As physician Marie Curie researched the effects of radiation on the human body in the early 20th century, she opened doors not only for physics but also for medicine. Since then, women have significantly shaped how we understand and manage health. Today, we are at another turning point: menopause is no longer passively endured but actively managed. With smart, scientifically-based strategies, this life phase can be transformed into strength, stability, and performance.

Menopause marks the end of ovarian function and the permanent cessation of menstruation. The declining estrogen levels accelerate remodeling processes in bones and muscles and affect heart, metabolism, and urogenital health. Importantly, bone mineral density (BMD)measure of bone strength decreases most sharply in the first years after menopause; sarcopeniaage-related loss of muscle mass and strength accelerates; visceral fatmetabolically active fat around internal organs often increases. At the same time, vascular stiffnessreduced elasticity of the arteries and blood pressure regulation change. The good news: training is one of the most effective levers against these changes. Strength, endurance, balance, and pelvic floor training address different systems—together, they form a safety net for vitality, longevity, and high performance.

Strength training in early postmenopause can stabilize or improve BMD at the hip, spine, and trochanter and helps maintain lean mass—a direct lever against injury risk and performance decline ^[1]. Aerobic activities such as brisk walking or swimming improve blood pressure, lipids, and triglycerides and increase HDL—a clear benefit for vascular health and cognitive performance [Ref40742785; Ref40782676]. Multicomponent programs that combine endurance, strength, and flexibility lower blood pressure and improve waist circumference—especially relevant in postmenopausal risk constellations ^[2]. Pelvic floor training reduces urinary incontinence and enhances quality of life—a frequently underestimated performance factor in daily life and sports ^[3]. Vitamin D (about 800–1000 IU/day) in combination with calcium (up to approximately 1200 mg/day) can maintain BMD and reduce fracture risk; evidence is particularly robust for 800 IU of vitamin D3 plus 1200 mg of calcium in protecting against hip and non-vertebral fractures in older adults [Ref35842938; Ref37544189]. Balance training increases standing stability, reduces fear of falling, and improves movement security—essential because falls are one of the greatest enemies of longevity [Ref26181147; Ref30990762].

A systematic review of the menopause transition shows that strength training and walking can positively influence BMD at several skeletal sites in early postmenopause; walking is particularly effective at the total hip region. Not all studies showed increased muscle mass, but the bone effects are clinically relevant. The quality of evidence is limited—longer, target-specific RCTs are required ^[1]. Meanwhile, a large meta-analysis of randomized studies demonstrates that aerobic training lowers systolic and diastolic blood pressure in postmenopausal women, increases HDL, and reduces LDL and triglycerides—effects that can measurably mitigate cardiovascular risk and reduce anxiety ^[4]. Additionally, reviews on exercise and heart health during this life phase underline consistent benefits but call for better methodology—the direction is correct, and the precision of dose-response recommendations is currently being refined ^[5]. Regarding micronutrients, evidence shows that vitamin D improves status (25-OH-D) and can stabilize BMD with calcium; the reduction of hard fractures is most clearly demonstrated for 800 IU of vitamin D3 plus 1200 mg of calcium daily, while very high bolus doses offer no benefits and may sometimes be ineffective [Ref37544189; Ref35842938].

- Start a structured strength training program 2–3 times/week: focus on basic exercises (squats, deadlift variations, presses, rowing), 2–4 sets, moderate-high load, proper technique. Goal: maintain/improve BMD and secure muscle mass—especially substantiated in early postmenopause ^[1].
- Add 150–210 minutes of endurance training per week: brisk walking, cycling, swimming, or interval forms depending on fitness. Expected effects: lower blood pressure, higher HDL, lower LDL/triglycerides; additionally, fewer anxiety symptoms [Ref40742785; Ref40782676]. Multicomponent programs show beneficial improvements in blood pressure and waist circumference ^[2].
- Train the pelvic floor 3–5 times/week: targeted contractions (slow holds and quick impulses), functionally apply in daily life (coughing, lifting). Effect: less incontinence, more quality of life ^[3].
- Incorporate balance exercises, 10–15 minutes, 3 times/week: single-leg stands, tandem stands, unstable surfaces, or Pilates. Goal: reduce fall risk, improve stand control, increase self-confidence [Ref26181147; Ref30990762].
- Optimize calcium and vitamin D: about 1200 mg of calcium daily (diet plus supplements if necessary) and 800 IU of vitamin D3 as a standard starting point; higher daily doses should be examined individually. This combination shows the strongest evidence for preventing hip and non-vertebral fractures in older adults ^[6]; vitamin D improves status and bone remodeling markers, especially at low baseline values ^[7]. Avoid large annual boluses without indication ^[7].

The next wave of research will clarify dose-response questions: Which load ranges in strength training maximize BMD without overloading? What is the optimal combination of endurance, balance, and pelvic floor training for different stages of menopause? Larger, longer-running RCTs on personalized training and supplementation strategies could further increase precision—and thus pave the way for evidence-based high performance in menopause.