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Strength training in perimenopause: why it matters and how to start

By the HerShape team · Last updated October 8, 2026 · 9 min read

Strength training is worth making a priority in perimenopause. Bone and muscle loss speed up around the menopause transition, and lifting weights that slowly get heavier works on both at once. Two or three full-body sessions a week is a sensible start, even if you've never lifted before, though the research done in perimenopause itself is still thin.

What changes in perimenopause

Perimenopause is the run-up to your final period, and the NHS says a change to your periods is usually one of the first signs. It also lists sleep problems, muscle aches and joint pains, and loss of bone density among the symptoms. For training, the changes to bone and muscle matter most.

Bone loss speeds up

The Study of Women's Health Across the Nation (SWAN) followed 862 women in the US with yearly bone scans as they went through menopause. Bone loss at the lower spine and hip began about a year before the final period and slowed, without stopping, about two years after it.

In that three-year window, women lost about 7% of their lower spine bone density on average, and about 6% at the hip, measured at the top of the thigh bone. Over the full 10 years the study covered, spine losses added up to about 10.6%. A large share of the bone you lose around menopause goes in a few years, and those years start before your periods stop.

Muscle slips too

A Finnish study called ERMA followed 234 women aged 47 to 55 from perimenopause into early postmenopause, about 15 months on average. Every measure of lean mass and thigh muscle size went down, by 0.5% to 1.5%. Leg lean mass, for example, dropped about 1.5%.

The numbers are small, and the study was observational, so it can't prove that hormone changes caused the loss. But it's a steady drift in just over a year. More active women held on to more muscle, and the authors concluded that staying active matters for lowering the risk of age-related muscle loss later.

What the research shows about lifting

Here's the honest part: very few exercise trials have been done in women going through the transition.

A 2025 systematic review in the journal Bone looked for randomized trials in women aged 45 to 60 who were in perimenopause or early postmenopause. It found only six: two in perimenopause and four in early postmenopause. All six were rated low quality with a high risk of bias.

In perimenopause, strength training, endurance training and tai chi didn't improve bone density or lean mass in the two trials.
In early postmenopause, strength training and walking did help. Strength training improved bone density at every site measured, though not every strength study improved lean mass.

The authors concluded that it's still unclear which type of training works best during the transition, and called for longer trials. Two small perimenopause studies can't settle that either way. Most of the case for lifting at this stage comes from women just past menopause and older, which is close but not a perfect match.

Heavy lifting can be safe with good supervision

Heavy lifting has traditionally been discouraged for people with low bone density. The LIFTMOR trial tested whether that caution was needed. It enrolled 101 postmenopausal women, average age 65, with low bone mass. Half did supervised 30-minute sessions twice a week for 8 months: heavy lifts of 5 sets of 5 reps at more than 85% of the most they could lift once, plus impact training. The other half did a light home exercise program.

After 8 months:

Lower spine bone density rose 2.9% in the lifting group and fell 1.2% in the home group.
Hip bone density rose 0.3% in the lifting group and fell 1.9% in the home group.
The lifting group did better on every physical test, including a timed get-up-and-walk test, reaching forward, standing up from a chair five times, and back and leg strength.
Women made it to 92% of sessions on average, and the only adverse event reported was one minor lower back spasm.

The authors stressed that this was done under close supervision. It's a reason not to fear heavy weights, not a reason to load up a barbell in week one.

What UK bone experts recommend

A UK expert consensus statement called Strong, Steady and Straight turns this research into practical advice. It was written for people with osteoporosis, but it's a useful template if protecting your bones is one of your reasons to lift:

Progressive strength training. First learn safe technique, then add load gradually until you can lift the weight only 8 to 12 times before needing a rest, working up to 3 sets of up to 8 reps.
Moderate impact, such as low jumps, skipping or dancing, building to about 50 impacts on each leg, with rest pauses, on most days.
Back extensor exercises, which strengthen the muscles along your spine, for posture.
Care with forward bending. Their review found very few fractures caused by exercise, some involving extreme, loaded or repeated forward bending, so they advise avoiding deep, rounded-back positions.
Less impact after spine fractures. People who've had a spinal fracture, or several fractures from minor falls, should usually keep impact to about the level of brisk walking.

Can lifting help with hot flashes?

Possibly, but the evidence is early. In a 2019 trial published in Maturitas, postmenopausal women with at least four moderate or severe hot flashes or night sweats a day were randomly assigned to 15 weeks of strength training or to keep their usual activity. Of the 65 who enrolled, 58 finished, and their average age was 55. Training was three sessions a week of eight exercises, 2 sets of 8 to 12 reps, with loads that went up over time. Moderate and severe hot flashes fell by about 44% in the training group and about 2% in the comparison group.

That's encouraging, but it's one small trial in women past menopause, not in perimenopause. If hot flashes or night sweats are affecting your sleep or daily life, talk to your doctor about your options rather than counting on exercise alone.

An 8-week starter plan

The LIFTMOR trial used two sessions a week and the hot flash trial used three, and two or three is a realistic target for you too. Each session covers the same basic movements. Pick one exercise from each row:

Movement	At home with dumbbells	At the gym
Squat	Goblet squat to a chair or box	Leg press or barbell squat
Hinge	Romanian deadlift, bending at the hips with a long back	Trap bar deadlift or hip thrust
Push	Floor press or bench press	Chest press machine
Pull	One-arm row	Seated row or lat pulldown
Back extension	Lying face down, lift your chest a little	Back extension bench
Carry	Farmer carry, a dumbbell in each hand	Farmer carry with heavier dumbbells

Then build up over eight weeks:

Weeks	Goal	Sets and reps	How heavy	Impact work
1 and 2	Learn the movements	2 sets of 10 to 12	Light: you could do 4 or more extra reps	10 small hops or heel drops per leg
3 and 4	Build the habit	2 to 3 sets of 10 to 12	Moderate: about 3 reps left at the end of each set	20 per leg
5 and 6	Start adding weight	3 sets of 8 to 10	Heavier: the last 2 reps feel hard	30 per leg
7 and 8	Settle into the 8 to 12 range	3 sets of 8	Heavy enough that 8 to 12 reps would be your limit	Build toward 50 per leg on most days

When you can finish every set at the top of the rep range with good form, add a little weight next time. Impact work is optional at first. Skip it, or keep to brisk walking, if you've had a spinal fracture or several fractures from minor falls, and check with your doctor first if you've been told you have osteoporosis.

Our perimenopause workout plan shows how sessions like these fit into a full week with walking and a mobility day.

Recovery, sleep and off days

Poor sleep and achy joints can make training feel harder. We didn't find good research on whether recovery from lifting itself slows in perimenopause, so plan around how you feel rather than a fixed rule:

Leave a day between sessions, for rest or a walk.
Trim, don't skip. After a bad night, do the session but drop one set from each exercise.
Move late sessions earlier if evening training seems to keep you awake.
Work around sore joints. Shorten the range or swap the exercise, such as a box squat for a deep squat. Sharp pain, or pain lasting more than a day or two, is a reason to stop and get it checked.
Plan for hot flashes. Train somewhere cool and keep water close.
Eat enough protein, spread across your meals. Our cycle syncing meal plan covers protein in more detail.

If your cycle is still fairly regular, the phase-by-phase tweaks in our cycle syncing workouts guide can help you decide when to push and when to ease off. Once periods become unpredictable, a steady weekly plan adjusted by sleep and energy usually works better.

What to do this week

Pick two days, at least one day apart, and put them in your calendar.
Choose one exercise from each row of the movement table.
Use light weights and do 2 sets of 10 to 12, with smooth, controlled reps.
Write down the weight and reps for each exercise, plus how you slept the night before.
Walk on the days in between if you can.

If you'd like the sessions planned for you, HerShape asks about your life stage during setup, including perimenopause, and builds your workout plan around it. Either way, your training log is what shows you whether it's working.

What to watch for

Talk to your doctor before you start, or before adding heavy lifts or impact work, if:

You've been told you have osteoporosis or low bone density, or you've broken a bone in a minor fall, especially in your spine.
You have a heart condition, or you get chest pain, palpitations, dizziness or unusual breathlessness.
You have ongoing joint or back pain.
You leak urine when you lift, jump or cough. A pelvic health physical therapist can help.
Your periods are getting heavier, or you have any bleeding after 12 months without a period. The NHS advises seeing a doctor for both.
Perimenopause symptoms are affecting your sleep, mood, work or relationships. A doctor can talk you through your options.

A coach or physical therapist can also check your technique, which matters more as the weights go up.

The bottom line

Bone and muscle loss speed up around menopause, and strength training has some of the most encouraging evidence for slowing that down. Trials in perimenopause itself are few and small, so nobody can promise exactly what lifting will do for you now. But results in women just past menopause are promising, heavy lifting went safely in a supervised trial of women with low bone mass, and starting light costs little. Begin with two sessions a week, add weight slowly, and keep a log so you can see your own progress.

Sources

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