You can build a long, strong life through menopause, even while it makes you feel lousy. Lifting weights. Eating enough protein. Better sleep, steadier blood sugar, a closer eye on your heart. None of it stops working just because you feel bad, and you don’t have to wait until you feel good to start.
Waking up drenched at 3 a.m. Knees that ache on every stair (I talked about those in October). Clothes fitting tighter without any warning. Standing in the kitchen wondering what you came in for.
Thinking you’ll wait until you feel better? In the Study of Women’s Health Across the Nation (SWAN), women with frequent hot flashes had them for a median of 7.4 years. While you wait, muscle and bone keep changing anyway.
Can you build muscle and bone after menopause?
Yes, and that’s where I tell people to focus.
SWAN showed that once the transition hits, fat gain picks up speed, about twice as fast, and muscle starts slipping away. Both kept changing until about two years after the last period.
The LIFTMOR trial took 101 postmenopausal women with low bone density, average age 65, and had them lift heavy twice a week for eight months. Supervised, 30 minutes each time, five sets of five reps, plus impact work. Their spine bone density went up 2.9%, while the group doing light work at home lost 1.2%. The lifters also did better on every function test, including standing up from a chair. Total injury report: one minor back spasm.
You don’t need to spend your life at the gym. A 2022 analysis linked 30 to 60 minutes a week of strength work to about a 10 to 20% lower risk of early death, heart disease and cancer. Two strength sessions a week, covering all your big muscle groups, is the bare minimum from the federal guidelines. If it’s a bad day, go lighter. It still counts.
Does menopause cause insulin resistance?
Yes, menopause speeds it up, which is exactly why November’s National Diabetes Month is worth your attention.
A SWAN study published in October 2026 followed 1,315 women for over 20 years. Even after adjusting for weight changes, insulin resistance climbed about 4.3% a year in the four years around the final period, compared with 1.2% a year before and 0.9% after. The researchers say menopause itself is part of the problem, not just getting older. Meanwhile, the CDC counts 115.2 million U.S. adults with prediabetes.
Two things help no matter how little sleep you got. First, lift: the American Diabetes Association recommends resistance training at least two non-consecutive days a week, ideally three. Second, walk after you eat: a 2022 review found that breaking up sitting with light walking lowered after-meal blood sugar by about 17% compared with sitting still. Start with a lap around the block after dinner. Slippers optional.
Ask your doctor to check your blood sugar next time you’re in.
How much protein do women need during menopause?
Enough to feed the muscle you’re trying to build. The PROT-AGE expert group recommends at least 1.0 to 1.2 grams of protein per kilogram of body weight a day for healthy adults over 65, and 1.2 or more if you exercise. That recommendation is for older adults, but muscle loss starts way before that. For someone who weighs 150 pounds, that’s about 68 to 82 grams a day. The group puts the amount older muscles need per meal to respond at about 25 to 30 grams.
Aim for 25 to 30 grams of protein at every meal, breakfast too. If you have kidney disease, talk to your doctor first.
Why does sleep get harder during menopause?
A lot of women have trouble sleeping through this time. In SWAN, 37.7% of women between 40 and 55 said they’d had trouble sleeping in the previous two weeks, and late perimenopause was the roughest stretch. The American Heart Association links poor sleep in this phase to metabolic syndrome.
The fix that’s been tested the most is cognitive behavioral therapy for insomnia, CBT-I. In a 2016 trial with 106 women who had both hot flashes and insomnia, six phone sessions cut insomnia scores about twice as much as just learning about menopause did. Ask your doctor where to find it.
After a bad night, lift lighter. Still lift.
Does menopause raise your risk of heart disease?
Yes. A 2020 statement from the American Heart Association found that LDL cholesterol goes up in midlife more because of menopause than because of getting older. At the same time, belly fat increases and lean muscle drops. Heather Samudovsky already covered which cholesterol tests to ask for here in October, so let’s talk about movement instead.
That same statement says only about 7% of women in perimenopause get the recommended amount of physical activity. The good part: lifestyle programs during this time helped prevent weight gain and brought down triglycerides, blood pressure, blood sugar and insulin.
Shoot for 150 minutes a week of moderate activity, like brisk walking, on top of those two lifting days.
When should you see a doctor about menopause symptoms?
Lifting does a ton of good for your bones, muscle and blood sugar, but hot flashes aren’t on the list. The Menopause Society looked at the nonhormone options in 2023 and found the evidence too weak to recommend exercise or yoga for hot flashes. What did make their list? Cognitive behavioral therapy, clinical hypnosis and, for some women, weight loss.
If your symptoms are making every day a struggle, make that doctor’s appointment, and talk about hormone therapy with someone who actually knows menopause. The Society’s 2022 statement says that for most healthy women with symptoms who are under 60 or within 10 years of menopause, the benefits outweigh the risks for treating hot flashes and preventing bone loss. It also says the choice should be personal and revisited over time. It isn’t right for everyone, which is exactly why you need to have the conversation. You can find a Certified Menopause Practitioner (MSCP) through the Society’s directory at menopause.org.
I’m a trainer, not your doctor. Treat this as a conversation starter.
You don’t have to feel good to get stronger. You just need to keep going, even when you’re running on fumes. Lift something. Eat the protein. Take the walk. Then do it again Thursday.
Frequently asked questions
Is menopause brain fog permanent? Most of the time, it looks temporary. A UCLA-led study of 2,362 midlife women found learning dipped during perimenopause and returned to premenopausal levels after menopause. If memory problems are severe or getting worse, see your doctor.
Will exercise stop my hot flashes? Probably not on its own. The Menopause Society doesn’t recommend exercise or yoga as a hot flash treatment because the evidence is weak. Keep exercising for your muscles, bones, blood sugar and heart, and ask a clinician about treatments aimed at hot flashes.
Is it okay to lift heavy if I have osteopenia? In the LIFTMOR trial, women with low bone mass lifted heavy under careful supervision, gained spine bone density and reported one minor back spasm. Supervision is the key. Get your doctor’s OK first and work with a coach who builds the load gradually.
How long do hot flashes last? Longer than most people expect. In SWAN, women with frequent hot flashes had them for a median of 7.4 years, including a median of 4.5 years after their final period. That’s why it makes sense to start your strength habits now.
Sources
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