Higher physical activity tied to lower perimenopause symptom burden

Higher physical activity frequency showed a statistically significant inverse association with total perimenopause symptom burden in a fully adjusted analysis (β = −0.57, P < 0.001), according to results of a cross-sectional study of users of the Flo menstrual tracking app presented at The Menopause Society 2026 Annual Meeting.¹

Regular physical activity has been shown to improve sleep, lower blood pressure, and reduce anxiety, while also building muscle, strengthening bones, and helping to control weight, stated The Menopause Society. Perimenopause is marked by hormone changes leading to physical and psychological symptoms that can impair quality of life, and the relationship between physical activity and perimenopause symptom burden remains underexplored, particularly in global populations.²

Surveying 1808 Flo app users across 87 countries

The study included English-, Spanish-, Portuguese-, and French-speaking Flo users aged 35 years or older who self-identified as being in perimenopause. Participants using hormonal contraception or hormone therapy were excluded.

Respondents completed an online survey including self-reported physical activity frequency, with 5 options ranging from “not physically active” to “≥5 days/week,” and the Menopause Rating Scale (MRS). The MRS is a validated instrument measuring symptom severity across somatic, psychological, and urogenital domains, with higher scores indicating greater symptom burden (total score range 0–44; somatic 0–16; psychological 0–16; urogenital 0–12).

Investigators used multivariable linear regression models. Confounders were prespecified using a causal framework and included age, BMI, smoking status, comorbidities, health care access, and the country-level Socio-Demographic Index. A total of 1808 respondents (mean age ± SD: 45 ± 4.5 years) across 87 countries over 6 continents were included.

Symptom scores declined with more frequent activity

In unadjusted analysis, mean total MRS scores decreased with increasing physical activity frequency, ranging from 17.46 ± 7.79 in those not physically active to 13.77 ± 7.06 in those active ≥5 days/week (P < 0.001). A similar pattern was observed across all domains, from not physically active to ≥5 days/week:

• Somatic: 6.06 ± 3.07 to 4.48 ± 2.58 (P < 0.001)
• Psychological: 7.77 ± 3.74 to 6.41 ± 3.49 (P < 0.001)
• Urogenital: 3.63 ± 2.69 to 2.87 ± 2.56 (P = 0.004)

In the adjusted model, physical activity frequency was also significantly inversely associated with the psychological (β = −0.26, P < 0.001), somatic (β = −0.21, P < 0.001), and urogenital (β = −0.10, P = 0.020) domains.

The authors reported that perimenopausal women reporting higher physical activity frequency had significantly lower symptom burden overall and across all domains when fully adjusted, and that the findings highlight the relevance of physical activity as a modifiable lifestyle intervention for perimenopausal symptom management.¹

Highlighting psychological symptom benefit with physical actvity

“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,” said Liudmila Zhaunova, presenting author of the study and director of science at Flo Health.

“Regular physical activity is associated with a wide range of health benefits and is already recommended as part of a healthy lifestyle during midlife. 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. Although additional research is needed to better understand this relationship, encouraging regular physical activity is a low-risk strategy that may help improve overall well-being during the menopause transition,” said Stephanie Faubion, medical director for The Menopause Society and a coauthor of the study.^1,2

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. Presented at: The Menopause Society Annual Meeting. October 20-24, 2026. San Diego, California.
2. Higher physical activity frequency associated with lower symptom burden in perimenopause. News release. The Menopause Society. Accessed October 20, 2026.