Exercise May Ease Depression and Boost Quality of Life During Menopause, Review Finds

A large-scale review led by researchers at University College London suggests that physical activity could offer a meaningful boost to psychological wellbeing during one of the most challenging transitions in a woman’s life. Published in Menopause Journal, the systematic review and meta-analysis pooled data from twelve randomised controlled trials involving more than 1,000 women, examining how different forms of exercise influence depression, mood and overall quality of life during perimenopause and early post menopause. The findings arrive at a time when treatment options for the psychological symptoms of menopause remain limited, and when an estimated one in ten women leave work because of their symptoms.

Menopause marks the point at which a woman’s periods stop due to declining hormone levels, typically occurring between the ages of 45 and 55. The years surrounding this transition, known as perimenopause, are characterised by fluctuating oestrogen levels that can destabilise mood long before periods cease entirely. It is estimated that around 13 million women in the UK are currently perimenopausal or menopausal. Beyond the well-known physical symptoms such as hot flushes, many women experience depression, low mood, anxiety, stress, and difficulties with thinking and memory. These psychological symptoms can have a significant impact on daily functioning, relationships and careers, yet the pharmacological and therapeutic options available to address them remain constrained.

The UCL-led team set out to determine whether exercise, one of the most accessible and low-cost interventions available, could move the needle on these psychological outcomes. The researchers divided the physical activity examined across the twelve trials into two distinct categories. The first, aerobic-based interventions, included walking, Zumba, aerobic exercise, dance and Taekwondo. The second, mind-body activities, comprised yoga, tai chi, Pilates and stretching. This distinction proved important, because the two categories appeared to deliver somewhat different benefits, with aerobic exercise showing the strongest effects on depressive symptoms and overall quality of life, while mind-body practices stood out for improving psychological quality of life specifically.

The mechanisms proposed for the aerobic benefits are rooted in well-established exercise physiology. The researchers point to increased endorphin release linked to mood enhancement, a neurochemical effect that may be particularly relevant during perimenopause, when oestrogen fluctuations increase vulnerability to mood instability. Oestrogen is known to interact with neurotransmitter systems involved in mood regulation, so hormonal turbulence during this stage may leave the brain more sensitive to stress and low mood. Interventions that reliably trigger endorphin release could therefore provide a buffer against this heightened vulnerability, offering a non-pharmacological counterweight to the hormonal shifts underway.

Practical considerations also favoured the aerobic programmes. The researchers noted that aerobic-based interventions tended to involve fewer sessions, suggesting they may be easier to fit into the lives of midlife women facing time and energy constraints. In one trial, women were instructed to walk three times per week for 30 minutes, while in another participants attended three one-hour Zumba classes per week. Across the twelve randomised trials, participants were generally required to attend multiple sessions per week, depending on the type of exercise prescribed. The relative simplicity of lacing up walking shoes or joining a dance class, compared with more demanding regimens, may be a decisive factor for women juggling work, family and the fatigue that often accompanies the menopausal transition.

Mind-body activities, by contrast, delivered their strongest improvements in psychological quality of life. These practices incorporate mindfulness, breathwork and body awareness, elements that may enhance emotional regulation. The dosing in these trials was often more intensive: in one study, women attended two weekly 75-minute yoga sessions, while in another participants attended daily one-hour yoga classes. The emphasis on slow, deliberate movement combined with attention to breathing and bodily sensation may help women develop greater equanimity in the face of symptoms that can otherwise feel unpredictable and distressing, though the review’s authors frame this as a plausible explanation rather than a settled mechanism.

The timing of benefits also varied across the menopausal stages. Improvements in depression, mood and quality of life were particularly evident among women in early post menopause, the stage of life that begins twelve consecutive months after a woman’s final menstrual period. Physical activity was also associated with improvements in depressive symptoms during perimenopause. This pattern suggests that exercise may offer benefits throughout the transition, but that women who have completed the hormonal shift may experience the most pronounced gains in overall wellbeing. For clinicians, this raises the possibility of tailoring exercise recommendations to a patient’s specific stage rather than treating menopause as a single homogeneous phase.

The researchers hope their findings will highlight physical activity as a low-cost and widely available intervention option for women experiencing psychological symptoms during menopause, particularly in comparison with other approaches such as hormone therapy and cognitive behavioural therapy. Lead author Simone Saidel, an NHS Clinical Psychologist who was a researcher at UCL when the review was conducted, noted that treatment options for menopause are limited, with many women unable to or choosing not to take hormone therapy. She also pointed to significant health inequalities in terms of HRT access, and ethnic variations in attitudes towards it. In this context, she said, the study plays an important role in expanding the options available for symptom management, whereby clinicians may recommend exercise as an early intervention or an adjunct to medical or psychological treatments.

Senior author Professor Aimee Spector, Director of the UCL Menopause Mind Lab in the UCL Division of Psychology and Language Sciences, described physical activity as an effective, accessible, non-pharmacological strategy to support psychological wellbeing and quality of life during midlife menopause. She observed that the majority of the interventions used group-based formats, which are likely to foster social connection and peer support, both factors associated with improved quality of life during menopause. The team believes this social dimension may have contributed to the improved mood and quality of life observed, adding a further layer to the case for group fitness classes, walking groups and communal yoga sessions as vehicles for menopause support beyond the physiological effects of the exercise itself.

The evidence base underpinning these conclusions is drawn from seven countries: Brazil, China, Tunisia, India, Iran, Korea and the United States, giving the review a broad international scope. However, the researchers are candid about its limitations. The evidence base remains limited, with substantial variation between studies, and many of the studies were judged to be at high risk of bias, underscoring the need for further high-quality trials. The team also emphasises that more research is needed to establish which forms of physical activity are most beneficial and how they can best be incorporated into support and care for women experiencing menopause. Even so, for the millions of women navigating this transition with limited treatment options, the message from this review is a pragmatic one: movement, whether a brisk walk or a yoga class, may be one of the simplest tools available for protecting mood and quality of life during menopause.

Subject of Research: The effects of physical activity interventions on psychological symptoms and quality of life during menopause

Article Title: Physical activity may improve mood and quality of life during menopause

Article References: Physical activity may improve mood and quality of life during menopause. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: menopause, perimenopause, physical activity, depression, quality of life, aerobic exercise, yoga, mind-body interventions, systematic review, meta-analysis, UCL, women's health