Strength Training in Perimenopause: What the Research Says About Muscle, Mood and Sleep

Perimenopause has a way of arriving without an invitation. One year your body responds to exercise the way it always has. The next, your sleep is patchy, your mood is less predictable, your waistline is shifting, and the workouts that used to keep everything in check no longer seem to work. If that sounds familiar, you are not imagining it, and you are not doing anything wrong.

At StrongHer we coach women 40 and up every day, and perimenopause is the season many of them are living in when they first walk through our door in Fort Mill. So we went looking at what the research actually says about strength training during this transition. Not the hype, just the evidence. Here is what we found.

What is happening to muscle and fat during the transition

The clearest picture comes from the Study of Women's Health Across the Nation, a long-running study that followed women through the menopause transition. Shieh and colleagues (2023) reported that over roughly four years of transition, women lost about 0.7 percent of their lean mass and gained about 6 percent body fat. Those numbers sound modest until you read the next finding: for every standard deviation of lean mass a woman lost, her risk of fracture rose by about 63 percent, and that was independent of bone density.

Read that again. Muscle is not just about how you look or how much you can carry. Losing it raises your fracture risk on its own, separately from what your bone scan says. That is one of the strongest arguments we know for protecting the muscle you have and building more of it.

Can you still build strength and muscle in perimenopause?

Yes. A 2023 trial by Isenmann and colleagues put women at different stages of menopause through the same resistance-training programme and compared results. Strength gains were the same regardless of menopausal status. The pre- and perimenopausal women also gained muscle and lost fat, while the postmenopausal group did not show those changes over the study period. The authors suggest postmenopausal women may simply need more training volume to see the same body-composition changes.

Two caveats. The study was small, with 31 women, so it is a signal rather than a verdict. But the practical message lines up with what we see in our own groups: perimenopause is a window where your body still responds well to lifting, and the earlier you start, the more you have in the bank for later.

Menopause symptoms: an encouraging but early picture

A 2025 review by Philip and colleagues pulled together four randomised trials of resistance training in menopausal women and found roughly a 15.7 percent reduction in the Kupperman index, a standard score for overall menopause symptoms. We want to be honest about this one. Four trials is a small base, the authors describe the findings as preliminary, and the effect on hot flushes specifically has not been established. It is promising, not proven.

What we can say is that no trial in that review found strength training made symptoms worse, and the direction of the evidence is favourable.

Mood: the effect is real, and you do not have to go hard

This is where the evidence is strongest. Yao and colleagues (2025) analysed 21 randomised trials with over 2,000 menopausal women and found exercise produced a meaningful reduction in depressive symptoms (a standardised effect of about 0.66) and in anxiety (about 0.55). Those are large effects by the standards of this kind of research.

Two details matter for you. First, low and moderate intensity worked just as well as higher intensity. You do not need to punish yourself to feel better. Second, most of the trials used aerobic exercise or yoga, and resistance training was not analysed on its own. So we can confidently say that moving your body helps mood in menopause. We cannot claim lifting is uniquely better for mood than walking. It is one good option among several, and for the women we coach it tends to be the option they actually stick with.

Sleep: combining strength and cardio comes out on top

Poor sleep is often the symptom women tell us about first. A 2025 network meta-analysis in Climacteric by Zhou and colleagues compared different types of exercise across 31 randomised trials. The combination of strength training and aerobic exercise ranked first for improving sleep, with a probability score of 93.5 percent. The benefit was larger for women aged 55 and under and for those who were already sleeping poorly. In other words, if you are in perimenopause and not sleeping well, you are the person most likely to benefit.

Blood sugar and inflammation

Perimenopause also tends to nudge blood sugar, insulin and inflammatory markers in the wrong direction. A 2024 review by Lopez and colleagues covering 20 trials in overweight postmenopausal and older women found that higher-volume resistance training improved glucose, insulin and C-reactive protein more than lower-volume programmes. The authors rate the certainty of that evidence as low, so treat it as a reasonable expectation rather than a guarantee. It does fit the broader pattern: more consistent lifting, more metabolic benefit.

How much, and how hard?

The American College of Sports Medicine's 2026 position stand recommends training every major muscle group at least twice a week. For building muscle, around ten working sets per muscle group per week is a solid target. For strength, two to three sets at roughly 80 percent of your one-rep max. And importantly, training to failure is optional, not required.

The Women's Health and Exercise Network (2026) makes the same point specifically for peri- and postmenopausal women: there is no evidence base for grinding every set to failure in this population, but progressive heavy lifting is well supported. That is exactly how we coach. Heavy enough to matter, with a rep or two left in the tank.

What this means for you

If you are in perimenopause, here is the short version of the research.

• Lift two to three times a week, covering your whole body each week. Our membership is built around three coached sessions weekly for this reason.

• Work up to genuinely heavy loads after a supervised technique ramp. Stop each set with one to three reps still in reserve.

• Add some aerobic work alongside the lifting. The sleep evidence favours the combination.

• If your goal is mood, know that moderate effort counts. Consistency beats intensity.

• Expect strength to improve quickly. Body-composition changes take longer and may need more volume the further through the transition you are.

One more thing. Strength training supports your health through menopause, but it is not a substitute for medical care, and it does not replace hormone therapy for women who need it. If symptoms are affecting your life, please talk with your clinician about all of your options. Lifting works well alongside whatever you and your doctor decide.

Getting older does not mean getting weaker. If you would like to see how coached small-group training feels, book a free 15-minute fit call with one of our coaches, or come in for a $25 New Member Trial session at our Fort Mill studio. No pressure, just a conversation about where you are and where you want to go.

Sources

• Shieh A, et al. (2023). Journal of Bone and Mineral Research (SWAN). academic.oup.com

• Isenmann E, et al. (2023). BMC Women's Health. link.springer.com

• Philip S, et al. (2025). Cureus. pmc.ncbi.nlm.nih.gov

• Yao L, et al. (2025). International Journal of Behavioral Nutrition and Physical Activity. link.springer.com

• Zhou Y, et al. (2025). Climacteric. pubmed.ncbi.nlm.nih.gov

• Lopez P, et al. (2024). Journal of Sport and Health Science. sciencedirect.com

• American College of Sports Medicine, Phillips S, et al. (2026). Resistance Training Position Stand. acsm.org

• Women's Health and Exercise Network (2026). Resistance training and menopause. when.org.au