Background <p>The impact of structured exercise interventions on vasomotor symptoms (VMS), quality of life, and sleep disturbances in postmenopausal women is inconclusive. This study aimed to evaluate the effects of a 12-week program combining resistance and aerobic training on these outcomes.</p> Methods <p>Thirty-eight postmenopausal women aged 45–65 years with moderate or severe VMS were randomized to a 12-week combined resistance and aerobic training program (<i>n</i> = 20) or a control group (<i>n</i> = 18). Resistance exercises using body weight were performed twice weekly, and moderate-intensity outdoor walking three times weekly. The primary outcome was the change in VMS severity from baseline to week 12, assessed by the vasomotor domain of the Menopause-Specific Quality of Life (MENQOL) questionnaire. Secondary outcomes were changes in quality of life and sleep quality assessed with the MENQOL, Menopause Rating Scale (MRS), and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using mixed-model repeated-measures ANOVA to compare within- and between-group changes.</p> Results <p>Of the 38 participants enrolled, 36 completed the trial. The exercise group showed a large improvement in VMS severity (MENQOL vasomotor domain, η²=0.81, <i>p</i> &lt; 0.001) and in somatic symptoms (MRS somatic domain, η²=0.62, <i>p</i> &lt; 0.01). Significant improvements were also observed in the MENQOL psychosocial and physical domains, MRS psychological symptoms, and PSQI sleep quality (all <i>p</i> &lt; 0.01). No significant between-group differences were found in the sexual domains of either scale (<i>p</i> &gt; 0.05).</p> Conclusions <p>A combination of resistance and aerobic exercise training is an effective way to alleviate menopausal symptoms, particularly the severity of VMS, and improve mood and sleep quality in postmenopausal women.</p> Registry <p>ClinicalTrials.gov, <i>Trial registration</i>: NCT05892094, <i>Registration date</i>: 17 May 2023.</p>