How to Optimise Exercise and Lifestyle Through Menopause and Perimenopause – Part 2
- Jun 1
- 11 min read
Written by Dan Raynham, The Fitness Scientists
Dan Raynham is a leading innovator of biohacking, peak fitness, and age reversal. He is the founder of The Fitness Scientists, the world's only measurable wellbeing system. His latest passion project, "The Biohacking Handbook," is a TV show that aims to democratize peak health, combining his background in science and the arts.
Obviously, any form of exercise activity will have a positive effect on anyone in perimenopause, menopause, or at any stage of life. Most exercise studies have focused on early menopause or postmenopause, however, in the last two years, a few studies have emerged specifically for perimenopause. In general, the optimum exercise is much the same for both, but even more intense and “jumpy” for perimenopause. If you missed the first part of this series, you can read Part 1 here, where we explore the foundations of perimenopause and menopause.
Optimised training
Most of the research shows the best training for menopause is basically the same as for overall health in the general population. Timed sequences encompassing resistance, cardio, and plyometrics that cover all bases can have an effect on imbalances caused by menopause. The main thing to be mindful of during menopause is not overdoing it and getting good, solid rest and sleep. With perimenopause, train harder and faster! Check with your doctor if you have heart problems, osteoporosis, or any other underlying condition, or if you have never done advanced training before. Start slowly.
The basic 3
Resistance training: Helps maintain muscle mass and strength. Supports bone, ligament, and tendon health through weight-bearing exercises like squats and lunges. Improves insulin sensitivity.
Cardio: High-intensity training can be beneficial for cardiovascular health, fat loss, increasing estrogen levels, and improving insulin sensitivity. Moderate-intensity cardio, for example, brisk walking, also supports overall health, but it is not enough to combat perimenopause and menopause.
Plyometrics: Plyometrics can be especially useful during perimenopause and menopause for bones, muscle power, and fall prevention. It is the “high-impact” piece that is often missing from walking, yoga, and the usual inadequate prescribed activities. It is one of the few exercises with direct “osteogenic” loading, which can increase bone density. Pair it with resistance training for best results.
Bone mineral density, a big win
Postmenopausal women lose 1 to 2% bone mass density, BMD, per year, mostly in the first 5 to 10 years. High-impact jumping directly loads the hip and spine to slow or reverse that.
Jumping works best before menopause to build density. After menopause, it mainly prevents loss. Power training and jumping have been shown to be more effective than slow strength training for maintaining BMD at the lumbar spine and total hip in postmenopausal women.
Muscle power and function
Menopause causes fast-twitch muscle fibre loss, which equals less power and worse balance. Plyometrics are “power training” by definition, and they increase those fast-twitch muscle fibres.
Body composition
Meta-analyses show exercise increases fat-free mass in postmenopausal women. Plyometrics alone, or combined with resistance training, can boost lean mass in just a few months. [5] [6] [7] [8] [9]
Caveats and how to do it safely
It is dose-dependent. More is not always better, and tendons take longer to adapt after menopause. Shorter, intense, optimised exercise could be best.
Landings matter. Barefoot on hard surfaces was used in many studies to maximise impact. But start on forgiving surfaces if you have joint issues or feel nervous.
Build to it. If you have osteoporosis, prolapse, or incontinence, do not start with max jumps. Work with a professional if possible.
Combine with resistance training. Best bone density results appear to come from mixed training, for example, weight-bearing jumps and dynamic resistance training.
Menopause limits gains. Postmenopausal women do not gain BMD as easily as premenopausal women. Expect maintenance or small increases, not big jumps. Still, it is massively worth it. You are fighting 1 to 2% annual loss. You could stop this in its tracks.
What science exists for perimenopause-specific training?
There has been a key 2024 to 2025 shift acknowledging that perimenopause behaves differently from menopause. Most pre-2023 studies used postmenopausal women. But perimenopause has those wild estradiol swings, so the response to exercise is different.
What is different from general health guidelines?
General adult guideline, GPs and health services | Perimenopause-specific tweaks, from studies |
150 minutes of moderate cardio. | Add 1 to 2 HIIT sessions. E2 swings impair fat oxidation, and interval training restores it. |
Two light resistance training sessions per week. | Go heavier and harder. Perimenopausal women need a higher mechanical load to stimulate muscle due to anabolic resistance. |
Walking is enough for bones. | Not in perimenopause, or anywhere! You need impact, such as jumps, hops, jumping push-ups, and stomping. 50 to 100 impacts, three times per week, prevents perimenopausal bone loss. |
Flexibility, yoga, and stretching. | Maybe good for stress, but it does not touch VMS, lean mass, or strength. It cannot be the main plan. It will achieve almost nothing. |
Mechanisms experts are targeting
Anabolic resistance: Fluctuating estradiol makes muscle less responsive to protein and normal loads. The solution is heavier weights and body-weight training.
Thermoregulation: HIIT resets the hypothalamic thermoneutral zone. Steady cardio does not.
Insulin resistance: The perimenopausal belly fat shift responds better to sprints and weights than walking, yoga, or Pilates.
Bone: Impact loading, such as jumping, requires 3 to 4 times body weight. Walking equals 1 times body weight. Hence, jump training wins in perimenopause.
The knowledge most people and NHS and GP services are lacking
“Lift weights” is not optional. It is the primary intervention for perimenopausal body composition and VMS.
Jump training is safe if you build up. 40% of bone loss across menopause happens in late perimenopause. Impact now matters more than postmenopause. [10]
HRT and exercise: A winning combo?
HRT experiences vary, but if it works for you, great! Exercise and healthy living can achieve similar benefits, and combining them with HRT seems to be the best approach for some people. Medications often have costs or side effects, but exercise and healthy living can create fitter humans, with very few downsides!
When it comes to managing menopause symptoms and improving overall health, there are several approaches to consider, fitness alone, fitness combined with hormone replacement therapy, HRT, or HRT alone. Here is a breakdown of what some of the science says:
Fitness alone: Exercise is a great way to manage menopause symptoms, improve bone density, and reduce cardiovascular risk. Weight bearing and resistance training exercises are particularly effective in maintaining bone health and muscle mass.
HRT alone: HRT can be effective in managing menopause symptoms, improving bone density, and reducing cardiovascular risk when initiated in women under 60 or within 10 years of menopause. However, HRT may not be suitable for everyone, and its benefits can vary depending on individual health factors. As with all medications, there are always possible side effects.
Fitness and HRT combined: Combining HRT with exercise may offer the best of both worlds. HRT can help alleviate symptoms, while exercise can enhance cardiovascular benefits, improve muscle mass, and support bone health. Research suggests that HRT combined with exercise can lead to greater improvements in bone density and muscle function compared to either approach alone.
Key considerations
Timing is everything: HRT is most effective when initiated in women under 60 or within 10 years of menopause.
Individualised approach: HRT and exercise plans should initially be tailored to each woman’s specific needs and health status, ultimately leading to a uniform peak fitness programme.
Risks and benefits: Weigh the potential benefits of HRT against individual risk factors, such as blood clots or breast cancer.
Ultimately, the best approach depends on your unique life situation, health goals, and preferences. If an individual can find success purely with exercise, this should, in my opinion, always be favoured. [11] [12]
Diet, supplements, and menopause: Let’s bust some myths
The biggest drivers of health are exercise quality first, total food intake second, and specific food choices third. Still, it is worth checking the evidence on food types to stop people from wasting time and money on supplements. Eat food you enjoy, not because you expect a miracle cure. Put more energy into training than into obsessing over diet details. If you are gaining fat, the main lever is eating less overall. You absolutely do not need to spend money on anything fancy. Most, if not all of it, is a money making con.
Menopause diet myths
Myth: Menopause weight gain is inevitable. Hormonal changes play a role, but diet, volume of calories, and exercise are huge factors. You can manage weight with healthy habits.
Myth: Red wine helps with menopause. Just no.
Myth: Caffeine worsens hot flashes for everyone. Some women may be sensitive. Try reducing caffeine or switching to herbal teas if it triggers symptoms.
Myth: Menopause means you need more protein. Protein needs do not drastically change.
Supplements are a waste of time and money
Calcium and vitamin D: Essential for bone health, but supplements are not always necessary. Get calcium from dairy, leafy greens, and fortified plant milk. Get vitamin D from sunlight, fatty fish, and supplements if needed.
Phytoestrogens: Plant based oestrogens in soy, flaxseeds, and legumes may help with hot flashes, but evidence is mixed. Whole foods are better than supplements.
Omega 3s: Anti inflammatory benefits are found in fatty fish, flaxseeds, and walnuts. Supplements may help with hot flashes, but food sources are preferred.
Herbal supplements: Black cohosh, red clover, and evening primrose oil are popular, but evidence is very limited. Avoid relying on them as a primary solution.[13] [14]
Mental health during menopause and perimenopause
Yes, menopause can hit mental health hard, but there is solid science on what actually helps. The drop in oestrogen and progesterone directly affects serotonin, norepinephrine, dopamine, and GABA systems, while sleep disruption and hot flashes can make things worse. About 15 to 50% of peri and postmenopausal women report anxiety, depression, or insomnia.
1. Exercise: strongest non drug evidence
Exercise cuts depressive symptoms significantly in menopausal women. What type works best, based on the SUCRA ranking system:
Aerobic exercise ranked number one for depression: SUCRA 78.7%.
Multi mode and resistance training nearly tied: SUCRA 78.1%.
Mind body exercises, including yoga, Pilates, tai chi, and qigong: SUCRA 45.4%.
Exercise also improves anxiety, sleep quality, and fatigue.
2. Cognitive behavioural therapy, CBT: Best psychological tool
CBT appears effective in reducing negative moods in group settings for menopausal women. It can also improve vasomotor symptoms, sexual dysfunction, and recurrent depression after 24 weeks of treatment.
Why it helps: Menopause disrupts emotional regulation circuits. CBT gives coping strategies for hot flashes, sleep, and catastrophic thinking about symptoms. It addresses the “straw that breaks the camel’s back” effect, midlife stress, hormones, and role changes.
3. Mind body therapies
Mindfulness, music therapy, dance therapy, and Reiki showed greater psychological benefits than yoga and qigong for sleep, depression, and anxiety. Overall, mind body therapies gave moderate to large effects.
4. Hormone therapy and antidepressants: When appropriate
Oestrogen has neuromodulatory effects. Transdermal estradiol, 0.1 mg per day, gave 68% remission versus 20% placebo for perimenopausal depressive symptoms. It works best in perimenopause, before prolonged hypoestrogenism. For women with depression and hot flashes, SNRIs such as venlafaxine are often considered.
5. Sleep and stress targeting
Perceived stress was the only factor linked to memory complaints. Poor sleep, daytime hot flashes, and night sweats all drive anxiety and depression. So treating VMS and sleep often lifts mood.
Key risk windows and who is vulnerable
Late perimenopause shows spikes in depression, tied to hormone variability and psychosocial factors. Studies have identified an increase in suicide risk among women of perimenopausal age. Previous major depressive disorder, MDD, is the biggest predictor of MDD during menopause. Women with previously diagnosed mood disorders are at higher risk. Severe VMS, a long transition, poor sleep, and life stressors equal higher risk. Social support drops in early perimenopause. Psychosocial factors are a recognised risk factor.[15] [16] [17] [18]
Important reality check
There is no compelling evidence that menopause universally raises the risk of depression or MDD. Many women do not get mood disorders. But if you do, it is real, in no small part because of fluctuating estradiol and progesterone affecting brain chemistry, inflammation, and neurotrophic factors. Misattributing all distress to “just menopause” can delay treatment. The biopsychosocial model works best, hormones, therapy, lifestyle, and social support. I cannot stress this enough, social support! That includes you, men!
In conclusion
Perimenopause and menopause are not a steady decline. They are chaos first, then a new baseline. The research is finally catching up to what women have known for decades, the old “gentle walking, yoga, and rest” script does not cut it.
The data is clear. Heavy resistance training, HIIT, and impact work are not extreme. They are the minimum effective dose to offset anabolic resistance, bone loss, and metabolic shifts. Food quality matters, but total calories and training quality drive results. Supplements will not save you. Jumping squats might.
This is not just women’s business. Partners, GPs, trainers, and health services need to update their playbook. We have ignored female physiology for too long, and the cost is fractures, depression, and preventable decline.
So here is the ask, start lifting heavy in your 30s. Jump before your bones demand it. Talk to your daughters, your patients, and your mates. Menopause prep should start 20 years before the final period, not 20 minutes after hot flashes begin.
The myths are busted. The neglect is ending. Exercise is not optional medicine for this transition. It is the foundation. HRT can help, therapy can help, but you still have to do the reps. Evidence based protocols now exist. The next step is implementation across healthcare and fitness. That starts with education, today. This transition is tough, but you are not powerless. With the right tools, community, and barbell, you come out stronger. Literally.
Your body is not broken. The advice was. Now we fix it.
I have received no sponsorship or payment for this article. There are no conflicts of interest.
Read more from Dan Raynham
Dan Raynham, The Fitness Scientists
Dan Raynham is a science-driven biohacker who believes that everyone should have access to optimal health. As a child, he suffered poor health, and didn't start exercising until his 30s. Now, at 51, he is an elite athlete who outperforms teens to 20s and professional athletes. Over the course of 20 years, he has honed a ground-breaking system that activates the body into peak fitness and age reversal. It works at a cell and molecular level in an incredible display of biochemistry. An ardent supporter of science-led, compassionate health and mythbusting, his company, The Fitness Scientists, offers the first and only data-driven wellbeing plan in the world.
References:
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[6] von Stengel S, Kemmler W, Kalender WA, Engelke K, Lauber D. Differential effects of strength versus power training on bone mineral density in postmenopausal women: a 2-year longitudinal study. Br J Sports Med. 2007;41(10):649-655. doi:10.1136/bjsm.2006.033480
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[9] Khalafi M, et al. The effects of exercise training on body composition in postmenopausal women: a systematic review and meta-analysis. Front. Endocrinol. 14:1183765. doi:10.3389/fendo.2023.1183765
[10] Hao S, Tan S, Li J, et al. Dietary and Exercise Interventions for Perimenopausal Women: A Health Status Impact Study. Front. Nutr. 8:752500. doi:10.3389/fnut.2021.752500
[11] Sánchez-Delgado JC, et al. Combined effect of physical exercise and hormone replacement therapy on cardiovascular and metabolic health in postmenopausal women. Braz J Med Biol Res. 2023;56:e12241. doi:10.1590/1414-431X2023e12241
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[13] health.harvard.edu — womens-health/menopause-supplements-effective-relief-or-empty-promises
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