You’re sleeping badly, your joints ache in the morning and your energy seems to have gone somewhere you can’t find it. Then someone tells you to exercise more. I understand why that can feel like one more thing to fail at. But exercise for menopause isn’t about punishing your body or shrinking it. It’s one of the most effective treatments you have for the changes happening inside you, and it works whatever your starting point.
Menopause usually happens between 45 and 55, and falling oestrogen affects far more than your periods. As a GP and menopause specialist certified by the British Menopause Society, these are questions I hear all the time from my patients: which exercise, how much, and how do I start when I’m already exhausted? Here’s what I tell them.
Your body is changing on the inside, too
Oestrogen protects many parts of the body at once, so when it falls, several things shift together. Bone loss speeds up, and it’s fastest around your final period. Muscle mass and strength drop more quickly, which affects your metabolism, balance, and weight. Cholesterol tends to move in the wrong direction, fat tends to settle around your middle and your cardiovascular risk rises.
You can’t feel most of this happening, which makes it easy to put off (I know!). The good news is that exercise works on all of these changes at once. That’s why I see it as a core part of midlife health, alongside any medical treatment that suits you, rather than an optional extra.
Exercise for menopause works best when strength comes first
If you only add one thing, make it strength training. Loading your muscles and bones tells both to adapt. Aim for two to three sessions a week that work the major muscle groups: legs, hips, back, abdomen, chest, shoulders and arms. You don’t need a gym. Bodyweight moves, resistance bands or a pair of dumbbells can absolutely be used. Make it gradually harder over time, and a few sessions with a qualified instructor will help you learn safe technique.
Then build in three other kinds of movement:
- Weight-bearing activity for your bones. Brisk walking, hiking, jogging, stair climbing and dancing all send load through your skeleton. Swimming and cycling are good for your heart but don’t load bone in the same way, so pair them with something on your feet.
- Aerobic exercise for your heart. Brisk walking counts. Interval sessions can build fitness quickly, but if they leave you wiped out or sleeping worse, cut back the volume rather than giving up.
- Balance and mobility. Yoga, Pilates, tai chi and stretching help flexibility and posture, and many women find they help with stress and sleep. Balance matters more as we age, because falls, not just fragile bones, drive fractures.
The UK activity guidelines recommend at least 150 minutes of moderate activity a week, or 75 minutes of vigorous activity, plus strengthening on at least two days. Moderate means breathing harder but still able to talk; vigorous means talking is difficult. If those numbers feel out of reach, start anyway. The biggest gain comes from going from very little to something, and every bit of movement counts, including short bursts that break up long spells of sitting. I promise they add up.
If you have osteoporosis, I want you to hear this clearly: exercise is still for you. UK expert guidance encourages it, with strength training two to three days a week and balance work at least twice a week. Moderate impact, such as jogging or hopping, suits most people with osteoporosis. If you’ve had spinal fractures or several fractures, keep impact to around brisk-walking level. Anyone with osteoporosis, a previous fragility fracture or significant joint disease should get tailored guidance before stepping up the impact.
Hot flushes and leaking don't have to stop you
Exercise has clear benefits for bone, heart and mood, but its effect on hot flushes is less certain. Some women find that being fitter and less stressed means flushes bother them less; others find a hard session or overheating sets one off. A cool room, breathable layers, plenty of water and exercising at a cooler time of day often help.
If hot flushes are affecting your quality of life, I recommend we discuss your options, including HRT, non-hormonal medicines and cognitive behavioural therapy (CBT). Exercise doesn’t replace HRT, or the other way round, because they do different jobs. HRT treats symptoms and helps prevent osteoporosis while you take it. Exercise protects your bones, heart, muscles and mood in its own way. Many women benefit from both. If HRT isn’t suitable for you, or you’d rather not take it, exercise is still one of the most useful things you can do, and there are other options for your symptoms.
Falling oestrogen can also bring urinary urgency, leaking and a weaker pelvic floor, which often shows up when you run or jump. Pelvic floor muscle training is the recommended first-line approach for stress incontinence: a supervised programme lasting at least three months, ideally with a pelvic health physiotherapist. Vaginal oestrogen can also help with urinary symptoms after menopause. If you notice leaking, heaviness or prolapse symptoms, get assessed before high-impact exercise.
Start smaller than you think you should
Fatigue, poor sleep, low motivation and joint pain are real barriers, not excuses. So the aim is a routine that survives a hard week, not just a good one.
Here’s the one thing I’d like you to do this week: attach two short strength sessions to things you already do. Ten squats while the kettle boils. Wall press-ups before your shower. Slow calf raises while you brush your teeth. Add a short walk after lunch and you have a solid foundation.
A few things make it easier to keep going:
- Look after recovery. Sleep, protein and rest days affect how well your body adapts.
- Track something other than weight. How much you can lift, your walking pace and your mood tell you far more.
- Get pain checked. Persistent joint or pelvic pain, or pain on one side, deserves an assessment, not avoiding all movement.
- Expect ups and downs. Symptoms vary from month to month, so a flexible plan lasts longer than a rigid one.
High-intensity exercise is fine for many women, but tolerance varies. If you have heart concerns or osteoporosis, get individual advice first. And whatever you’re doing, stop and seek medical advice if you get chest pain, unusual breathlessness, palpitations or dizziness while exercising.
Exercise is treatment, not punishment
I want us to move away from the idea that exercise in midlife is about burning calories, earning dinner or changing how you look. It’s a real treatment for your bones, heart, muscles and mood, and it protects your strength and independence for the decades ahead. That treatment starts with two short strength sessions this week.
In one unhurried 45-minute consultation at 10 Harley Street, Dr Katy Kasraie will look at your health history, your goals and every suitable option, including approaches that do not involve medication. No referral needed, and most major insurers are accepted. Click here to book your appointment.