Menopause is often discussed in relation to hot flushes, sleep disturbance and bone loss, but changes in muscle deserve equal attention. During the menopausal transition, body composition can shift toward greater fat mass and lower lean mass, while ageing simultaneously contributes to reductions in muscle strength, power and physical capacity. Longitudinal data from the Study of Women’s Health Across the Nation showed that lean mass begins to decline around the menopausal transition even when body weight alone does not clearly reflect the change (Greendale et al., 2019).

Strength training provides a direct way to challenge these changes. Importantly, the aim is not simply to “stay toned". Progressive resistance exercise can improve strength, preserve or increase muscle tissue, support bone loading and maintain the capacity required for everyday activities such as climbing stairs, lifting, carrying and getting up from the floor.

Why Strength Training Matters Through Menopause

Oestrogen decline occurs alongside changes in bone remodelling, body composition and the neuromuscular environment. However, menopause should not be treated as a single explanation for every change in strength or muscle mass. Chronological ageing, physical inactivity, sleep disruption, nutrition, chronic disease and previous exercise exposure also influence muscle function.

This distinction is clinically important. Women should not be told that muscle loss is unavoidable after menopause. Resistance-training studies consistently demonstrate that postmenopausal women remain capable of gaining substantial strength. A 2024 systematic review and meta-analysis found beneficial effects of resistance training on several physical-fitness outcomes in healthy postmenopausal women (González-Gálvez et al., 2024).

The practical message is therefore straightforward: menopause may change the context in which muscle is trained, but it does not remove the muscle's ability to adapt.

What Does the Evidence Tell Us?

Resistance training improves strength across menopause stages, although the response of muscle size may depend on training dose. In a 20-week study of middle-aged women, both premenopausal and postmenopausal participants improved maximal strength following free-weight training. Muscle hypertrophy was less evident in the postmenopausal groups, leading the researchers to suggest that sufficient weekly training volume may be particularly important when increasing muscle mass is the goal (Isenmann et al., 2023).

Even relatively small doses can produce useful early adaptations. Dias et al. (2024) studied menopausal women completing resistance exercise twice weekly using two sets of 8–12 repetitions for three dynamic exercises plus plank exercise. Improvements in bench-press and leg-press strength occurred after only four weeks, although broader functional and cardiovascular changes were not demonstrated over such a short period.

The 2026 American College of Sports Medicine (ACSM) position stand strengthens the overall evidence base. After synthesising 137 systematic reviews involving more than 30,000 participants, it concluded that progressive resistance training improves strength, muscle size, power and physical function in adults. Greater strength gains were associated particularly with heavier loads, full-range exercise, approximately 2–3 sets and training at least twice weekly (Currier et al., 2026).

Resistance training is also relevant to skeletal health. A 2025 meta-analysis reported beneficial effects on lumbar-spine, femoral-neck and total-hip bone mineral density in postmenopausal women, with higher-intensity programmes—approximately ≥70% of one-repetition maximum (1RM)—appearing particularly useful, although results varied between studies (Zhao et al., 2025).

A Practical Strength-Training Prescription

For most healthy women entering or progressing through menopause, two to three resistance-training sessions per week provide a realistic starting framework. This is consistent with international physical-activity guidance recommending muscle-strengthening exercise involving the major muscle groups on at least two days each week (World Health Organization [WHO], 2020).

A programme should emphasise movement patterns rather than an unnecessarily long list of isolated exercises.

A simple full-body session might include:

squat, sit-to-stand or leg press;
hip hinge or deadlift variation;
horizontal or vertical pulling;
chest or overhead pressing;
step-up, split squat or another unilateral lower-limb exercise;
calf strengthening;
loaded carry or trunk stability exercise.

Machines, dumbbells, barbells, resistance bands and appropriately progressed body-weight exercises can all be effective. The ACSM's current guidance specifically notes that meaningful adaptations are not dependent on one particular type of equipment (Currier et al., 2026).

How Heavy Should Women Lift?

“Heavy” should be defined relative to the person, not by the number printed on a dumbbell.

A beginner may initially need moderate resistance while learning movement quality. As capacity improves, progressively heavier loading becomes appropriate. If maximal strength is the main goal, evidence suggests that loads around 80% 1RM or greater can optimise strength development when tolerated. For hypertrophy, total weekly training volume becomes particularly important; the 2026 ACSM position stand identifies approximately 10 sets per muscle group per week as a useful higher-volume target for maximising muscle growth (Currier et al., 2026).

This does not mean every woman must immediately perform ten sets or lift at 80% 1RM. These are optimisation targets, not entry requirements.

A clinically sensible progression is:

Learn the movement → establish consistent training → increase resistance → accumulate adequate weekly volume → introduce heavier strength or power work according to goals.

Power also becomes increasingly relevant with ageing because everyday tasks often require force to be produced quickly. Once a woman has adequate strength, balance and technique, selected exercises can be performed with a controlled lowering phase followed by an intentionally faster concentric phase. Current ACSM evidence supports moderate loads of approximately 30–70% 1RM for power-focused training (Currier et al., 2026).

Adapting Training to Menopause Symptoms and Clinical Risk

A prescription should be progressive but not rigid. Sleep disturbance, vasomotor symptoms, pain and fatigue can temporarily affect exercise tolerance. On a poor-recovery day, reducing load or volume may be more appropriate than abandoning training altogether. Conversely, repeated symptom-free sessions should lead to progression rather than maintaining permanently light resistance.

Physiotherapists should also consider conditions that become increasingly relevant in midlife. Known osteoporosis, previous fragility fracture, significant joint disease, uncontrolled cardiovascular disease or marked balance impairment may require modification or further assessment before high-load or impact exercise. Higher-intensity resistance exercise may benefit bone health, but appropriate technique and individual risk assessment remain important, particularly in women with established osteoporosis (Zhao et al., 2025).

Pelvic-floor symptoms should also be actively screened. Urinary leakage, vaginal heaviness or pressure during lifting should prompt assessment of breathing strategy, load, movement technique and pelvic-floor function rather than simply removing all resistance exercise.

Warning symptoms such as unexplained chest pain, syncope, severe breathlessness, acute neurological symptoms, suspected fracture or rapidly worsening musculoskeletal pain require appropriate medical assessment rather than routine exercise progression.

The Physiotherapist's Role: From Exercise List to Long-Term Capacity

A good strength prescription involves more than giving a patient three sets of ten repetitions. The physiotherapist should establish the person's baseline strength, previous training experience, functional goals, bone and cardiovascular risk, symptom behaviour and confidence with resistance exercise.

Progress can then be measured using clinically appropriate outcomes such as repetition maximum testing, hand-held dynamometry, sit-to-stand performance, functional lifting capacity or exercise logs. The programme should evolve as capacity improves.

Most importantly, menopause-specific strength training does not require an entirely different physiology textbook. The fundamental principles remain specificity, progressive overload, adequate recovery and consistency. What changes is the clinical context in which those principles are applied.

For a woman who has never lifted weights, two well-designed sessions each week may be an excellent beginning. For an experienced lifter trying to maximise strength, muscle or bone loading, heavier loads and greater weekly volume may be necessary. The prescription should, therefore, meet the individual where she is—and progressively prepare her for where she wants to go.

Viva-Ready Summary

The menopausal transition is associated with changes in body composition, including declining lean mass, although ageing and lifestyle factors also contribute.
Resistance training remains effective for improving strength in peri- and postmenopausal women.
A practical starting prescription is 2–3 sessions per week, training all major muscle groups.
Strength-focused programmes can progress toward heavier loading; ≥80% 1RM is associated with greater maximal-strength gains in healthy adults.
Muscle hypertrophy requires adequate weekly volume, with approximately 10 sets per muscle group per week representing a useful higher-volume target.
Higher-intensity resistance training may also contribute to preservation of bone mineral density after menopause.
Training should be individualised according to symptoms, osteoporosis risk, cardiovascular status, pelvic-floor symptoms, previous experience and recovery.

One-line recall:
Through menopause, muscle still adapts: train major muscle groups at least twice weekly, progressively increase the challenge and use sufficient load and volume for the intended goal.

References

American College of Sports Medicine. (2025). ACSM's guidelines for exercise testing and prescription (C. Ozemek, A. R. Bonikowske, J. W. Christle, & P. M. Gallo, Eds.; 12th ed.). Wolters Kluwer.

Currier, B. S., D'Souza, A. C., Fiatarone Singh, M. A., Lowisz, C. V., Rawson, E. S., Schoenfeld, B. J., Smith-Ryan, A. E., Steen, J. P., Thomas, G. A., Triplett, N. T., Washington, T. A., Werner, T. J., & Phillips, S. M. (2026). American College of Sports Medicine position stand: Resistance training prescription for muscle function, hypertrophy, and physical performance in healthy adults: An overview of reviews. Medicine & Science in Sports & Exercise, 58(4), 851–872. doi:10.1249/MSS.0000000000003897.

Dias, R. K. N., Penna, E. M., Noronha, Á. S. N., et al. (2024). Minimal dose resistance training enhances strength without affecting cardiac autonomic modulation in menopausal women: A randomized clinical trial. Scientific Reports, 14, 19355. doi:10.1038/s41598-024-69073-4.

González-Gálvez, N., Moreno-Torres, J. M., & Vaquero-Cristóbal, R. (2024). Resistance training effects on healthy postmenopausal women: A systematic review with meta-analysis. Climacteric, 27(3), 296–304. doi:10.1080/13697137.2024.2310521.

Greendale, G. A., Sternfeld, B., Huang, M., Han, W., Karvonen-Gutierrez, C., Ruppert, K., Cauley, J. A., Finkelstein, J. S., Jiang, S.-F., & Karlamangla, A. S. (2019). Changes in body composition and weight during the menopause transition. JCI Insight, 4(5), e124865. doi:10.1172/jci.insight.124865.

Isenmann, E., Kaluza, D., Havers, T., Elbeshausen, A., Geisler, S., Hofmann, K., Flenker, U., Diel, P., & Gavanda, S. (2023). Resistance training alters body composition in middle-aged women depending on menopause—A 20-week control trial. BMC Women's Health, 23, 526. doi:10.1186/s12905-023-02671-y.

World Health Organization. (2020). WHO guidelines on physical activity and sedentary behaviour. World Health Organization.

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, 523. doi:10.1186/s13018-025-05890-1.