How to Work Out During Perimenopause: A Simple, Strong Plan for Women 35–55

Perimenopause can hit you like a freight train. It can show up as early as your late thirties and you might completely miss it. Most of us think about perimenopause as hot flashes and night sweats, but the earliest signs? Much more subtle. Think unexplained anxiety, trouble sleeping, a feeling that something's off.

If you're nodding along, you're not alone. Those subtle early signs are easy to dismiss or attribute to stress, aging, or just life being life.

While working out isn't a cure-all, a strong workout routine can help you regain a sense of control over your changing body and put you on track for a healthy lifestyle. In this post, I'll outline the basics for a training routine that works with your body instead of against it and show you an example of what that may look like. We'll also talk about recovery and nutrition because feeling better in your body involves pulling on multiple levers. There's no simple trick, but good habits and consistency make for lasting change.

What Is Perimenopause (and Why Your Training Needs a Tweak)

The menopause transition happens when your ovaries stop producing viable follicles, eventually leading to stopping the production of sex hormones like estradiol and progesterone. Menopause is defined by the absence of periods for 12 months. But the period before this final transition can last years. During this transition, while hormones are trending down, it's not a slow decline. Rather it's a chaotic decline involving wide fluctuations. These fluctuations trigger a wide variety of symptoms that affect all body systems and can catch us off-guard.

We all think about perimenopause in terms of hot flashes and cycle changes, but these are not necessarily the earliest symptoms. The list is long, but often the earliest warning signs involve sleep disruption, stress, mood swings, anxiety, depression, rage, low libido, insulin resistance. Think of it like PMS on steroids. And it can happen at any time in your cycle. One day you're fine, the next you're not. No you're not crazy. No it's not all in your head. No you're not broken. Congratulations, you've entered your next level up and now you need to adjust your plan to work with your changing body (again).

The consequences of the menopause transition go beyond the loss of your menstrual cycle. Women lose up to 20% of bone density during the 5-7 years following menopause, increasing their chance of bone fracture dramatically 1. Cardiovascular risk increases by 3% for each year of earlier menopause 2. Sleep problems spike: 56% of perimenopausal women get less than seven hours of sleep nightly, compared to 32.5% of premenopausal women 3 . Genitourinary symptoms become prevalent, with increased UTI rates 4. Metabolic changes including insulin resistance and unfavorable cholesterol shifts also become more common.

Because of all these changes, we need to adapt our lifestyle and training. We need to take action to protect our bones and metabolism. The training strategies that worked in your twenties will not cut it. The goal has changed.

Core Training Principles for the Perimenopause Transition

Lift Heavy(-ish) with Great Form

The main goal for your training sessions needs to be to preserve (and even increase) your bone density. You want your body to remain strong as you age. To do that, you need to lift heavy.

Focus on compound movements: These are exercises that work multiple muscle groups and joints simultaneously, giving you the biggest bang for your buck. Think squat, hinge (deadlifts), push (overhead press, bench press), pull (rows, pull-ups), and carry (farmer's walks, suitcase carries). These movements mirror real-life activities and create the kind of mechanical stress your bones need to stay strong.

Adjust your rep ranges: Shift to shorter, heavier sets in the 4-8 rep range, working at least 80% of your one-rep max. This intensity is crucial for bone-building. Your skeleton needs to feel challenged to adapt. Since you're doing fewer reps per set, aim for 3-4 sets to maintain adequate training volume.

Progressive overload: This fundamental principle doesn't change during perimenopause. If you want to get stronger, you must progressively challenge your body. Each week, increase one variable: add weight, squeeze out an extra rep, include an additional set, or slow down your tempo. Small, consistent progressions compound over time into significant strength gains.

The key is consistency over perfection. Heavy is relative to your current strength level, and what matters most is providing your skeleton with the stimulus it needs to thrive.

Keep Cardio Short and Smart

Too many people think of working out as doing some cardio. Long cardio on the machines in a gym, going for a run, a bike ride. While it's good to get the blood flowing, it should not be your main effort for health and longevity. Muscles are what keep you healthy longer.

You absolutely want cardiovascular fitness, but you need to be strategic about it. During perimenopause, your body is already dealing with hormonal stress, so piling on excessive cardio can backfire by increasing inflammation and spiking cortisol levels. The best stimulus for your heart in perimenopause is to hit 1 or 2 short but intense sessions. Think sprints or high intensity interval training. Short bursts of cardio and long full recovery.

High-intensity intervals: Aim for 1-2 sessions per week of 3-5 sets of sprints or HIIT work. Think 20-second all-out efforts followed by 2-3 minutes of complete recovery. This approach gives you maximum cardiovascular benefit while allowing your body to fully recover between efforts.

Daily movement for health: For baseline cardiovascular health and stress management, nothing beats a daily walk. It's gentle on your system, helps clear your head, and can improve insulin sensitivity, especially if you take a short walk after meals. This is more about keeping your body moving and your stress levels in check than mindlessly burning calories.

The goal is working with your changing physiology, not against it. Save the intense stuff for short bursts and let gentle movement handle the rest.

Respect Recovery Like It’s a Training Day

Recovery is no longer optional. If you're the kind of person that trains hard 7 days a week, you will need to slow down. If you think sleep is for the weak, think again. During this transition, it's important to work with your body and not against it. And if your body needs to take it slow, slow down. Be intentional with your training:

Prioritize sleep: Given how common sleep issues are during this transition, this becomes even more crucial. Poor sleep disrupts recovery, increases cortisol, and makes everything harder. Treat your sleep schedule as seriously as your workout schedule.

Program deload weeks: Plan lighter training weeks every 4-6 weeks to let your body reset and adapt. This strategic recovery helps prevent burnout and keeps you progressing long-term.

Adjust based on symptoms: Some days your energy will be great, others you'll feel like you're moving through molasses. Learn to read your body's signals and modify accordingly. A lighter workout is always better than no workout or pushing through and feeling awful for days.

Include mobility work: Your tissues are changing, and maintaining flexibility becomes more important. Even 10-15 minutes of stretching or mobility work can make a significant difference in how you feel and move.

Think of recovery as an active investment in your training, not time away from it. The better you recover, the harder you can train when it matters.

Pelvic Floor & Core Considerations

The pelvic floor is often considered a taboo topic, but it's a crucial part of your core system that directly impacts your quality of life and training capacity. Yet it's one of the most overlooked aspects of women's health, especially during perimenopause when hormonal changes can significantly affect these tissues.

What is the pelvic floor: This group of muscles stretches like a hammock from your pubic bone to your tailbone, supporting your bladder, uterus, and rectum. Think of it as the foundation of your core: it works with your diaphragm, deep abdominal muscles, and back muscles to provide stability and control pressure in your torso.

Recognizing dysfunction: Common signs include involuntarily leaking urine (especially when coughing, sneezing, or exercising), a feeling of heaviness or pressure in your pelvis, difficulty inserting tampons, or pain during intercourse. You might also experience frequent urination, constipation, or lower back pain that doesn't seem related to other issues.

Training modifications: If you're experiencing pelvic floor symptoms, high-impact activities like jumping, running, or heavy overhead pressing might need temporary modification. Focus on breath work and gentle core activation before progressing to more intense movements. Exercises like dead bugs, bird dogs, and wall sits can help you rebuild coordination and strength.

When to seek help: A pelvic floor physical therapist can assess your specific needs and provide targeted exercises. This isn't something you need to "tough out", proper treatment can dramatically improve your symptoms and get you back to training pain-free.

Your pelvic floor health directly impacts your ability to train effectively and live comfortably. It deserves the same attention you give to any other part of your body.

Your Perimenopause Workout Template

Here's what a week of perimenopause-friendly training actually looks like. This isn't set in stone. See it as a guide you can modify based on your schedule and how you're feeling. Can't do all seven days? Start with the three strength sessions and daily walks.

Sample Strength Session Structure (40-55 minutes)

Train With Your Symptoms, Not Against Them

One of the most important skills you can develop during perimenopause is learning to auto-regulate your training based on how you're actually feeling, not just what's written on your program. Your energy, strength, and recovery will fluctuate more than ever before, and fighting against these natural variations will only leave you frustrated and burnt out.

How to auto-regulate (RPE, RIR, sleep score, cycle notes):

If you know your max lifts and are used to thinking in terms of % 1RM, target at least 80% 1RM and up. However, if you're experiencing symptoms, fatigue due to poor sleep, take it down a notch and target 70-75%.

If you're not used to working with max lift percentages, you can think in terms of rate of perceived exertion (RPE). On a scale of 1-10, how does the effort feel? You'll want to target 8 and up but if you feel low, staying around 6-7 will ensure you progress without overdoing it.

Another way of thinking about effort is reps in reserve (RIR). For this one, you'll need to know what it feels like to go until failure—until you no longer can do a single rep. That's RIR 0, you have no reps in reserve. For a standard workout, you'll want to stay within 2-3 RIR unless you're feeling low or deloading. In that case, aim for 5-6 RIR.

If you've had a particularly challenging night, experience symptoms, feeling low, take it easy. Playing around with intensity or swapping your strength session for a walk will help you support your body and stay consistent.

Joint-friendly modifications: Small tweaks make a big difference as hormonal changes affect your connective tissues. Try neutral-grip pressing, split squats over deep lunges, and controlled eccentrics to reduce joint stress while maintaining training benefits.

Work with your body's rhythms, not against them.

Nutrition Basics to Support Hormones, Muscle, and Energy

Training smart is only half the equation. What you eat and when plays an equally important role in supporting your changing body through this transition.

Protein First, Especially at Breakfast

I know it seems like everybody is talking about protein and it can feel overwhelming or just too much hammering about it but protein should be your priority (and that's true not only for perimenopause. At any stage of your life, protein should be the first priority when you think about your meal).

Why protein?

• It keeps you fuller longer, reducing cravings and energy crashe
• It provides essential amino acids that your body can't make on its own
• It promotes recovery and muscle protein synthesis
• It helps maintain healthy metabolism and blood sugar stability

How much? A good target is about 1g per pound of ideal body weight. But it doesn't have to feel like homework. You don't need to start weighing all your food to meet your protein needs/goals. Here's a simple rule of thumb: Aim to incorporate at least one palm-sized source of quality protein at each meal and snack throughout the day. That's it.

While it can be hard to think about protein for each meal, another very powerful approach that ensures you hit your goal is to start your day with a high protein meal (30-50g for breakfast). This single meal can account for nearly half your daily needs and helps control hunger throughout the day.

If you don’t know where to start, take a look at my free high protein breakfast recipes to help you hit your goal

Carbs for Training, Fiber for Gut & Metabolic Health

Carbs are sometimes demonized but they shouldn't be. They're a great source of fuel, but can be easy to overeat, so a simple trick is to target eating them around your workout. Because your body will use the glucose straight away, your blood sugar will not rise as much and so this strategy helps maintain good metabolism. If you're not working out that day, a simple 10-15min walk after the meal can also help with metabolism.

When we think about carbs, we usually think about sugary and starchy food. But let's not forget about fiber. High fiber foods are often sources of carb. Fiber is important for your gut and metabolic health. For meals further from workout timing, aim for high fiber sources as your source of carbs.

Check out my blog post about fiber to learn more

Hydration & Electrolytes

Staying hydrated becomes more challenging during perimenopause, especially on sweat/flash days. Plain water isn't always enough—when you're losing significant fluid through increased sweating, you need to replace what you're losing.

On particularly sweaty days or after intense hot flash episodes, add a pinch of sea salt to your water or include potassium-rich foods like bananas, avocados, or coconut water. You don't need expensive supplements—simple electrolyte replacement helps maintain energy levels and prevents headaches.

Smart Supplements (always check with your clinician)

The supplement industry is wild: unregulated and full bold claims about efficacy that promise miraculous results. Now, I'm not saying all supplements are garbage—there are definitely some worth taking. But here's the catch: many supplements contain way less of the active ingredient than what's claimed on the label, or sometimes wildly inconsistent amounts between batches.

So if you're going to invest in supplements, you need a trustworthy source. Look for third party tested brands as these ensure transparency in terms of composition. Basically, an independent lab has verified that what's on the label is actually in the bottle at the right doses.

Before starting any supplement, you want to check with your clinician that there are no contraindications for your specific case. My top picks:

Creatine monohydrate (3-5g daily): One of the most researched supplements available, creatine supports muscle strength, power, and cognitive function. All particularly valuable during perimenopause when maintaining muscle mass becomes more challenging. Learn more about creatine benefits for women

Vitamin D and Omega-3s: Essential for bone and cardiovascular health, both of which become priority concerns during this transition. Even in sunny climates, many people don't get adequate vitamin D from sun exposure alone. Omega-3s support heart health and may help with mood stability during hormonal fluctuations.

Sleep & Stress: The Silent Performance Killers

All the protein and smart carb timing in the world won't help if you're not recovering properly. Sleep and stress management aren't optional extras, they're the foundation everything else builds on.

Getting a good night of sleep is hard, especially as we get older, and perimenopause doesn't make it any easier. Poor sleep has become epidemic—and the consequences extend far beyond feeling tired. With poor sleep comes a wide varitey of consequences:

• Impaired stress response and emotional regulation
• Weight gain and increased belly fat storage
• Weakened immune function and slower recovery
• Increased insulin resistance and cravings
• Higher cortisol levels that interfere with muscle building

You don't need a 75 minute bedtime routine, but a few habits can help you get better sleep quality:

• Consistency: Same bedtime and wake time every day, even weekends
• Dim the lights in the evening, especially blue light from screens
• A cool dark room is the best environment
• Mind your timing: No large meals or intense exercise within 3 hours of bedtime
• Create a buffer: 15-30 minutes of calm activity (reading, gentle stretching) before sleep

Target at least 7h of sleep a night. Even if you function great on 6h, it's not enough and the lack of sleep builds up leading to lasting health consequences.

Track What Matters (and What to Ignore)

Tracking. That one does feel like homework and there's no way around it. It's tedious but oh so helpful! Without tracking, it's hard to know whether something is trending in one direction or not. You don't need to track everything all the time, but these four areas can help actually move the needle.

Your symptoms: If you're in perimenopause, it can be helpful to track your symptoms daily and log their intensity. Sleep quality, mood, energy, headaches, hot flashes, joint pain... The list can be long but not everyone will experience the same so track only what you're actually experiencing. Rate intensity on a simple 1-5 scale and keep a daily log. This data becomes invaluable when working with healthcare providers.

Your training: If you want to progress, it's good to know where you're at so logging your workouts is really helpful. You don't want to make all these efforts in the gym blind. Keeping track of your loads, reps, and RPE will help you see progress even if you feel stuck.

Menstrual cycle: It may seem trivial, but the menstrual cycle can reveal a lot about your health and what's going on in your body. Even irregular cycles tell a story.

Food intake (strategically): Food tracking can feel overwhelming for sure. It's annoying to track your food, I'm not gonna lie. But the truth is, we are terrible at estimating portion sizes and food composition. Without knowing what is in your plate, it will be extremely challenging to reach your goals. You don't need to track forever though: try one week to see what you're actually eating. The results often surprise people and provide valuable baseline data for making informed changes.

Skip the Rest: Daily weight fluctuations, obsessive step counting, and any metric that creates anxiety rather than insight.

The goal: Track to learn and adjust, not to judge yourself.

The Non-Negotiables: Your Perimenopause Training Essentials

After all the details, here's what actually moves the needle:

Strength first: 2-4 sessions per week focusing on compound movements in the 4-8 rep range. Your bones and muscles need this stimulus more than ever.

Recovery as training: Sleep, deload weeks, and listening to your body aren't optional extras—they're part of the program.

Protein at every meal: Aim for a palm-sized portion each time you eat. Your changing hormones make muscle preservation more challenging.

Track what matters: Symptoms, cycle patterns, and training loads. Skip the daily weight obsession.

Everything else—the specific exercises, timing, and supplements—can be customized to your life. But these four principles are your foundation.

Common Myths—Busted

"Cardio is best for fat loss" While cardio burns calories, focusing solely on cardio for fat loss is a losing strategy. Yes, you might lose weight, but a significant portion will be muscle mass, not just fat. Your body burns muscle for fuel much faster than fat, especially if you don't strength train. Strength training preserves muscle and keeps your metabolism elevated.

"Heavy lifting will bulk me up" Honestly, I wish that just the idea of lifting weights would make me bulk up. It's really hard and requires dedication to get jacked. Lifting heavy will help with your bone density and metabolism much faster than it will make you bulky.

"I should avoid HIIT" HIIT gets a bad rap because many people overdo it, but short, intense intervals are incredibly efficient for cardiovascular health and can improve insulin sensitivity in minimal time. It's about dose and recovery, not never.

Safety & When to Get Help

Starting a new activity should always involve your care team. Talk to your healthcare provider before initiating a new activity.

Red flags that need immediate medical attention

• New or worsening pelvic floor symptoms (leaking, pressure, pain)
• Unusual bleeding patterns or heavy bleeding
• Dizziness, chest pain, or shortness of breath during exercise
• Persistent joint swelling or pain that doesn't improve with rest
• Severe fatigue that doesn't respond to adequate sleep and recovery

When to work with a fitness professional: If you're concerned about proper form, coaches can help assess your level and cue you to help ensure you lift safely. A coach can also help you with programming and accountability.

Trust your instincts: You know your body better than anyone. If something feels off, don't hesitate to seek professional guidance. Early intervention often prevents bigger problems down the road.

Your health and safety always come first. There's no workout worth risking your wellbeing, and getting the right support makes your fitness journey more effective and enjoyable.