Resistance Training vs Pilates for Perimenopause: Which Is Better
Resistance training and Pilates both help during perimenopause, but in different ways. Compare what each does for bones, mood, weight, and energy.
Both Are Good. But for Different Reasons.
During perimenopause, exercise becomes more important than ever for bone health, mood, body composition, and energy. Resistance training and Pilates are two of the most popular options, and both have genuine benefits. But they work through different mechanisms and suit different goals, preferences, and starting fitness levels. This comparison will help you understand what each actually delivers so you can make a choice that fits your body and your life right now.
What Resistance Training Does During Perimenopause
Resistance training, also called strength training or weight training, involves working your muscles against a load. This can mean barbells, dumbbells, resistance bands, or even bodyweight exercises like push-ups and squats. The primary benefits for perimenopausal women are significant. Muscle mass naturally declines with age and accelerates after estrogen drops. Resistance training directly counters this by stimulating muscle protein synthesis. More muscle means a higher resting metabolic rate, which helps manage the weight changes that many women experience during this transition. Bone density is another major benefit. Weight-bearing and resistance exercises create mechanical stress on bone that stimulates new bone growth, helping to offset the bone loss that accelerates when estrogen declines. Several large studies, including the BEST trial, have shown that progressive resistance training significantly improves bone mineral density in postmenopausal women. Strength training also improves insulin sensitivity, which matters because the hormonal shifts of perimenopause can affect blood sugar regulation. And there is strong evidence that it reduces symptoms of depression and anxiety, both of which are common during this life stage.
What Pilates Does During Perimenopause
Pilates focuses on controlled movement, core stability, posture, and flexibility. It uses either a mat or a specialized reformer machine and emphasizes breath, body awareness, and precise muscle engagement. Pilates is lower intensity than most resistance training programs, which makes it accessible to women who are dealing with joint pain, recovering from injury, or returning to exercise after a long break. The core-strengthening focus is particularly relevant during perimenopause because falling estrogen affects connective tissue laxity, which can increase the risk of pelvic floor issues and lower back pain. Pilates addresses postural changes and builds the deep stabilizing muscles that support the spine and pelvis. Research on Pilates for perimenopause and menopause is smaller in scale than the resistance training literature, but existing studies suggest it can improve balance, reduce back pain, and have a modest positive effect on mood and sleep quality. It is also beneficial for proprioception, which is your body's sense of its own position in space, and this becomes increasingly important for fall prevention as you age.
Head-to-Head: Key Differences
When it comes to bone density, resistance training has a stronger evidence base. Load-bearing exercise creates more bone-building stimulus than Pilates typically does. For muscle mass preservation, resistance training again has the advantage because it provides progressive overload that Pilates mat work generally does not, though reformer Pilates can approach low-level resistance work. For weight management, resistance training has a clearer metabolic benefit due to its effect on muscle mass and post-exercise calorie burn. For core stability, pelvic floor health, and postural alignment, Pilates has a more direct and specific focus. For stress reduction and mindfulness, Pilates has a slight edge because of its emphasis on breath and body awareness, though both forms of exercise reduce cortisol. For accessibility and injury recovery, Pilates is generally gentler and easier to modify. For overall cardiovascular and metabolic benefits, neither is primarily a cardio workout, though resistance training at sufficient intensity does elevate heart rate.
What the Research Actually Recommends
Current guidelines from organizations including the American College of Sports Medicine and the Menopause Society recommend that perimenopausal women prioritize resistance training at least two to three times per week because of its proven effects on bone density, muscle mass, and metabolic health. These are areas where perimenopause creates specific vulnerability. However, the research also recognizes that exercise adherence matters more than the perfect workout. A Pilates practice you stick with consistently will deliver more long-term benefit than a resistance training program you abandon after three weeks. The best clinical recommendation is to combine both where possible, using resistance training as the foundation for bone and metabolic health and Pilates as a complement for core stability, flexibility, and recovery.
Who Is Each Option Best For
Resistance training is the better primary choice if your main concerns are bone density, muscle preservation, weight management, or metabolic health. It is also the stronger choice if you are already reasonably fit and comfortable with gym environments or home workouts with weights. Pilates is particularly well suited if you have chronic pain, pelvic floor issues, a history of back problems, or are returning to exercise after a break. It is also a good choice if you find high-intensity workouts leave you feeling depleted rather than energized, which is common during perimenopause when cortisol levels and energy fluctuations are already a challenge.
A Practical Starting Point
If you can only choose one, start with resistance training and work up to two to three sessions per week using progressive overload, meaning gradually increasing the weight or resistance over time. Add Pilates once or twice a week as a complement, especially if you have any pelvic floor concerns or postural issues. A well-rounded approach that includes both will serve you better than either alone, and most women find that a combination feels more sustainable and enjoyable than doing only one type of movement week after week.
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