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Feeling low on energy? Struggling to build muscle? Results hitting a plateau? We asked women’s health gurus how we can adapt our workouts for these hormonal changes
Summary
1How are my hormones changing during perimenopause
In the months and years leading up to menopause, oestrogen and progesterone fluctuate much more erratically as they begin to decline...
2Does stress play a role during perimenopause?
Alongside oestrogen and progesterone, the stress hormone cortisol can have a big impact on the way we respond to fitness during perimenopause...
3How should I exercise during perimenopause then?
When your results randomly start to plateau, it’s easy to panic and think you need to run further, sweat harder or throw yourself into...
Google ‘menopause exercise’ and you’ll be faced with millions of results detailing the endless ways you can tweak your training to support your changing hormones, from Gwyneth Paltrow-approved kegel exercises to cortisol-releasing rage workouts.
It can be overwhelming to say the least. How do you know which ones work? Which advice is based on outdated science? And, more importantly, are you at risk of making your symptoms worse?
If you’re currently in the thick of perimenopause and you feel like your body isn’t adapting to exercise in the way that it used to, we’ve consulted with renowned perimenopause experts Dr Emma Ross and Baz Moffat of The Well HQ to create your no-nonsense training guide. Here’s everything you need to know.
How are my hormones changing during perimenopause?
In the months and years leading up to menopause, oestrogen and progesterone fluctuate much more erratically as they begin to decline in the lead-up to menopause, which is when your periods and ovulation stop. This transitional time is called: perimenopause.
“Rather than oestrogen leaving the scene swiftly, it can take years to level out, with both progesterone and oestrogen fluctuating dramatically on their way down,” says Dr Ross, consultant physiologist.
This unpredictable pattern gives rise to the classic perimenopause symptoms, such as anxiety, night sweats and brain fog. However, one massively overlooked aspect is the effect it can have on your fitness, as well as how your body responds to exercise.
As your hormone levels peak and crash, it’s common to notice shifts in your energy levels, endurance, muscle recovery time and performance metrics. With all this going on, it’s no surprise that your motivation can take a dive too.
Does stress play a role too?
Alongside oestrogen and progesterone, the stress hormone cortisol can have a big impact on the way we respond to fitness during perimenopause.
During these years, we’re already naturally sitting in a higher state of stress due to a decline of the female reproductive hormones. For many midlife women, we’re also at the peak of our careers and in the thick of juggling family responsibilities, all of which can add to the invisible mental load. In turn, the body’s natural stress response is to produce extra cortisol.1
Without smart strategies to keep it in check, this stress can lead to increased fat storage, a breakdown of muscle tissue3 and higher levels of fatigue, and it risks tipping us over into mental burnout too.
"Every woman should strength train during perimenopause"
How should I exercise during perimenopause then?
When your results randomly start to plateau, it’s easy to panic and think you need to run further, sweat harder or throw yourself into endless rounds of burpees and crunches. But because your hormones and body have changed, it makes sense that your approach to fitness needs a rethink too.
According to Baz, a women's health and fitness coach, training smarter and not harder is the way forward. “Rather than burning yourself out with back-to-back cardio sessions and restrictive dieting, women often see better results if they dial things down with quality strength training sessions and a bigger focus on recovery.
“There’s two big benefits to this,” she continues, “it avoids loading extra cortisol into the system that can hinder fitness results, and it also changes your body composition, maintaining a leaner balance between muscle and fat mass.”
Here, she shares her top perimenopause fitness tips:
1) Aim for 2 to 3 strength sessions per week
If you take away one thing today, let it be this: resistance training is incredibly beneficial during perimenopause.
As we age, muscle mass decreases by 3-8% per decade over the age of 30,1 and this accelerates as oestrogen drops. "Every woman should strength train during perimenopause," says Moffat. "Studies show that shifting your focus from cardio to weights can slow muscle and bone loss." Not only does this boost strength and reduce injury risk, but it also helps build a lean physique that many women mistakenly turn to crash dieting to achieve.
Having more muscle can work wonders for firing up your metabolism too. The thinking is that the more muscle you have, the higher your resting metabolic rate (RMR),2 which is the number of calories your body burns at rest.
To make strength training effective, focus on progressive overload - gradually increasing the weight in your workouts. And remember, if you’re a gym newbie then remember to start slow and grow your strength with the support of the gym staff or a beginner’s class.
“Prioritise big, compound movements like squats, deadlifts, and leg presses that work multiple muscle groups at once,” Moffat recommends.
2) Don’t neglect cardio
While you need to shift a good proportion of your workouts to the weights room, aerobic exercise should still have a place in your fitness routine. While it’s often thought to be a men's health issue, women are at an increased risk of cardiovascular disease as they age, as studies have found that the risk of heart attack is five times higher4 post-menopause than it is before.
Brisk walking, cycling, jogging and stair climbing are all great choices for boosting your heart rate to 50 to 70% of its maximum capacity - the sweet spot for working your cardiovascular strength without pushing it too hard.
3) Dial down the intensity
When you're testing your fitness limits - whether through intense HIIT sessions, an all-out boxing class, or sprinting at the local ParkRun - it's vital to give your body the time it needs to unwind and recover, both physically and hormonally, to avoid putting extra stress on your system.
“If you’ve just finished a workout at home, instead of jumping straight back on your laptop to get back to work, try adding a few minutes of gentle stretching or breathwork to help your body shift into recovery mode. After a gym session, you could go for a gentle swim or walk home rather than jumping straight onto public transport,” says Baz. “The goal is to gradually bring your system back down after jacking it up during exercise.”
4) Time your training
For the all-too-common sleep disturbances that crop up during perimenopause, timing your training can make a big difference to your ability to drift off peacefully.
“Training too late in the evening can spike cortisol and adrenaline, which might add to your struggles with falling asleep later on,” warns Moffat. “Likewise, if you’ve had a rough night with very little kip, it could be better to skip the 6am run and rest up instead.”
The key takeaway here? Stay flexible. Timing for your workout schedule can help regulate your circadian rhythm, and a midday training session might become your new favourite way to reap the benefits of exercise without sabotaging your sleep.
“Hormonal changes, particularly reduced oestrogen, can impact muscle recovery”
5) Schedule rest days (and stick to them)
Because we’re more prone to injury and stress during perimenopause, it’s important to schedule longer and more frequent recovery periods.
“In your 20s and 30s, you might have managed back-to-back runs with ease, but as you age, sustaining that intensity becomes tougher,” notes Moffat. “Hormonal changes, particularly reduced oestrogen, can impact muscle recovery, so you’ll need more frequent rest days to let your muscles repair.”
Active recovery, a type of movement-focused rest, can help to reduce the post-exercise aches and pains that can ramp up during perimenopause. Try incorporating activities like yoga, walking or gentle Pilates into your routine, and leave at least 48 hours of downtime between big energy sessions.
6) Fuel your body
Protein-rich foods become more of a biggie during perimenopause, when we’re aiming to maintain our muscle mass.
Not sure how much you should be eating? A 2024 review5 estimated we should consume roughly 0.8-1.2g per kilogram of body weight daily, with at least half coming from plant-based sources like beans, lentils, tofu, nuts, seeds and whole grains. So, if you weigh 70kg, that’s around 56-84g of protein each day.
Elsewhere, healthy fats and complex carbohydrates are great for overall wellbeing while omega-3 fatty acids, found in fish and flaxseeds, are another good addition to your diet.
7) Limit the post-work glass of wine
Many mid-life women, juggling stressful jobs and busy schedules, often reach for a glass of wine in the evening. “I’m not suggesting you quit entirely,” says Moffat. “But it’s helpful to monitor your symptoms in relation to your nightly glass or two.”
Since perimenopause puts you in a heightened inflammatory state, even one glass of wine could exacerbate symptoms and disrupt sleep. And that restless night can ripple out, affecting your exercise routine, dietary choices and even how much caffeine you need the next day.
8) Incorporate pelvic floor work
The vagina is packed with oestrogen receptors, and as levels drop, many women start to notice unwelcome changes like vaginal dryness and atrophy. These issues can then spill over into lots of other parts of life, including comfort and confidence with exercise.
Moffat’s solution? For countering atrophy, make pelvic floor exercises as routine as your warm-up. “Every workout should include a couple of minutes dedicated to strengthening the muscles that support the bladder, uterus and bowels,” she suggests.6
“Not because you’ve already run into an issue, but as an insurance policy against urinary incontinence and other issues down there.” The Squeezy app has guided exercises if you’re not sure where to start.
9) Brain fog
Misplacing your gym kit, losing your locker key and difficulty focusing is common during perimenopause, when brain fog is on the rise.
“When you link brain training skills with physical exercise, the benefits are twofold, working your cognitive and physical fitness at the same time,” says Moffat. “Sports that require you to think on your feet, like boxing, netball and indoor climbing challenge your hand-eye coordination, helping you to stay sharp as a tack.”
10) Hydration
How many glasses of water have you drunk today? If the answer is woefully few, here’s a compelling reason to top up your reusable bottle: menopausal symptoms like hot flushes and night sweats can cause us to lose more fluid than usual, putting us at greater risk of dehydration.
With the potential to make symptoms like headaches, tiredness, dizziness and irritability worse, hydration is a key part of the training puzzle.
“Staying hydrated can also bring cortisol levels down in the body, so drinking ample amounts of water before, during and after a heavy training effort is all part of a wider strategy to manage stress in the body,” says Moffat.
The final say
The great news is that when you understand what’s happening to your body during perimenopause, you can tailor your movement to work with these changes, rather than against them.
By making just a few smart adjustments to your training, you can transform how exercise feels and achieve powerful, effective results at the same time.
- Thau L, Gandhi J, Sharma S. Physiology, cortisol [Internet]. National Library of Medicine. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538239/
- Aristizabal JC, Freidenreich DJ, Volk BM, Kupchak BR, Saenz C, Maresh CM, et al. Effect of resistance training on resting metabolic rate and its estimation by a dual-energy X-ray absorptiometry metabolic map. European Journal of Clinical Nutrition. 2014 Oct 8;69(7):831–6.
- Katsuhara S, Yokomoto-Umakoshi M, Umakoshi H, Matsuda Y, Iwahashi N, Kaneko H, et al. Impact of Cortisol on Reduction in Muscle Strength and Mass: A Mendelian Randomization Study. The Journal of Clinical Endocrinology & Metabolism. 2021 Nov 28;107(4):e1477–87.
- Boardman HM, Hartley L, Eisinga A, Main C, Roqué i Figuls M, Bonfill Cosp X, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database of Systematic Reviews. 2015 Mar 10;(3).
- Erdélyi A, Pálfi E, Tűű L, Nas K, Szűcs Z, Török M, et al. The Importance of Nutrition in Menopause and Perimenopause—A Review. Nutrients [Internet]. 2024 Jan 1;16(1):27. Available from: https://www.mdpi.com/2072-6643/16/1/27
- Mercier J, Morin M, Lemieux MC, Reichetzer B, Khalifé S, Dumoulin C. Pelvic floor muscles training to reduce symptoms and signs of vulvovaginal atrophy. Menopause. 2016 Jul;23(7):816–20.
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