Perimenopause Fatigue: Why You’re Feeling Tired and How to Cope

Does perimenopause truly lead to fatigue? If you’ve been feeling more exhausted than usual, rest assured, you’re not alone. Perimenopause fatigue is one of the most common symptoms of the transitional phase leading to menopause. As with other symptoms during this stage of life, fatigue is heavily influenced by hormonal fluctuations. 

This article will explore the causes behind perimenopause fatigue and offer actionable steps to help you manage exhaustion. Let’s dive in.

• Fatigue is a common symptom experienced during perimenopause. It’s driven by sleep disturbances, hormonal fluctuations, or underlying health conditions. 
• You can address perimenopause fatigue by focusing on sleep, exercise, a healthy diet, targeted supplementation, and seeking support for your mental and emotional well-being. 
• If the fatigue becomes too much to handle or you feel concerned about any underlying health conditions, you should talk to a trusted healthcare provider. They will perform tests to rule out any serious issues and guide you through available treatment options, including hormone replacement therapy (HRT). 

Is Perimenopause Fatigue Normal? 

Not entirely “normal,” but perimenopause fatigue is very common. According to a 2018 study analyzing annual health reports and monthly health diaries from 56 women, 46% reported feeling more tired than usual. This indicates that fatigue can be considered a typical symptom of perimenopause.¹

Perimenopause fatigue can leave you feeling utterly drained, overwhelmed, and unable to tackle even the simplest everyday tasks. It’s more than just feeling tired at the end of the day. The good news is that this fatigue doesn’t last forever and it’s likely to subside once you reach menopause. 

How Does Perimenopause Make You Feel Tired? 

The exhaustion experienced during perimenopause is a unique type of fatigue. It’s more than just physical or mental exhaustion. 

Hormonal changes

As you approach menopause, your body produces less and less estrogen and progesterone. This triggers vasomotor symptoms like hot flashes and night sweats. Furthermore, your levels of cortisol—the notorious “stress hormone”—begin to increase. A cortisol surge can trigger feelings of stress and anxiety, along with physiological changes such as an increased resting heart rate and body temperature, potentially disrupting sleep quality.⁴

Sleep disturbances

If we look at the research about perimenopause symptoms, about 56% of women report struggling with insomnia.² Trouble sleeping often arises as a result of all the changes your body is adjusting to. 

Changes in estrogen and progesterone levels can disrupt the metabolism of various brain chemicals that are important for sleep regulation. This means that areas of the brain that play a role in how you sleep will also be affected.³ In addition to brain neurochemistry, it’s difficult to get quality sleep when you repeatedly wake up in the middle of the night because of hot flashes or night sweats (see above). 

Underlying medical conditions

Fatigue often goes hand-in-hand with mental health conditions such as depression and anxiety. However, the root cause could also be metabolic health, including thyroid imbalances or diabetes. Other conditions, for example, autoimmune or heart disease, can also make you feel fatigued. 

If you’re experiencing fatigue along with symptoms not typically associated with menopause, consult your healthcare provider. These symptoms might include shortness of breath, chest pain, an irregular heartbeat, abdominal pain, or vision changes. In these cases, it’s important to rule out any serious underlying conditions. 

How to Combat Perimenopause Fatigue 

Wondering about perimenopause fatigue treatment options? You’re alone. Here are practical steps you can take to improve your well-being during this transition. 

Sleep interventions

It’s hard to get adequate rest when you keep waking up feeling hot and sweaty. To stay cooler, use lightweight bedding and wear breathable fabrics like cotton. Also decrease your room temperature to about 68 F or lower. If tension or anxiety keeps you up, incorporate a relaxing deep breathing exercise or a short meditation into your bedtime routine. 

Don’t forget about good regular sleep hygiene: no naps during the day, no screen time before bed (primarily to avoid blue light exposure), and limited caffeine during the day. Making sure you are tired and relaxed before going to bed is the key to actually getting good quality rest. When it comes to sleep, routine is important. 

The goal with these interventions is to align the body’s circadian rhythms. While a detailed explanation is beyond the scope of this article, circadian rhythms are the natural body cycles that recur roughly every 24 hours. Even small changes such as morning sunlight exposure can have a big impact. Why? Daylight is a primary environmental cue for the body's circadian clock, helping to synchronize it with the 24-hour day-night cycle.^5,6,7 

Exercise

While dealing with perimenopause fatigue, we know that exercise is the last thing on your mind. But, this might be just the way for you to feel better. 

Research shows that engaging in moderate to vigorous physical activity tends to improve the energy levels of perimenopausal women.⁸ You don’t have to run a marathon or plan grueling workouts five times a week—riding a bike or doing pilates is just fine. Some activity is better than none. 

Sarcopenia, the age-related loss of muscle mass, can impact metabolism and contribute to weight gain. Incorporating resistance training into your routine is a proactive way to combat sarcopenia, support a healthy metabolism, and improve bone health.⁹

Nutrition and supplements

Uncomfortable perimenopause symptoms, such as hot flashes and night sweats, can be triggered by certain food choices. It’s best to avoid spicy foods and limit your caffeine and alcohol intake. Instead, focus on eating a well-balanced and nutritious diet based on fruits, vegetables, healthy fats, and high-quality animal proteins. 

Many women benefit from taking perimenopause supplements like calcium and vitamin D to support bone health.⁷ DHEA, wild yam, and vitex might help you balance your hormones—including testosterone—and alleviate mood swings.^11,12

Black cohosh and red clover may help reduce hot flashes and night sweats, while soy isoflavones can provide plant-based estrogen-like effects to balance hormones.^13–15 Ginseng may help combat fatigue and improve sleep quality, while dong quai, a traditional Chinese herb, is thought to support menstrual regularity and circulation.^16,17

Emotional well-being

On top of fatigue and hot flashes, you might be feeling anxious, moody, irritable, or depressed. Taking care of your mental health during perimenopause is just as important as dealing with any physical symptom. 

We encourage all perimenopausal women to seek support from their friends and family. Simply talking about how you’re feeling can make a big difference. You might discover that other people, especially women around the same age, are going through the same. 

That said, we know that sometimes, you need a professional to help you get through challenging times. Psychotherapy can be a great source of support for women who feel like they cannot cope with perimenopause symptoms on their own. 

HRT 

Perimenopause symptoms can be persistent and intense. A lot of women benefit from taking perimenopause supplements and hormone replacement therapy (HRT), but you have to discuss these options with your healthcare provider.³

The Bottom Line 

Perimenopause fatigue is not like any tiredness you’ve experienced before. It’s a direct result of all the hormonal shifts, disrupted sleep, and sometimes, underlying health factors. The good news is that even small lifestyle adjustments can make a significant difference. Focus on healthy sleep, exercise, nutrition, and supplements, and seek all the mental health support that you need. 

If fatigue is significantly impacting your ability to manage work or daily life, it’s time to consult with a healthcare professional. Speaking to a doctor is also a good idea if you are concerned about underlying health issues like thyroid problems or need guidance on treatment options like HRT.  

References

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9. González-Gálvez N, Moreno-Torres JM, Vaquero-Cristóbal R. Resistance training effects on healthy postmenopausal women: a systematic review with meta-analysis. Climacteric. 2024;27(3):296-304. doi:10.1080/13697137.2024.2310521

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11. Tang J, Chen LR, Chen KH. The Utilization of Dehydroepiandrosterone as a Sexual Hormone Precursor in Premenopausal and Postmenopausal Women: An Overview. Pharmaceuticals (Basel). 2021;15(1):46. doi:10.3390/ph15010046

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14. Zukić M, Taljić I, Banjari I. Effectiveness of Commercial Red Clover (Trifolium pratense L.) Products for the Treatment of Symptoms in Menopausal Women—A Narrative Review. Nutraceuticals. 2024;4(3):430-449. doi:10.3390/nutraceuticals4030026

15. Chen LR, Chen KH. Utilization of Isoflavones in Soybeans for Women with Menopausal Syndrome: An Overview. International Journal of Molecular Sciences. 2021;22(6):3212. doi:10.3390/ijms22063212

16. Ghorbani Z, Mirghafourvand M, Charandabi SMA, Javadzadeh Y. The effect of ginseng on sexual dysfunction in menopausal women: A double-blind, randomized, controlled trial. Complementary Therapies in Medicine. 2019;45:57-64. doi:10.1016/j.ctim.2019.05.01517. Ames H. Dong quai: Uses, dosage, and side effects. Medical News Today. November 8, 2023. Accessed January 19, 2025. https://www.medicalnewstoday.com/articles/dong-quai