Someone on social media suggested we rename menopause, and I love this idea! Life after women stop having periods is more than ‘Oh now you can’t have babies’ so I suggested Ovation!
As I’ve been posting recently here and here menopause and life after menopause is often associated with more musculoskeletal pain, so I thought it time to look at what clinicians might consider. The problem is…. oh yeah, not much in the literature apart from MHT. Guidance for allied health for people in this time of life is pretty slim. Superficially it looks like the usual ‘exercise’ and ‘diet’ and ‘stress reduction’ but not much that addresses what this might look like in a woman’s life.
Let’s start with the physical activity part. There’s little doubt that exercise is good for maintaining bone health (Shojaa et al., 2020). The only problem is that, according to Shojaa et al., (2020) the effect size is quite small even though statistically significant. The authors consider that both heterogeneity in the studies and differences among the exercise protocols could dilute the effect size and make it difficult to interpret and they were not able to give recommendations for optimised bone-strengthening protocols, arguing that exercise is a complex intervention ranging from walking, balance exercises and balance training. At the same time intensity, duration, frequency and training principles (progression etc) have an effect on outcomes at the end point of a study (well yeah…) with studies going for anywhere from 6 – 30 months, so wildly varying research making it really hard to summarise. Note too, this meta-analysis was only considering bone health, not pain or fatigue or anxiety or cardiovascular health.
From Shojaa et al., (2020) exercise intensities varied widely from very low to high, 3 times a week (ranging 2 – 9 sessions/week), durations from 2 – 110 minutes, 1 – 21 exercises with up to 108 repetitions in 1 – 5 sets, and only occasionally listed rest periods. 59 of the 75 studies were supervised exercise protocols.
The effect of exercise on a painful condition like knee osteoarthritis was examined in a recent meta-analysis by Wolf et al., (2024) who found that while exercise improved physical function (as measured by the 6-minute walk test and the WOMAC physical function scale), there were no significant differences found for pain or stiffness.
Nguyen et al., (2020) in a meta-analysis of exercise and quality of life in women with menopausal symptoms (not necessarily pain!) found positive effects on physical and psychosocial quality of life measures but no evidence for effects on general, social and menopause-related quality of life.
In a scoping review focused only on walking exercise programmes and with a broad outcome of ‘improved health’ (in other words, lots of different outcomes were included), Sydora et al., (2020) found that walking programmes (again, varying widely in study duration, intensity, and outcomes) provided ‘evidence of their possible benefit as a wellness option’ [italics mine] and the usual call for ‘more research please.’
The so what question
Let’s be practical here. Post menopause starts from 12 months after the last period and then goes on. And on. And on. For decades. Physical exercise options therefore need to take into account the transitions that women go through from the ages of ~late 40’s through to death. These transitions include children leaving home, careers starting to take off, changes in spouse/partner, other health problems becoming more evident, right through to safety engaging in physical activity as an older woman. Women’s experiences of movement will be widely variable – from regular triathetes to walking the shopping mall. Some will have a lifetime of loving exercise, others not so much. There is definitely no one size fits all.
- Don’t over-hype the benefits of exercise
A good clinician will firstly be aware that exercise research doesn’t show all-out awesome effect sizes, so don’t over-hype the benefits. Don’t suggest that exercise will reduce low back pain more than a few points (see Rizzo et al., 2025) and know that it doesn’t look much more promising for other body parts. Do acknowledge that currently the research does not indicate any specific type of exercise, exercise intensity or frequency, or load being superior to any other, particularly for pain. This uncertainty gives us room to encourage simple practices such as walking, cycling, yoga, Pilates, dance – and I’d advocate for trying lots of different options.
2. Older women know stuff, have developed habits, and have opinions
The second point to make is that post-menopausal women have had a lifetime of living and learning – and behaviour change is always hard – use her knowledge about her own lifestyle, preferences, and available resources when discussing options. Take the time to listen.
3. Help her develop a reasoning model for her movement practice
While your preference might be exercise in one format, remember that the aim is movement practices for the rest of life. What this means is helping her to develop a reasoning process for movement practices – how might she start off if she’s not moving regularly now? (this might happen in the future if she has some other health problem and needs to stop) what options does she have? what resources are available? how might she vary her movement practice if life changes? (more time, less time, interruptions to her routines, need to fit movement into other important values in life). How might she progress her movement practice?
4. Help her feel what it feels like to move confidently
This approach helps her use her sensory information as feedback – because this helps build confidence in the body and how it responds to movement (and stress) and this in turn helps build flexible movement practice as she uses this feedback in an ongoing way. By exploring what it feels like to move, she learns what it feels like in any situation, not just ‘doing exercise.’ And this is invaluable, given that life is far larger than an exercise programme.
5. Start where she’s at, and move at her pace
If the aim is movement practices for life, thinking about ‘dose’ and ‘frequency’ at the beginning if her confidence is low is missing the point. Dose and frequency will occur over time – but if you start too high, she’ll be put off and your opportunity to build confidence for all movement for her future is weakened. Start with the frequency and duration that she will do – or perhaps a little less – once she’s consistent, then think about how you might progress. A walk to and from the clothes line or around the supermarket for some women may be all they will do regularly, while some will be far more capable. The aim isn’t ‘do X quantity’ it’s about ‘building confidence to move.’
Nguyen, T. M., Do, T. T. T., Tran, T. N., & Kim, J. H. (2020). Exercise and Quality of Life in Women with Menopausal Symptoms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Environ Res Public Health, 17(19). https://doi.org/10.3390/ijerph17197049
Rizzo, R. R., Cashin, A. G., Wand, B. M., Ferraro, M. C., Sharma, S., Lee, H., O’Hagan, E., Maher, C. G., Furlan, A. D., van Tulder, M. W., & McAuley, J. H. (2025). Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane reviews. Cochrane Database of Systematic Reviews, 3(3), CD014691. https://doi.org/10.1002/14651858.CD014691.pub2
Shojaa, M., Von Stengel, S., Schoene, D., Kohl, M., Barone, G., Bragonzoni, L., Dallolio, L., Marini, S., Murphy, M. H., Stephenson, A., Manty, M., Julin, M., Risto, T., & Kemmler, W. (2020). Effect of Exercise Training on Bone Mineral Density in Post-menopausal Women: A Systematic Review and Meta-Analysis of Intervention Studies. Front Physiol, 11, 652. https://doi.org/10.3389/fphys.2020.00652
Sydora, B. C., Turner, C., Malley, A., Davenport, M., Yuksel, N., Shandro, T., & Ross, S. (2020). Can walking exercise programs improve health for women in menopause transition and postmenopausal? Findings from a scoping review. Menopause, 27(8), 952-963. https://doi.org/10.1097/GME.0000000000001554
Wolf, D. F., Carvalho, C., Moreira Padovez, R. F. C., Braz de Oliveira, M. P., & Mendes da Silva Serrao, P. R. (2024). Effects of physical exercise on muscle function of the knee, pain and quality of life in postmenopausal women with knee osteoarthritis: A systematic review with meta-analysis. Musculoskelet Sci Pract, 71, 102929. https://doi.org/10.1016/j.msksp.2024.102929