Where the Strength-Training Research for Women in Midlife Runs Thin

When I open a strength-training study now, I skip straight to the table describing the participants and look for a row that sounds like a woman in her late forties. Maybe her periods are irregular, maybe they've stopped, maybe she isn't sure which. Most of the time that row isn't there. So this week I stopped skimming past it and tried to find out how often she's missing, and what that does to what anyone can honestly say.

Who is in the studies at all

Start with the widest view. A 2021 analysis in the Women in Sport and Physical Activity Journal counted participants across 5,261 human-subject publications from six sport and exercise science journals, 2014 to 2020, about 12.5 million people in total. Women were 34% of them, and only 6% of the studies enrolled women alone. That's a count of publications across the whole field, not of strength-training trials specifically, so it shows the shape of the problem rather than its exact size.

A 2024 editorial in the British Journal of Sports Medicine, written by some of the same authors, goes one step further. They say they expect the numbers to be even lower for women who are perimenopausal or postmenopausal, in studies that enroll women only. It's an editorial, mind you, and they call it an expectation, because nobody has counted. I'm holding it loosely.

The two boxes

The biggest dataset I've found on women and lifting is a 2026 systematic review and meta-analysis in the Journal of Science and Medicine in Sport: 126 studies, 4,019 healthy women, 66.2% of them postmenopausal. Strength rose substantially in both premenopausal and postmenopausal groups, by almost the same amount (standardized mean differences of 1.50 and 1.46, no significant difference between groups). I wrote about that result in an earlier article, and it cheered me up. The authors open their abstract by saying women are underrepresented in this research and that guidelines are mainly based on men.

This time I stopped at something else. The review's average age was 50.9, with a spread of 19.2 years, so the "average" hides a wide mix of ages. And the comparison is built on two boxes, before menopause and after. In the abstract, I didn't see perimenopause reported as a group of its own. A result of "no significant difference" also means the review didn't detect one, which is not the same as showing the groups respond identically.

A smaller trial aimed squarely at ages 40 to 60 shows the same sorting. Published in BMC Women's Health in 2023, it enrolled 41 women (average age 52), 31 of whom finished, and divided them into pre- or postmenopausal by hormone profile. After 10 weeks of training twice a week, strength rose in every group, but muscle mass rose only in the premenopausal women. The authors suggest postmenopausal women may need larger training volumes. That's a hypothesis nobody has tested yet, and 31 women split four ways (two menopausal groups, two intensity levels) leaves very small groups to hold it up.

Short trials, stand-in measures

Even where the topic is well covered, the questions being asked are narrower than they look. A 2025 scoping review in the Journal of Strength and Conditioning Research screened 790 studies and found 69 that tested resistance training for health outcomes in postmenopausal women. Its authors state that there are currently no evidence-based recommendations for health-promoting resistance-training programs specifically for this group. The programs in those studies mostly followed general strength-training guidelines, and few included functional movements like carrying groceries. A scoping review maps what has been done; it doesn't test whether it works.

Bone shows the stand-in problem most clearly. A 2025 meta-analysis of 17 randomized trials and 690 postmenopausal women found resistance training improved bone density at the spine and hip. But the trials disagreed a lot with each other (heterogeneity of 91% at the spine), and the authors say that limits how far the pooled result generalizes and that more high-quality trials are needed. Bone density is also a measurement, not an outcome anyone feels. In a 2011 Cochrane review of 43 randomized trials and 4,320 postmenopausal women, exercise had a small effect on bone density, but fractures were reported only as side events in some of the trials, and the pooled result (odds ratio 0.61) came with a confidence interval wide enough to include no effect at all. That review is old, so newer trials may have moved this. I wrote more about the bone question here.

What this can look like in practice

I don't read any of this as "the research says don't bother." Strength gains show up across ages in the pooled data. What's thin is a specific set of questions: whether perimenopause itself changes how muscle responds. Whether trials of 10 or 12 weeks miss what longer ones would show. And whether bone changes in women without a diagnosis ever turn into fewer fractures. What I do with that is small. I read the participant table and the length of the trial before the result, and One finding is a question to me until someone repeats it. Whether any particular routine suits your joints or your history is a conversation for your own doctor. I gathered the trail, including the unanswered parts, in a workbook called Strength After 40 ($17), if having it in one place is useful.

What's worth skipping

Skip anyone who tells you exactly what a perimenopausal woman needs in the gym. Most of the studies behind those claims didn't set her apart as a group. And skip the opposite conclusion too: "nobody knows anything" isn't true either, and a missing study is not proof of a missing effect. If the advice is firm and the participant table is vague, I go with the table.