Working With Female Clients During Menopause and Beyond

By Amanda Thebe

If you're a trainer who works with women, and your clients are experiencing menopausal symptoms, then chances are you've entered a realm of personal training that's as clear as mud!

Being a veteran trainer in this game for nearly 20 years and now a woman experiencing menopause, I say this as the voice of experience: I truly struggled to find information or guidance to help me understand the changes to my body and how this impacted my everyday life, including exercising.

I hadn’t realized the impact that menopause would have on my life, my family and my ability to reach my potential until it hit me like a sledgehammer. Entering my forties was a breeze: I was fit and healthy, and in better condition both physically and mentally than I was in my twenties — I felt awesome!

Then, approximately four years ago, I was at my boxing class, having the time of my life knocking the crap out of the bag, when I started to feel strange. My state kept deteriorating until, later that evening, I realized that I couldn’t event get up from the sofa because the whole room was spinning: I was having a vertigo attack. This was followed by utter fatigue, nausea and vision problems. Thinking that I had caught a virus, I assumed that it would just pass, yet these symptoms wouldn’t subside. For a few weeks, I continued to feel unwell, to the point where I couldn’t walk properly as my whole equilibrium had shifted, in the end I decided to visit my doctor to see if he could work out what was happening.

Fast forward 18 hellish months of tests and visits to ENTs, gynecologists and neurologists, it was finally determined that hormones were the culprit. After specific bloodwork, my gynecologist confirmed that my estrogen levels had plummeted — I was entering perimenopause. While, over time, my symptoms progressively changed, I still found the experience difficult to describe, and felt as if I was enduring a silent, invisible pain that no one else would understand.

As a trainer, it’s your responsibility to learn more about this important life transition and use this knowledge to help you plan and design your workouts with your clients. To start with let’s clarify what menopause really means.

What Is Menopause?

We can break the menopause phase of a woman's life into three areas: perimenopause, menopause, and postmenopause1,2. Below is a very high-level overview of what this entails. For the remainder of this article, I will combine them all into the term menopause, simply for digestibility and ease.

Perimenopause means "around menopause" and refers to the time during which your body makes the natural transition to menopause, marking the end of the reproductive years. Perimenopause is also called the menopausal transition. Women start perimenopause at different ages, starting as early as their 30s and this phase can last from eight to 10 years. Women typically experience many menopausal symptoms, but can still have their period and can still get pregnant.

Menopause is defined as occurring 12 months after your last menstrual period, and marks the end of menstrual cycles. Menopause can happen in your 40s or 50s, the average age being 51 in the United States.

Postmenopause typically sees a decrease in some symptoms, like hot flashes, but can also present additional health concerns, such as osteoporosis and heart disease, due to the decreased production of estrogen in the body.

What Symptoms Can Women Expect During Menopause?

Not every woman will experience menopause the same way; it is a deeply individual experience. My main purpose for this article is to raise awareness about some of the issues your client may be facing, and how you might have to adjust your approach to your training sessions.

If you have female clients aged between 35 and 55 years old who are experiencing any of the following symptoms, they are likely to be menopausal:

  • Irregular periods
  • Stress incontinence or urinary incontinence
  • Depression
  • Vaginal dryness
  • Hot flashes
  • Sleep problems (from insomnia to utter fatigue)
  • Mood changes (like batsh*t mood changes)
  • Weight gain and slowed metabolism
  • Thinning hair and dry skin
  • Loss of breast fullness
  • Short term memory loss
  • Night sweats
  • Migraines
  • Fatigue
  • Short term memory loss (see what I did there?)

The list goes on and on and on… in fact I keep could keep coming back to this article and adding items!

To Exercise or Not To Exercise? That Is the Question!

And also the title of a great study from ASCM Health and Fitness Journal3. The study showed that the physical activity level of the woman had no influence on the age at which they undergo menopause, but we know that physical activity has positive effects on our mood and ability to reduce stress, so that in itself can help symptoms feel easier4. It’s also understood that depression is a potential symptom of menopause and exercise can be a successful treatment for mild to moderate depression.

Symptoms can fluctuate on a daily basis: your client feels fantastic one day, and completely depleted the next. It’s not only very frustrating for them, but also very hard to plan for.

I personally get exasperated when I organize my own workout programs, only to end up losing three days to utter fatigue or migraines. What’s made the difference for me now is just accepting that these changes are going to happen and then alter my workout to suit my needs. This can be something like a mobility/flexibility session or a light strength training session focusing on form, instead of my scheduled HIIT session — being adaptable is paramount!

During Menopause and Beyond, Building Lean Muscle Is Key

Over my years of experience, I have established that eating less and working out more as we age just doesn’t work. It is at this time of life that we really need to focus on both maintaining an intelligent exercise protocol and promoting a healthy diet for our clients, with a focus on building lean muscle.

There are several reasons why building lean muscle is a benefit to your body, from purely health-based considerations to more aesthetic ones. Chiefly among those is how our muscle mass affects our basal metabolic rate (BMR), which is the minimum amount of energy, expressed in calories, that one needs to keep the basic functions going (i.e. liver and brain function, breathing, food breakdown, etc.)

The general principle is that our BMR starts to decrease by around 2 percent each decade, starting around the age of 25, mostly due to loss of mass (typically muscle mass). Therefore, in order to maintain a higher, and therefore more desirable BMR, building lean muscle mass is key.

Simply stated: Fat is metabolically inactive; muscle is metabolically active. As our metabolism changes with age, there is a direct impact on both cortisol and insulin levels, which in turn affect body composition. Remaining aware of this can help us, as fitness professionals, to guide our clients into adopting a new, better approach to exercise and nutrition, instead of clinging to old habits that simply will not work anymore.

What You Can Do To Help Your Menopausal Clients

When your clients share some of the issues they might be facing, you need to be sensitive to them while respecting their desire for privacy, they may feel too embarrassed to talk about some of them, such as incontinence. Ask them how they are feeling, inquire about their energy level, and be prepared to change exercises on the go if you feel like they are struggling to be successful.

For example: You have programmed a single-leg deadlift to help with lateral stability, core strengthening, and glute activation — all important things! Today, however, your client keeps falling over, can’t maintain her balance and is starting to feel defeated. Under the circumstances, instead of persisting with a plan which isn’t creating a positive experience for your client, you could take the exercise from a unilateral back to a bilateral stance and work on a simple hip hinge against the wall. This allows you and your client to still focus on activating the glutes and loading the hamstrings, while feeling successful in their training session.

Taking into consideration the emotional component of training your menopausal client can help take you from being a simple personal trainer to becoming a fully fledged coach!

Keep in mind that while your menopausal clients can train hard and enjoy the challenge of working out — there will be days where they simply can’t. Be mindful and respectful of how they might be feeling, and acknowledge that you may need to implement some changes to ensure the success of their sessions with you.

By programming their strength workout with the option of regressing exercises as dictated by the circumstances and symptoms of the day, you can make sure that they experience a successful session each time, which will go a long way to establishing confidence, trust, and longevity in your relationship with your clients!

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About the author:  Amanda Thebe

Amanda Thebe is a force of nature helping women who are experiencing menopause hell in their 40’s and beyond. Through her very frank articles and hilarious social media presence, she’s here to help you feel healthy and fit, while making you laugh like a 20 year old throughout. Her raging fans have called her “an unstoppable inspiration”, “resilient bitch,” and one woman called her “THE Over 40 Guru to watch in 2017”. You can connect with Amanda on her website Fit n' Chips or on Facebook, and on her FB group Menopausing So Hard. When she’s not fitnessing, you can find her indulging in her family and friends and the occasional Netflix binge session with the hubby.


  1. The Menopause Years, The American College of Obstetricians and Gynecologists, FAQ047, May 2015.
  2. Menopause, Office on Women’s Health, U.S. Department of Health and Human Services.
  3. Robyn M. Stuhr, MA, Exercise Through Menopause, ACSM’s Health & Fitness Journal, July/August 2002, Vol. 6, Issue 4.
  4. Chris Esbach, Ph. D., Exercise Recommendations for Menopause-Aged Women, American College of Sports Medicine.

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