Training Through Perimenopause and Menopause: What Actually Changes and What to Do About It
What's Actually Changing
As oestrogen declines through perimenopause and menopause, bone turnover shifts out of balance, with bone broken down faster than it's rebuilt. The numbers are worth knowing: the average woman loses up to 10% of her bone mass in the first five years after menopause, and by age 60, an estimated 51% of Australian women are osteopenic and 27% have osteoporosis. One in two women over 60 will experience a fracture as a result. This isn't a distant "old age" issue. The window where bone loss accelerates fastest starts well before most women expect it to, and it's something we see regularly in our Panania studio: women who've noticed changes in strength and recovery long before anyone raised bone health with them.
The good news is that this is one of the areas of women's health where exercise has some of the strongest evidence behind it, and it's an area where an Exercise Physiologist can make a genuine, measurable difference.
What the Research says about Resistance Training and Bone Density
A 2025 systematic review and meta-analysis (17 randomised controlled trials, 690 participants) looked specifically at how resistance training affects bone mineral density in postmenopausal women, and found statistically significant improvements at the sites that matter most for fracture risk:
Lumbar spine: significant improvement
Femoral neck (hip): significant improvement
Total hip: significant improvement
The training that produced the best results wasn't gentle. The research pointed to higher-intensity loading (around 70% of one-rep max or more), performed roughly three times a week, sustained over 48 weeks or longer, in sessions of 40 minutes or more. Two of the landmark trials in this space, the LIFTMOR trial and the Erlangen Fitness and Osteoporosis Prevention Study, found that heavier, supervised resistance training produced greater gains in both bone density and strength than lighter-load programs.
The Women's Health and Exercise Network (WHEN) position statement, drawing on a Cochrane review of 43 trials, confirms resistance training is effective for bone health, and that combining resistance training with impact loading (like stair climbing, jogging or skipping) produces the strongest results of all.
Why "just lift heavy" isn't the Whole Story
Here's where an evidence-based, individualised approach matters. The same WHEN position statement is explicit that training to failure or near-failure has no evidence base in perimenopausal or menopausal women, and is generally cautioned against in adults over 50 due to added cardiovascular load and longer recovery needs. It also notes that 71% of women in this stage of life report musculoskeletal pain, and many need pelvic floor considerations factored in before starting a heavier loading program.
In other words: the goal isn't to go as hard as possible. It's to load bone and muscle safely, increasing the challenge over time in a way that's sustainable, which is exactly the gap an Exercise Physiologist is trained to close. It's also why WHEN's own guidance is that the best form of exercise is the one a woman can actually take up and keep doing. Heavy barbell lifting is one valid pathway, but resistance bands, supervised machine work and modified bodyweight loading are all legitimate too, depending on where someone is starting from.
What This Looks Like in Practice
For most women, an effective approach through perimenopause and menopause combines:
Progressive resistance training, individually loaded and supervised so intensity increases safely over time rather than guessed at
Weight-bearing impact activity where appropriate, layered in alongside resistance work
A starting point that matches where you are now: if heavy lifting is new to you, or you're managing existing pain or a diagnosis of osteopenia, this is precisely the situation an EP-led program is designed for, rather than a generic class or program
This is also why we don't believe in a one-size-fits-all approach. Whether you're starting in our small-group strength sessions, working 2:1 with one of our team, or beginning your program with a full assessment from an Exercise Physiologist, the goal is the same: build strength and bone density that actually holds up over the next twenty, thirty, even forty years, not just get through a workout.
If you're based in Panania, Revesby or the surrounding suburbs and you're navigating this stage of life, or you want a program built around your own bone health and strength picture, our Exercise Physiology team can help you build a plan around real evidence, not guesswork. Book a free 15-minute discovery call to get started.
Related reading: Start Low, Progress Smart: The EP Approach to Exercise → /blog/start-low
References
Howe, T. E., Shea, B., Dawson, L. J., Downie, F., Murray, A., Ross, C., Harbour, R. T., Caldwell, L. M., & Creed, G. (2011). Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews, 2011(7), CD000333. https://doi.org/10.1002/14651858.CD000333.pub2 (PMID: 21735380)
Kemmler, W., Lauber, D., Weineck, J., Hensen, J., Kalender, W., & Engelke, K. (2004). Benefits of 2 years of intense exercise on bone density, physical fitness, and blood lipids in early postmenopausal osteopenic women: Results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS). Archives of Internal Medicine, 164(10), 1084-1091. https://doi.org/10.1001/archinte.164.10.1084 (PMID: 15159265)
Watson, S. L., Weeks, B. K., Weis, L. J., Harding, A. T., Horan, S. A., & Beck, B. R. (2018). High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: The LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research, 33(2), 211-220. https://doi.org/10.1002/jbmr.3284 (PMID: 28975661)
Zhao, F., Su, W., Sun, Y., Wang, J., Lu, B., & Yun, H. (2025). Optimal resistance training parameters for improving bone mineral density in postmenopausal women: A systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 20(1), Article 523. https://doi.org/10.1186/s13018-025-05890-1 (PMID: 40420105)
Other sources cited (organisational/clinical guidance, not journal articles, no PMID):
Australasian Menopause Society. (n.d.). Osteoporosis [Information sheet]. https://www.menopause.org.au/hp/information-sheets/osteoporosis
Better Health Channel. (n.d.). Menopause and osteoporosis. Victorian State Government, Department of Health. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menopause-and-osteoporosis
Women's Health and Exercise Network. (n.d.). Resistance training and menopause [Position statement]. https://when.org.au/education/resistance-training-menopause/