Exercise During Perimenopause and Menopause May Offer a Much-Needed Mood Boost

“The good news is that physical activity in general seems to have benefits for emotional changes during this reproductive transition,” says Margo Nathan, MD, an assistant professor of reproductive psychiatry at the University of North Carolina School of Medicine in Chapel Hill, who specializes in mood and anxiety disorders during menopause, and was not involved in the study.

Aerobic and Mind-Body Exercises May Offer Different Emotional Health Benefits

To better understand whether exercise could help, researchers analyzed 12 randomized controlled trials involving around 1,000 women ages 40 to 65 in perimenopause or early postmenopause. The trials examined several types of physical activity, including walking, dancing, Zumba, yoga, tai chi, Pilates, and stretching.

Overall, physical activity was associated with improvements in depressive symptoms, mood, and quality of life — but the findings varied by exercise type. For example:

• Aerobic activities (such as walking and dance-based exercise) were linked to improvements in depressive symptoms, mood, and overall quality of life.
• Mind-body activities (including yoga and tai chi) were associated with improvements in psychological quality of life, which refers to aspects of emotional well-being and satisfaction with life.

“Whilst we can fairly confidently say that exercise helps, more nuanced research is needed to understand more about how different programs and doses work, as well as individual variations in response,” Dr. Spector says.

Experts say more studies are needed to determine whether one approach truly offers greater mental health benefits over the other. “Clinically speaking, I would be cautious about drawing a firm distinction between them, since there were too few mind-body studies assessing depression and mood to conclude that their benefits are limited to quality of life,” says Daniel Sheinbein, MD, psychiatrist specializing in reproductive mental health and founder of Calabasas Psychiatry in Calabasas, California.

How Exercise May Support Mental Health During a Woman’s 40s, 50s, and 60s

Exercise may help counter some of the emotional challenges associated with perimenopause and menopause through several overlapping mechanisms.

Exercise is also known to offer psychological and social benefits at every age. “Completing an exercise routine can give a sense of accomplishment, and group activities can increase feelings of community, both of which can support mood and mental health in general,” Dr. Nathan adds.

The new review did not directly examine these mechanisms, though, so more research is needed to understand exactly how exercise affects psychological symptoms during menopause.

Which Type of Exercise Is Best During Perimenopause and Menopause?

The findings don’t establish that one type of exercise is best for everyone. Instead, experts recommend choosing activities that fit a person’s symptoms, fitness level, health conditions, and preferences.

“The advice I like to share with my perimenopausal and menopausal patients is not to compare themselves to who or what they used to be able to do,” says Lauren Schiff, MD, a professor of obstetrics and gynecology at the University of North Carolina School of Medicine. “Striving to achieve an abstract fitness or wellness objective can be counterproductive.”

Dr. Schiff recommends paying attention to whether different activities improve mood, sleep, stress, and cognitive symptoms, while considering individual health needs and schedules. “There is no one recommendation other than to start somewhere,” she adds.

In practice, this could look like exercising 30 minutes a day, five days per week. “Someone just getting started can begin with shorter sessions and build gradually, based on their health, fitness level, and symptoms,” Sheinbein says. “Those with osteoporosis, significant joint problems, or other medical conditions should discuss suitable activities with their physician.”

The researchers couldn’t identify an ideal exercise schedule because the programs varied widely in frequency and duration. For example, one trial involved walking for 30 minutes three times weekly, while another included two 75-minute yoga sessions per week.

“Interestingly, the ‘dose’ of exercise varied hugely between studies and didn’t clearly link to outcome,” Spector says. “Our general advice would be to do as much as you can fit in, whilst balancing all the other demands of life.”

More Research Is Needed

Though the findings are encouraging, the researchers say more studies are needed to determine which activities, intensities, and durations offer the greatest benefits during this life stage.

Other limitations include 10 out of the 12 trials being judged to have a high risk of bias, Sheinbein says, which could limit interpretation of the results. Exercise programs and outcome measures also varied, and fewer studies examined mind-body activities, limiting comparisons between exercise types. The researchers also couldn’t fully account for differences in participants’ underlying health conditions or determine whether exercise intensity influenced the results, Schiff notes.

Experts say exercise may be a useful tool for supporting emotional well-being during perimenopause and menopause — but it shouldn’t replace medical treatment when symptoms are persistent or severe.

“We are still learning how exercise and physical activity fit with other tools we have to treat depressive symptoms during the menopausal transition,” Nathan says. “For moderate to severe depressive symptoms, it’s still really important to consider medications — such as antidepressants or hormonal options — and psychotherapy, though physical activity can be a helpful adjunct or additional component to treatment.”

People experiencing depressive symptoms that interfere with everyday activities should speak with a healthcare professional about appropriate treatment options.