Perimenopause Fatigue Is Real. Here’s What to Do About It

If you’re like me, midlife isn’t a marathon, it’s a triathlon. I’m running on empty because I’m swimming in responsibilities (can’t anyone besides me put the milk back in the fridge?). Plus, of course, I’m cycling from time to time. Oh, I don’t ride my bike around town.  I mean that I have irregular periods. As if the hormone swings aren’t enough fun, there’s also perimenopause fatigue to deal with. 

All too often, perimenopause and fatigue go hand in hand, which is why I have a feeling I’m not just another middle-aged woman tired all the time from my busy life. You may not be either: Perimenopause may play more of a role in your feeling wiped than you think. Happily, there are more solutions than you might think, too.  

Does Perimenopause Cause Fatigue?

Almost everyone knows that menopause fatigue is a thing, but perimenopause fatigue isn’t quite as well known. Turns out, I’m hardly the only one who’s dragging: A study of over 3,000 perimenopausal women, which was published in the journal Women’s Health (London), found that nearly 67% of participants suffered from fatigue (1).

So, what goes on in the body during peri that creates this need-coffee-NOW energy deficit? Blame a lot of it on hormonal shifts. “Generally, levels of estrogen and testosterone go down during the menopausal period,” which includes the time leading up to it, or perimenopause, says Yves-Richard Dole, M.D., a general OB/GYN at Mercy Medical Center in Baltimore. The decline in testosterone is nothing new to your body—according to The North American Menopause Society, the hormone slowly decreases after your 20s, and by the time you reach menopause, it will be at about half its peak. The effects of that decrease aren’t terribly dramatic, says Natasha Spencer, M.D., a general OB/GYN at Orlando Health Physician Associates in Altamonte Springs, FL.

Estrogen, though, isn’t going down without a fight. Low levels bring on some seriously uncomfortable symptoms, including headaches and heart palpitations. And of course, fatigue.

About the Experts

Yves-Richard Dole, M.D., a general OB/GYN at Mercy Medical Center in Baltimore. 

Natasha Spencer, M.D., a general OB/GYN at Orlando Health Physician Associates in Altamonte Springs, FL.

Is Perimenopause or Something Else Causing My Fatigue? 

Clearly, there are zillions of things that could be making you feel exhausted—like, for instance, BEING RESPONSIBLE FOR EVERYTHING. The fact that you’re dealing with perimenopause and fatigue at the same time is a lucky coincidence. 

It also may be a simple lack of sleep that’s making you a zombie. Sleep during perimenopause can be anything but simple. “More often [than not] the cause of fatigue is from hot flashes, which interfere with sleep,” says Spencer. When infamous hot flashes happen at night, they can cause night sweats, potentially soaking you right through to your jammies. Needless to say, it’s a little hard to go back to sleep after that. 

But there are other sleep killers, such as anxiety and depression (mood changes are another symptom of perimenopause), and just plain too much to do. Other things can also mimic perimenopause fatigue, according to the Menopause Charity, a nonprofit in the United Kingdom. They include fibromyalgia (a chronic condition that causes pain throughout the body), and chronic fatigue syndrome (now called myalgic encephalomyelitis, or ME/CF). Having an underactive thyroid, a condition called hypothyroidism, can also cause peri-like sluggishness. So see your doctor to rule out anything more serious if perimenopause or menopause is making you feel tired.

Perimenopause

Perimenopause Decoded: Common Signs and Smart Solutions

Perimenopause Fatigue Is Real. Here’s What to Do About It

How Long Does Perimenopause Fatigue Last?

Unfortunately, perimenopause fatigue can last for some time. While it is just a phase, it’s not a short phase. “It can begin maybe six to seven years before going into menopause,” Spencer says. 

Of course, your energy levels will ebb and flow during that time, not just because of the ups and downs of perimenopause, but also because of whatever else is going on around you. But if menopause or perimenopause is making you feel tired all the time, you have more control over your symptoms than you may think.

Managing Perimenopause Fatigue

Fortunately, there are expert-approved ways to mitigate exhaustion during perimenopause and menopause. Try any of these to reap some significant benefits:

Practice good sleep habits

They’ll give you the best chance of getting a decent night’s rest. If you already stay up till midnight and have a 4 a.m. night sweat, that will leave your tank pretty empty when you face the new day. “Avoid caffeine and caffeinated drinks after five o’clock, and don’t take your phone to bed with you. Sleep in a dark room, and have the temperature just slightly on the cool side,” Dole recommends. Some women find weighted blankets comforting, especially if they have anxiety; it all depends on how often you seem to get hot flashes at night.

Eat a balanced diet

Make sure it includes fruits and vegetables and minimizes carbs and sugar. Body changes, including extra pounds, can be stressful. “The decrease in estrogen and testosterone may lead to weight gain around the trunk of the body. This can lead to stress and mood changes, all compounding the other effects of perimenopause fatigue,” Dole says.

Limit processed foods.

“A lot of them have ingredients that could interfere hormonally with everyone’s bodies. It can be a component of some of your symptoms,” says Spencer.

Exercise

Move throughout the day so you feel sleepy at night. The Centers for Disease Control and Prevention’s current Physical Activity Guidelines for Americans call for getting 150 minutes of moderate-intensity physical activity per week and doing muscle-training activity twice weekly. Although the conventional wisdom has long been to avoid exercising in the evening, a 2018 study published in the journal Sports Medicine suggests that some people benefit more from evening workouts, so long as you don’t do any vigorous workouts less than an hour before bedtime (2). 

Ask your doctor about medications

Hormonal therapies can support women who feel tired during menopause or perimenopause, says Spencer, who typically prescribes oral contraceptives. Hormone replacement therapy (HRT) is another option, as is bioidentical hormone replacement therapy. In addition, adds Dole, some mental-health medications, such as the SSRIs escitalopram (Celexa) and paroxetine (Paxil)  can help reduce those sleep-stealing hot flashes. There is also a hot-flash-specific medication, fezolinetant (Veozah), that could be a good option (3).  

Consider supplements

Black cohosh, which is made from a plant related to buttercups, is a popular herbal remedy for perimenopause and fatigue. A 2017 research review suggested it has the potential to ease general menopause symptoms. But don’t start using this supplement (or any others) before checking with your physician (4). 

Try acupuncture, meditation, and yoga.

Spencer says they may provide relief when menopause makes you feel tired, but there’s no one-size-fits-all prescription; see what works for you.