Are you a woman in midlife finding yourself constantly feeling tired, battling low energy, or struggling with an overwhelming sense of exhaustion? If so, you might be experiencing perimenopause fatigue.

This isn’t just ordinary tiredness; it’s a persistent lack of energy that can significantly impact your daily life, relationships, and overall well-being. Many perimenopausal and menopausal women report this as a major concern, but the good news is that understanding its causes and exploring effective strategies can help you regain your vitality.

This article will explore what perimenopause fatigue is, its common causes and symptoms, and practical ways to manage it, helping you navigate this transitional period with more energy and confidence.

What is Perimenopause Fatigue?

Perimenopause fatigue is more than just feeling a bit sleepy. It’s a common symptom experienced by many women during the menopause transition, sometimes affecting a large percentage of those going through it. While some estimates vary, it’s clear that a significant number of women grapple with this issue.

Perimenopause fatigue is characterized by:

Extreme tiredness that isn’t relieved by rest or sleep.
Consistently low energy levels.
A general and persistent feeling of exhaustion.

This isn’t the kind of fatigue you feel after a single poor night’s sleep; it’s often a chronic state that can be debilitating. For many women, this symptom can interfere with work, family life, and social activities, leading to a reduced quality of life.

Causes of Perimenopause Fatigue

Understanding why you feel so tired during perimenopause is the first step toward finding relief. The causes are often multifaceted, involving both hormonal changes and various lifestyle factors.

Hormonal Changes

The primary driver behind many perimenopause symptoms, including fatigue, is the shift in your hormone levels.

Estrogen and Progesterone Fluctuations: During perimenopause, estrogen levels begin to decline erratically, and progesterone levels also change. These hormonal fluctuations are notorious for disrupting the body’s natural rhythms. Estrogen, for instance, plays a role in energy regulation at a cellular level. When its levels dip, your energy can too. These changes can directly contribute to feelings of extreme fatigue.
Testosterone Decline. Testosterone levels decline with age and can be an often overlooked cause of fatigue. We have the most data to support the use of testosterone for low libido, but low testosterone can also contribute to low energy, poor muscle recovery, and exercise intolerance.
Sleep Disruption: These same hormonal shifts are a major culprit behind poor sleep quality. Many women experience new or worsening sleep problems, such as difficulty falling asleep or staying asleep. Hot flashes and night sweats, common vasomotor symptoms linked to changing estrogen levels, frequently interrupt sleep, leading to increased fatigue the next day. The lack of estrogen and progesterone can also affect sleep regulation and circadian rhythms.
Thyroid Dysfunction: Sometimes, thyroid problems can develop or become more apparent during midlife. An underactive thyroid (hypothyroidism) is a well-known cause of fatigue, and its symptoms can overlap with those of perimenopause.

Lifestyle Factors

Beyond hormones, certain lifestyle factors can either cause or worsen perimenopause fatigue.

Stress: Midlife often comes with significant stressors, such as managing a demanding job, caring for children, or looking after aging parents. Chronic stress depletes your energy reserves and can make fatigue much worse. Cortisol levels, the body’s stress hormone, can also be altered during perimenopause, potentially leading to increased feelings of stress and further interfering with sleep.
Poor Nutrition: A diet lacking in essential nutrients can leave you feeling drained. For example, heavy menstrual bleeding during perimenopause can sometimes lead to iron deficiency anemia, a condition where fatigue is a primary symptom. Not getting enough protein, healthy fats, or complex carbohydrates can also impact your blood sugar and energy levels.
Lack of Exercise (or Too Much): While regular physical activity can boost energy, a sedentary lifestyle can contribute to feelings of lethargy. Conversely, over-exercising without adequate rest can also lead to exhaustion.
Poor Sleep Hygiene: Habits like irregular sleep schedules, consuming caffeine or alcohol too close to bedtime, or excessive screen time before bed can all contribute to sleep disruption and, consequently, daytime fatigue.

Symptoms Associated with Perimenopause Fatigue

Perimenopause fatigue rarely occurs in isolation. It’s often accompanied by a cluster of other physical and emotional symptoms that are part of the menopausal transition.

Physical Symptoms

Beyond the overwhelming tiredness, you might experience:

Insomnia and Sleep Disturbances: Difficulty falling or staying asleep is one of the most common complaints.
Weight Gain: Hormonal changes can make it easier to gain weight, particularly around the abdomen.
Hot Flashes and Night Sweats: These sudden feelings of intense heat can be disruptive, especially to sleep.
Joint Pain: Aches and stiffness in the joints are reported by some perimenopausal women.
Abnormal Menstrual Bleeding: Changes in your period, such as heavy bleeding or prolonged menstrual bleeding, can occur and may lead to iron deficiency anemia, compounding fatigue.

Emotional Symptoms

The hormonal rollercoaster of perimenopause can also affect your mental health:

Mood Swings: You might find yourself feeling irritable or experiencing rapid shifts in mood.
Anxiety and Depression: An increased risk of anxiety and depression is linked to the hormonal changes of perimenopause.
Brain Fog: Difficulty concentrating, memory lapses, and a general feeling of mental fuzziness (often called “brain fog”) can be frustrating and add to the feeling of being overwhelmed and tired.

Feeling tired, irritable, and overwhelmed is a common experience for many women navigating this phase of life.

How to Manage Perimenopause Fatigue

The good news is that you don’t have to resign yourself to years of feeling tired. There are many effective strategies to combat perimenopause fatigue and improve your energy levels.

Adjust your lifestyle

Simple adjustments to your daily routine can make a significant difference.

Regular exercise: Engaging in regular physical activity, such as brisk walking, yoga, swimming, or strength training (like lifting weights), can surprisingly boost energy levels and improve mood. Aim for a consistent routine. Even gentle restorative exercise is important during periods of intense fatigue.
Well-balanced diet: Focus on a diet rich in whole foods. Include plenty of lean protein, healthy fats, and a rainbow of veggies. Ensure you’re getting enough iron (especially if you experience heavy bleeding), B vitamins, calcium, and vitamin D.
Master stress management: Incorporate stress-reduction techniques into your day. This could be meditation, deep breathing exercises, spending time in nature, or engaging in hobbies you enjoy. Relaxation techniques can greatly benefit your mental health.
Get better sleep: Regulate your sleep by maintaining a consistent daily sleep-wake schedule, including weekends. Establish a relaxing bedtime routine and optimize your bedroom environment for darkness, quiet, and coolness. Limit caffeine and alcohol, particularly before bed, and avoid heavy late-night meals to improve sleep quality.

“Now is the time to rethink carbohydrates: breads, white rice, white potatoes, and pasta will spike your blood sugar and leave you feeling more tired. Focus on intact grains like quinoa, black rice, and buckwheat to maintain stable blood sugar and energy.”

—Dr. Polly Watson

Natural Remedies for Perimenopause Fatigue

Some women explore natural remedies, though it’s important to approach these with informed caution and discuss them with your healthcare provider.

Iron Supplements: If blood tests confirm iron deficiency anemia, iron supplements can make a significant difference in alleviating fatigue.
Vitamin D and Omega-3s: Deficiencies in Vitamin D can contribute to fatigue, and omega-3 fatty acids are important for overall health. Supplements may be beneficial if your intake is low. Most of us don’t get 3 sesrvings of wild caught fatty fish a week and would benefit from high quality fish oil. At Hormone Wellness MD, we like Nordic Naturals Ultimate Omega.
Adaptogenic Herbs: Ashwagandha and rhodiola are marketed to help the body manage stress and improve energy. Always consult your doctor before starting any new vitamins or supplements, as they can interact with medications or have side effects.

“Ashwaganda is typically used as a calming herb and can help with the wired and tired feeling. Rhodiola is “the Viking herb” and can help with energy when taken in the morning.”

—Dr. Polly Watson

Medical Treatments for Perimenopause Fatigue

If lifestyle changes and natural remedies aren’t enough, medical treatments can offer relief for persistent perimenopause symptoms, including fatigue.

Menopause Hormone Therapy (MHT)

Previously known as hormone replacement therapy (HRT), MHT can be a very effective treatment for alleviating moderate to severe menopause symptoms like hot flashes, night sweats, and resulting sleep disruption.

MHT typically involves managing levels of key hormones like estrogen, progesterone, and often testosterone, which fluctuate and decline during aging and the menopausal transition.

By managing these underlying issues, MHT can significantly reduce fatigue and improve overall quality of life for many women. Notably, it has been shown to enhance sleep quality by reducing sleep fragmentation.

Other Medical Options

Your medical provider should be testing several areas to determine the cause of your fatigue. Common areas to investigate are:
- Thyroid dysfunction
- Metabolic dysfunction, such as insulin resistance
- Sleep apnea
- Low protein intake
- Overexercise
- Anemia
- Vitamin deficiencies, like low B vitamins and vitamin D
- Cortisol imbalance
- Functional medicine providers may also be evaluating mitochondrial dysfunction, gut dysbiosis, and investigating other issues like long COVID

When to Seek Medical Attention for Perimenopause Fatigue

While some fatigue is common during the menopausal transition, consult your healthcare provider about your perimenopause fatigue if:

It’s severe, persistent, or worsening: Especially if extreme tiredness significantly impacts your daily activities and quality of life despite trying self-care strategies.
It’s accompanied by other disruptive symptoms that exacerbate exhaustion: This includes severe hot flashes or night sweats that consistently ruin your sleep, or significant joint pain that limits activity and rest, thereby intensifying your fatigue.
You suspect an underlying contributor like iron deficiency: For example, if your fatigue is coupled with heavy menstrual bleeding, which can lead to anemia and worsen tiredness. If you are on a vegan diet, this may be another reason to check for iron deficiency or nutrient deficiency.
It’s linked with significant mood changes: If persistent low mood, anxiety, or symptoms of depression are also present alongside your debilitating fatigue.

Discussing your specific experience of perimenopause fatigue with a healthcare provider is crucial. They can help investigate potential underlying causes, rule out other medical conditions, and create a personalized plan to help you manage your fatigue effectively. Note: This guidance is specific to seeking help for fatigue during perimenopause; always seek immediate medical attention for urgent symptoms like chest pain or difficulty breathing.

Take Control of Your Menopause Journey

Perimenopause fatigue is indeed a common symptom that can feel overwhelming, but it doesn’t have to dictate your life.

Prioritizing self-care, fostering open communication with family members and healthcare providers, and seeking support are crucial for managing not just the physical aspects like extreme tiredness but also the emotional symptoms that can accompany this transitional period.

If you’re struggling with perimenopause fatigue and other menopause symptoms, you don’t have to navigate this journey alone. Our team is dedicated to helping women find relief and improve their well-being. Contact us today to schedule a consultation and learn how we can support you.

Frequently Asked Questions

What is perimenopause fatigue?

Perimenopause fatigue is more than just ordinary tiredness; it’s a persistent and often debilitating lack of energy experienced by many women during the menopausal transition. It is characterized by extreme tiredness, low energy levels, and a general feeling of exhaustion that isn’t typically relieved by rest.

What are the main causes of fatigue during perimenopause?

The primary causes include fluctuating hormone levels, particularly estrogen and progesterone, which can disrupt sleep patterns and energy regulation. Lifestyle factors like stress, poor nutrition, lack of exercise, and poor sleep hygiene can also significantly contribute to or worsen this fatigue.

Besides extreme tiredness, what other symptoms can accompany perimenopause fatigue?

Perimenopause fatigue often comes with other physical symptoms like insomnia, hot flashes, night sweats, joint pain, and abnormal menstrual bleeding. Emotional symptoms such as mood swings, anxiety, depression, and brain fog can also be experienced.

What lifestyle changes are most effective for managing perimenopause fatigue?

Prioritizing regular exercise, adopting a well-balanced diet rich in whole foods, mastering stress management techniques like meditation or deep breathing, and improving sleep hygiene are foundational. These adjustments can significantly boost energy levels and improve overall well-being.

Can hormone therapy (MHT) help with perimenopause fatigue?

Yes, Menopause Hormone Therapy (MHT) can be very effective for perimenopause fatigue, particularly if the fatigue is linked to disruptive symptoms like hot flashes and night sweats. By alleviating these underlying issues, MHT can improve sleep quality and thereby reduce fatigue for many women.

When should I consult a doctor about my perimenopause fatigue?

You should consult a doctor if your fatigue is severe, persistent, or worsening despite self-care efforts, or if it’s accompanied by other concerning symptoms like heavy bleeding or severe joint pain. It’s also important to seek medical advice if your fatigue significantly impacts your quality of life.

How does perimenopause fatigue impact mental well-being?

Perimenopause fatigue is often linked with emotional symptoms such as mood swings, irritability, anxiety, and even depression, contributing to a reduced quality of life. Cognitive issues like brain fog and difficulty concentrating can also be frustrating and add to the feeling of being overwhelmed.

Perimenopause Fatigue: Symptoms, Causes, and Treatments