CrossFit Bodmin

Women’s Strength Training

An evidence-based guide to the Big Three: your cycle, pregnancy and menopause.

Strength training has never had more information behind it.

It’s never been more studied, more debated or more programmed. Every variable has a paper, every opinion has a podcast.

But one area has always lagged behind.

Women-specific training.

This guide pulls the most up-to-date ideas into one place, in a form you can actually use.

It’s for the women who want to get in the gym and get strong.

It’s for the coaches who want to understand the people they train.

It’s for anyone who trains alongside women and wants to be in their corner.

This guide is the answer.

How to use this guide

This guide is a big one: there’s a lot of information in it, and reading all of it takes about 45 minutes.

You don’t have to read it all.

Read the key takeaways at the start of each of the main chapters for a great overview of the science, then use the navigation to go deeper into the parts that matter most to you.

And in every chapter, we tell you what to actually do about it.

We’ve done our best to bring together the best evidence there is, and every finding is numbered to its source. As ever, do your own research and come to your own conclusions: the original studies are all listed at the back, so you can read them yourself.

Part 1

The Big Three

Your menstrual cycle, pregnancy and menopause

Your menstrual cycle (and the pill)

About 6 minutes to read

How your cycle changes your mood, and how it changes your lifts.

Figure 1Your cycle in four phasesTwo hormones rise and fall across the month. Here’s roughly where you are in it.
Early follicularLate follicularLutealLate lutealOvulation, day 14OestradiolProgesteroneDay 1Day 6Day 15Day 24Day 28EarlyfollicularLatefollicularLutealLatelutealOvulationOestradiolProgesteroneDay 1Day 6Day 15Day 24Day 28
  1. Days 1 to 5Early follicular phaseYour period: both hormones low
  2. Days 6 to 14Late follicular phaseAfter your period: oestrogen climbs to ovulation
  3. Days 15 to 23Luteal phaseAfter ovulation: progesterone takes over
  4. Days 24 to 28Late luteal phaseThe days before your period: both fall

A typical 28-day cycle; yours may be longer or shorter. The textbook shape of the cycle, drawn as an illustration, not measured values. The four phases roughly group the six in McNulty 2020.5

Phase 1. Early follicular phase, days 1 to 5: your periodOften the toughest days

What’s happening. Both hormones sit at their lowest. These are the days most women feel: cramps, tiredness, maybe a heavy flow.

What the research shows. Three in four elite British track and field athletes said in a survey that their cycle had hurt their performance at some point, most often in the days before their period or during it.4

Figure 2Change in performance on period daysNine studies of the heaviest lift, tested or estimated. Each bar is how far below their best phase the group lifted during their period. A longer bar is a bigger dip.
  1. Leg press12 women · Shalfawi 2021−6.3%
  2. Back squat24 women · Isenmann 2024−5.6%
  3. Leg press12 women · Rodrigues 2019−4.2%
  4. Leg press19 women · Cabre 2024−3.6%
  5. Bench press11 women · Houchlei 2025−3.6%
  6. Half squat13 women · Romero-Moraleda 2019−1.5%
  7. Bench press10 women · Köse 2018−1.2%
  8. Leg press16 women · Peltonen 20220%
  9. Leg press20 women · Arazi 20190%

The dashed line is the average of the nine, −2.9%.

Group averages from each study, period days against that study’s best phase; the percentages and the average are our sums. Only one of the nine differences passed its own study’s statistical test.1

Here’s what that looks like on the bar. In one study, 24 strength-trained women tested their heaviest back squat. They averaged 64 kg on days 2 to 3 of their period and just under 68 kg in the luteal phase (days 20 to 23). That’s 3.8 kg, or 5.6%.2

In another study, the dip showed up in reps. Twelve women squatted a heavy weight for as many reps as they could. They averaged 12 reps during their period and 14 to 15 the week after: about two reps fewer.3

Practical takeaways for the gym. Come in anyway, but accept that the same weight will feel heavier. If you get one or two reps fewer than normal, or you have to take a plate off, that’s typical for your period. Let your intuition lead.

A consideration on iron. Heavy periods are common, and losing a lot of blood raises your risk of low iron.6 In one survey, more than one in three London Marathon runners had heavy periods, and a third of all the women asked said they’d been anaemic at some point.7

Phase 2. Late follicular phase, days 6 to 14: after your periodOften the strongest

What’s happening. Oestradiol, the main oestrogen, rises to a peak just before you ovulate, around day 14. Many women find this the easiest stretch, with the period over.

What the research shows. This was the strongest phase in four of the nine studies, 1 to 6% above period days, though in two of those four it was a near tie with the second half of the cycle.1

Practical takeaways for the gym. If you feel good, this is a fine time to try a heavier set or go for an extra rep.

Phase 3. Luteal phase, days 15 to 23: after ovulationSteady

What’s happening. After ovulation, progesterone rises, and oestrogen has a second, smaller hump.

What the research shows. There’s no reliable change in performance here.5 In three of the nine studies, this second half of the cycle was the strongest of all.1

Practical takeaways for the gym. Train as normal. There’s no reason to ease off in these days.

Phase 4. Late luteal phase, days 24 to 28: the days before your periodMood can dip

What’s happening. Both hormones fall. A lot of women notice changes in mood, or sore breasts, in these days.

What the research shows. Again, there’s no reliable change in measured performance.5 Among the athletes who said their cycle had hurt their performance, slightly more named these days than the period itself.4 The few studies that tested lifting on these days disagree with each other.1

Practical takeaways for the gym. Your mood and comfort may change more than your strength. Keep to your plan, adjust for how you feel on the day, and go by your own record of these days.

What you’ll feel

In a survey of 6,812 women who exercise, the most common cycle symptoms were mood changes, tiredness and cramps. The more symptoms a woman had, the more likely she was to miss or change a session. Among the women with the most symptoms, the chance of missing or changing a session was almost nine in ten.8

Set that beside the measured dip on the heaviest lift: a few percent on average, and up to about 6%.

Practical takeaways for the gym. That’s a reason to change a session rather than miss it: on a rough day, match the session to how you feel. Let your intuition lead.

What the evidence shows

Performance dips a little on period days: about 3% below the best phase on the heaviest lift, and a couple of reps on a hard set.1,3 Seven of the nine lifting studies show a reduction, even if only one of the nine differences passed its own study’s statistical test.1 The big reviews pool every kind of test together, and they find the effect is very small. The largest, of 78 studies, found a very small dip in the first days of the period and no clear difference between the other phases.5 A 2023 review of the strength research found the evidence too thin and too mixed to say that your phase changes your strength, or the muscle you build over time.9

Both the studies and the reviews carry the same warning: the groups are small, and women vary. In all nine lifting studies, the spread between women was bigger than the gap between phases.1 So you don’t need a different programme for each phase. The numbers here tell you what’s typical; your own record tells you what’s true for you, and you adjust on the day.

What to know about the pill. Across 42 studies, any effect of the pill on performance was very small.10 For building muscle, the trials are few and they disagree. One 10-week study found no real difference in the lean mass pill users gained. Another 10-week study found they gained less: 1.0 kg against 1.6 kg.11 Two newer studies, of about 12 weeks, found pill users gained more lean mass in their arms.12 So the evidence is inconclusive, and it leans towards the pill making little difference to the muscle you build.

Nobody should change their contraception for a better squat, so choose it with your GP, for everything else it does.

What to do

When to see someone.

Pregnancy, and the postnatal year

About 12 minutes to read

How training changes from trying for a baby, through pregnancy, to the year after the birth.

The phases, from before pregnancy to the year after

  1. BeforeBefore pregnancyTrying for a baby
  2. Weeks 1 to 12First trimesterBefore the bump shows
  3. Weeks 13 to 27Second trimesterThe bump shows
  4. Weeks 28 to 40Third trimesterThe heaviest weeks
  5. Weeks 0 to 12 afterThe fourth trimesterThe first weeks with your baby
  6. From 3 months afterReturn to trainingFeeling like yourself again

Phase 0. Before pregnancy, the months you’re trying: getting ready

What the research shows. Moderate exercise may slightly shorten the time it takes to conceive. In 3,628 Danish women planning a pregnancy, those doing five or more hours a week of moderate activity were about 18% more likely to conceive in any given month than women doing under an hour.20

Hard training is different. Women doing five or more hours a week of vigorous exercise were 32% less likely to get pregnant in any given month than women doing none. In practice, that means it took them longer on average to conceive.20

Interestingly, the biggest drop was found in women with a healthy BMI of under 25, and in those with a BMI of 25 or over there was no clear effect, though only 23 of them became pregnant at that level of training.20

Fuel could be the missing link. Hard training uses a lot of energy, and when food doesn’t cover it, the cycle can be disturbed. A trial of 34 young women on supervised exercise and set meals showed it: the bigger the gap between what they ate and what they burned, the more often their cycles were disturbed.21

Studies following women over time found that shorter sessions showed no added risk, but more than an hour of exercise a day was linked to a higher risk of not ovulating.22 And ovulating is what getting pregnant depends on.

Practical takeaways for the gym. The research is limited, but it points one way. While you’re trying, make regular moderate exercise your base, eat enough to match your training, and use your judgement on the hard sessions. We found no evidence that lifting needs to stop.

  • If your periods change. A period that turns irregular or stops is worth acting on.
  • From the NHS. 400 micrograms of folic acid a day while you’re trying, ideally starting three months before you conceive, and no alcohol.23
  • When to see someone. Your GP if you’ve been trying for a year, or sooner if you’re 36 or over, or if you miss three periods in a row.24

Phase 1. First trimester, weeks 1 to 12: before the bump shows

What’s happening. Nobody can see it yet, but you’ll feel it: tired, maybe sick, and tempted to stop.

What the research shows. Heavy lifting was well tolerated by very active pregnant women, so if you already lift, you can usually carry on. In a 2025 study, 48 of them, at 26 to 35 weeks, did heavy sets at about three-quarters of their max (the most they could lift once). The babies’ heart rates rose a little, as yours does when you exercise, and stayed in the normal range on average, and blood flow through the cord didn’t change. The researchers judged it safe for highly active women.16

In a second study, 10 trained women squatted, benched and deadlifted at up to 90% of their ten-rep max (the most they could lift ten times), and rated the effort about 6 to 7 out of 10. No baby’s heart rate left the normal range.25 And in a survey of 679 women who lifted at 80% of their max or more while pregnant, those who kept up their usual training to the end reported fewer complications.17 That’s reassuring if you already lift, but it isn’t a reason to start lifting heavy if you don’t.

New to lifting? You can start. The guidelines say women who weren’t active before pregnancy can begin, building up gradually.15,26 In one study, 32 pregnant women who weren’t strength training started in the second trimester (weeks 21 to 25): 2 sets of 15 on five machines, twice a week for 12 weeks, at a low to moderate effort. None had a muscle or joint injury, and symptoms such as dizziness came up in 13 of 768 sessions.27

Your pelvic floor. Women who did pelvic floor training in pregnancy had half the odds of leaking during it, and over a third lower odds after the birth, compared with women who didn’t.15 It keeps dry women dry, but it didn’t fix leaking that had already started.15 NICE (the body that writes the NHS’s clinical guidelines) recommends it.28

Practical takeaways for the gym. Start your pelvic floor exercises early; the pelvic floor chapter shows you how. Stay active, even if some days that’s just a walk, and pick your training back up when you’re able.15 Most movements can stay the same through the first trimester. You’ll get out of breath sooner, so work at a lower effort and rest more.29

How hard to train. In the lifting studies above, efforts of up to about 7 out of 10 were well tolerated, so use that as your top end; another common guide is to work at an effort where you can still hold a conversation.26

How much to do. The UK guidance is 150 minutes of moderate activity a week, strength work twice, listen to your body, and don’t bump the bump.30

Phase 2. Second trimester, weeks 13 to 27: the bump shows

What’s happening. The bump shows, and your balance shifts with it. As the bump grows, lying flat can make you light-headed or sick. The tummy muscles make room.

What the research shows. A gap down the middle, diastasis recti, shows in a third of first-time mothers at 21 weeks.19

Practical takeaways for the gym. For most women we coach, this is when training starts to look different. Long spells on your back are best avoided,15,26 and we leave out handstands and other upside-down work. The swaps we use come from CrossFit’s own scaling guide for pregnancy, written in 2017 by a Level 4 coach whose gym had trained more than 30 women through pregnancy. They are one gym’s practice, not research: some women keep a movement for longer, some drop it sooner, and she says some are comfortable going heavier.29

  • Kipping stops at around three to four months. Use strict pull-ups or ring rows.
  • Handstand push-ups become a seated dumbbell press.
  • Sit-ups, toes-to-bar and other curl-up movements stop after the first trimester, and sooner if your tummy domes.
  • Box jumps become step-ups and double-unders become singles, once jumping feels jarring.
  • If running gets uncomfortable, swap it for the rower, the bike or the sled.
  • Once the bump shows, a barbell gets awkward to keep close to your body. Cleans and snatches move to dumbbells, or start from the hang.
  • From three to five months on, squats and deadlifts stay under about 70% of your pre-pregnancy best, with no heavy singles.

Phase 3. Third trimester, weeks 28 to 40: the heaviest weeks

What’s happening. You’ll feel heavy, you’ll get out of breath sooner, and your pelvic floor is carrying the most it ever will.

Practical takeaways for the gym. Listen to your body and adapt, as the UK guidance puts it.30 If something feels wrong, stop and ask. At this point we heavily modify workouts to work around the bump, and training is simpler and less intense. Everything from the second trimester still applies.

After the birth: the postnatal year

There’s a saying: nine months in, nine months out. Your body took nine months to change for the birth; give it about as long to find a sensible baseline and feel like you used to. So give yourself permission to be patient.

Phase 4. The fourth trimester, weeks 0 to 12 after the birth: the first weeks

What’s happening. The first weeks feel tired and wobbly. Your middle may feel soft, as if it belongs to someone else, and broken nights make every day different.

What the research shows. The tummy gap shows in 60% of first-time mothers at six weeks.19 After a caesarean, the tummy’s connective tissue has only about half its strength back at six weeks.18 More than one in ten mothers has postnatal depression at some point in the first year, and it can start at any time in it.31 Sleep is broken for months, and poor sleep is thought to slow recovery.18

Joints may loosen for a while, but the popular idea that the hormone relaxin makes them unstable after the birth hasn’t been proven.18

Practical takeaways for the gym. The six-week check is where your way back starts; it isn’t the all-clear to go straight back to what you did before. Start with breathing, walking and pelvic floor work, then build back in the stages below. If you’re breastfeeding, it’s fine to train: exercise doesn’t change how much milk you make, or what’s in it.18

Figure 3The first 12 weeks after a babyYou build back in stages, and running comes last.
  1. 0–2weeks
    Pelvic floor exercises, basic core (pelvic tilts, bent-knee drop-outs, side-lying leg lifts), walking.
  2. 2–4weeks
    Add squats, lunges, bridges.
  3. 4–6weeks
    Low-impact cardio (static bike, cross-trainer), once you’re comfortable on a saddle.
  4. 6–8weeks
    Scar mobilisation, power walking, resistance work. Light deadlift technique.
  5. 8–12weeks
    Swimming (once bleeding has stopped and wounds have healed), spinning.
  6. 12+weeks
    Return-to-running tests, then running.

Goom, Donnelly & Brockwell 2019, Appendix 2–3: their example progression.18

Phase 5. Return to training, from 3 months after the birth: feeling like yourself again

What’s happening. Your first sessions back will feel strange: warm-up weights feel heavy, and the brace takes thought again. Most women start to feel like themselves in the gym again at around six to nine months. Some get there sooner and some take the full year.

What the research shows. The tummy gap is common: it still shows in 45% of first-time mothers at six months, and in 33% at a year. But women with the gap had no more back or pelvic pain than women without it.19

Return to training: what the evidence suggests. From about 12 weeks after a baby, climb Figure 4 one step at a time.18 A weak strength test just shows you where to train, and it doesn’t stop you going on to running.18 Then run by time before speed (a couch-to-5K plan fits),18 then build towards what your sport or training asks of you.

Figure 4The return-to-training ladderYou move up a step when you pass the one below. The strength tests show where to train; they don’t hold back the run.

Pass each step with no pain, heaviness, dragging or leaking

  1. 5Specific sport demands
  2. 4Run by time
  3. 3Strength tests
  4. 2The seven tests
  5. 112 weeks+ and a pelvic health check

The seven tests.

  • Walk 30 min
  • Single-leg balance 10 s
  • Single-leg squat 10 per side
  • Jog on the spot 1 min
  • Forward bounds 10
  • Hop 10 per leg
  • Running man 10 per side

Strength tests, aim for 20 each.

  • Single-leg calf raise
  • Single-leg bridge
  • Single-leg sit-to-stand
  • Side-lying leg lift

Steps 1 to 4: Goom, Donnelly & Brockwell 2019, the return-to-running guidance.18 Step 5 is the demands of your own sport or training.

Practical takeaways for the gym. Reset your old numbers and see every new session as a win. With a bit of patience and persistence, you’ll get back to where you were. Set the weight by the best technique you can hold, rather than by what you used to lift, and go by your symptoms.

What the evidence shows

Figure 5What training in pregnancy protects you fromIn trials where exercise was the only change, women who exercised in pregnancy had lower odds of each of these than women given no exercise programme.
  • 38%lower oddsDiabetes in pregnancy
  • 39%lower oddsHigh blood pressure
  • 41%lower oddsPre-eclampsia
  • 67%lower oddsDepression in pregnancy

And no link to miscarriage, stillbirth, preterm birth or low birth weight.

Davenport 2018, British Journal of Sports Medicine: exercise-only interventions against none. Diabetes, blood pressure and pre-eclampsia from a review of 106 studies, depression from a separate review of 52. The 2019 Canadian guideline.15

It protects you. In a review of 106 studies, the trials where the only change was exercise gave women 38 to 41% lower odds of diabetes in pregnancy, high blood pressure and pre-eclampsia than women given no exercise programme (Figure 5 shows each one). About 140 minutes of moderate exercise a week was enough for at least 25% lower odds of all three, and strength training counted.15 In a separate review, women who exercised had 67% lower odds of depression in pregnancy, in five trials of 683 women.15

It’s safe for your baby. Exercise wasn’t linked to miscarriage, stillbirth, preterm birth or low birth weight.15

What to do

Before pregnancy.

While you’re pregnant.

After the birth.

When to see someone.

Want a plan that fits you, or guidance on how to start? Talk to a coach.

Menopause

About 7 minutes to read

How the years around your last period change your body, and what lifting does about it.

Menopause usually arrives between 45 and 55; the UK average is 51. Strictly, it’s one point: your last period, which you can only name once you’ve gone 12 months without one. Perimenopause comes before it, postmenopause after.31

The years around it follow a pattern, and bone loss speeds up for a few of them.35

Figure 6The oestrogen windowOestrogen drops over a few years, and bone goes with it, fastest in a window you can see coming.
Fast bone lossabout 2.5% a yearLast periodFSH starts to riseabout 6 years beforeOestradiol starts to fallabout 2 years beforeFSHOestradiol444546474849505152535455Your age, if your last period comes at 51, the UK averageFast boneloss, about2.5% a yearLast periodFSH risesOestradiol fallsFSHOestradiol444648505254Age, if your last period comes at 51

10.6% of spine bone lost over the ten years, most of it in the shaded band.

  1. Age 45 to 49Early perimenopauseAbout 6 to 2 years before your last period: hormones start to shift, and a change in your periods is usually the first sign
  2. Age 49 to 53Late perimenopause, your last period and the first years afterAbout 2 years before to 2 years after: oestrogen falls, and bone goes fastest
  3. Age 53 onLater postmenopauseFrom about 2 years after your last period: the loss slows

The ages are for a last period at 51, the UK average; yours may come earlier or later. SWAN (the Study of Women’s Health Across the Nation): Randolph 2011 and Greendale 2012. UK average age, NHS inform.31,35

Phase 1. Early perimenopause, about 6 to 2 years before your last period: the first signs

What’s happening. It starts about six years before your last period, when the hormone FSH begins to rise. Oestradiol hasn’t started to fall yet.35 You can’t feel that change. One of the first signs is usually a change in your periods, often with hot flushes, night sweats or poor sleep.37

What the research shows. Bone responds to impact before menopause. In young women, 50 small jumps a day, six days a week, raised hip bone density by 2.8% in five months. In women past menopause the same jumps weren’t enough on their own.36

Practical takeaways for the gym. Starting early may give you a buffer: more bone and strength going into the years when bone loss speeds up. If you’re past this stage, training still works later. Lift heavy enough to count, and add impact while your pelvic floor and joints are happy.38

Phase 2. Late perimenopause and your last period, about 2 years before to 2 years after: oestrogen falls

What’s happening. Oestradiol starts to fall about two years before your last period, and it falls fastest right around it. About one year before, fast bone loss starts: about 2.5% a year at the spine for around three years, and less at the hip.35

Hot flushes and night sweats. For more than half of women who get frequent ones, they last over seven years in all, starting before the last period and carrying on after it.35

Mood. In one group of women followed through these years, the odds of major depression were two to four times what they had been before, in perimenopause and early postmenopause.35

A change in shape. Lean mass goes from gaining 0.2% a year to losing 0.2%, and fat gain speeds up. The rate of weight gain doesn’t change.35

Whilst the scales are saying nothing’s happening, your jeans are saying otherwise.

What the research shows. Training holds bone through these years: in five trials of women in the first years after their last period, the women who trained held or gained spine bone, while the women who didn’t lost it.39 Hot flushes respond to training too. In women having several a day, 15 weeks of strength training cut the number of flushes by 44%, against 2% in the control group.32

What helps mood. Exercise reduces depression.40 Strength training is great for your bones, but in 26 trials of women past menopause, lifting on its own hasn’t been shown to lift mood. What did was cardio: walking, running, swimming or cycling, the work that gets you breathing harder. Programmes that mixed more than one kind of training helped too, and classes such as yoga, tai chi and Pilates had the strongest evidence of all.34

Practical takeaways for the gym. Some sessions you’ll arrive after a broken night, and a hot flush can land halfway through a set. Keep water nearby and wear layers you can take off. If a flush hits, let it pass, then pick the set back up. Hot and sleepless? Train earlier and cooler. A bad night counts as load, so go lighter rather than going home.

Women often tell us they feel weaker or slower in these years than they really are: their numbers stay steady while the weights feel much heavier. Write your lifts down and check the feeling against them. Slower can be real, as power fades before strength (more on that further on).

Phase 3. Later postmenopause, from about 2 years after your last period: the loss slows

What’s happening. The loss slows to about 1% a year at the spine, but it doesn’t stop.35

What the research shows. Bone still responds to training after menopause, but it needs more than small jumps: heavy works. In a trial called LIFTMOR, 101 women past menopause, average age 65 and all with low bone density, were split into two groups. One group built up over the first month or two to lifting heavy: 5 sets of 5 of the back squat, deadlift and overhead press at about 80 to 85% of max, plus jumping chin-ups with drop landings, twice a week for 30 minutes, supervised. The other group did gentle exercise at home.33,41

Figure 7Lifting built bone, and they stood a little tallerHeavy lifting built spine bone and held the hip, while gentle exercise at home lost both.
+0.2 cm
Heavy lifting, twice a week
−0.2 cm
Gentle exercise at home

Change in height after eight months. The researchers think it came from stronger back muscles and less of a stoop. And the bone:

Spine bone density+2.9%−1.2%Heavy liftingGentle, at homeHip bone density+0.3%−1.9%Spine bone density+2.9%−1.2%Heavy liftingGentle, at homeHip bone density+0.3%−1.9%

Watson 2018, Journal of Bone and Mineral Research: the LIFTMOR trial.33

After eight months, the lifters’ spine density had risen while the home group’s fell: that’s bone being rebuilt. Their hip held, and every test of physical function improved. Across more than 2,600 supervised sessions there was one mild injury, a back strain, with two sessions missed.33 Lifting heavy and landing hard hadn’t traditionally been recommended for healthy women in their sixties with low bone density.

Practical takeaways for the gym. Lift heavier at this stage, to hold on to what you’ve built, with a coach’s eye on your technique.

What the evidence shows

In all eleven charted trials, the women who trained finished ahead on spine bone density, by 2.6% of where they started on average, by our sums.39

Figure 8Spine bone after menopause: what training addedEleven trials, one bar each. The bar is how far ahead the women who trained finished, as a share of their starting spine bone density, against women who didn’t train or did only gentle exercise. A longer bar is a bigger gap.
  1. Weight training, 9 months26 women · Pruitt 1992+5.2%
  2. Heavy lifting and impact, 8 months101 women · LIFTMOR 2018+4.1%
  3. Strength and impact, 38 months78 women · EFOPS 2005+4.1%
  4. Squat and deadlift, 12 months69 women · Maddalozzo 2007+4.0%
  5. Strength training, 12 months39 women · Nelson 1994+2.8%
  6. Blocks of hard bone work, 12 months85 women · Kemmler 2013+1.9%
  7. Heavy lifting and impact, 8 months86 women · MEDEX-OP 2021+1.8%
  8. Heavy lifting and drop landings, 9 months38 women · STOP-EM 2026+1.6%
  9. Mixed programme, 18 months246 women · SEFIP 2010+1.4%
  10. Impact and heavy resistance, 13 months54 women · ACTLIFE 2021+1.2%
  11. Lifting at 80% of max, 12 months19 women · Pruitt 1995+0.8%

Every charted training group finished ahead on average, though the smallest gap could have been chance. Three more trials found no difference at the spine and reported no figures we could chart. The gap was widest where the women who didn’t train were losing bone fastest, so heavier programmes aren’t always at the top.

Group averages from each trial, training group against comparison group; the gaps and the average are our sums.39

What to do

In your training.

When to see someone.

Part 2

Other things worth knowing

About 8 minutes to read

The pelvic floor: it comes down to pressure

Between a quarter and nearly half of adult women leak at least sometimes,53 and lifting sports leak too: earlier reviews found 37 to 54% of women weightlifters, 41 to 49% of powerlifters and 32 to 45% of CrossFitters leaked.54 Our reading is that it comes down to pressure: how well your trunk and pelvic floor handle the pressure of lifting, landing and breathing, and whether the floor switches on in time.

It trains like any other muscle.55 Of women with stress leaking who trained it, 56% said they were cured, against 6% of women given no treatment or a dummy one, in four trials.44

How to train it. Sitting or lying down, imagine you’re stopping wind and a wee at the same time, and draw the muscles up and forwards. You may feel a lift and a tightening.55 The target the UK’s pelvic health physios set is up to 10 long holds of up to 10 seconds, then 10 quick squeezes, at least three times a day. Let go fully after each one, and start with what you can manage.55 Keep breathing, keep your buttocks and legs relaxed, and don’t practise by stopping the flow when you wee.55 You should notice an improvement in three to five months. After that, once a day keeps it up.55

If you lift. In the one trial in women who do CrossFit-style training, 64% of those who did hard squeezes at home for 16 weeks said their leaking had improved, against 8% of those who carried on training as normal. Nobody reported being fully cured.56 Timing matters as much as strength: 27 older women taught to squeeze before and during a cough leaked 98% less urine on a medium cough than without the squeeze, a week later.57 The researchers called it “the Knack”.

That’s all a brace before a lift really is: the Knack, on a barbell. Breathe in, gently lift your pelvic floor just before the effort, and breathe out through the hard part. That part is our coaching: no trial has tested the squeeze under a barbell. The technique section in Part 3 shows you how.

When squeezing isn’t the answer. If the exercises hurt, or you see a bulge when you squeeze, stop and see a pelvic health physio.55 For women with stress leaking, NICE recommends a programme of at least three months, supervised by a physio or another trained health professional.28

Going to the loo before class is fine, but it’s a workaround, and it won’t fix the leak.

Fuel: eat for the training you do

Energy first. If you train more and eat less, your periods, bones, mood, immunity and performance all suffer. It’s called REDs (relative energy deficiency in sport).14 The research is mostly in athletes, but anyone who trains hard and eats too little can end up there. Irregular or missing periods, when you’re not pregnant or on contraception that stops them, can be a sign of it.14 Other things can cause them too, so see your GP. If it is fuel, the fix is to eat more.

Protein. If you train, aim for 1.4 to 2.2 g per kg of bodyweight a day,45 in doses of 20 to 40 g every three or four hours.58 For a 65 kg woman that’s 90 to 140 g a day, or 25 to 35 g a meal. A palm of meat or fish, or a shake, is roughly 20 to 30 g. Three eggs, a pot of Greek yoghurt or half a block of tofu is nearer 20 g.

What changes with your stage.

Carbs fuel the fast, hard stuff.59 So train fed: a meal two or three hours before, or a banana or toast 30 to 60 minutes before an early class.

Iron, calcium and vitamin D.

Two supplements with evidence behind them.

Don’t bother. BCAAs (branched-chain amino acids, sold as a muscle supplement): a protein shake does their job better.66 In our view, pills that claim to “balance hormones”, “burn fat” or “tone” aren’t worth your money. If you do buy supplements, look for an independent testing mark, such as Informed Choice or NSF, which lowers the chance of a banned substance in the tub.66

Will I get bulky?

It’s the question we hear most, and the answer is no.

What lifting actually adds. In a 10-week trial, 38 young women who weren’t on the pill gained 1.6 kg of lean mass on average.11 Beginners gain muscle at the same relative rate as men,67 but less in absolute terms: in kilograms, it’s the kind of change most people would call toning up.

What “bulky” would take. Women who compete as bodybuilders carry about 8 kg more lean mass than a typical young woman of the same height, by our sums from two studies: about five times that first gain, built over years of training and eating for it.47 Men’s testosterone is more than 15 times women’s, so women build less muscle in kilograms.47

Practical advice. Expect to feel stronger and more solid. If your shape changes in a way you don’t want, you’ll see it coming months ahead, and you can change the plan.

Gym kit includes breast support

In a survey of 2,089 UK schoolgirls aged 11 to 18, 46% said their breasts had some effect on taking part in sport. The most common worry was bounce. More than half never wore a sports bra for sport, and 87% wanted to know more.48 Without support, breasts can move up to 15 cm during running.48

So treat a sports bra as kit, the same as your shoes. The general advice is that a fitted, high-support one matters most when you run or jump, and it’s suggested for women running after a baby.18

Practical advice. If your chest hurts when you run or jump, change the bra before you change the workout.

Power fades before strength

Strength is how much you can move, and power is how fast you can move it.

Strength goes before muscle does. In 1,880 adults aged 70 to 79, leg strength fell about three times faster than the muscle itself, which shrank by about 1% a year. In the women, strength fell 2.6 to 3.0% a year.49 So keeping your muscle isn’t enough on its own.

Power goes first. In 100 healthy men and women aged 65 to 89, leg power was about 3.5% lower for each year of age, against 1 to 2% for strength.68 In the women alone, that gap was not statistically clear. And power tracks how well older adults get out of a chair, climb stairs and walk, a little better than strength alone does.69

So train fast. In 30 women with an average age of 73, sixteen weeks of lifting as fast as possible raised leg power by 267 watts. Lifting the same weights slowly raised it by 139.50 A review of 20 trials in older adults, two thirds of them women, found that lifting fast also improved everyday function a little more than lifting slowly: about 0.6 of a second on a get-up-and-walk test, from 13 trials and 383 people.70

And living longer? In studies that followed 263,058 people, those who did any muscle-strengthening exercise were 15% less likely to die during the follow-up than those who did none, with the biggest benefit at 30 to 60 minutes a week.71

Sleep and mood

Mood. Exercise reduced depression across 218 trials, and more so the harder it was prescribed. Strength training and yoga were the easiest to stick with.40

Sleep. Training may help: in a 12-week trial of 160 women aged about 69, the poor sleepers who lifted improved their sleep score from 7.3 to 4.6, where lower is better.52 And an evening session doesn’t harm sleep for most people. Only a very hard one that ends within an hour of bed may delay it.52

Practical advice. Caffeine takes 4 to 6 hours to halve, so an afternoon coffee can still be keeping you awake at 11 pm.65 For sleep itself, the NHS has a short guide: How to fall asleep faster and sleep better.

Part 3

How to train

About 7 minutes to read

The six things that deliver

1. Load. Heavy lifting is well backed for bone: the women past menopause who built bone lifted 5 sets of 5 at about 80 to 85% of their max.33 That’s a very heavy load, and lifting it well takes real skill, so it isn’t where a beginner starts. Build up over months, learn the technique first, and get a coach’s eye on it if you can. As an example, the 12-week plan starts with bodyweight and light weights, following the return-to-training guidance after a baby, and builds steadily to sets of 5 with a dumbbell or kettlebell. After 12 weeks shows the step to 5 sets of 5 at 80 to 85% of your max, with a coach. You don’t need to go to failure.38

2. Progression. Keep adding weight. Stay on each lift for several weeks and make small, regular increases to the load: sets of 5 with three reps in the tank, building to heavy sets of 3 once every rep of your 5s looks the same. One change at a time, and the smallest jump you can. Over the months, the weight you lift should keep going up; sitting with the same kettlebell for a year won’t keep changing you.

3. The brace. Today’s load is the heaviest you can brace for with no leaking, heaviness or doming. If one shows up, drop the weight and carry on with the session. It’s the Knack, done before every lift: see Figure 9.

4. Impact, when your floor allows. Small jumps and landings give bone the signal it needs. After a baby, follow the return-to-training ladder in Figure 4. The same brace as the squat, only faster.

5. Protein. 1.4 to 2.2 g per kg a day, towards the top from perimenopause on.45 The doses and the foods are in Fuel.

6. Your week. An ideal week has strength training two or three times, something that gets your heart rate up, and something calm, such as yoga or a walk. That mix covers what this guide points to: strength for muscle and bone, cardio and calmer classes for mood.

Technique: the basics

Figure 9The brace, in five stepsThe brace is a sequence you can learn. Step 3 is the Knack, which cut leaking on a cough in a small trial.
  1. 1Set your feet and grip
  2. 2Breathe in, low and widethe pelvic floor relaxes
  3. 3Gently lift the pelvic floorthe Knack
  4. 4Brace the trunk all the way roundno sucking in
  5. 5Liftbreathing out through the hard part

The five steps are our coaching, from the technique points below. The Knack: Miller 1998 and POGP (the UK’s pelvic health physiotherapists’ body).57,55

The breath. Lie on your back, knees bent. Breathe in through your nose, low and wide: belly, sides, back. Not your shoulders. In, the pelvic floor drops a little. Out, it gently lifts. Five breaths lying, then sitting, standing, and at the bottom of a goblet squat. Shoulders rising? Hands on your lower ribs. Breathe into your hands.

The brace. Feet set, grip set. Breathe in, low and wide. Lift your pelvic floor as if stopping wind and a wee at once, just before the effort: that’s the Knack.55 We coach it as a gentle lift, not a max squeeze. Stiffen your middle all the way round, like someone’s about to poke you in the ribs. Don’t suck in. Lift. Lighter sets, breathe out through the hard part. Heavy sets, if you’re experienced and symptom-free, hold the breath and breathe out at the top. Reset every rep.

The squat. Feet shoulder-width, toes slightly out. Breathe, brace, and sit down between your heels, knees following toes, chest tall. As deep as your back stays flat and your heels stay down. Drive up, breathing out through the sticking point.

The hinge. Soft knees. Hips back until the backs of your legs load up. Weight close, back flat. Drive your hips forward and squeeze your bum to stand; don’t lean back at the top. Your depth is wherever your back stays flat.

The landing. Step off a low step, 10 to 20 cm, and land quietly on one foot, then two: knees over toes, hips soft, hold two seconds, breathe out. Brace as for the squat, just before you land.

Watch the lifts. CrossFit’s own pages show each one, with a video and the points to look for: the air squat, the back squat, the deadlift, the shoulder press and the box step-up.

Where a coach comes in. The barbell lifts built on these basics are best learned with a coach watching. This is where an experienced personal trainer or coach can help.

The Strong Start: your 12-week plan

Twelve weeks from beginner back to the gym: strength three times a week, with walking and low-impact cardio. Download the free printable plan.

This plan is built around the postnatal return-to-training guidance, to take you from beginner back to the gym steadily. It’s designed around those criteria, but it works well for any beginner. All of it can be done in a gym too. If you want faster progress, for example towards heavier, bone-building lifting in menopause, reach out to a coach who can help you from day one and teach you to strength train.

New mum? You can start after your six-week check. Running and jumping wait until you’ve passed the tests on the return-to-training ladder in Figure 4, at 12 weeks or more after the birth, and had a pelvic health check. If you’re pregnant, this plan isn’t written for pregnancy: see the pregnancy chapter, and talk to a coach. Osteoporosis, a heart condition, high blood pressure or pain that wakes you at night: see your GP first. Chest pain, feeling faint or sharp pain in a session: stop and get checked.

What’s in it. Three blocks of four weeks, in the order the postnatal guidance in Figure 3 sets out.18 Weeks 1 to 4 start steady: the breath, the pelvic floor and walking, then squats, bridges and lunges, low-impact cardio on a bike or cross-trainer, and a light hinge. Weeks 5 to 8 load the main lifts with a dumbbell or kettlebell, add the goblet squat and the overhead press, and build single-leg strength. Weeks 9 to 12 add the deadlift from the floor and the step-up, and end with the tests that clear you for running and jumping. Each movement has an easier and a harder version, so you start where every rep looks the same. Every session opens with a short warm-up and ends with a few stretches. To start, a dumbbell, a kettlebell or a backpack of books is all the kit you need; from week 5, heavier weights as you get stronger.

How it builds. Weeks 1 to 4, you find your level and go up one small step at a time. Weeks 5 to 8, the main lifts get heavier, with fewer reps and reps still in the tank. Weeks 9 to 12, you learn the movements a gym builds on and keep going up by the same rule, one change at a time. You test yourself in weeks 1, 4 and 12, so what changed is written down in your own numbers. Pass the week 12 tests, and running and small jumps come next, with the barbell lifts learned from an experienced coach.

The printable has the rest: every session written out, the sets and reps, the effort rule, the tests, and how to do each movement.

After 12 weeks: what we suggest

A mix. Strength training two or three times a week, with the barbell lifts learned from an experienced coach: the squat, the deadlift and the overhead press. They were at the heart of the LIFTMOR trial in the menopause chapter, alongside jumping and landing work.33 And cardio for your mood: walking, running, swimming or cycling lifted mood in women past menopause, across 26 trials.34

The principles.

Mechanics, then consistency, then intensity. This is CrossFit’s order: learn to move well, then move well every rep and turn up week after week, and only then add weight or speed.72 The weight goes up only while every rep still looks the same.

One change at a time. Add weight when every set reaches its reps with reps still in the tank, and every rep looks the same. Then make the smallest jump you can: as a rule of thumb, 1 kg on the press, and 2.5 to 5 kg on the squat and deadlift.

Consistency over months. Two or three strength sessions a week, kept up month after month. The women in LIFTMOR trained twice a week for eight months.33

Effort set by reps in the tank. You never need to know your max, the most you could lift once. The percentages in this guide are rough, a rule of thumb from how many reps most people manage at each weight,73 and the reps left in the tank are the tool. Never train to failure: it adds nothing to strength.74

Why heavy. Strength grows most at around 80% of your max or more, with 2 to 3 sets and two or more sessions a week. It holds for complete beginners too: the American College of Sports Medicine’s 2026 guideline found it across 137 reviews covering over 30,000 people.74 In practice, 80% of your max is a very heavy load: lifting it safely needs good technique and a coach’s eye, which is why the 12 weeks build towards it. For bone, the UK’s experts also put good technique before heavier weights, and say supervised heavier lifting likely does bone the most good.42 The target is what the women in LIFTMOR lifted: 5 sets of 5 at about 80 to 85% of their max, twice a week, with a coach watching.33 Keep the jumps and landings going as your pelvic floor allows: UK guidance aims for at least 50 impacts a session.42

How a professional coach helps. A good coach teaches you the barbell lifts from the lightest version up, sets your loads and when to add weight, and watches your heavy sets. They adjust the plan around your pelvic floor, your period, pregnancy or menopause.

Want a hand with any of this?

Talk to one of our coaches. We have knowledgeable coaches, and if you’d prefer a female or a male coach, just say so and we’ll find what works best for you.

Message us on 07888 865631, or email info@crossfitbodmin.com.

Lift heavy. Land soft. Eat your protein.

Free resources

Common terms

Sources

A line with a number says only what that source says. A line without one is our own coaching, or textbook background. Where a figure mixes the two, its caption says which part is which. After each source: why it is fit to cite.

  1. Our own tally of nine studies that tested or estimated the heaviest lift at different points in the cycle, in women not on hormonal contraception (one study, Houchlei 2025, pooled 4 women who were with 7 who were not): Isenmann 2024, back squat (pmc.ncbi.nlm.nih.gov/articles/PMC11531699/); Cabre 2024, leg press and bench press (pmc.ncbi.nlm.nih.gov/articles/PMC12666725/); Peltonen 2022, leg press (pmc.ncbi.nlm.nih.gov/articles/PMC9208809/); Rodrigues 2019, leg press (www.asep.org/asep/asep/JEPonlineOCTOBER2019_Rodrigues.pdf); Shalfawi and El Kailani 2021, bench press and leg press (pmc.ncbi.nlm.nih.gov/articles/PMC8472434/); Houchlei 2025, bench press (pmc.ncbi.nlm.nih.gov/articles/PMC12452452/); Romero-Moraleda 2019, half squat (johk.pl/wp-content/uploads/2023/03/10078-68-2019-v68-2019-10.pdf); Arazi 2019, leg press (www.apunts.org/en-is-there-difference-toward-strength-articulo-S1886658118300410); and Köse 2018, bench press, whose figures we saw only as tabled in Niering 2024, which rates that study very low quality (pmc.ncbi.nlm.nih.gov/articles/PMC10818650/). The percentages and the average are our sums from each study’s group averages. Three of the nine lifts were estimated from reps, bar speed or a formula. Eight of the nine found no difference that passed their own statistical test; one (Rodrigues 2019, 12 women) did. Of the nine, only Rodrigues tested the days before a period, where its lifts were lowest; three further studies of those days, read as abstracts only (Zinner 2025, Schatz 2026, Fort-Vanmeerhaeghe 2026), do not agree with each other.
  2. Isenmann E, Held S, Geisler S, Flenker U, Jeffreys I, Zinner C (2024). The effect of the menstrual cycle phases on back squat performance, jumping ability and psychological state in women according to their level of performance: a randomized three-arm crossover study. BMC Sports Science, Medicine and Rehabilitation 16:224. pmc.ncbi.nlm.nih.gov/articles/PMC11531699/ · 24 strength-trained women, heaviest back squat on days 2 to 3, days 8 to 10 and days 20 to 23: 64.0, 65.9 and 67.8 kg on average. The difference did not pass the study’s own statistical test.
  3. Osmani F, Terán-Fernández D, Alonso-Pérez S, Ruiz-Alias SA, García-Pinillos F, Lago-Fuentes C (2024). Can women maintain their strength performance along the menstrual cycle? Applied Sciences 14(21):9818. repositorio.uneatlantico.es/15199/1/applsci-14-09818.pdf · 12 active women, squat reps to failure at 80% of their estimated best: 12.3 during the period, 14.5 on days 6 to 12. Their bench press reps did not differ.
  4. Jones BP, L’Heveder A, Bishop C, Kasaven L, Saso S, Davies S, Chakraverty R, Brown J, Pollock N (2024). Menstrual cycles and the impact upon performance in elite British track and field athletes: a longitudinal study. Frontiers in Sports and Active Living 6:1296189. pmc.ncbi.nlm.nih.gov/articles/PMC10912517/ · 128 athletes over five years; of the 125 who answered, 77% said their cycle had hurt their performance at some point; of the 91 who named a time, 40% said before the period and 35% during it. Self-reported.
  5. McNulty KL et al. (2020). The effects of menstrual cycle phase on exercise performance in eumenorrheic women: a systematic review and meta-analysis. Sports Medicine 50:1813–27. www.ncbi.nlm.nih.gov/pmc/articles/PMC7497427/ · The first meta-analysis on the question: 78 studies, 1,193 women; UK authors.
  6. NHS. Vitamins and minerals: iron. www.nhs.uk/conditions/vitamins-and-minerals/iron/ · Women who lose a lot of blood during their period are at higher risk of iron deficiency anaemia and may need supplements; speak to a GP.
  7. Bruinvels G et al. (2016). The prevalence and impact of heavy menstrual bleeding (menorrhagia) in elite and non-elite athletes. PLoS One 11:e0149881. journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0149881 · UK study with a validated heavy-bleeding screen, including London Marathon runners.
  8. Bruinvels G et al. (2021). Prevalence and frequency of menstrual cycle symptoms are associated with availability to train and compete: a study of 6812 exercising women recruited using the Strava exercise app. British Journal of Sports Medicine 55:438–43. repository.lboro.ac.uk/articles/journal_contribution/Prevalence_and_frequency_of_menstrual_cycle_symptoms_are_associated_with_availability_to_train_and_compete_a_study_of_6812_exercising_women_recruited_using_the_Strava_exercise_app/13614257 · Large UK-led survey of ordinary exercising women, none on the combined pill. Several of its authors work for Orreco, a sports-science company.
  9. Colenso-Semple LM, D’Souza AC, Elliott-Sale KJ, Phillips SM (2023). Current evidence shows no influence of women’s menstrual cycle phase on acute strength performance or adaptations to resistance exercise training. Frontiers in Sports and Active Living. www.frontiersin.org/journals/sports-and-active-living/articles/10.3389/fspor.2023.1054542/full · Umbrella review of the reviews, specific to strength training.
  10. Elliott-Sale KJ et al. (2020). The effects of oral contraceptives on exercise performance in women: a systematic review and meta-analysis. Sports Medicine 50:1785–812. www.ncbi.nlm.nih.gov/pmc/articles/PMC7497464/ · 42 studies, Bayesian meta-analysis; UK authors.
  11. Two contraception-and-training trials: Dalgaard LB et al. (2022) Influence of second generation oral contraceptive use on adaptations to resistance training in young untrained women. J Strength Cond Res 36:1801–9, pubmed.ncbi.nlm.nih.gov/32694286/ · and Riechman SE, Lee CW (2022) Oral contraceptive use impairs muscle gains in young women. J Strength Cond Res 36:3074–80, pubmed.ncbi.nlm.nih.gov/33993156/ · Both 10-week supervised training studies; cited together because they disagree.
  12. Two newer contraception-and-training trials, read as abstracts only: Holm MR, Holtvedt H, Hansen M, Paulsen G, Seynnes O (2025) Second-generation oral contraceptive use is associated with greater muscle hypertrophy following resistance training. Scand J Med Sci Sports 35(12):e70189, pubmed.ncbi.nlm.nih.gov/41420473/ · and Engstad MK, Seynnes O, Vesterhus I, et al., Paulsen G (2025) Effect of oral contraceptive use on muscle hypertrophy following strength training. Scand J Med Sci Sports 35(4):e70052, pubmed.ncbi.nlm.nih.gov/40219704/ · Both about 12 weeks; both found a larger gain in arm lean mass in pill users.
  13. Iron in active women: Pedlar CR et al. (2018) Iron balance and iron supplementation for the female athlete: a practical approach. Eur J Sport Sci 18:295–305, pubmed.ncbi.nlm.nih.gov/29280410/ · and Sim M et al. (2019) Iron considerations for the athlete: a narrative review. Eur J Appl Physiol, pubmed.ncbi.nlm.nih.gov/31055680/ (15–35% of female athletes deficient) · Peer-reviewed reviews by UK and Australian sport-science groups.
  14. Mountjoy M et al. (2023). 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine 57:1073–97, corrected 2024 (58:e4). doi.org/10.1136/bjsports-2023-106994 · International expert consensus, written about athletes.
  15. The 2019 Canadian Guideline for Physical Activity throughout Pregnancy and its evidence reviews: guideline csepguidelines.ca/wp-content/uploads/2020/11/4208_CSEP_Pregnancy_Guidelines_En_HR.pdf · Davenport MH et al. (2018) Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy (106 studies) pubmed.ncbi.nlm.nih.gov/30337463/ · Davenport MH et al. (2018) Impact of prenatal exercise on both prenatal and postnatal anxiety and depressive symptoms (52 studies) pubmed.ncbi.nlm.nih.gov/30337464/ · Davenport MH et al. (2018) Prenatal exercise (including but not limited to pelvic floor muscle training) and urinary incontinence during and following pregnancy (24 studies) pubmed.ncbi.nlm.nih.gov/30337466/ · All BJSM. The most systematic evidence base behind any national pregnancy guideline.
  16. Dalhaug EM et al. (2025). Pushing limits: the acute effects of a heavy-load resistance protocol and supine exercise on fetal well-being. BMJ Open Sport & Exercise Medicine. pmc.ncbi.nlm.nih.gov/articles/PMC12406897/ · Measured fetal heart rate and blood flow during heavy lifting; experienced lifters only.
  17. Prevett C, Kimber ML, Forner L, de Vivo M, Davenport MH (2023). Impact of heavy resistance training on pregnancy and postpartum health outcomes. Int Urogynecol J 34:405–11. shura.shu.ac.uk/35179/1/DeVivo-ImpactOfHeavyResistance(AM).pdf · An online survey of 679 women who lifted at 80% of their max or more in pregnancy. Self-reported, recalled afterwards.
  18. Goom T, Donnelly G, Brockwell E (2019). Returning to running postnatal: guidelines for medical, health and fitness professionals managing this population. absolute.physio/wp-content/uploads/2019/09/returning-to-running-postnatal-guidelines.pdf · The best-known UK guide on running after a baby, written by three pelvic health physios from expert opinion: the 12 weeks, the impact and strength tests, the example progression, breastfeeding, sleep and REDs.
  19. Sperstad JB et al. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine 50:1092–6. pubmed.ncbi.nlm.nih.gov/27324871/ · Prospective cohort of 300 first-time mothers, clinically examined.
  20. Wise LA et al. (2012). A prospective cohort study of physical activity and time to pregnancy. Fertility and Sterility 97(5):1136–1142. pubmed.ncbi.nlm.nih.gov/22425198 · 3,628 Danish women planning a pregnancy; what they said they did, not a trial.
  21. Williams NI et al. (2015). Magnitude of daily energy deficit predicts frequency but not severity of menstrual disturbances associated with exercise and caloric restriction. American Journal of Physiology: Endocrinology and Metabolism 308(1):E29–E39. pubmed.ncbi.nlm.nih.gov/25352438 · 34 young women, three cycles, supervised exercise and set meals.
  22. Hakimi O, Cameron LC (2017). Effect of exercise on ovulation: a systematic review. Sports Medicine 47(8):1555–1567. pubmed.ncbi.nlm.nih.gov/28035585
  23. NHS. Trying to get pregnant and Pregnancy vitamins and supplements. www.nhs.uk/pregnancy/trying-for-a-baby/planning-your-pregnancy/ · www.nhs.uk/pregnancy/keeping-well/pregnancy-vitamins-and-supplements/
  24. NHS. Infertility and Missed or late periods. www.nhs.uk/conditions/infertility/ · www.nhs.uk/conditions/stopped-or-missed-periods/
  25. Moolyk AN et al. (2025). Maternal and fetal responses to acute high-intensity resistance exercise during pregnancy. Br J Sports Med 59(3):159–66. doi.org/10.1136/bjsports-2024-108804 · 10 pregnant women with at least two years of lifting; squat, bench press and deadlift at up to 90% of a ten-rep max, with and without a held breath; no fetal heart rate outside the normal range. One lab session.
  26. American College of Obstetricians and Gynecologists (2020). Committee Opinion 804: Physical activity and exercise during pregnancy and the postpartum period. www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/04/physical-activity-and-exercise-during-pregnancy-and-the-postpartum-period · The US professional body; used for the talk test, lying flat, the warning signs, women starting out and women already training hard.
  27. O’Connor PJ, Poudevigne MS, Cress ME, Motl RW, Clapp JF (2011). Safety and efficacy of supervised strength training adopted in pregnancy. J Phys Act Health 8:309–20. pmc.ncbi.nlm.nih.gov/articles/PMC4203346/ · 32 women who had not been strength training, 2 sets of 15 on five machines twice a week for 12 weeks; no musculoskeletal injuries; mild symptoms such as dizziness in 13 of 768 sessions.
  28. NICE (NG210, 2021). Pelvic floor dysfunction: prevention and non-surgical management. www.nice.org.uk/guidance/ng210/chapter/recommendations · The NHS clinical guideline in England.
  29. CrossFit. Is it safe to do CrossFit while pregnant? www.crossfit.com/essentials/is-it-safe-to-do-crossfit-while-pregnant · and Pregnancy: a practical guide for scaling www.crossfit.com/essentials/pregnancy-a-practical-guide-for-scaling · CrossFit’s own scaling guidance; used for the movement swaps and the first-trimester effort note.
  30. UK Chief Medical Officers (updated July 2026). Physical activity for pregnant women and Physical activity for women after childbirth (birth to 12 months). www.gov.uk/government/publications/physical-activity-guidelines-pregnancy-and-after-childbirth · The UK government’s current guidelines. The 2017 supporting note once listed here has been withdrawn, and nothing in this guide rests on it now.
  31. NHS and NHS inform patient guidance: Menopause (usually 45–55, UK average 51) www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/menopause · Postnatal depression (more than 1 in 10 mothers within a year) www.nhsinform.scot/illnesses-and-conditions/mental-health/postnatal-depression/ · Calcium (700 mg a day) www.nhs.uk/conditions/vitamins-and-minerals/calcium/ · Vitamin D (consider 10 µg in autumn and winter) www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ · Foods to avoid in pregnancy (caffeine no more than 200 mg) www.nhs.uk/pregnancy/keeping-well/foods-to-avoid/ · and University Hospital Southampton NHS Foundation Trust, Fragility fractures (patient factsheet, reviewed November 2025: a break from a fall from standing height or less; ask your GP for a bone health check) www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Muscles,jointsandbones/Fragility-fractures-2559-PIL.pdf · The UK health service’s own public advice.
  32. Berin E et al. (2019). Resistance training for hot flushes in postmenopausal women: a randomised controlled trial. Maturitas 126:55–60. www.maturitas.org/article/S0378-5122(18)30761-8/fulltext · Randomised trial, 15 weeks, symptom diaries.
  33. Watson SL et al. (2018). High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. J Bone Miner Res 33:211–20. pubmed.ncbi.nlm.nih.gov/28975661/ · Randomised trial of supervised heavy lifting in 101 healthy women past menopause with low bone density.
  34. Han B et al. (2024). Effects of exercise on depression and anxiety in postmenopausal women: a pairwise and network meta-analysis of randomized controlled trials. www.ncbi.nlm.nih.gov/pmc/articles/PMC11229230/ · 26 trials in exactly this group; used to keep the mood claim honest.
  35. SWAN (Study of Women’s Health Across the Nation), five papers: Randolph JF et al. (2011) Change in FSH and estradiol across the menopausal transition, J Clin Endocrinol Metab, pmc.ncbi.nlm.nih.gov/articles/PMC3047231/ · Greendale GA et al. (2012) Bone mineral density loss in relation to the final menstrual period, J Bone Miner Res 27:111–18, pubmed.ncbi.nlm.nih.gov/21976317/ · Greendale GA et al. (2019) Changes in body composition and weight during the menopause transition, JCI Insight, insight.jci.org/articles/view/124865 · Avis NE et al. (2015) Duration of menopausal vasomotor symptoms over the menopause transition, JAMA Intern Med, pmc.ncbi.nlm.nih.gov/articles/PMC4433164/ · Bromberger JT et al. (2011) Major depression during and after the menopausal transition, Psychol Med, pmc.ncbi.nlm.nih.gov/articles/PMC3584692/ · The largest long-term study of the menopause transition: over 3,000 women followed yearly from their forties.
  36. Bassey EJ et al. (1998). Pre- and postmenopausal women have different bone mineral density responses to the same high-impact exercise. J Bone Miner Res 13:1805–13. pubmed.ncbi.nlm.nih.gov/9844097/ · Randomised trials in both groups with the same jumping programme; the clearest evidence for the window.
  37. NHS. Menopause: symptoms. www.nhs.uk/conditions/menopause/symptoms/ · The first sign of perimenopause is usually a change to your periods.
  38. Women’s Health Education Network (last reviewed 22 June 2026). Resistance Training Across the Menopausal Transition: WHEN Clinical Position Statement. when.org.au/education/resistance-training-menopause/ · Clinician-led statement written to correct the popular over-claims. Australian; no UK equivalent found.
  39. Our own tally of strength and impact trials in women after menopause, training group against comparison group, spine bone density: Pruitt 1992 (pubmed.ncbi.nlm.nih.gov/1570762/); Watson 2018, LIFTMOR (pubmed.ncbi.nlm.nih.gov/28975661/); Engelke and Kemmler, EFOPS at 38 months (pubmed.ncbi.nlm.nih.gov/16096715/); Maddalozzo 2007 (pubmed.ncbi.nlm.nih.gov/17291843/); Nelson 1994 (pubmed.ncbi.nlm.nih.gov/7990242/); Kemmler 2013 (pubmed.ncbi.nlm.nih.gov/21631599/); Kistler-Fischbacher 2021, MEDEX-OP (pubmed.ncbi.nlm.nih.gov/34033146/); Whitman 2026, STOP-EM (pmc.ncbi.nlm.nih.gov/articles/PMC13324662/); Kemmler 2010, SEFIP (pubmed.ncbi.nlm.nih.gov/20101013/); Hettchen 2021, ACTLIFE (pmc.ncbi.nlm.nih.gov/articles/PMC7810823/); Pruitt 1995 (pubmed.ncbi.nlm.nih.gov/8592957/). The gaps and the plain average of these eleven are our sums from each trial’s group averages; the ACTLIFE figure is our conversion from its raw values. Five of the comparison groups did gentle exercise, not nothing (LIFTMOR, Kemmler 2013, MEDEX-OP, SEFIP, ACTLIFE). The women counted are those randomised in some trials and those who finished in others, and the MEDEX-OP count is as we read it from the abstract. Three further trials (Kerr 2001, Bemben 2000, Bolton 2012) found no difference at the spine. The five “first years after the last period” trials are Maddalozzo, Kemmler 2013, Pruitt 1992, EFOPS and STOP-EM. No trial has yet followed women who started training before the menopause transition through it.
  40. Noetel M et al. (2024). Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ 384:e075847. pmc.ncbi.nlm.nih.gov/articles/PMC10870815/ · 218 trials, 14,170 people. Its authors rate the certainty low for walking or jogging and very low for the rest, strength training included; a later correction did not change the findings.
  41. Fischbacher M, Weeks BK, Beck BR (2019). The influence of antiresorptive bone medication on the effect of high-intensity resistance and impact training on osteoporotic fracture risk in postmenopausal women with low bone mass: protocol for the MEDEX-OP randomised controlled trial. BMJ Open 9(9):e029895. doi:10.1136/bmjopen-2019-029895 · pmc.ncbi.nlm.nih.gov/articles/PMC6731910/ · The LIFTMOR lab’s own open-access write-up of the same programme, including its 80 to 85% load.
  42. Brooke-Wavell K, Skelton DA, Barker KL, et al. (2022). Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. Br J Sports Med 56:837–46. doi:10.1136/bjsports-2021-104634 · pmc.ncbi.nlm.nih.gov/articles/PMC9304091/ · The UK consensus on exercise for bone: strength work 2 to 3 days a week, moderate impact on most days (at least 50 impacts a session), and usually no more than brisk-walking impact after a spinal fracture or several low-trauma fractures.
  43. NICE (NG23, last updated 15 April 2026). Menopause: identification and management. www.nice.org.uk/guidance/ng23/chapter/recommendations · The NHS clinical guideline in England.
  44. Dumoulin C, Cacciari LP, Hay-Smith EJC (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews. www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005654.pub4/full · Cochrane review of 31 trials; the cure figure is from 4 of them (165 women with stress leaking). The basis for pelvic floor training as first-line treatment.
  45. Sims ST et al. (2023). International Society of Sports Nutrition position stand: nutritional concerns of the female athlete. JISSN 20:2204066. pmc.ncbi.nlm.nih.gov/articles/PMC10210857/ · Peer-reviewed position stand; used for protein and supplements, not for its cycle-phase advice, which the evidence in the cycle chapter does not support.
  46. Energy in pregnancy and breastfeeding: NHS Start for Life, Healthy eating in pregnancy, www.nhs.uk/start-for-life/pregnancy/healthy-eating-in-pregnancy/ (about 200 extra calories a day in the final three months); Scientific Advisory Committee on Nutrition (2011), Dietary reference values for energy (191 kcal a day in the third trimester; 330 kcal a day for the first six months of breastfeeding).
  47. What “bulky” would take: Handelsman DJ, Hirschberg AL, Bermon S (2018), Endocrine Reviews 39:803–29, pmc.ncbi.nlm.nih.gov/articles/PMC6391653/ (men’s testosterone more than 15 times women’s); Schutz Y, Kyle UG, Pichard C (2002), Int J Obes, pubmed.ncbi.nlm.nih.gov/12080449/ (typical young women); Graybeal AJ et al. (2020), J Strength Cond Res, pubmed.ncbi.nlm.nih.gov/30161092/ (10 female bodybuilders). The 8 kg is our sum for a woman 1.65 m tall from those two studies, which measured differently, so it is a rough scale.
  48. Scurr J et al. (2016). The influence of the breast on sport and exercise participation in school girls in the United Kingdom. J Adolesc Health 58:167–73. doi.org/10.1016/j.jadohealth.2015.10.005 · and University of Portsmouth (8 August 2024). A million breast bounces have helped scientists lead a bra revolution. www.port.ac.uk/news-events-and-blogs/news/a-million-breast-bounces-have-helped-scientists-lead-a-bra-revolution · The Portsmouth breast health group (lead: Prof Joanna Scurr): their survey of 2,089 schoolgirls, and the university’s own summary of their movement and pain research.
  49. Strength lost faster than muscle: Goodpaster BH et al. (2006), J Gerontol A, pubmed.ncbi.nlm.nih.gov/17077199/ · 1,880 adults aged 70 to 79 followed for three years: leg strength fell 2.6 to 4.1% a year (2.6 to 3.0% in women), about three times the loss of leg lean mass. The word dynapenia: Clark BC, Manini TM (2008), Sarcopenia ≠ dynapenia, J Gerontol A, pubmed.ncbi.nlm.nih.gov/18772470/ · Abstracts read.
  50. Fielding RA et al. (2002). J Am Geriatr Soc. pubmed.ncbi.nlm.nih.gov/11982665/ · 30 women, average age 73, sixteen weeks of leg press and knee extension at 70% of max, lifted fast or slowly. Strength rose similarly in both groups.
  51. Morris SJ, Oliver JL, Pedley JS, Haff GG, Lloyd RS (2022). Comparison of weightlifting, traditional resistance training and plyometrics on strength, power and speed: a systematic review with meta-analysis. Sports Medicine. pubmed.ncbi.nlm.nih.gov/35025093/ · 16 studies; the authors flag high variation between them.
  52. Sleep: NHS Every Mind Matters, How to fall asleep faster and sleep better, www.nhs.uk/every-mind-matters/mental-wellbeing-tips/how-to-fall-asleep-faster-and-sleep-better/ · Stutz J, Eiholzer R, Spengler CM (2019), Sports Med, pubmed.ncbi.nlm.nih.gov/30374942/ (23 studies of evening exercise) · Cunha PM et al. (2025), Psychol Sport Exerc, pubmed.ncbi.nlm.nih.gov/40784602/ (160 women aged about 69, 12 weeks of lifting; one trial).
  53. Milsom I, Gyhagen M (2019). The prevalence of urinary incontinence. Climacteric 22:217–22. www.tandfonline.com/doi/full/10.1080/13697137.2018.1543263 · Review of population studies across countries.
  54. Domínguez-Pérez N et al. (2026). Urinary incontinence in women athletes: umbrella review and meta-analysis of sport-related factors. Sports Medicine. pmc.ncbi.nlm.nih.gov/articles/PMC13499830/ · 32 studies, 4,649 women; the most complete by-sport picture available.
  55. Pelvic Obstetric and Gynaecological Physiotherapy (POGP). Pelvic floor muscle exercises for women (patient leaflet). thepogp.co.uk/resources/115/pelvic_floor_muscle_exercises_for_women/ · The UK professional network of pelvic health physios; the leaflet NHS trusts hand out. Dated 2018 and marked for review in 2024.
  56. Skaug KL, Engh ME, Bø K (2024). Pelvic floor muscle training in female functional fitness exercisers: an assessor-blinded randomised controlled trial. British Journal of Sports Medicine. doi.org/10.1136/bjsports-2023-107365 · 47 women who did CrossFit-style training and leaked.
  57. Miller JM, Ashton-Miller JA, DeLancey JOL (1998). A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc 46:870–4. pubmed.ncbi.nlm.nih.gov/9670874/ · The original study of “the Knack”; small, older women, but the mechanism is the one we coach.
  58. Jäger R et al. (2017). International Society of Sports Nutrition position stand: protein and exercise. JISSN 14:20. www.ncbi.nlm.nih.gov/pmc/articles/PMC5477153/ · Peer-reviewed position stand.
  59. Thomas DT, Erdman KA, Burke LM (2016). Nutrition and athletic performance: joint position statement of the American College of Sports Medicine, the Academy of Nutrition and Dietetics and Dietitians of Canada. Med Sci Sports Exerc 48:543–68. pubmed.ncbi.nlm.nih.gov/26891166/ · The joint position of the three professional bodies.
  60. Royal Osteoporosis Society. Vitamin D for bones. theros.org.uk/information-and-support/food-and-supplements/vitamin-d/ · The UK’s osteoporosis charity. Its quick guide to the exercise consensus is no longer online; the consensus paper itself is source 42.
  61. Naddafha S, Antonio J, Kreider RB, Stout JR (2026). Creatine monohydrate for lean mass, strength, and bone density in postmenopausal women: a systematic review and meta-analysis. JISSN. pmc.ncbi.nlm.nih.gov/articles/PMC13182165/ · 7 randomised trials, 608 women.
  62. Smith-Ryan AE et al. (2025). Creatine in women’s health: bridging the gap from menstruation through pregnancy to menopause. JISSN. pmc.ncbi.nlm.nih.gov/articles/PMC12086928/ · Review by the leading researchers on creatine in women; names the gaps.
  63. Chilibeck PD et al. (2023). A 2-yr randomized controlled trial on creatine supplementation during exercise for postmenopausal bone health. Med Sci Sports Exerc. pmc.ncbi.nlm.nih.gov/articles/PMC10487398/ · The longest and largest trial on the question.
  64. Jeryous Fares B et al. (2026). The effect of creatine monohydrate on mental disorders: a systematic review of randomized controlled trials. Canadian Journal of Psychiatry. pmc.ncbi.nlm.nih.gov/articles/PMC12823350/ · Includes the risk signal as well as the benefit.
  65. Guest NS et al. (2021). International Society of Sports Nutrition position stand: caffeine and exercise performance. JISSN 18:1. pmc.ncbi.nlm.nih.gov/articles/PMC7777221/ · Peer-reviewed position stand.
  66. Kerksick CM et al. (2018). ISSN exercise and sports nutrition review update: research and recommendations. JISSN 15:38. pubmed.ncbi.nlm.nih.gov/30068354/ · Grades common supplements by strength of evidence.
  67. Roberts BM, Nuckols G, Krieger JW (2020). Sex differences in resistance training: a systematic review and meta-analysis. J Strength Cond Res 34:1448–60. journals.lww.com/nsca-jscr/fulltext/2020/05000/sex_differences_in_resistance_training__a.30.aspx · Pre-registered meta-analysis of men and women on the same programmes.
  68. Skelton DA et al. (1994). Age and Ageing. pubmed.ncbi.nlm.nih.gov/7825481/ · 50 men and 50 women aged 65 to 89, compared by age at one point in time. In the women alone, the gap between power and strength was not statistically clear.
  69. Reid KF, Fielding RA (2012). Skeletal muscle power: a critical determinant of physical functioning in older adults. Exercise and Sport Sciences Reviews 40:4–12. pubmed.ncbi.nlm.nih.gov/22016147/ · The standard review on power, as distinct from strength, and ageing.
  70. Balachandran AT et al. (2022). JAMA Network Open. pmc.ncbi.nlm.nih.gov/articles/PMC9096601/ · 20 randomised trials, 566 adults aged 60 and over, 65% women. Fast lifting against slow lifting; evidence rated low-certainty; strength and walking speed did not differ.
  71. Momma H et al. (2022). Br J Sports Med. pmc.ncbi.nlm.nih.gov/articles/PMC9209691/ · Seven long-term studies, 263,058 people. Observational: it shows an association, and the authors rate the certainty very low.
  72. O’Connor E (2025). Finding the Sweet Spot: Mastering CrossFit’s Mechanics-Consistency-Intensity Hierarchy. CrossFit, 13 August 2025. www.crossfit.com/pro-coach/crossfit-sweet-spot-mci · CrossFit’s own article on its coaching order: mechanics first, then consistency, then intensity. Checked 2 Oct 2026.
  73. Nuzzo JL, Pinto MD, Nosaka K, Steele J (2024). Maximal number of repetitions at percentages of the one repetition maximum: a meta-regression and moderator analysis of sex, age, training status, and exercise. Sports Med 54(2):303–21. pmc.ncbi.nlm.nih.gov/articles/PMC10933212/ · Reprints the textbook table of reps against percentage of max used for the rough percentages, and finds people vary widely around it.
  74. Currier BS, D’Souza AC, Fiatarone Singh MA, et al., Phillips SM (2026). American College of Sports Medicine position stand. Resistance training prescription for muscle function, hypertrophy, and physical performance in healthy adults: an overview of reviews. Med Sci Sports Exerc 58(4):851–72. doi.org/10.1249/MSS.0000000000003897 · Replaces the 2009 stand; 137 systematic reviews, more than 30,000 people, from complete beginners up.

Service link (not a source): Cornwall NHS physiotherapy, www.cornwallft.nhs.uk/physiotherapy/ (you can refer yourself, and it covers pelvic health; checked 30 Sep 2026).