Exercise in Perimenopause: A Physiotherapist’s Guide to Staying Strong

If you’re in your 40s or early 50s and noticing that your body feels different during exercise — more fatigue, slower recovery, or changes in your strength and weight — you’re not imagining things. Perimenopause, the transition period leading up to menopause, brings real hormonal shifts that affect your muscles, bones, and overall fitness. The good news? The right kind of exercise can make an enormous difference. Here’s what a physiotherapist wants you to know.

What Happens to Your Body During Perimenopause?

Perimenopause typically begins in the mid-to-late 40s, though it can start earlier. As estrogen levels fluctuate and gradually decline, several physical changes occur that directly affect how your body responds to movement and exercise:

• Muscle mass decreases more rapidly (a process called sarcopenia)
• Bone density starts to drop, increasing fracture risk
• Joint laxity may increase, making you more prone to sprains and instability
• Recovery time lengthens, meaning your body needs more time between intense sessions
• Body composition shifts, with fat redistributing toward the abdomen

These changes aren’t inevitable consequences you simply have to accept — they’re signals that your exercise routine may need to evolve. For a deeper look at how menopause affects your body and what support is available, visit our menopause condition page.

Why Resistance Training Matters Most

Of all the types of exercise you can do during perimenopause, resistance training — also called strength training or weight-bearing exercise — is the most important. This is backed by strong research showing that lifting weights or working against resistance helps preserve both muscle and bone density during hormonal transition.

A study published in PMC examining resistance training in postmenopausal women found that progressive resistance exercise significantly improved muscle strength, lean mass, and bone mineral density — all areas that are vulnerable during and after perimenopause.

What Does Resistance Training Look Like?

You don’t need to become a competitive weightlifter. Effective resistance training for women over 40 can include:

• Free weights (dumbbells or barbells)
• Resistance bands
• Bodyweight exercises like squats, lunges, and push-ups
• Weight machines at a gym
• Pilates reformer work

Aim for two to three sessions per week, targeting major muscle groups — legs, hips, back, core, and upper body. Start with a manageable load and gradually increase the challenge as you get stronger.

Don’t Forget About Bone Health

Bone loss accelerates significantly during perimenopause and the years following. Osteoporosis — brittle, fragile bones — becomes a real concern for women in this stage of life. The encouraging news is that weight-bearing exercise is one of the most effective ways to slow bone loss and even build bone density.

Weight-bearing activities that benefit bone health include:

• Walking (especially brisk walking on varied terrain)
• Hiking
• Dancing
• Tennis and racquet sports
• Resistance training (yes, it counts here too)

Research published on PubMed examining exercise interventions and bone density in perimenopausal women supports combining resistance and impact-based activities for the best bone health outcomes.

How a Physiotherapist Can Help

Many women in perimenopause exercise regularly but may unknowingly be using a routine that no longer matches their body’s needs. A physiotherapist can assess your movement patterns, identify any muscle imbalances or joint issues, and design a program specifically suited to where you are in your hormonal journey.

Common Issues a Physio Can Address

• Pelvic floor changes — hormonal shifts can affect bladder control and pelvic stability, which matters during exercise
• Joint pain or stiffness — especially in the hips, knees, and shoulders
• Poor movement mechanics — which can lead to injury if not corrected before loading up with weights
• Returning to exercise after a break — perimenopause is a common time to restart fitness routines, and doing so safely is key

Our team at Wellness Place is experienced in supporting women through every stage of life. If you’re looking for guidance on exercise in perimenopause from a qualified professional, our physiotherapy services are a great place to start.

Practical Tips to Get Started

If you’re new to resistance training or returning after time away, here are a few simple guidelines:

1. Start slow and build gradually — two sessions per week is a solid beginning
2. Prioritize form over load — proper technique protects your joints and gets better results
3. Include rest days — recovery is part of the process, not a weakness
4. Combine strength with movement — add walking, yoga, or swimming for a well-rounded routine
5. Listen to your body — discomfort that lingers more than a day or two is worth discussing with a physio

Perimenopause doesn’t have to mean slowing down. With the right approach, this phase of life can be when you build your strongest, most resilient body yet. If you’re unsure where to begin or want a personalized plan, reach out to our team — we’re here to help you move well at every age.