I wish I was more active. I want to be, but honestly it’s a combination of being the default parent of young kids, contending with old injuries, and an inclination to spend my limited free time relaxing and not sweating.
Exercise isn’t foreign to me.
I used to be a competitive swimmer. I volunteered as a ski patroller. Regular exercise used to be built into my identity but all of that was before kids, a career, and the constant balancing act of who needs what from me next.
Enter perimenopause into the mix and I can’t get away with walking the dog and carrying a tired child back from the park as my main form of exercise. Not only has my belly changed my image, but I’m now at a higher risk for osteoporosis and heart disease. Exercise isn’t about just aesthetics, it’s about protection. It’s a well-established intervention and I need to get better about it.
A 2026 review in Current Opinion In Obstetrics and Gynecology1 emphasizes that midlife weight gain is mostly driven by age-related metabolic changes with a tendency towards central fat accumulation. And the authors highlight that while current pharmacological treatments are one of the tools, that lifestyle interventions, primarily resistance training, remain foundational.
How does declining estrogen affect health?
- Muscle and bone loss – lower estrogen levels contributes to less muscle mass and lower bone density, increasing the risk of fractures
- Metabolic changes – loss of lean muscle and hormonal shifts reduce how much you burn resting, and promote fat accumulation
- Cardiovascular risk – the inclination towards truncal obesity (fat around midsection) is a risk factor for cardiovascular disease. There’s also a metabolic shift towards insulin resistance.
- Mood shifts, sleep disruption – these factors often impact physical health as well as emotional well-being
What exercise is best for menopausal & perimenopausal women?
- Strength training – resistance training is the cornerstone. Resistance training preserves muscle mass, supports bone density, and impacts metabolic health.
- Weight bearing cardio – brisk walking and hiking support cardiovascular health while also maintaining bone strength.
- Balance and Flexibility – Yoga, Tai Chi, and pilates all improve stability and flexibility
- High Intensity Interval Training (HIIT) – short bursts of intense activity followed by rest (burpees, jump-squats, etc)
I also want to mention the importance of a well-rounded approach.
Namely, a Mediterranean style diet (mostly fruits and vegetables with some protein), mental health support, screening for cardiovascular health and bone density.
Briefly, GLP-1 drugs have a time and a place and can be used as a great tool. However, there is a real risk of loss of lean muscle mass during weight loss, making strength training even more important. I highly recommend working with a trainer, at least initially, to learn how to lift safely.
High impact or fall-prone activities may increase the risk of fracture, so be aware of what activities you’re choosing. (Maybe not starting with skateboarding.) But chose activities that you enjoy, start small and increase gradually, and combine strength, cardio, and flexibility training.
Perimenopause and menopause changes metabolism, impacts cardiovascular and bone health, but you still have the ability to impact your health. Strength training preserves muscle and forces the bones to stay strong.
I’m no longer the same person I was in my twenties. (Thank goodness, right?!) I’m calmer, more confident, hopefully wiser. And sure, I’m no longer logging miles in the pool or dragging toboggans and backboards down a snowy mountain. But, I can still show up for my body. I hope you can too.
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Dr. Jennifer Potter, ND
Naturopathic Doctor San Jose
408-356-1364
Dr. Jennifer Potter, ND provides natural healthcare solutions for families and individuals, focusing on perimenopause/menopause, autoimmune conditions, fatigue, and immune support. She is deeply committed to her patient’s well being, prioritizes patient education and combines natural and conventional therapies to deliver personalized care. Outside of her practice, she enjoys time with her two kids, reading fiction, and crocheting.
1 Hung S, Adams KE. Midlife weight gain: challenges and solutions. Curr Opin Obstet Gynecol. 2026 Apr 1;38(2):94-102. doi: 10.1097/GCO.0000000000001093. Epub 2026 Feb 24. PMID: 41740621.
