Pilates for Perimenopause and Menopause: What It Can and Can't Do

By Katherine, Lead Instructor, Certified Pilates Instructor

Pilates may help some menopause-related symptoms, but the evidence is early. Small trials in postmenopausal women report better overall symptom scores and quality of life, yet exercise in general has not clearly reduced hot flushes in trials, and the Pilates trials are few, short and small. Pilates fits best as one part of a plan that also includes strength training and advice from your doctor.

Key takeaways

• Two small randomized trials (30 and 40 women, 6 to 8 weeks) found Pilates improved menopausal symptom scores and quality of life in postmenopausal women, but certainty is low (Yiğit Kocamer & Atilgan, 2025; Arslan et al., 2026).

• A Cochrane review found no clear evidence that exercise changes the frequency or intensity of hot flushes, and the evidence was low quality (Daley et al., 2014).

• During the menopause transition, fat mass tends to rise faster and lean mass tends to fall, which is one reason strength training deserves a place in your week (Greendale et al., 2019).

• The evidence for Pilates improving sleep in postmenopausal women is not convincing, and for depression and anxiety the largest recent review found it limited or non-significant (Chen et al., 2020; Tsartsapakis et al., 2026).

• Canada's guidelines call for muscle strengthening at least twice a week plus 150 minutes of aerobic activity (CSEP, 24-Hour Movement Guidelines).

What does the research say about Pilates and menopause symptoms?

Two small randomized controlled trials (where people are randomly assigned to an exercise or comparison group) are the only Pilates trials we found that measured menopause symptom scales directly.

In the first, 30 postmenopausal women were split into two groups: one did an 8-week Pilates program and the other attended menopause information sessions. The Pilates group scored better afterward on menopausal symptoms, quality of life and sexual function (Yiğit Kocamer & Atilgan, 2025). In the second, 40 postmenopausal women were split between online Pilates (twice a week for 6 weeks) and a comparison group. Their physical and psychological symptom scores, quality of life, depressive symptoms and state anxiety (anxiety in the moment) improved more than in the comparison group (Arslan et al., 2026).

Both trials were small and short, and both come from research groups based mainly in Turkey. We did not find a systematic review of Pilates for menopause symptoms themselves. A 2024 review of 11 trials in postmenopausal women found Pilates improved several areas of general quality of life, such as bodily pain and physical functioning, but none of its findings reached high certainty (de Almeida et al., 2024). So Pilates is a reasonable thing to try for many people, but it is not an established treatment for menopause symptoms.

For the wider picture of training safely from midlife onward, see our guide to Pilates after 50.

Will Pilates help hot flushes and night sweats?

We cannot say that it will. A Cochrane review included five randomized trials (733 women). In the three that compared exercise with no active treatment (454 women), it found no evidence of a difference in the frequency or intensity of hot flushes and night sweats, and it rated the evidence as low quality. The authors concluded the evidence was insufficient to show whether exercise is an effective approach for these symptoms (Daley et al., 2014).

That review looked at exercise in general, not Pilates. One small online Pilates trial did report a larger improvement on the hot flush and night sweat section of a menopause quality-of-life questionnaire, but a single 6-week study is not enough to rely on (Arslan et al., 2026). If hot flushes or night sweats are disrupting your life, talk to your doctor about your options.

Can Pilates help with weight and body composition changes?

Possibly a little, but expect modest effects at best. During the menopause transition, a large US study that followed 1,246 women found the rate of fat gain doubled and lean mass began to decline, while overall body weight did not speed up (Greendale et al., 2019).

We would not promise fat loss or muscle gain from Pilates alone. The wider evidence is in our post on whether Pilates helps you lose weight.

What about joint stiffness and aches?

The NHS lists muscle aches and joint pains among common perimenopause and menopause symptoms (NHS), and the Society of Obstetricians and Gynaecologists of Canada notes that flexibility activities help keep joints mobile (Menopause and U, SOGC).

We did not find a Pilates trial on menopausal joint stiffness. What we can say is practical: Pilates includes controlled mobility work through the spine, hips and shoulders, and in our sessions we adapt exercises to you, for example changing the range, the position or the spring setting. If a joint is swollen, hot, locked or painful at rest, that needs a medical assessment first.

Does Pilates help with sleep and mood?

Sleep

The evidence here is weaker than many articles suggest. A meta-analysis of six randomized trials (477 participants) found Pilates groups improved their Pittsburgh Sleep Quality Index scores more than non-exercising groups overall. But when the authors looked separately at postmenopausal women, and at healthy people over 40, the difference was not statistically significant (Chen et al., 2020). So Pilates is not a proven fix for menopausal sleep trouble, and persistent insomnia is worth raising with your doctor. Our post on Pilates, stress, anxiety and sleep goes further into this evidence.

Mood

Results are mixed. The online trial above found lower depressive symptoms and state anxiety, though not trait anxiety (a person's more stable tendency toward anxiety), after 6 weeks (Arslan et al., 2026). A 2026 meta-analysis of 32 trials (1,264 participants) across all populations found benefits for quality of life and self-esteem, while evidence for depression and anxiety specifically was limited or non-significant (Tsartsapakis et al., 2026). Pilates is not a substitute for care if you are struggling with low mood or anxiety.

What happens with the pelvic floor and urinary or vaginal symptoms?

Vaginal dryness and irritation are listed among common menopause symptoms (NHS), and stress urinary incontinence (leaking with a cough, laugh or jump) is more common after menopause (Canadian Continence Foundation). Pilates evidence for these symptoms is mixed. The online trial found no significant change in urogenital symptoms or sexual quality of life (Arslan et al., 2026), while the 8-week trial reported better sexual function scores (Yiğit Kocamer & Atilgan, 2025).

For leaks, our guide to Pilates for your pelvic floor covers what the evidence does and does not show, and when a pelvic health physiotherapist is the right first call. Incontinence is common but not normal, and most people improve with treatment such as physiotherapy and lifestyle changes (Canadian Continence Foundation).

Is Pilates enough, or do you need strength training too?

For most people in midlife, Pilates alone is not enough. Canada's 24-Hour Movement Guidelines recommend at least 150 minutes a week of moderate to vigorous aerobic activity and muscle-strengthening activities at least twice a week (CSEP, adults 18 to 64). We compare the two approaches in Pilates vs strength training.

What does a practical week look like?

This is a sample built around the Canadian guidelines, not a prescription. Scale it down if you are new to exercise, and build up gradually. If you have been told you have low bone density or osteoporosis, read Pilates and osteoporosis first, because some common spinal movements need to be modified.

• Two Pilates sessions (about 55 to 60 minutes each), for example Monday and Friday, focused on control, breathing and mobility.

• Two strength sessions (30 to 45 minutes), for example Wednesday and Saturday, using weights, bands or machines for the major muscle groups, with the load rising slowly as it gets easier.

• About 150 minutes of aerobic activity, such as 30-minute brisk walks on Tuesday and Thursday, plus walks, hikes or rides adding up to about 90 minutes over the weekend. SOGC notes that minutes count when added up 10 minutes at a time (Menopause and U, SOGC).

• One or two easy days, and room to swap a session when a poor night's sleep or a flare of symptoms leaves you tired.

Safety note: This article is general information, not medical advice, and it does not replace an assessment by your health care provider. See your family doctor about menopause symptoms that disrupt your life, before starting a new program if you have heart disease, high blood pressure, diabetes, low bone density, a joint condition or pelvic floor symptoms, and promptly for vaginal bleeding after 12 months without a period, heavier bleeding or heart palpitations (NHS). If you feel persistently low or hopeless, talk to your doctor; if you have thoughts of harming yourself, call or text 9-8-8 (Canada's Suicide Crisis Helpline), or call 911 if you are in immediate danger. Stop and seek care for chest pain, fainting, unusual shortness of breath, sharp or radiating pain, or dizziness that does not settle. We work alongside your health care provider and do not diagnose or treat menopause or any medical condition.

Pilates for menopause with us in Markham

If you would like a program built around how you feel right now, a Private 1:1 Pilates with Instructor session lets us adapt the pace, position and intensity to your symptoms and goals, and a Small Group Pilates Class (reformer, maximum 3 people) offers a supportive setting with personal attention. Book online to get started.

Frequently asked questions

Can Pilates replace hormone therapy or other medical options?

No. There is no evidence that Pilates replaces medical options for menopause symptoms, and in the Cochrane review one small study found hormone therapy worked better than exercise for hot flushes (Daley et al., 2014). Whether hormone therapy suits you is a decision for you and your doctor.

Does Pilates work in perimenopause, or only after menopause?

The two Pilates trials we found enrolled postmenopausal women, so we do not have Pilates-specific evidence for perimenopause. Canada's exercise guidelines are set by age, not menopause stage, so they are the same either way (CSEP, adults 18 to 64).

What if I am exhausted or sleeping badly? Should I push through?

On a rough day, reduce the intensity: shorter range, fewer repeats, a spring setting your instructor adjusts for you, or a slower pace. Sharp pain, dizziness or chest symptoms are stop signs, not something to push through. If fatigue is constant, mention it to your doctor.

Sources

1. Yiğit Kocamer M, Atilgan E (2025). Investigating the effects of Pilates exercises on menopausal symptoms and sexual dysfunction in postmenopausal women: A randomized controlled trial. Medicine (Baltimore). 104(23):e42689. https://pubmed.ncbi.nlm.nih.gov/40489883/

2. Arslan EGB, Tufekci B, Acar M, Cetindag EN, Sahin E (2026). Effects of Tele-Pilates Exercise on Menopausal and Urogenital Symptoms and Psychosocial Outcomes in Postmenopausal Women: A Randomized Controlled Trial. International Urogynecology Journal. https://pubmed.ncbi.nlm.nih.gov/42142163/

3. Daley A, Stokes-Lampard H, Thomas A, MacArthur C (2014). Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews, Issue 11, CD006108. https://www.cochrane.org/evidence/CD006108_exercise-vasomotor-menopausal-symptoms

4. Greendale GA, Sternfeld B, Huang M, et al. (2019). Changes in body composition and weight during the menopause transition. JCI Insight. 4(5):e124865. https://insight.jci.org/articles/view/124865

5. Chen Z, Ye X, Shen Z, Chen G, Chen W, He T, Xu X (2020). Effect of Pilates on Sleep Quality: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in Neurology. 11:158. https://pubmed.ncbi.nlm.nih.gov/32265816/

6. Tsartsapakis I, Zafeiroudi A, Kouthouris C (2026). Effects of Pilates-Based Exercise on Mental Health, Psychological Well-Being, and Quality of Life: A Systematic Review and Meta-Analysis. Sports (Basel). 14(5):171. https://pubmed.ncbi.nlm.nih.gov/42188548/

7. de Almeida PP, de Oliveira RG, de Almeida LIM, de Oliveira LC (2024). Effects of Pilates exercises on health-related quality of life in postmenopausal women: a systematic review and meta-analysis. Quality of Life Research. 33(8):2067-2079. https://pubmed.ncbi.nlm.nih.gov/38602630/

8. Canadian Society for Exercise Physiology. Canadian 24-Hour Movement Guidelines for Adults 18 to 64 years. https://csepguidelines.ca/adults-18-64/

9. Society of Obstetricians and Gynaecologists of Canada. Menopause and U: Exercise and an active lifestyle. https://menopauseandu.ca/am-i-in-menopause/lifestyle-changes/exercise-active-lifestyle

10. NHS (2026). Symptoms of menopause and perimenopause. https://www.nhs.uk/conditions/menopause/symptoms/

11. Canadian Continence Foundation. Urinary Incontinence. https://www.canadiancontinence.ca/urinary-incontinence