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Strength Training Through Menopause: Bone, Muscle and Hot Flushes

10 min read

The NHS notes that women lose bone rapidly in the first few years after the menopause. The NHS also lists muscle aches, joint pains and sleep problems among menopause symptoms. Strength training has direct trial evidence for bone and muscle, but not for every symptom.

This guide covers what heavy resistance and impact training did for bone in a supervised trial of women with low bone mass, what pooled trials show for bone and muscle, what exercise did and did not do for hot flushes, and how to start safely.

+2.9%
Lumbar spine bone density after 8 months of supervised heavy resistance and impact training, against a 1.2% loss with light home exercise
LIFTMOR trial, Watson et al. 2018, 101 postmenopausal women with low bone mass
70%+
Estimated share of women with muscle, bone or joint symptoms through the transition
Wright et al. 2024, Climacteric review
5,581
Postmenopausal women pooled from 80 exercise studies, with bone density gains at spine and hip
Mohebbi et al. 2023, Osteoporosis International
10.7
Average number of menopause symptoms reported by survey respondents
Huang et al. 2023, 953 UK respondents, convenience sample
21 trials
Reviewed for hot flushes: exercise made no significant change to how often they happened
Liu et al. 2022, Climacteric, 2,884 women
Sources: Watson et al. 2018, Journal of Bone and Mineral Research. Wright et al. 2024 and Liu et al. 2022, Climacteric. Mohebbi et al. 2023, Osteoporosis International. Huang et al. 2023, BMC Women's Health.

What changes in the body

The NHS says menopause usually affects women between 45 and 55, and lists weakening bones among its symptoms, alongside hot flushes, sleep problems, mood changes and weight gain around the stomach. In a 2024 review in the journal Climacteric, Vonda Wright and colleagues estimated that more than 47 million women worldwide enter the menopause transition each year. They estimated that more than 70% will have musculoskeletal symptoms and 25% will be disabled by them.

The review proposed a new term, the musculoskeletal syndrome of menopause, for the group of changes linked to falling oestrogen: joint pain, loss of muscle mass, loss of bone density and progression of osteoarthritis. A UK online survey by David Huang and colleagues at Imperial College London gives a sense of the wider load. Its 953 respondents reported an average of 10.7 symptoms. The most common were sleep disturbance (81.8%), hot flushes or night sweats (80.7%) and forgetfulness (75.6%). It was a convenience sample, mostly university-educated, collected during the pandemic, so it does not necessarily represent all UK women.

Heavy lifting and bone: the LIFTMOR trial

The LIFTMOR authors note that high-intensity resistance and impact training is not traditionally recommended for people with osteoporosis because of a perceived fracture risk. Their trial, led by Steven Watson at Griffith University in Australia, put that to the test. It randomised 101 postmenopausal women with low bone mass, average age 65, after screening for conditions and medicines that affect bone. One group did 8 months of supervised, twice-weekly, 30-minute sessions of high-intensity resistance and impact training: 5 sets of 5 repetitions above 85% of their one-repetition maximum. The other group did a light home exercise programme.

Bone density change over 8 months Percent change, heavy training versus light home exercise Heavy training Light home exercise 0% Lumbar spine -1.2% +2.9% Femoral neck (hip) -1.9% +0.3%
Source: Watson et al. 2018, LIFTMOR randomised controlled trial, Journal of Bone and Mineral Research. 49 women did supervised heavy resistance and impact training, 52 did light home exercise. Both site differences were statistically significant.

Lumbar spine bone density rose by 2.9% in the heavy-training group and fell by 1.2% in the home group. At the femoral neck of the hip, it rose by 0.3% against a 1.9% fall. The heavy group also did better on every functional test: timed up-and-go, functional reach, five sit-to-stands, and back and leg strength. Only one adverse event was reported, a minor lower back spasm. The authors stressed that training was highly supervised and that the women were otherwise healthy, so in our reading the result supports coached, progressive heavy training, not unsupervised maximal lifting.

"Weight-bearing exercise and resistance exercise are particularly important for improving bone density and helping to prevent osteoporosis."
NHS, Osteoporosis prevention

What meta-analyses show for bone

A 2023 meta-analysis led by Ramin Mohebbi pooled 80 exercise studies with 5,581 postmenopausal women, each running at least 6 months. Exercise improved bone density at the lumbar spine, femoral neck and total hip, with small effect sizes of 0.29, 0.27 and 0.41. An effect size is a standardised gap between groups. The effects did not differ significantly between women with and without osteopenia or osteoporosis, between early and late postmenopausal women, or between predominantly supervised and predominantly unsupervised programmes.

A 2025 meta-analysis led by Fang Zhao looked at resistance training alone, across 17 randomised trials with 690 women. Bone density improved at the lumbar spine, femoral neck and total hip, but not significantly at the trochanter, part of the upper thigh bone.

Resistance training and bone density, by site Effect size versus control, larger means a bigger gain Lumbar spine 0.88 Femoral neck 0.89 Total hip 0.30 Trochanter 0.23, not significant
Source: Zhao et al. 2025, Journal of Orthopaedic Surgery and Research. 17 randomised trials, 690 postmenopausal women. Results varied widely between trials at the spine and femoral neck.

In subgroup analyses, high-intensity training at 70% of one-repetition maximum or more improved the femoral neck and total hip, training three times a week improved all four sites, and programmes of 48 weeks or longer improved the femoral neck and total hip. The authors flagged large differences between trials at the spine and femoral neck and called for more high-quality trials. Read the larger effect sizes in this analysis with that caution in mind.

Muscle and body fat

A 2023 meta-analysis led by Mousa Khalafi pooled 101 studies with 5,697 postmenopausal women. Exercise training increased muscle mass and fat-free mass and reduced fat mass, body fat percentage, waist size and visceral fat. Resistance and combined training had the larger effects on muscle, while aerobic and combined training had the larger effects on fat. The authors suggested combining the two as a practical approach to body composition after menopause.

What lifting will not fix: hot flushes

A 2022 meta-analysis by Liu and colleagues reviewed 21 randomised trials with 2,884 women. Exercise made no significant change to how often hot flushes and night sweats happened, and the authors rated the certainty of that finding as high. Exercise lowered their severity a little, but the authors rated that certainty as very low, and the effect shrank when trials at high risk of bias were removed. If hot flushes affect your life, the NHS advises talking to a doctor, nurse or pharmacist about HRT and other options, and also lists cognitive behavioural therapy for managing hot flushes.

A starting plan

The plan below is our coaching suggestion, built on the trials above and NHS guidance. For adults up to 64, the NHS asks for strengthening activities that work all the major muscle groups on at least 2 days a week, plus at least 150 minutes of moderate or 75 minutes of vigorous activity. From 65, it asks for activities that improve strength, balance and flexibility on at least 2 days a week. If you have osteoporosis, have not exercised for some time or have medical conditions, the NHS advises speaking to your GP first. If you have had a fracture, including a spinal fracture, our advice is to get the same clearance and to train with a qualified coach or physiotherapist.

  • Train two or three days a week, full body, with a rest day between sessions. Base each session on a squat or leg press, a hip hinge such as a Romanian deadlift, a press, a row and a loaded carry.
  • Learn each movement with light loads and coaching, then build the load over months. LIFTMOR worked up to loads above 85% of one-repetition maximum in screened, supervised women, and the Zhao analysis linked loads of 70% or more with hip gains. Keep a neutral spine on hinges and lifts, and with osteoporosis, avoid loaded rounding or twisting of the back.
  • Add impact work. The NHS lists skipping, dancing, aerobics and jumping on the spot as high-impact weight-bearing exercise. LIFTMOR included impact work for women with low bone mass under close supervision. Outside that setting, get clearance first if you have osteoporosis or a fracture history.
  • Keep aerobic activity in the week, such as brisk walking or cycling, to cover the NHS aerobic guideline and the fat-loss side of body composition.
  • Eat calcium-rich foods such as milk, yoghurt and kale. The NHS says all adults should consume 10 micrograms of vitamin D a day and suggests considering a daily supplement.
  • Stop a session if you feel sharp pain or dizziness, and see a GP if it persists or returns. If you get chest pain, stop and call 999.

Common mistakes

  • Staying light for good once you are cleared and coached. The bone results in LIFTMOR came from heavy, supervised loads, and the Zhao subgroups linked high intensity with hip gains.
  • Jumping straight to heavy lifting. LIFTMOR screened its participants and supervised every session.
  • Expecting lifting to stop hot flushes. The Liu meta-analysis found no significant change in how often they happen.
  • Stopping after a few weeks. LIFTMOR ran for 8 months, and in the Zhao analysis, programmes of 48 weeks or more improved the hip.

Frequently asked questions

Is it safe to lift heavy after menopause?
In the LIFTMOR trial, 49 screened, otherwise healthy women with low bone mass did supervised heavy resistance and impact training for 8 months, and one minor adverse event was reported. If you have osteoporosis, the NHS advises talking to your GP before starting a new exercise programme.
How often should I strength train for bone?
LIFTMOR used two 30-minute sessions a week. In the 2025 Zhao meta-analysis, three sessions a week improved bone density at all four sites measured. The NHS asks for strengthening activities on at least 2 days a week.
Will strength training stop hot flushes?
A 2022 meta-analysis that reviewed 21 trials found no significant change in how often hot flushes happened with exercise. Talk to a doctor, nurse or pharmacist about HRT and other options.
Is walking enough for bone?
None of the studies above reported a separate result for walking alone. The NHS names weight-bearing exercise, including brisk walking for people over 60, and resistance exercise as particularly important for bone density. Our advice is to do both.
Will lifting build muscle after menopause?
In a 2023 meta-analysis of 101 studies in postmenopausal women, exercise training increased muscle mass, and resistance and combined training had the larger effects on muscle.

The bottom line

In the LIFTMOR trial, supervised heavy resistance and impact training raised spine bone density in women with low bone mass, while a light home programme lost bone. Meta-analyses found exercise improved bone density at the spine and hip, and built muscle in postmenopausal women. Exercise made no significant change to how often hot flushes happened. Start with coached, progressive strength training two or three days a week, keep your aerobic activity, and check with your GP first if you have osteoporosis.

Train through menopause with a coach
DT Fitness London coaches one-to-one strength training for women through menopause, with load built up step by step around your bone health.
Book a consultation at dtfitnesslondon.com

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Sources

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