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Women's Health

How Women Can Prevent Injury While Weightlifting In Their 40s & Beyond

Author: Stephanie Estima, D.C.

April 23, 2026

Doctor of Chiropractic

By Stephanie Estima, D.C.

Doctor of Chiropractic

Dr. Stephanie Estima is a world-renowned health expert on female-centric health span, lifespan, and performance. Through a deep understanding of neuroscience, metabolism, nutrition, and exercise physiology, she helps women make informed choices on evidence-based health strategies and tools.

Image by Mireya Acierto / Getty

April 23, 2026

Women are being told to lift heavy weights for the sake of their health—and I totally agree with the sentiment.

But while I believe resistance training is the key to aging well (and developing confidence and mental resilience), one aspect of it is being grossly overlooked: Most women, especially those who are now in perimenopause, grew up in the era of step class and cardio kickboxing.

It wasn't popular for women to be in the weight room until recently, and many of us were not taught how to lift properly.

After 16 years in private practice caring for thousands of female patients, these are my top tips for women looking to build muscle safely and without injury.

Why women are more injury-prone—especially once they hit perimenopause

There are well-documented increases in tendon and ligament injury risk among premenopausal and postmenopausal women. For example, women are at greater risk than men of sustaining an anterior cruciate ligament (ACL) rupture1 in the years leading up to menopause. One of the working hypotheses for elevated ACL injury in females is that long-term exposure to high levels of circulating estrogen influences tendon and ligament collagen turnover, composition, and function, and thereby, susceptibility to injury.

Another area we see commonly injured is the shoulder—most often presenting as adhesive capsulitis (also known as frozen shoulder). While frozen shoulder can affect both sexes, it is most commonly diagnosed in women aged 40-602. Although we don't know exactly why frozen shoulder occurs, changes in sex hormones, loss of collagen, and an overexpression of fibroblasts that drive an immune response within the shoulder joint could be risk factors for women.

To make matters worse, when ligaments and tendons are injured during perimenopause or menopause, they can take more time to heal due to hormonal changes that occur during this time—namely, the attenuation of estrogen.

How to prevent injuries in the gym

Consider this a road map for how perimenopausal and menopausal women can build muscle, prevent injury, and maximize their time in the gym:

1.Do a muscle-specific warmup

The first thing you want to think about when gearing up to lift any weights is how you can best direct neural attention to the muscles in question. Anatomically, nerves and blood vessels travel beside each other through the body, so where (neural) attention goes, energy (blood) flows.

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Warm-ups have classically been thought of as five or 10 minutes on the treadmill. While not a bad idea, this isn't a great one if you are going to be lifting weights. A good warm-up is specific to the movement patterns in question. So ask yourself: What are going to be the best movement patterns to prime my muscles for the work they're about to do?

Let's say it's leg day and you're going to be squatting with weights. Irrespective of the kind of squat or the machine you might be using, you want to prime the body for the squatting motion. What better way to prepare your body for squats than…well…with squats? Body-weight squats, Smith machine squats (with no weight), or back squats with a barbell with no plates on it are excellent choices for a warm-up if weighted squats are on the menu.

If you are scheduled for some pull-ups, why not start with assisted pull-ups on a machine? If you are going to be deadlifting, why not deadlift just the bar?

The other objective of a muscle-specific warm-up set is to get you sweaty and ready to work. So typically I like to perform three or four sets of a warm-up before the weights get serious, progressively adding on a bit of weight each time. Remember, you're not trying to go to failure but instead ramping up the neural stimulus for when you are ready to lift heavy.

Each progressive warm-up set should get slightly more difficult. When your warm-up is complete, you should feel warm, slightly dewy (aka, you're sweaty), and ready to work.

Here is a sample warm-up set for leg day:

- Walking Lunges, body weight only: 20 reps per leg

- Walking Lunges, 10 lbs: 15 reps per leg

- Walking Lunges, 25 lbs: 12 reps per leg

Here is a sample warm-up set for back day:

- Assisted Pull-Up Machine, 130 lbs: 20 reps

- Assisted Pull-Ups, 70 lbs: 15 reps

- Assisted Pull-Ups, 45 lbs: 10 reps

(Note: the assisted pull-up machine is "