How *Exactly* Should You Work Out During Perimenopause?

Lift heavy weights. Sprint, don’t run. Go for gentle walks.

If you’re a woman in your 40s or 50s, you’re probably inundated with information about how you need to adapt your exercise routine during perimenopause, a years-long transition that leads to menopause, or the end of your period entirely.

But what kind of workout should you be doing? If anyone knows, it’s Dr. Stacy Sims, a Stanford University–affiliated exercise physiologist who shared her views on midlife workouts on the Mel Robbins Podcast and Andrew Huberman’s Huberman Lab.

Sims, the author of the book Women Are Not Small Men, delivers her advice with science-heavy explanations. But the core of her message is simple: adapt to what’s changing in your body and you’ll see better results.

How to exercise during perimenopause

Sims suggests that women undertake an exercise reset, prioritizing high-quality strength training (lift heavy and in the low-rep ranges) three times a week. She also says cardio should be reduced to two times a week, and it should consist of sprint interval training or SIT, a form of high-intensity interval training that consists of 30 seconds of all-out effort (think: sprinting on a track or pushing it on an assault bike) followed by three to four minutes of recovery. You aim to repeat that cycle up to five times.

Is it a good idea to switch up your workout during perimenopause?

For many women, following that advice means making a big shift in their exercise routines. But Sims’ approach works according to Dr. Catherine Hansen, an ob-gyn and the chief medical officer for Effica Health, a new virtual menopause and perimenopause clinic serving Albertans and Ontarians.

That’s because, in her view, this kind of exercise routine actually addresses the physiological changes women are undergoing during perimenopause.

There are three major physiological shifts happening during perimenopause because of a decline in estrogen, Hansen explains: muscle loss, bone density changes and changes in metabolism. Those hormonal changes make it harder to gain muscle and easier to put on weight, especially around your middle.

“Perimenopause is a wake-up call” about the need to adapt, Hansen says.

Making strength training the centre of your routine is going to offset muscle loss, she says, and that muscle is going to help you deal with metabolic changes that improve body composition. Muscle growth is also beneficial to bone health. Hansen sees the sprint training as an efficiency model for cardio, too—you get results with a lower time commitment but greater investment in overall intensity of effort.

More than that, she says women are already efficient cardio endurance machines and may need to change it up in midlife. “When we hit perimenopause, we want to be doing something that’s going to challenge our physiology," she says, “or work with some of those deficits that are starting to develop because of declining estrogen.”

What not to do while training during perimenopause

What you shouldn’t do is just jump into this kind of program all of a sudden, says Hansen. That’s something Sims also makes clear when she talks about the need for change.

Hansen tells patients who have little to no experience with strength training that it’s wise to make this overhaul a progressive shift, ideally guided by a personal trainer. The risk of injury is real, and lifting heavy weights without proper form is a recipe for hurting yourself and setting yourself back weeks or months.

In addition to strength training and cardio that challenges you, Hansen believes activities that address your balance are an important piece of the longevity puzzle, too—core work, yoga, Tai Chi, or “something that’s going to help you prevent falls as you get older,” she says.

Think beyond the body, too

There’s a great deal of pressure over the course of a woman’s life to do everything right, and the push to optimize perimenopause is no different. But Hansen stresses that you don’t need to perfect perimenopause or exercise like you’ve got a PhD in kinesiology.

Part of perimenopause’s wake-up call, says Hansen, is the recognition that it’s “time to write our own rules.” We’re socialized to care more about our gooier mid-section, but that’s often at the expense of celebrating the broader emotional and mental shifts that make this time of life exhilarating, too.

“A lot of the hormone shifts leave us with a greater sense of independence,” says Hansen.

“Take time to be loving to yourself and self-compassionate,” she adds. “And if that means taking an extra couple days off or a week off to let yourself rest, do it—because that's going to help you have a happier, more joyful life.”