The role of physical activity in managing menopausal symptoms: a narrative review

Abstract

Background: Menopause is accompanied by a decline in ovarian estrogen production that gives rise to vasomotor, psychological, musculoskeletal, metabolic and cardiovascular disturbances that materially reduce women's quality of life. Growing recognition of the need for holistic and accessible wellness solutions has increased interest in non-pharmacological strategies, among which physical activity occupies a central place. Aim: This narrative review synthesizes current evidence on the effects and mechanisms of action of physical activity in the management of menopausal symptoms. Material and methods: A narrative review of the literature was performed, drawing on 66 peer-reviewed articles retrieved from PubMed, Google Scholar and related databases, comprising systematic reviews, meta-analyses, randomized controlled trials, cohort studies and clinical guidelines published mainly between 2022 and 2026. Results: The evidence indicates that regular physical activity, particularly combined aerobic and resistance exercise, reduces the frequency and severity of vasomotor symptoms, enhances mood and reduces anxiety and depressive symptoms, improves subjective sleep quality, preserves bone mineral density and muscle mass, and optimizes cardiometabolic and vascular health during the menopausal transition and beyond. Conclusions: Physical activity should be considered a first-line, evidence-based component of menopause management, complementary to or, in selected patients, as an alternative to hormone therapy. Individualized, sustainable exercise interventions combining aerobic, resistance and mind-body modalities are recommended for clinicians, physiotherapists and exercise professionals working with midlife women.