PULS3

Guide

Exercise in perimenopause: what helps, and a week to start

The best exercise in perimenopause is a mix: strength work on 2 or more days a week, something that gets you a little out of breath on most days, and some balance and mobility work. Research in women in perimenopause is thin, so treat the trial results as leads, not rules. The harder part is a week that still works when your sleep, energy and periods are hard to predict.

This guide covers what the research found and who was in it, a starting week if you do little now, what to change on a rough day, what to skip, and when to see your GP.

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Last checked: 7 October 2026

What the research says about perimenopause

If you want to feel strong and steady again, here is what the studies found, and how close their volunteers were to you.

Muscle starts changing early

A long-running study that followed women through the transition (Greendale, JCI Insight, 2019) found that at the start of the menopause transition, the rate of fat gain doubled and lean mass declined. The pace of weight gain did not change. So the scale can look steady while you lose muscle underneath, and perimenopause is when it starts.

Strength and cardio do different jobs

A review of 101 trials in 5,697 postmenopausal women (Khalafi, Frontiers in Endocrinology, 2023) found exercise training increased muscle mass and decreased fat mass. Resistance and combined training had the greater effect on muscle. Aerobic and combined training had the greater effect on fat mass. A smaller review of 12 trials (Sá, Menopause, 2023) found resistance training "seems to promote an improvement in functional capacity", with no serious adverse events reported, though the authors rate that evidence very low to low certainty.

Bone

A review of 8 trials (Jones, Menopause, 2026) found small but significant effects of high-intensity, impact and strength training on bone density at the hip and lower spine in postmenopausal women. It did not detect an effect before menopause, but only 2 small trials looked at that, so the question is still open.

Sleep and hot flushes

One review is about women in perimenopause specifically. Across 12 trials in 1,493 perimenopausal women (Zhao, Explore, 2023), exercise improved sleep. The best result came from fitness Qigong, a gentle movement practice, done for 10 to 12 weeks, more than 3 times a week, 30 to 60 minutes a time. Another review, of 9 trials in 1,579 women with hot flushes or night sweats (Corrêa, Maturitas, 2025), found exercise did not significantly improve sleep quality or insomnia. For hot flushes themselves, a review of 21 trials (Liu, Climacteric, 2022) found no significant change in how often they happened, and that was the high-certainty finding.

Your cycle

In a trial of 24 women with regular cycles (D'Souza, Medicine & Science in Sports & Exercise, 2026), timing resistance training to cycle phase built no more muscle or strength than training the same way all month. A review of 78 studies (McNulty, Sports Medicine, 2020) found performance might be trivially lower early in the cycle, on low-quality evidence. Neither studied perimenopause. Still, if training by phase made no difference with regular cycles, there is little reason to plan around a cycle you can no longer predict.

Who was in these studies

Most of the strength and body composition trials enrolled women past menopause. Only the sleep review above studied women in perimenopause. The results are the best evidence there is, but they were not tested in most women in their 40s.

A week to start with

Australia's Physical Activity and Sedentary Behaviour Guidelines for adults aged 18 to 64 ask for muscle-strengthening activities on 2 or more days per week, moderate to vigorous activity for 30 minutes or more on most days, and activities for mobility, balance and coordination on 3 or more days per week. If you are doing little now, do not start there. Start here, and build over a month:

Each week, add one thing: a third set, five more minutes of walking, or a little more weight. Pick a weight you could lift a couple more times when you stop, and go up only when the last set feels steady. No trial tested this exact week. It is a gentle way into the national guideline.

After about a month, move to the fuller week in our guide to strength training through perimenopause and menopause.

On a rough day

Perimenopause weeks rarely go to plan. A night sweat, a hot flush at work, sore joints or a period that turns up early can all change the day. That is not a failed week.

What to skip

When to see your GP

For neutral reading, Jean Hailes for Women's Health, the Australasian Menopause Society and healthdirect.gov.au all cover perimenopause and exercise.

How PULS3 helps

PULS3 is an iPhone coach that plans your training, food and sleep together. Tell it you are in perimenopause, and Today's plan leads with your strength session. On a rough day, it changes the plan for you:

Those changes come from what you log in PULS3, not from a guess about your cycle. It also reads your workouts and sleep from Apple Health, and your sleep from Oura if you wear one, so it knows when you last trained. PULS3 is coaching, not medical care: it does not diagnose or prescribe, and it tells you when something is one for your GP.

For how the whole team works together, see PULS3 for you.

Start small, keep going on the rough weeks, and get stronger through the change.

Download on the App Store

Free for everyone until 31 October 2026. From 1 November, every plan starts with a 7-day free trial. Nothing to pay until then, and nothing renews unless you choose to subscribe.

Questions

What is the best exercise during perimenopause?

A mix, because each part does a different job. Australia's physical activity guidelines for adults aged 18 to 64 ask for muscle-strengthening activities on 2 or more days per week, moderate to vigorous activity for 30 minutes or more on most days, and mobility and balance work on 3 or more days. In a review of 101 trials in 5,697 postmenopausal women (Khalafi, Frontiers in Endocrinology, 2023), resistance and combined training had the greater effect on muscle, and aerobic and combined training had the greater effect on fat mass. Those women were past menopause, so treat it as a strong lead rather than proof for perimenopause.

How often should I exercise in perimenopause?

Aim for some movement on most days and strength work on 2 or more days a week, the same as Australia's guideline for every adult aged 18 to 64. If you are doing little now, start with two short strength sessions, a brisk walk, three short balance sessions and one thing you enjoy each week, and build from there.

Is it too late to start exercising at 45?

No. Muscle still responds to training well after the menopause transition. In a review of 101 trials in postmenopausal women (Khalafi, Frontiers in Endocrinology, 2023), exercise training increased muscle mass and fat-free mass. Every woman in those trials was past menopause, and their muscle still responded. Start light, learn the movements, and see your GP first if you have a bone, joint or heart condition.

Should I train around my cycle in perimenopause?

There is little reason to. In a trial of 24 women with regular cycles (D'Souza, Medicine & Science in Sports & Exercise, 2026), timing resistance training to cycle phase built no more muscle or strength than training the same way all month. A review of 78 studies (McNulty, Sports Medicine, 2020) found performance might be trivially lower early in the cycle, on low-quality evidence. Both looked at regular cycles. When your periods become hard to predict, go by how you feel on the day instead.

Can exercise help me sleep in perimenopause?

Maybe, and the results conflict. A review of 12 trials in 1,493 perimenopausal women (Zhao, Explore, 2023) found exercise improved sleep. The best result came from fitness Qigong, a gentle movement practice, done for 10 to 12 weeks, more than 3 times a week, 30 to 60 minutes a time. A review of 9 trials in 1,579 women with hot flushes or night sweats (Corrêa, Maturitas, 2025) found exercise did not significantly improve sleep quality or insomnia. Move for its own sake, and talk to your GP if night sweats are breaking your sleep.

Will exercise help my hot flushes?

Do not count on it. A review of 21 trials (Liu, Climacteric, 2022) found no significant change in how often hot flushes happened with exercise, and that was the high-certainty finding. Exercise is still worth doing for muscle, strength and everyday function. Talk to your GP about hot flushes that get in the way.

What exercise is best for perimenopause belly?

Whole-body training, not crunches. In a small trial of 24 inactive adults aged 18 to 40 (Vispute, Journal of Strength and Conditioning Research, 2011), six weeks of abdominal exercises did not significantly change belly fat compared with doing nothing. In a review of 101 trials in postmenopausal women (Khalafi, Frontiers in Endocrinology, 2023), exercise training decreased waist circumference and visceral fat, and strength plus cardio covered both muscle and fat. See our guide to menopause belly.

Should I stop high-intensity workouts in perimenopause?

Not if you enjoy them and recover well. A review of 8 trials (Jones, Menopause, 2026) found small but significant effects of high-intensity, impact and strength training on bone density in postmenopausal women, and too few trials in women before menopause to say either way. Keep hard sessions for days you slept, and swap one for a walk after a broken night.

Sources

PULS3 provides coaching guidance, not medical advice, diagnosis, or treatment. Talk to your GP about your own health.