Exercise during menopause: why strength training is the best investment for your bones and muscle
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As the menopause transition begins, the rate of fat gain doubles and muscle starts to decline, even though the scale barely moves. Strength training is the tool with the most evidence for slowing this down, and it protects bone too.
The SWAN study followed women from different backgrounds for years through menopause, measuring their body composition with DXA scans. Greendale and colleagues (2019) found that, as the transition began, the rate of fat gain doubled and lean mass started to decline, and that this change lasted until about two years after the final period. The striking part: weight kept rising at the same rate as always. The scale does not see it; body composition does.
At the same time, falling oestrogen speeds up bone loss. Less muscle and less bone are exactly what strength training can slow down better than any other tool that is in your hands. This is what the evidence says and how to apply it.
What changes in the body during menopause
| What changes | What happens | What helps |
|---|---|---|
| Body fat | Is gained at twice the rate from the start of the transition (Greendale, 2019) | Strength training, daily movement and a moderate deficit if needed |
| Muscle mass | Starts to decline during the transition | Progressive strength training and enough protein |
| Bone | Mineral density falls faster, raising the risk of osteoporosis | Heavy loads and impact, adapted to your level (Beck, 2017) |
| Hot flushes | Affect most women, with very variable intensity | In one trial, strength training reduced them (Berin, 2019) |
Metabolism, on the other hand, does not collapse with age: adjusted for lean mass, energy expenditure stays stable between 20 and 60. What changes is how much muscle you have and how much you move, and that can be worked on. We explain it in how to speed up your metabolism.
Bone needs real load: the LIFTMOR trial
For years, women with weak bones were advised to avoid heavy loads for fear of fractures. The LIFTMOR trial (Watson, 2018) tested the opposite with 101 postmenopausal women with osteopenia or osteoporosis. Half of them did two supervised 30-minute sessions a week for 8 months of deadlifts, squats and overhead presses at 5 sets of 5 reps above 80-85% of their maximum, plus jumping chin-ups with drop landings to add impact. The first month was spent learning the movements with light loads.
| Measure | High-intensity strength training | Control group (gentle home exercise) |
|---|---|---|
| Lumbar spine bone density | +2.9% | -1.2% |
| Femoral neck bone density | +0.3% | -1.9% |
| Physical function tests | Improved on all of them | Smaller improvement |
| Adverse events | One minor (lower back spasm) | — |
The key is intensity. The meta-analysis by Shojaa and colleagues (2020), covering 75 studies and 5,300 postmenopausal women, found that exercise improves bone density significantly but with a small average effect, and put much of that modesty down to the fact that many programmes used insufficient loads or impact. Walking or doing very light exercises is good for you, but it is not enough for bone.
Important: the LIFTMOR participants were supervised by professionals and increased the load gradually. If you have already been diagnosed with osteoporosis or have had fractures, talk to your doctor or a physiotherapist before lifting heavy loads or doing jumps.
What the guidelines recommend
The World Health Organization (Bull, 2020) recommends muscle-strengthening activities on at least two days a week for all adults, in addition to 150-300 minutes of moderate aerobic activity. For bone, the position statement from Exercise and Sports Science Australia (Beck, 2017) goes further:
- Progressive, high-intensity strength training, adapted to each person, because bone responds to heavy loads.
- Impact exercise (jumps, landings), unless osteoarthritis or frailty rule it out.
- Balance and mobility to reduce the risk of falls, which cause most fractures.
- Avoiding loaded spinal flexion (for example, weighted sit-ups) if there is osteoporosis.
- Enough calcium and vitamin D as the foundation of any programme.
Hot flushes: a promising result
In the trial by Berin and colleagues (2019), 58 sedentary postmenopausal women with frequent hot flushes did 15 weeks of strength training, three times a week, with 8 exercises of 2 sets of 8-12 reps. Their moderate or severe hot flushes fell by 43.6%, compared with 2% in the control group. It is a single trial and needs confirming, but it is another reason to train. If your symptoms are severe, talk to your doctor about treatment options; exercise complements them, it does not replace them.
Strength routine for menopause (2-3 days)
Two or three full-body sessions a week, with at least one rest day between them. The goal is to reach, over a few months and with good technique, heavy sets of 5-8 reps on the main lifts.
| Exercise | Sets × reps (weeks 1-4) | Sets × reps (from month 2) |
|---|---|---|
| Squat (to a box, with a dumbbell or with a barbell) | 3 × 10-12, light | 3-4 × 5-8, heavy |
| Deadlift with a hex bar, or Romanian deadlift | 3 × 10-12, light | 3-4 × 5-8, heavy |
| Overhead press (dumbbells or barbell) | 3 × 10-12 | 3 × 6-8 |
| Dumbbell or cable row | 3 × 10-12 | 3 × 8-10 |
| Lunges or step-ups | 2 × 10 per leg | 3 × 8-10 per leg |
| Impact: small jumps and controlled landings | Only if not contraindicated: 2 × 10 | 3 × 10-20 |
| Balance: single-leg stance | 2 × 30 s per side | 2 × 30-45 s per side |
Warm up each session with progressive sets of the first exercise, as we explain in the RAMP warm-up. Increase the load when you complete every set at the top of the range with good technique: that is progressive overload, and it is what keeps the body adapting.
Protein and nutrition
Muscle is built with training and protein. The PROT-AGE group (Bauer, 2013) recommends at least 1.0-1.2 g of protein per kilo of body weight per day for people over 65, and 1.2 g/kg or more for those who exercise. These figures were designed for older people, but they point the way: with age you need more protein, not less. Work out yours with the protein calculator and read how much protein you need per day.
If you also want to lose fat, keep the deficit moderate and keep lifting: that is how you make sure what you lose is fat and not muscle. We cover it in losing fat without losing muscle.
Measure what matters, not just weight
As the SWAN study shows, your weight can stay put while you swap fat for muscle or the other way round. Better indicators: waist circumference, your strength on your exercises (log it every week), how your clothes fit and, if possible, a bone density scan when your doctor recommends it. There is more on body fat in body fat percentage.
Common mistakes
- Sticking with very light weights forever. They are perfect for learning, but bone needs loads that are a real challenge.
- Doing only cardio. It is good for the heart, but it does not slow muscle and bone loss the way strength training does.
- Very restrictive diets. They speed up the loss of lean mass just when it is hardest to keep.
- Thinking it is too late. In LIFTMOR the average age was 65, and bone and physical function improved.
If you still have cycles, you may be interested in how the menstrual cycle affects training, and if you are looking for a general plan from a certain age, the routine for over-40s. The Progrevia generator builds a strength routine tailored to your level, your equipment and your available days, and takes into account any injuries you tell it about.
- Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865.
- Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research. 2018;33(2):211-220.
- Shojaa M, von Stengel S, Schoene D, Kohl M, Barone G, Bragonzoni L, et al. Effect of exercise training on bone mineral density in post-menopausal women: a systematic review and meta-analysis of intervention studies. Frontiers in Physiology. 2020;11:652.
- Beck BR, Daly RM, Singh MA, Taaffe DR. Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. Journal of Science and Medicine in Sport. 2017;20(5):438-445.
- Berin E, Hammar M, Lindblom H, Lindh-Åstrand L, Rubér M, Spetz Holm AC. Resistance training for hot flushes in postmenopausal women: a randomised controlled trial. Maturitas. 2019;126:55-60.
- Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. Journal of the American Medical Directors Association. 2013;14(8):542-559.
- Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine. 2020;54(24):1451-1462.
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Frequently asked questions
What is the best exercise during menopause?
Progressive strength training, combined with some impact and balance work. It does the most to preserve muscle and bone. The WHO recommends muscle strengthening on at least two days a week, in addition to aerobic activity.
Is it safe to lift heavy weights if I have osteopenia?
In the LIFTMOR trial, 101 postmenopausal women with osteopenia or osteoporosis trained above 80-85% of their maximum, supervised and with gradual progression, and there was only one minor adverse event. If you have osteoporosis or previous fractures, check with your doctor or physiotherapist first.
Does exercise reduce hot flushes?
A 2019 trial (Berin) found that 15 weeks of strength training, three days a week, reduced moderate or severe hot flushes by 43.6%, compared with 2% in the control group. It is a promising result that still needs confirming with more studies.
Why am I gaining weight during menopause if I eat the same?
According to the SWAN study (Greendale, 2019), as the transition begins fat is gained at twice the rate and lean mass is lost, even though weight rises as before. Strength training, moving more each day and eating enough protein help counter it.
How much protein do I need during menopause?
The recommendations for people over 65 (PROT-AGE) are at least 1.0-1.2 g per kilo per day, and 1.2 g/kg or more if you train. The Progrevia protein calculator gives you a figure based on your weight and your goal.
Informational content based on the available scientific evidence: it does not replace advice from a healthcare professional. If you have an injury or a medical condition, or are pregnant, check with one before changing your training or diet.
