Taking Back Control in Perimenopause: How Exercise Becomes Your Strongest Tool

Ever catch yourself thinking, “When did my body start doing… this?” Perimenopause has a way of sneaking in like an uninvited guest, changing your sleep, your mood, your patience, your energy and even how your clothes fit. It can feel unsettling, unpredictable, and at times unfair. 

So what exactly is perimenopause, and what is going on inside your body during all of this? In simple terms, this is the stage when your hormones start shifting in ways that can feel anything but subtle. Estrogen begins to behave like it’s on a roller coaster, rising one moment and dropping the next. Progesterone gradually declines. Other hormones, like FSH, climb higher while LH moves unpredictably.

With all of this happening behind the scenes, it is not surprising that you are noticing shifts in how you feel. These are changes that can be hard to explain to your partner or family members.  Your body is moving through a major transition, and the symptoms you are experiencing are real reflections of the hormonal changes happening within you.

But here is the part that rarely gets said out loud: you are not simply at the mercy of these changes. Even in the middle of the hormonal whirlpool, you still have influence. You still have agency. And there is one powerful, accessible, and completely free tool that can help you feel steadier, stronger, and more in control of your body again: exercise.

Think of it not as pressure or perfection, but as a way to build your strength, support your metabolism, lift your mood, and steady the hormonal ups and downs. It’s one of the most empowering choices you can make during perimenopause and it’s always within reach.

The Three Types of Exercise Every Perimenopausal Woman Needs

1. Cardiovascular Exercise

During perimenopause, the hormonal changes affect your heart, blood vessels and cholesterol levels. This is a time when your cardiovascular system becomes more vulnerable. Regular cardiovascular exercise is one of the most effective ways to support and protect your heart during this transition. 

How Cardio Supports Your Heart

Cardiovascular exercise does so much more than raise your heart rate. It strengthens the way your heart pumps blood and helps your blood vessels stay healthier. It can lower your resting heart rate, reduce blood pressure, improve cholesterol levels, lower blood sugar, and calm inflammation. It also helps prevent the weight gain that many women notice around the belly as hormones fluctuate.

How Cardio Eases Your Symptoms

Cardio does not just help your heart. It also supports the symptoms that often make perimenopause feel so disruptive. Regular cardiovascular movement can lift your mood, reduce anxiety, improve sleep, ease joint and muscle discomfort, and boost your daily energy. Many women describe feeling more grounded and clearer mentally when they stay active.

How Much Cardio Do You Need?

The American Heart Association recommends at least 150 minutes of moderate-intensity aerobic activity each week, such as brisk walking, or 75 minutes of vigorous activity, such as jogging. You can mix and match both types depending on what feels right for you.

If committing to long sessions feels overwhelming, start with 5 or 10 minutes at a time and increase each week. Small, consistent steps add up and still give your body benefits.

What Counts as Cardiovascular Exercise?

Cardio is any movement that gets your heart beating faster and makes you breathe a little harder. Excellent options include brisk walking, jogging, swimming, cycling, dancing, and aerobic classes. Weight-bearing forms of aerobic exercise, like walking or dancing, offer added benefits for your bones, which become more vulnerable during this stage. The repetitive impact forces from weight-bearing cardiovascular activities help preserve bone density by producing force on bones. This promotes bone growth and strength. Walking has been shown to improve bone mineral density at the hip in early postmenopausal women.

2. Strength and Resistance

As you move through perimenopause, maintaining strength becomes more important than ever. Declining estrogen affects the balance between bone formation and bone breakdown, which can lead to faster bone loss. At the same time, muscle loss naturally accelerates. Strength training is one of the most effective ways to protect both your bones and your muscles during this stage of life.

Why Strength Training Matters

When you lift weights or work against resistance, your muscles pull on your bones with meaningful force. Your bones respond to that stress by becoming stronger and denser. This is your body’s natural way of adapting to the demands you place on it. Strength training also helps preserve muscle mass, which supports your metabolism, balance, mobility, and overall physical function. Many women even notice that regular resistance training helps with hot flashes, mood changes, and daily energy.

How Much Strength Training Do You Need?

Aim for strength or resistance training at least two to three days per week. You can use dumbbells, resistance bands, weight machines, or your own body weight through movements such as squats, push-ups, lunges, and rows. The goal is to challenge your muscles enough that they feel tired by the end of each set.

If you are unsure how much weight to use, a helpful guideline is working at 40 to 80 percent of your one repetition maximum, or 1RM. Your 1RM is the heaviest weight you can lift once with good form. For example, if you can push 100 pounds one time on a leg press, then 60 pounds is about 60 percent of your 1RM. At that intensity, most women can complete 8 to 12 repetitions before the muscles fatigue.

Why Heavier Loads Help

Within safe limits, gradually increasing the weight over time sends a stronger signal to your bones and muscles. This approach, called progressive resistance training, is especially effective during perimenopause because it directly counters the accelerated bone and muscle loss that can occur during this transition.

The Bottom Line

Strength training is one of the most powerful tools you have to protect your long-term health during perimenopause. It supports your bones, your muscles, your metabolism, and your overall well-being. When combined with cardiovascular exercise, it creates a balanced foundation that helps you feel strong, capable, and more in control through the hormonal changes ahead.

3. Mind-Body Exercise

Perimenopause affects far more than your physical health. Sleep may feel disrupted, stress may rise more easily, and your mood may shift in ways that feel unfamiliar. Mind-body exercises offer a gentle but powerful way to steady these changes and support both your emotional and physical well-being.

Why Mind-Body Practices Matter

Practices such as Yoga, Tai Chi, Pilates, and Qigong blend movement with breath and mental focus. They are not just exercises. They help calm your nervous system, release tension stored in the body, and bring you back to a sense of steadiness and presence. For many women, these practices become an anchor during the unpredictability of perimenopause.

How Mind-Body Exercise Helps

Research shows that mind-body practices improve bone mineral density, sleep quality, anxiety, depression, and fatigue in perimenopausal and postmenopausal women. Yoga, in particular, has been shown to enhance both physical and psychological quality of life. These benefits make mind-body exercise especially helpful if you are experiencing stress, restless nights, or mood changes.

Where to Start

You do not need long sessions or complicated routines. Even ten minutes of gentle stretching, focused breathing, or guided movement can shift how you feel. Choose a practice that feels approachable. A simple yoga flow, a beginner Pilates class, or a Tai Chi video can be a supportive way to reconnect with your body when everything else feels in flux.

The Power of Combining All Three

Each type of exercise plays a different role during perimenopause, and together they create a powerful foundation for your health. Programs that blend aerobic exercise, strength training, and mind-body practices tend to be the most effective for managing the wide range of symptoms women experience during this transition. When movement is paired with supportive nutrition, such as reducing saturated fat and cholesterol, the benefits grow even stronger.

Making Exercise Work for You

The best exercise plan is the one you can actually stick with. Choose activities you enjoy. Your routine should feel functional, meaning it supports the way you move through daily life, and it should be varied enough to keep you interested over time. Small steps taken consistently will always be more effective than the perfect plan that never gets started.

What to Approach with Care

Most exercises are safe for perimenopausal women, but certain conditions call for more caution. If you have osteoporosis, joint pain, or a higher risk of falling, approach high-impact activities carefully. Working with a healthcare provider or physical therapist can help you design a safe, effective plan that protects your bones and joints while still helping you stay active.

The Bottom Line

Cardiovascular exercise, strength training, and mind-body practices each offer meaningful benefits during perimenopause. While researchers continue to refine the optimal prescription, the evidence clearly supports a balanced and well-rounded routine. If you are unsure where to begin, speaking with a knowledgeable primary care physician can help you create a plan that feels safe, sustainable, and tailored to your goals.

The path forward does not require perfection, only the willingness to begin. If you have five minutes today, start there. Five minutes is enough to gently move you toward strength and steadiness.

Dr. Sapna Rajput

Primary Care Physician

Doctor or Osteopathic Medicine

Board Certified in Family Medicine

Civil Surgeon

drsapnarajput.com

650-254-6665