.
With osteoporosis and a spinal fracture or several broken bones, start with the plan for women over 50 and a physiotherapist's advice, with impact kept to brisk-walking level, as the UK consensus advises. You can still get pregnant in the perimenopause: the NHS advises contraception for 2 years after your last period if you're 40 to 49, and for 1 year if you're 50 or over. If you're pregnant, follow our pregnancy plan.
Sources 69, 24, 16
Stop and get helpStrong evidence
Call 999 in the UK or 911 in the US for chest pain that feels tight, heavy or like squeezing, or spreads to your arms, neck, jaw, stomach or back; chest pain with sweating, feeling sick, light-headedness or breathlessness; severe difficulty breathing; or signs of a stroke, such as one side of the face drooping, weakness in one arm or slurred speech, even if they pass. Don't drive yourself to hospital.
Call NHS 111 (in the US, your doctor or an urgent care centre) if you're suddenly more short of breath than usual, or have chest pain with feeling sick or a heartbeat that races, skips or flutters.
Dark, red or cola-coloured urine, much less urine than usual, or very painful, weak or swollen muscles after unusually hard training can be rhabdomyolysis, a breakdown of muscle that can harm the kidneys: get medical help the same day.
Stop the session for feeling sick, dizziness, severe breathlessness, clamminess, chest tightness or any pain, as the Royal Osteoporosis Society advises.
See a GP for any bleeding from the vagina after the menopause, even a small amount or only once; bleeding between periods or after sex, or heavy periods that are affecting your life; a lump, bulge or heaviness in the vagina; any leaking; or symptoms that are hard to live with.
Sources 70, 71, 72, 73, 74, 75, 76, 57, 38, 35
How to adapt it
Our suggestions, with the evidence where there is some:
- Two days: strength A and the bone workout, plus walks; that still meets the guideline of muscle strengthening on 2 or more days a week.
- Four days: the 4-day option in the phases.
- At home: the dumbbell workouts A and B, and the bone workout with dumbbells or a kettlebell.
- Leaking with impact: pelvic floor training first, cycling or swimming for cardio for now, and impact back gradually; see a GP or pelvic health physiotherapist.
- Osteopenia or osteoporosis without fractures: the plan works, with a physiotherapist's advice before heavy lifting.
- Sore knees: a shorter squat range, a lower step and cycling for cardio; see our knee pain guides.
- Heavy or painful periods: the lighter-week dose that day, or a walk.
- Missed a week: one session at your last weights, then carry on; after two weeks off, go back to the weeks 1 to 2 doses.
Sources 15, 34