More Frequent Physical Activity Linked to Fewer Perimenopause Symptoms in Global Study

Women who reported more frequent physical activity experienced significantly lower perimenopause symptom burden across psychological, somatic, and urogenital domains, according to findings from an international study presented at The Menopause Society 2026 Annual Meeting, held October 20-24 in San Diego, California.¹

In the cross-sectional analysis of 1808 women across 87 countries, mean total Menopause Rating Scale (MRS) scores decreased from 17.46 among women reporting no physical activity to 13.77 among those active at least 5 days per week (P < .001). The inverse association remained statistically significant after adjustment for age, body mass index (BMI), smoking status, comorbidities, health care access, and country-level socioeconomic factors.¹

The findings suggest that physical activity frequency may be an important consideration in perimenopause symptom management, particularly for psychological symptoms such as low mood, irritability, and anxiety. However, the observational design does not establish that increasing exercise frequency directly reduces symptom severity.

"Something that stood out to us was that the benefits of physical activity seemed to be strongest for psychological symptoms like low mood irritability and anxiety. These symptoms can really impact daily life, and regular movement may be an accessible way to help," Liudmila Zhaunova, PhD, presenting author and director of science at Flo Health, said in a press release.²

Investigators from Flo Health and Mayo Clinic examined survey data from English-, Spanish-, Portuguese-, and French-speaking users of the Flo menstrual tracking application who were aged 35 years or older and self-identified as being in perimenopause. Women using hormonal contraception or menopause hormone therapy were excluded.¹

Participants reported their physical activity frequency across 5 categories, ranging from no physical activity to activity on at least 5 days per week. Symptom severity was assessed using the validated MRS, which measures menopausal symptoms across 3 domains: somatic, psychological, and urogenital. Total MRS scores range from 0 to 44, with higher scores indicating greater symptom burden.

The mean participant age was 45 years (SD, 4.5). Investigators used multivariable linear regression to examine the association between physical activity frequency and MRS scores, adjusting for prespecified potential confounders, including the country-level Socio-Demographic Index.¹

Higher Activity Frequency Associated With Lower Symptom Scores

In unadjusted analyses, women reporting physical activity on at least 5 days per week had lower mean scores across all 3 MRS domains compared with those reporting no physical activity:

• Psychological symptoms: 6.41 vs 7.77 (P < .001).
• Somatic symptoms: 4.48 vs 6.06 (P < .001).
• Urogenital symptoms: 2.87 vs 3.63 (P = .004).
• Total symptom burden: 13.77 vs 17.46 (P < .001).

The associations remained statistically significant in fully adjusted models. Greater physical activity frequency was inversely associated with total MRS scores (β = −0.57; P<.001), as well as psychological (β = −0.26; P<.001), somatic (β = −0.21; P<.001), and urogenital symptom scores (β = −0.10; P=.020).¹

The magnitude of the adjusted associations was greatest for psychological symptoms, followed by somatic and urogenital symptoms. These findings suggest that the relationship between physical activity and perimenopause symptoms may extend beyond physical complaints to include emotional and psychological well-being.

Implications for Perimenopause Management in Primary Care

The findings add to evidence supporting physical activity as an important component of midlife women's health, particularly as clinicians seek nonpharmacologic strategies to address symptoms during the menopause transition.

"Regular physical activity is associated with a wide range of health benefits and is already recommended as part of a healthy lifestyle during midlife," Stephanie Faubion, MD, MBA, medical director of The Menopause Society, said in the press release. "The findings from this large international study suggest that women who are more physically active may experience a lower burden of perimenopause symptoms, particularly psychological symptoms."²

For primary care physicians, the findings support discussing physical activity habits as part of a broader assessment of perimenopausal symptoms, particularly among women reporting mood changes, sleep disturbances, or other symptoms affecting quality of life.

However, several limitations warrant consideration. Physical activity frequency and menopausal symptoms were self-reported, and the study did not assess exercise intensity, duration, or type. Additionally, the cross-sectional design prevents investigators from determining whether physical activity contributed to lower symptom burden or whether women experiencing fewer symptoms were more likely to remain physically active.

The study also relied on a self-selected population of Flo app users who identified themselves as perimenopausal, potentially limiting generalizability to women who do not use menstrual tracking applications or have different healthcare access and symptom profiles.

Although the investigators adjusted for several potential confounders, residual confounding cannot be excluded. The findings also do not establish an optimal exercise frequency or demonstrate that physical activity can replace established treatments for bothersome menopausal symptoms.

The researchers concluded that greater physical activity frequency was associated with significantly lower overall perimenopause symptom burden across all 3 domains, highlighting a potentially modifiable factor in symptom management. Additional prospective and interventional studies are needed to determine whether increasing physical activity can directly improve perimenopausal symptoms and identify which exercise approaches offer the greatest benefit.

References

1. Cunningham A, Castillo Silva J, Hewings-Martin Y, et al. Physical activity frequency and perimenopause symptom burden: global insights from the Flo app. Poster P-146. Presented at: The Menopause Society 2026 Annual Meeting; October 20-24, 2026; San Diego, CA.
2. The Menopause Society. Higher physical activity frequency associated with lower symptom burden in perimenopause. News release. October 20, 2026. Accessed October 23, 2026. https://menopause.org/press-releases/higher-physical-activity-frequency-associated-with-lower-symptom-burden-in-perimenopause