In our other article here, we unpacked why so many women experience anxiety for the first time during perimenopause.
Here, we’re focusing on what genuinely helps.
Does hormone therapy help?
For some women, menopausal hormone therapy (MHT) can be genuinely life changing. If anxiety is occurring alongside other symptoms of perimenopause, such as hot flushes, night sweats or disrupted sleep, it can make a real difference. If you’re a suitable candidate, your GP or a doctor experienced in menopause care can talk you through the different options. Many women use transdermal oestrogen, delivered through a patch, gel or spray, and if you still have a uterus, you’ll usually also need progesterone to protect the uterine lining. The type of progesterone matters, and finding the right regimen is an individual process. This isn’t something to self-prescribe or rule out on your own; it’s a conversation worth having with a healthcare professional who can help you weigh up the benefits and risks based on your individual circumstances.
Strength training... has some of the strongest evidence of any non-medication approach for improving anxiety and wellbeing.
What’s the single most evidence-backed thing I can do that isn’t medication?
Strength training. It makes me so happy to write this! Not only is it one of the very best things we can do for our bodies during this stage of life, helping to maintain muscle mass, strengthen our bones and support healthy ageing, it also has some of the strongest evidence of any non-medication approach for improving anxiety and wellbeing. Better still, those benefits have been studied specifically in women going through this transition.
What if I’ve never lifted weights before?
No problem. And if you’re worried you’ll bulk up, please don’t be. Building large amounts of muscle is actually very difficult for most women, especially as our hormone levels change during perimenopause and beyond. What you’re far more likely to notice is feeling stronger, more capable and more confident.
You don’t have to figure it out alone. One of the things I love about Fernwood is that you’re surrounded by women on the same journey. Whether you’re working with a personal trainer or joining a small-group strength class, having the right support can make all the difference when you’re building confidence, learning good technique and making regular strength training part of your life.
You don't have to figure it out alone. One of the things I love about Fernwood is that you're surrounded by women on the same journey.
Whether you’re working with a personal trainer or joining a small-group strength class, having the right support can make all the difference when you’re building confidence, learning good technique and making regular strength training part of your life.
How does strength training help with anxiety?
Strength training doesn’t just make us physically stronger; it changes what’s happening in our brains. Research suggests it can reduce anxiety by influencing several systems involved in mood regulation, including GABA, our brain’s main calming chemical, and BDNF, a protein that supports learning, memory and our brain’s ability to adapt to stress. Some research even suggests women may benefit more than men.
In other words, every strength session is doing double duty, supporting both your body and your brain.
Does this actually hold up specifically for perimenopause and menopause, or is that just general exercise science?
It holds up. A randomised trial had postmenopausal women strength train three times a week for 15 weeks, and it significantly improved their quality of life, sleep and menopausal symptoms such as hot flushes, compared with women who didn’t train. One caveat: a follow-up two years later found the benefits faded once the structured program ended. The takeaway isn’t that it doesn’t work, it’s that consistency is what makes it work, which is exactly why finding a routine that fits your life matters more than any single workout.
The takeaway isn't that it doesn't work, it's that consistency is what makes it work
What about other types of movement?
They genuinely help too, especially mind-body practices like yoga and reformer Pilates, which have shown benefits for sleep and mood during this stage of life. General advice to ‘move more’ is absolutely worthwhile, but when it comes specifically to reducing anxiety, the evidence for resistance training appears particularly strong. If we’re choosing where to spend our energy, strength training deserves a central place, with other movement layered in alongside it.
Beyond exercise, what else genuinely helps?
Cognitive behavioural therapy has some of the strongest evidence of any approach for anxiety, at any stage of life. It helps us identify and gently challenge the thought patterns that intensify anxiety. Mindfulness-based practices also have solid evidence, particularly for women under heavy life stress.
Don’t underestimate the importance of sleep, either. Poor sleep can fuel anxiety, while anxiety can make sleep harder, creating a frustrating cycle. If hot flushes or night sweats are disrupting your sleep, addressing those symptoms with your GP can often make a meaningful difference to both your sleep and your anxiety.
And don’t overlook the basics: slow, intentional breathing, genuine social connection and doing hard things alongside supportive people all help regulate our nervous system. Training alongside other women who understand exactly what this stage of life feels like can make it so much easier to keep showing up. Consistency matters.
Don't underestimate the importance of sleep, either. Poor sleep can fuel anxiety.
What would I want any woman going through this to know?
This is a transition, and our nervous systems can be genuinely supported through it. We don’t have to wait until things feel overwhelming before asking for help, and we don’t have to figure it out alone. Speak with your GP about what’s been changing for you and the treatment options that may help, whether that’s menopausal hormone therapy, psychological support, lifestyle strategies or a combination of these. I also recommend booking a longer appointment so the conversation doesn’t feel rushed.
And please, don’t underestimate how strength training, alongside the right support, can improve how you feel today and support your health and quality of life for years to come.
Don't underestimate how strength training, alongside the right support, can improve how you feel today and support your health
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References
Stute, P., & Lozza-Fiacco, S. (2022). Strategies to cope with stress and anxiety during the menopausal transition. Maturitas, 166, 1–13.
Strickland, J. C., & Smith, M. A. (2014). The anxiolytic effects of resistance exercise. Frontiers in Psychology, 5, Article 753. https://doi.org/10.3389/fpsyg.2014.00753
Cefis, M., Chaney, R., Wirtz, J., Méloux, A., Quirié, A., Leger, C., Prigent-Tessier, A., & Garnier, P. (2023). Molecular mechanisms underlying physical exercise-induced brain BDNF overproduction. Frontiers in Molecular Neuroscience, 16, Article 1275924. https://doi.org/10.3389/fnmol.2023.1275924
Berin, E., Hammar, M., Lindblom, H., Lindh-Åstrand, L., & Spetz Holm, A. C. (2022). Effects of resistance training on quality of life in postmenopausal women with vasomotor symptoms. Climacteric, 25(3), 264–270. https://doi.org/10.1080/13697137.2021.2015079
Australasian Menopause Society. (2023). Menopause and mental health. https://www.menopause.org.au/health-info/fact-sheets/menopause-and-mental-health
