Exercise during perimenopause: a window of opportunity for cardiometabolic disease prevention

Abstract Perimenopause, the 2–8 year period preceding menopause, represents a critical window characterized by adverse physiological changes and increasing symptom burden that contribute to elevated cardiometabolic disease risk. Regular physical activity is a cornerstone strategy for cardiometabolic disease prevention, and public health guidelines recommend that adults accumulate ≥150 min/week of moderate-vigorous physical activity to reduce chronic disease risk. However, achieving this volume of exercise may be challenging for midlife women who, due to competing family and career demands, frequently report lack of time as a primary barrier to physical activity. High-intensity interval training (HIIT), characterized by brief bouts of vigorous exercise interspersed with recovery periods, has emerged as a time-efficient alternative to traditional moderate-intensity continuous training. HIIT elicits similar or greater improvements in cardiovascular and metabolic health compared with moderate-intensity continuous exercise despite requiring less time, suggesting it may represent a practical strategy for perimenopausal women. This narrative review examines the cardiometabolic consequences of perimenopause and evaluates the extent to which these changes reflect chronological ageing vs. hormonally-mediated physiological acceleration. We hypothesize that HIIT represents a strategically aligned intervention that addresses the biological vulnerability and time constraints characteristic of this life stage, with the potential to counteract the physiological drivers of postmenopausal cardiometabolic disease risk.