Is Exercise Important for Menopause?

Margaret is a 62-year-old woman who began experiencing a gradual decrease in strength over the past 5 years. She was able to compensate for a while until she began to notice urinary leakage with coughing and sneezing. After going to her primary care physician, Margaret was referred to physical therapy, specifically pelvic floor physical therapy. During her initial evaluation, Margaret was asked about her overall health including hydration, nutrition, physical activity, and menstrual cycle. Margaret shared that she mostly drank water and ate plenty of fruits, vegetables, and protein. Her physical activity consisted of two daily 15-to-20-minute walks with her dog but “nothing too strenuous” as her dog often stops and sniffs along the way. Margaret had gone through menopause at 57 years old.  

Margaret is like many women that seek pelvic floor PT in that she is not super sedentary and sitting on the couch all day, but she is not continuing to challenge her body before, during, or after menopause which can have protective benefits as we age.  

Menopause officially occurs when there has been no menstruation for 12 consecutive months.1 It typically happens between 45-55 years old and signals the end of estrogen production. The years leading up to menopause may have cyces that are sporadic, frequent, heavy, or light. The most common symptom reported by 75% of women are hot flashes. However, there are other changes that may not be as apparent initially. The changes that occur due to the reduction in estrogen and the aging process are loss of muscle strength, reduced bone mineral density, and weight gain, which can increase our chances of developing chronic diseases like cardiovascular disease and osteoporosis.1,3 Post-menopausal women are also found to be at an increased risk of higher total cholesterol and “bad cholesterol” (LDL-C) compared to pre-menopausal women.2  

The good news is exercise, specifically strength or resistance training, can be helpful to prevent or reduce worsening of symptoms. A systematic review published in 2023, which is one of the highest levels of research evidence, looked at how strength exercises impact menopause symptoms.1 Strength exercises were found to improve leg strength, improve pelvic floor strength, increase physical activity, improve bone density, curb metabolic and hormonal changes, reduce heart rate, reduce blood pressure, reduce waist circumference, reduce body fat percentage, and may contribute to a reduction in hot flashes as compared to women who do not participate in a strength program.1,3 In fact, when studying postmenopausal women ages 50-79 years old over a 6-week resistance training schedule, these changes were seen with 2, 40 minute sessions a week at a moderate to high intensity.3 Physical activity has also been found has been found to increase HDL (“good cholesterol”), lower LDLs, lower triglycerides, and lower fasting blood glucose levels regardless of menopausal status.2 

I always tell my patients that some exercise is better than no exercise; however, there are some types and quantity of exercises that are more beneficial than others. For example, high volume exercises were found to have more benefit to lower cholesterol, improve muscle performance and improve lean mass as compared to low volume exercises.1 Strengthening, of course, has more benefit from a muscle strength and hormonal aspect whereas stretching does not have any benefit.1  

There is also evidence that exercise order matters although this has been studied much less in the “older” population.4 Generally, when a particular exercise is performed earlier in a routine, you can perform more repetitions with greater force. In other words, if there is a particular muscle group or exercise that is more difficult for you, do that earlier in your exercise routine versus later when your body is more tired.4 

Another important physical activity is aerobic exercise or cardio. I have some patients who enjoy going for one full walk a day, but I have others who feel like they may not be able to dedicate one larger chunk of time to a walk. Luckily, we can split up our walking time into two different bouts on the same day if that is more convenient and still receive benefit. A study looked at women who recently went through menopause and found that leg strength and walking performance improved in women who walked briskly 5 days a week combined with a moderate muscle strengthening program 2 days per week over 15 weeks.5 One group was chosen to walk continuously one time per day for an average of 46 minutes and the second group walked in two separate times of about 24 minutes with a 5-hour break in between. The two, smaller bouts of walking were found to be just as effective as the one, longer bout.5  

If increasing leg strength, increasing pelvic floor strength, good bone density, reduced heart rate and blood pressure, reduced body fat, and improved cholesterol aren’t enough of a reason to exercise than consider this. Because of the hormonal changes that occur with menopause, women can experience other less than desirable effects including vaginal dryness, vaginal atrophy (loss of plumpness of the tissues), reduced libido, lack of arousal and painful intercourse.6 Exercise stimulates the nervous system and muscles and allows for increased blood flow, including to the pelvic area, which could assist with arousal. In fact, a study of 269 menopausal women found that those who were physically active had a reduced risk of female sexual dysfunction by 89% as compared to women who were not physically active.6  

So, if I have to give women one piece of advice it would be this: MOVE! Move often, move with purpose, move with intensity, and move heavy things. Developing a healthy exercise habit earlier in life sets us up for success as we age, and those habits become even more vital to our health over time. If you have not exercised for most of your life, that’s okay! Our body has an amazing ability to adapt even if we consider ourselves to be “too old”. Pro tip: walk daily and with a purpose or go on two, smaller walks per day, strength train at least 2 days per week, and do the more challenging exercises earlier in your routine. Also, it is very important that we continue to exercise, specifically strength train, as the benefits don’t last if we stop doing the exercises. Consistency is key! 

If you find you are having difficulty choosing the right type of exercise, weight to use, number of sets or reps, or other challenges, reach out to your local physical therapist! And remember, if you are having pelvic floor specific concerns, such as pelvic pain, leakage, or urgency, reach out to your local pelvic floor physical therapist as they are specialized in this area. 

Written by Jordan Schmidt, PT, DPT 

References  

1. Capel-Alcaraz, A., García-López, H., Castro-Sánchez, A., Fernández-Sánchez, M., & Lara-Palomo, I. (2023). The Efficacy of Strength Exercises for Reducing the Symptoms of Menopause: A Systematic Review. Journal of Clinical Medicine, 12(2), 

1. Karvinen, S., Jergenson, M., Hyvärinen, M., Aukee, P., Tammelin, T., Sipilä, S., Kovanen, V., Kujala, U., & Laakkonen, E. (2019). Menopausal Status and Physical Activity Are Independently Associated With Cardiovascular Risk Factors of Healthy Middle-Aged Women: Cross-Sectional and Longitudinal Evidence. Frontiers in Endocrinology, 10, 

1. Lee, D., & Schroeder, E. (2016). Resistance training improves cardiovascular health in postmenopausal women. Menopause, 23(11), 1162-1164. 

1. Jesus, J., Brown, A., Cardozo, D., Santos, L., Dias, I., Cahuê, F., Salerno, V., Simão, R., & , (2018). The influence of exercise order on strength performance in post menopause women. Medical Express, 

1. Asikainen, T., Suni, J., Pasanen, M., Oja, P., Rinne, M., Miilunpalo, S., Nygård, C., & Vuori, I. (2006). Effect of Brisk Walking in 1 or 2 Daily Bouts and Moderate Resistance Training on Lower-Extremity Muscle Strength, Balance, and Walking Performance in Women Who Recently Went Through Menopause: A Randomized, Controlled Trial. Physical Therapy, 86(7), 912-923. 

1. Amin, M., Mozid, N., Ahmed, S., Sharmin, S., Monju, I., Jhumur, S., Sarker, W., Dalal, K., & Hawlader, M. (2022). Status of female sexual dysfunction among postmenopausal women in Bangladesh. BMC Women's Health, 22(1),