Perimenopause, Muscle and Bone Health: What Women Should Focus On
Updated: Aug 4
Frequently asked questions
Does strength training help during perimenopause?
Yes. Progressive resistance training helps preserve or build muscle, strength and physical function during midlife. The program should be progressed gradually and matched to training history, symptoms and injury risk.
What type of exercise supports bone health?
A combination of progressive resistance training and appropriately selected weight-bearing or impact exercise is generally most useful. The right loading depends on bone health, joint tolerance and individual risk factors.
Should women in perimenopause have a bone-density scan?
Not everyone needs an early DXA scan. Medical assessment is appropriate when risk factors are present, including previous low-trauma fracture, prolonged low body weight, early menopause, certain medications or relevant medical conditions.
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Written and clinically reviewed by Nigel Morgan, Physiotherapist and Exercise Physiologist.
Perimenopause is not simply a change in periods. It is a transition that can affect sleep, temperature regulation, mood, energy, body composition and the way training feels. It is also an important window for protecting two tissues that strongly influence long-term health and independence: skeletal muscle and bone.
The goal is not to chase a perfect hormone profile or respond to every change by exercising harder. The most useful approach is usually a clear, progressive plan built around resistance training, appropriate weight-bearing or impact exercise, adequate nutrition, recovery and medical assessment when risk factors or significant symptoms are present.
WHY MUSCLE AND BONE MATTER DURING PERIMENOPAUSE
Oestrogen helps regulate bone remodelling. As oestrogen levels become more variable and eventually decline around menopause, bone breakdown can begin to outpace bone formation. Bone loss is often most rapid around the final menstrual period and in the early postmenopausal years.
Muscle is affected by ageing, activity levels, nutrition, sleep and hormonal changes. The practical issue is that a gradual loss of muscle mass and strength can reduce metabolic health, physical capacity, joint resilience and protection against falls. Strong muscles also allow women to expose bone to the mechanical loading it needs.
This is why midlife training should be designed to create useful adaptation rather than simply burn calories.
1. MAKE PROGRESSIVE RESISTANCE TRAINING THE FOUNDATION
Walking is excellent for general health, but it does not provide the same stimulus as progressive strength training. A complete program should train the major movement patterns: squat or sit-to-stand, hinge, push, pull, step or lunge, carry and trunk control.
For many women, two or three well-designed strength sessions each week is a realistic starting point. The exercises do not need to be complicated. Machines, dumbbells, barbells, cables and body-weight variations can all work. What matters is that the resistance becomes appropriately challenging and progresses over time.
A useful session might include five to eight exercises. Most can be performed for two to four sets, with a load that leaves only a few technically sound repetitions in reserve by the end of the set. Beginners may initially use lighter loads to learn technique, but remaining indefinitely with very easy resistance is unlikely to maximise strength, muscle or bone adaptation.
Progress can come from adding a small amount of weight, completing more repetitions with the same load, improving range or control, or advancing to a more demanding variation. It should be gradual enough that joints and tendons adapt with the muscles.
2. INCLUDE BONE-SPECIFIC LOADING
Bone responds to mechanical loading. Weight-bearing activity, resistance training and—where appropriate—impact exercise provide different forms of stimulus.
Examples of weight-bearing activity include brisk walking, stair climbing, hiking and dancing. Impact work may include small jumps, hops, skipping or short bouts of running. The appropriate level depends on training history, pelvic-floor symptoms, joint health, balance, fracture risk and whether osteoporosis is already present.
More impact is not automatically better. Someone who has not jumped for years should not begin with a large volume of maximal jumping. A sensible progression might begin with faster sit-to-stands, heel drops, step-ups or low-level landing drills before advancing to repeated jumps or hops.
Women with osteoporosis, previous fragility fractures, significant pelvic-floor symptoms or spinal problems should obtain individual guidance before adding high-impact exercise. The aim is to find the strongest safe stimulus, not to avoid loading altogether.
3. PROTECT POWER, BALANCE AND FUNCTION
Strength is the ability to produce force; power is the ability to produce it quickly. Both matter. The ability to rise from a chair, arrest a trip, climb stairs or move a heavy object often depends on generating force promptly.
Once basic technique is sound, selected movements can be performed with a controlled but deliberate lifting phase. Medicine-ball throws, faster sit-to-stands, step-ups and appropriately programmed jumps can also train power.
Balance work is most effective when it is progressive. Standing on one leg may be a starting point, but balance can be challenged further by narrowing the base of support, turning the head, reaching, stepping in different directions or combining balance with strength tasks. This helps reduce falls risk while keeping training relevant to daily life.
4. EAT ENOUGH PROTEIN AND TOTAL ENERGY
Muscle cannot be built from training alone. Protein provides the amino acids required for repair and adaptation. Rather than relying on one large evening meal, many women benefit from distributing protein across three or four meals.
The exact target should reflect body size, appetite, kidney health, energy needs and training. A practical meal-based approach is to include a substantial protein source at breakfast, lunch and dinner, with an additional protein-rich snack when required. Examples include Greek yoghurt, milk, eggs, fish, poultry, lean meat, tofu, tempeh and legumes.
Aggressive dieting can work against both muscle and bone health. A large, prolonged energy deficit makes it harder to train well, recover, retain lean mass and obtain enough calcium and other nutrients. If fat loss is a goal, a moderate approach with resistance training and adequate protein is generally more sustainable.
5. COVER CALCIUM AND VITAMIN D—PREFE
RABLY WITH FOOD AND TESTING WHERE NEEDED
Calcium is a structural component of bone, while vitamin D supports calcium absorption and other musculoskeletal functions. Australian nutrient-reference values increase the calcium target for women after 50, reflecting the greater challenge of maintaining calcium balance after menopause.
Food-first calcium sources include dairy products, calcium-fortified alternatives, canned fish with edible bones, calcium-set tofu and selected leafy greens. Supplements should fill an identified gap rather than automatically replace a balanced diet. Excessive supplementation is not necessarily beneficial and should be discussed with a doctor or dietitian, particularly when there are kidney, cardiovascular or medication considerations.
Vitamin D status depends partly on sun exposure, skin type, season, latitude and individual health. A blood test may be appropriate when deficiency risk is present. Supplement dose should be based on clinical advice rather than guesswork.
6. TAKE SLEEP AND RECOVERY SERIOUSLY
Hot flushes, night sweats, anxiety and changes in sleep can make recovery more difficult. This does not mean training must stop. It may mean adjusting volume, exercise selection or session timing while preserving the strength stimulus.
On a poor-sleep week, keeping the main exercises but reducing accessory work can be more useful than abandoning the program. Autoregulation—adjusting the load while maintaining good effort and technique—helps keep training consistent without treating every session as a test.
Recovery also includes spacing demanding sessions, managing alcohol, eating adequately and addressing persistent symptoms with a qualified clinician.
7. KNOW WHEN TO DISCUSS BONE-DENSITY ASSESSMENT
A DXA scan is not automatically required for every woman entering perimenopause. Assessment becomes more relevant when risk factors are present, including a previous minimal-trauma fracture, strong family history of osteoporosis or hip fracture, early menopause, prolonged absence of periods, very low body weight, smoking, heavy alcohol intake, malabsorption, rheumatoid or endocrine disease, or prolonged use of medicines such as glucocorticoids.
Unexpected height loss, persistent unexplained back pain or a fracture from a relatively minor incident also warrants medical review. A GP can consider overall fracture risk, blood tests, medication history and whether DXA is appropriate.
8. TREAT HORMONE THERAPY AS A MEDICAL DECISION, NOT A TRAINING SHORTCUT
Menopausal hormone therapy may be appropriate for some women and can have beneficial effects on bone, but the decision depends on symptoms, age, timing, medical history, preferences and individual risks. Exercise professionals should not prescribe it, and it should not be presented as a replacement for progressive exercise or adequate nutrition.
Women experiencing disruptive symptoms should speak with a GP or menopause-informed clinician for an individual assessment. Training and medical treatment can complement each other when each is used for the right purpose.
A PRACTICAL WEEK
A balanced week might contain two or three whole-body resistance sessions, regular walking or other aerobic exercise, and one to three short exposures to impact, power or balance work depending on capacity. This can be modified around symptoms and recovery without losing the essential ingredients.
The program should be measurable. Track a handful of key lifts, exercise tolerance, pain response, energy and functional markers such as stair climbing or sit-to-stand performance. Progress is easier to see when the plan is recorded.
THE BOTTOM LINE
Perimenopause is a strong reason to train with greater purpose, not a reason to become cautious and inactive. Progressive strength training, appropriate bone-loading activity, sufficient protein and energy, calcium and vitamin D adequacy, recovery and risk-based medical assessment form a practical foundation.
The best program is individual. It should account for symptoms, injury history, pelvic-floor function, current bone health, preferences and the time available to train. When those variables are addressed, women can build strength and physical confidence through perimenopause and well beyond it.
WOULD YOU LIKE TO SCHEDULE AN APPOINTMENT?
Complete the enquiry form below and a member of our team will contact you. You can also email nigel@bodyclinicsydney.com or call 0410 148 296.
Body Clinic Sydney is located at SOHO Gym, 2 Bligh Street, Sydney NSW 2000.
GENERAL INFORMATION DISCLAIMER
This article provides general health and exercise information only. It is not a diagnosis or a substitute for individual medical, physiotherapy, exercise physiology or nutrition advice. Seek personalised guidance before changing exercise if you have osteoporosis, a previous fracture, significant symptoms, pelvic-floor concerns or another medical condition.
REFERENCES AND FURTHER READING
Healthy Bones Australia: Menopause, vitamin D and bone-health fact sheets.
International Osteoporosis Foundation: Exercise and bone-health guidance.
Australian Government Nutrient Reference Values: Calcium.
Exercise is Medicine Australia: Menopause and Exercise fact sheet.
American College of Sports Medicine: Resistance-training and physical-activity guidance.
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