Resistance Training Across the Menopausal Transition : WHEN Clinical Position Statement
WHEN’s position: what you need to know
You’ve probably seen the message: women in perimenopause need to lift heavy. The research behind that message is real. There’s more to it than what’s making the rounds on social media though. This document explains what the evidence actually shows and what it doesn’t.
Resistance training in all its forms is supported by evidence and has value for perimenopausal and menopausal women (Currier et al., 2026).
Heavy lifting is well supported for bone density and strength and WHEN endorses it for women who choose it (Watson et al., 2019; Kemmler et al., 2015; Howe et al., 2011).
Training to failure or near failure has no evidence base in perimenopausal or menopausal women for any outcome, produces no additional benefit over stopping short of failure in younger populations, and is explicitly cautioned against in adults over 50 due to cardiovascular and recovery concerns (Fragala et al., 2019; Martorelli et al., 2017; Ruple et al., 2023).
Perimenopausal and menopausal women have multiple interconnected health needs including muscle preservation, joint health, and pelvic health, and different forms of exercise serve different needs (Alshehri & Lega, 2025; Wright et al., 2024).
Current Australian clinical guidance explicitly recognises pelvic floor dysfunction as a consideration in exercise recommendations, and this should be reflected in public messaging (RACGP and Healthy Bones Australia, 2024; Healthy Bones Australia, 2024).
Public messaging does not consistently reflect bone health, pelvic health, joint capacity, and connective tissue together. WHEN’s position is that it should.
Equitable messaging acknowledges that different women need different options and that all forms of movement have value (Australian Sports Commission, 2024).
WHEN’s position is grounded in the full evidence base and a commitment to messaging that works for all women across the menopausal transition.
Full Position Statement
Why WHEN has developed this position
Resistance training has become a central part of the conversation about women’s health in perimenopause and menopause. The evidence supporting resistance training for this population is strong and growing, and WHEN welcomes that.
Alongside that evidence, a particular message has become prominent on social media and across health platforms: that heavy lifting is the essential form of exercise for perimenopausal and menopausal women, and that other forms of movement may be insufficient. Women are encountering this message widely, and it is leaving many confused about what exercise is right for them, and whether what they are already doing has any value.
WHEN’s position is that this framing does not reflect the full evidence base, and that perimenopausal and menopausal women have multiple, interconnected health needs that no single form of exercise addresses alone. This statement sets out where WHEN stands and what the evidence actually supports.
What WHEN supports
WHEN supports resistance training for perimenopausal and menopausal women in all its forms, including progressive heavy lifting for women who choose it and do so without contraindication, resistance band training, bodyweight training, Pilates and yoga with resistance elements, home-based training, gym-based training at moderate loads, and any form of progressive loading that works for the individual woman.
All of these are supported by evidence across a range of outcomes. The evidence is consistent that individualisation matters more than any specific method (Currier et al., 2026), and that the best form of exercise is one a woman can access, sustain, and progress over time.
What the evidence shows
The most comprehensive current evidence synthesis on resistance training, the American College of Sports Medicine 2026 Position Stand, reviewed 137 systematic reviews involving more than 30,000 participants (Currier et al., 2026). It found that resistance training significantly improves strength, muscle mass, balance, and physical function, and that many forms of resistance training produce these benefits. This evidence base was developed in healthy adults broadly and does not address menopausal populations specifically. In the absence of evidence specific to perimenopausal and menopausal women, this represents the best available evidence on resistance training and is used here transparently on that basis.
For bone mineral density, a Cochrane systematic review of 43 randomised controlled trials confirms that resistance training is effective, and that combined resistance and impact training produces the strongest results (Howe et al., 2011). Higher loads do show advantages for bone density and maximal strength outcomes, as demonstrated in the LIFTMOR trial and the Erlangen Fitness and Osteoporosis Prevention Study, both conducted in postmenopausal women with osteopenia or osteoporosis under supervised conditions (Watson et al., 2019; Kemmler et al., 2015), and WHEN supports progressive load where it is appropriate and clinically indicated. Effect sizes are positive and current guidelines position exercise as one important component of bone health management alongside nutrition and other interventions (Mohebbi et al., 2023; RACGP and Healthy Bones Australia, 2024).
For muscle preservation, evidence in postmenopausal women shows that resistance training across a range of loads effectively addresses muscle loss (Isenmann et al., 2026). For most outcomes other than maximal strength, the evidence supports a range of loading approaches rather than a single approach (Currier et al., 2026).
A specific claim in current public messaging warrants attention: that women should train to failure or near failure. Training to failure or near failure is not established as necessary for perimenopausal or menopausal women for any outcome, including strength, muscle mass, or bone density. Evidence from younger and general adult populations indicates that stopping short of failure produces similar strength and hypertrophy gains when training volume is equated (Martorelli et al., 2017; Ruple et al., 2023; Lopez et al., 2021; Currier et al., 2023). Resistance training guidance for adults over 50 supports individualised progression and cautions against unnecessary fatigue, impaired technique, and excessive recovery burden (Fragala et al., 2019).
WHEN’s position is consistent with current Australian clinical guidance. The Royal Australian College of General Practitioners and Healthy Bones Australia (2024) recommend progressive resistance training, including progression to higher loads where appropriate, alongside weight-bearing and impact activity as part of bone health management. Critically, the same guidance explicitly identifies pelvic floor dysfunction as a clinical consideration that may require modification of an exercise program (RACGP and Healthy Bones Australia, 2024). Healthy Bones Australia exercise prescription guidance recommends that pelvic floor dysfunction be assessed before prescribing heavy lifting and impact training, and that women with prolapse or pelvic floor dysfunction consult a specialist pelvic health physiotherapist (Healthy Bones Australia, 2024). Exercise and Sports Science Australia similarly supports individualised exercise assessment for women with osteoporosis and comorbidities (Beck et al., 2017). WHEN supports this guidance in full, while acknowledging that access to exercise physiologists and pelvic floor assessment is not equally available to all women due to cost, geography, and availability. Where assessment is not accessible, awareness of pelvic health as a relevant consideration remains important.
Why the whole woman matters
Perimenopause and menopause are whole-system transitions. Declining oestrogen affects bone, muscle, tendons, cartilage, joints, and pelvic connective tissue simultaneously (Alshehri & Lega, 2025). Each of these systems has its own evidence base, varying in maturity and scope, and each responds differently to different forms of exercise.
Heavy lifting is well supported for bone density and strength. It is one of several important tools. It does not address all of the health needs that emerge during this life stage.
Approximately 71 percent of perimenopausal and menopausal women report musculoskeletal pain (Wright et al., 2024). Genitourinary syndrome of menopause, which includes significant structural changes to pelvic connective tissue, affects between 40 and 90 percent of postmenopausal women and is also present during perimenopause (Portman & Gass, 2014; Australasian Menopause Society, 2024). Urinary incontinence is common in postmenopausal women and prevalence increases with age, though reported rates vary widely across studies depending on how the condition is defined and measured (Batmani et al., 2021; Milsom & Gyhagen, 2019). Pelvic organ prolapse affects an estimated 10 to 50 percent of postmenopausal women on clinical examination, with symptom-based rates considerably lower, and prevalence increases with age and parity (Brown et al., 2022). Musculoskeletal pain and arthralgia are common during the menopausal transition and can affect exercise confidence and tolerance. This does not mean resistance training should be avoided. Appropriately modified resistance exercise can improve strength, function and, for many women, pain. Where symptoms are persistent, severe or worsening, exercise should be adapted and clinical assessment considered (Alshehri & Lega, 2025).
Heavy resistance training produces transient increases in intra-abdominal pressure, which are a normal feature of exertion and do not in themselves demonstrate pelvic floor harm (Gerten et al., 2008). The evidence does not establish that heavy lifting causes pelvic floor dysfunction. Pelvic symptoms should inform exercise selection and progression, and women experiencing leakage, prolapse symptoms, or pelvic pain should seek clinical assessment (RACGP and Healthy Bones Australia, 2024).
Public messaging around resistance training for perimenopausal and menopausal women does not consistently reflect bone health, pelvic health, joint capacity, and connective tissue together. WHEN’s position is that women deserve information that reflects the full picture of what is happening in their bodies during this life stage.
Equity matters too
Only 21 percent of Australian women aged 35 to 54 participate in the minimum recommended muscle strength sessions per week (Australian Sports Commission, 2024). The majority of perimenopausal and menopausal women are not doing resistance training at all.
Heavy gym-based training requires financial resources, equipment, time, confidence, and physical capacity that are not equally available to all women. Women carry disproportionate unpaid caring and domestic responsibilities alongside paid employment. For women in regional and rural areas, access to appropriate facilities may not exist.
When one form of exercise is presented as the only valid approach, women who cannot access it are left with the impression that exercise has nothing to offer them. The evidence does not support that impression. Every woman doing any form of resistance training is doing something that benefits her health, and messaging that reflects this will reach and support far more women.
References and Supporting Documents
Alshehri, S., & Lega, I.C. (2025). The impact of menopause on the musculoskeletal system: a practical overview. Climacteric, 28(1), 1–9.
Australasian Menopause Society. (2024). Genitourinary syndrome of menopause. Australasian Menopause Society Information Sheet.
Australasian Menopause Society. (2025). Lifestyle and behavioural modifications for menopausal symptoms. Australasian Menopause Society Hub. https://hub.menopause.org.au/Play?pId=baf6c5a6-ae1c-4fe3-80d5-0ae1aa1065cb
Australian Sports Commission. (2024). AusPlay: national sport and physical activity participation report. Australian Government.
Batmani, S., Jalali, R., Mohammadi, M., & Bokaee, S. (2021). Prevalence and factors related to urinary incontinence in older adults women worldwide: a comprehensive systematic review and meta-analysis of observational studies. BMC Geriatrics, 21(1), 212. https://doi.org/10.1186/s12877-021-02135-8
Beck, B.R., Daly, R.M., Fiatarone Singh, M.A., & Taaffe, D.R. (2017). Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. Journal of Science and Medicine in Sport, 20(5), 438–445. https://doi.org/10.1016/j.jsams.2016.10.001
Brown, H.W., Hegde, A., Huebner, M., Neels, H., Barnes, H.C., Vissoci Marquini, G., Mukhtarova, N., Mbwele, B., Tailor, V., Kocjancic, E., Trowbridge, E., & Hayward, L. (2022). International urogynecology consultation chapter 1 committee 2: Epidemiology of pelvic organ prolapse: prevalence, incidence, natural history, and service needs. International Urogynecology Journal. https://doi.org/10.1007/s00192-021-05018-z
Currier, B.S., Mcleod, J.C., Banfield, L., Beyene, J., Welton, N.J., D’Souza, A.C., Keogh, J.A.J., Lin, L., Coletta, G., Yang, A., Colenso-Semple, L., Lau, K.J., Verboom, A., & Phillips, S.M. (2023). Resistance training prescription for muscle strength and hypertrophy in healthy adults: a systematic review and Bayesian network meta-analysis. British Journal of Sports Medicine, 57(18), 1211–1220. https://doi.org/10.1136/bjsports-2023-106807
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 and Science in Sports and Exercise, 57(3), 531–583. https://doi.org/10.1249/MSS.0000000000003897
Fragala, M.S., Cadore, E.L., Dorgo, S., Izquierdo, M., Kraemer, W.J., Peterson, M.D., & Ryan, E.D. (2019). Resistance training for older adults: position statement from the National Strength and Conditioning Association. Journal of Strength and Conditioning Research, 33(8), 2019–2052. https://doi.org/10.1519/JSC.0000000000003230
Gerten, K.A., Richter, H.E., Wheeler, T.L., Pair, L.S., Burgio, K.L., Redden, D.T., & Varner, R.E. (2008). Intraabdominal pressure changes associated with lifting: implications for postoperative activity restrictions. American Journal of Obstetrics and Gynecology, 198(3), 306.e1–5. https://doi.org/10.1016/j.ajog.2007.09.004
Healthy Bones Australia. (2024). Exercise prescription to support the management of osteoporosis for physiotherapists and exercise physiologists. Healthy Bones Australia.
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, 7, CD000333. https://doi.org/10.1002/14651858.CD000333.pub2
Isenmann, E., Geisler, S., Havers, T., Siegert, F., Hemke, F., & Held, S. (2026). It’s never too late: The impact of resistance training on strength and body composition in females across the lifespan – A systematic review and meta-analysis. Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2026.03.002
Kemmler, W., Bebenek, M., Kohl, M., & von Stengel, S. (2015). Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Osteoporosis International, 26(10), 2491–2499. https://doi.org/10.1007/s00198-015-3165-3
Lopez, P., Radaelli, R., Taaffe, D.R., Newton, R.U., Galvão, D.A., Trajano, G.S., Teodoro, J.L., Kraemer, W.J., Häkkinen, K., & Pinto, R.S. (2021). Resistance training load effects on muscle hypertrophy and strength gain: systematic review and network meta-analysis. Medicine and Science in Sports and Exercise, 53(6), 1206–1216. https://doi.org/10.1249/MSS.0000000000002585
Martorelli, S., Cadore, E.L., Izquierdo, M., Celes, R., Martorelli, A., Cleto, V.A., Alvarenga, J.G., & Bottaro, M. (2017). Strength training with repetitions to failure does not provide additional strength and muscle hypertrophy gains in young women. European Journal of Translational Myology, 27(2), 6339. https://doi.org/10.4081/ejtm.2017.6339
Milsom, I., & Gyhagen, M. (2019). The prevalence of urinary incontinence. Climacteric, 22(3), 217–222. https://doi.org/10.1080/13697137.2018.1543263
Mohebbi, R., Shojaa, M., Kohl, M., von Stengel, S., Jakob, F., Kerschan-Schindl, K., Lange, U., Peters, S., Thomasius, F., Uder, M., & Kemmler, W. (2023). Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators. Osteoporosis International, 34, 1145–1178. https://doi.org/10.1007/s00198-023-06682-1
Portman, D.J., & Gass, M.L.S., on behalf of the Vulvovaginal Atrophy Terminology Consensus Conference Panel. (2014). Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause, 21(10), 1063–1068. https://doi.org/10.1097/GME.0000000000000329
RACGP and Healthy Bones Australia. (2024). Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age. Royal Australian College of General Practitioners.
Ruple, B.A., Plotkin, D.L., Smith, M.A., Godwin, J.S., Sexton, C.L., McIntosh, M.C., Kontos, N.J., Beausejour, J.P., Pagan, J.I., Rodriguez, J.P., Sheldon, D., Knowles, K.S., Libardi, C.A., Young, K.C., Stock, M.S., & Roberts, M.D. (2023). The effects of resistance training to near failure on strength, hypertrophy, and motor unit adaptations in previously trained adults. Physiological Reports, 11(9), e15679. https://doi.org/10.14814/phy2.15679
Watson, S.L., Weeks, B.K., Weis, L.J., Harding, A.T., Horan, S.A., & Beck, B.R. (2019). 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, 34(3), 475–485. https://doi.org/10.1002/jbmr.3659
Wright, V.J., Schwartzman, J.D., Itinoche, R., & Wittstein, J. (2024). The musculoskeletal syndrome of menopause. Climacteric, 27(5), 466–472. https://doi.org/10.1080/13697137.2024.2380363
A note on the evidence base
The full evidence base underpinning this position statement is available in the companion backing document: Resistance Training Across the Menopausal Transition, prepared for the WHEN Clinical Governance Committee. This position statement will be reviewed and updated as new evidence emerges.
Developed by the WHEN Clinical Team
Clinically reviewed by the WHEN Clinical Governance Committee
Last reviewed: 22/06/2026
