In Conversation with Midi Health: How Exercise Can Support Through Perimenopause and Menopause

At Pure Barre, we are proud to support women throughout every chapter of life — including pregnancy, perimenopause, menopause and beyond! October is Menopause Awareness Month and we teamed up with Midi Health, the nation’s largest virtual clinic supporting women through midlife to highlight the critical role of movement in supporting women through life’s transitions. 

We sat down with Dr. Kathleen Jordan, internal medicine physician and Menopause Society Certified Provider who also serves as Midi Health's Chief Medical Officer, to answer our hottest questions about the connection between exercise and menopause. 

Read on for expert insights on the best exercise for menopause, how regular low-impact exercise (like Pure Barre!) can support through perimenopause.

In layman’s terms, what is perimenopause and what are the most common symptoms women face?
Think of perimenopause as the lead up to menopause—it's when your hormones are overall declining but with a bit of a roller coaster journey.  Your estrogen and progesterone levels are fluctuating but overall trending downward. With average age of menopause being 51, most women enter and remain in perimenopause in their 40’s. It may kick off as early as your 30s. It ends when you reach full menopause, where your hormone levels are low, and stay low–no more rollercoastering of hormone levels.   

Perimenopause symptoms vary greatly for women–with both a wide variety of symptoms and different levels of severity. Period changes are common–with periods changing frequency and duration–often with periods first coming close together and later becoming further apart, sometimes heavy, sometimes light and often entirely irregular just before full menopause. You might notice hot flashes, dry skin, hair thinning, night sweats that leave you changing pajamas, periods that show up whenever they feel like it, achy joints, mood swings, trouble sleeping, and that stubborn weight that seems to gravitate toward your middle. For others the fluctuations in perimenopause exacerbate migraines, ADHD, a rise in stress, anxiety or underlying depression and for many the hormone changes trigger difficulty sleeping, too.

How does low-impact movement specifically support women in perimenopause?
Low-impact exercise is like a gentle reset button for your changing metabolism, your sleep and your mental health. It helps combat things like insulin resistance and inflammation that can creep up during perimenopause, while building the lean muscle that keeps your metabolism humming and your bones strong. Plus, it's easier on your joints when they may be feeling a bit cranky from hormonal changes.

Can low-impact workouts provide the same health benefits (bone strength, cardiovascular health, muscle maintenance) as higher-intensity training?
Definitely. The magic isn't in how hard you go—it's in consistency and gradually challenging yourself. Low-impact exercise can absolutely boost your muscle power, support your bones, and help with heart health by lowering your blood pressure. Regular exercise can help your metabolism, your sleep, your mental health–and has even been shown to decrease breast cancer risk–it’s one of the most effective tools to support your overall health that there is!

What are the most common physical changes women experience during perimenopause that affect exercise (e.g., energy, metabolism, joints, recovery)?
Women talk to us a lot about weight gain (especially belly fat) and sheer exhaustion. I hear this phrase all the time: “I haven’t changed a thing, I’m still active and still eat what I’ve always eaten, yet all of a sudden, I’m gaining weight” or “my cholesterol went up” or “all of a sudden I’m getting a belly.” They want to know what is going on. Yes, these things are common and known to be linked to the hormone changes of menopause. These hormone changes affect many changes:  Metabolism changes, muscle mass can begin declining, and fat tends to migrate to your midsection in menopause and perimenopause. You might also feel stiffer, perhaps even develop frozen shoulder (a painful inflammation of the shoulder that is common in midlife), have less energy some days, and need more recovery time between tough workouts.

Can low-impact exercise like Pure Barre help alleviate symptoms of menopause and menopause?
Barre classes are fantastic for this because they can help boost muscle tone, positively impact your metabolism, and bolster bone health. It can keep blood sugar steady, and help you sleep–helping with overall energy levels. Plus, that post-workout endorphin rush is real and can be a game-changer for your mood during hormonal ups and downs.

Can you speak on the relationship between resistance training and bone density, and how that relates to perimenopause and menopause?

Fifty percent of women will break a bone due to osteoporosis. And fractures can be severely disabling, even life-threatening, especially as you get older. If you weren’t already paying attention to your bone health, now’s the time to start, because during and after the menopause transition, women’s risk of osteoporosis and serious bone fractures jumps up. 

Here’s what’s going on: Throughout the first few decades of life, estrogen helps to maintain bone strength and density by promoting new bone formation. But after age 50, a decrease in estrogen levels significantly contributes to osteopenia, or lower-than-normal bone density. Without treatment, osteopenia may progress to full-on osteoporosis, a disease that causes bones to become weak, which makes fractures more likely.  Minor bumps can result in major fractures, or no trauma at all can lead to spinal compression fractures and pain.  We can avoid much of this by supporting our best bone health.

The best exercises you can do to build or maintain strong bones include weight-bearing, resistance, posture, and balance exercises. And you need not lift huge amounts of weight to get benefits; even lighter resistance gives your bones the signal to maintain and build density, which is especially important when estrogen starts declining. Weight bearing exercise is not limited to barbells–exercise, like in barre where you use your body weight against gravity does the trick well.

Weight-bearing and resistance exercises, like those done in barre, require you to support your body against gravity. This puts healthy stress on the skeleton, which slows bone mineral loss and encourages bone-forming cells to get to work. 

What’s the ideal balance of cardio, strength, flexibility, and recovery for someone in perimenopause?
All of it is good for you, in different and complementary ways. Women historically, though,  have focused on aerobic exercise and calorie burn with the benefits of weight bearing exercise being underemphasized for women in particular. That is changing as we learn more about how to live longer and stronger. During perimenopause, strength training becomes your best friend—aim for 2-3 sessions per week. Add some flexibility work daily (even just a few minutes of stretching in the morning counts), and give yourself permission to rest with gentle walks or restorative yoga. Your body is working hard during this transition, so be kind to it.

How do Pure Barre’s 4 different class formats offer unique benefits to women in perimenopause and menopause?
It's like having options for every kind of day. Classic gives you that stable, strengthening foundation. On higher energy days, Empower gets your heart pumping which has added cardiovascular benefits. Define helps you build strength while Align is ideal for when you need to restore and reconnect. Having choices is a great way to honor how you’re feeling that day so you can still prioritize movement consistently.

Are there any misconceptions women have about exercise during perimenopause that you’d like to clear up?
The biggest misconception is that exercise is simply about the calorie burn. There is so much more to it than that–it helps with many aspects of health from improving sleep, mood, muscle tone, metabolism and bone health to name a few!

Another myth is that you need to really go all out to get results—that's just not true. Low impact doesn't mean low benefit. And please don't worry about getting "bulky" from strength training. Strength training is actually your secret weapon for keeping your metabolism healthy and your body strong for decades to come.

Looking to get support navigating midlife with Midi Health? Book a visit to get affordable, insurance-covered care from expert clinicians. Excited to get started at Pure Barre? Fill out the form below to get started with a complimentary Pure Barre class!