Why Am I So Tired? Understanding Menopause Fatigue

February 7, 2024
A tired women drinking water

Many women passing through perimenopause and menopause experience night sweats, hot flashes, mood changes, and trouble sleeping. These symptoms and others are attributed to decreasing estrogen and progesterone levels.

Menopause is a natural transition that marks the end of the reproductive phase in a woman’s life. The average age for menopause is 51. While menopause is a natural transition, the symptoms it brings may have a significant impact on a woman’s quality of life.1

The Causes of Menopause Fatigue

Unless you have abrupt menopause due to a surgical procedure, fluctuations in estrogen and progesterone levels typically occur for several years before menopause. Menopause is defined as having no menstrual cycles for 12 consecutive months. Most women notice changes in the length and quality of their menstrual cycles long before menopause.

The hormonal changes that take place during perimenopause and menopause are what primarily cause menopause-related fatigue. Changes in estrogen and progesterone levels can also impact adrenal and thyroid gland function. These changes can affect how your body regulates cellular energy use.

Common perimenopausal symptoms that can impact sleep and cause fatigue include:

In a study that enrolled 300 women, 85.3% of postmenopausal women and 46.5% of perimenopausal women reported symptoms of physical and mental exhaustion, compared to just 19.7% of pre-menopausal women.2

The Symptoms of Menopause Fatigue

Many women who experience menopause-related fatigue describe it as a persistent feeling of tiredness and a lack of energy that does not go away with rest. It can feel like an overwhelming exhaustion that makes it difficult to fully participate in the activities of daily life.

Strategies to Improve Sleep Patterns and Boost Energy Levels

While managing menopause-associated fatigue can be challenging, here are some lifestyle changes and complementary therapies that may help you develop a menopause self-care plan.

exercise and aging

1. Regular Exercise

If you are dealing with extreme fatigue, exercise may be the last thing you want to try to improve your energy levels. What a dilemma! You are too tired to exercise. But exercise improves energy utilization and cardiovascular function in your body, boosting energy.3,4

Experts recommend about 30 minutes of aerobic exercise per day, along with two strength-building sessions per week.

Benefits of exercise include:

  • Increasing endurance and strength
  • Boosting mood
  • Improving sleep quality
  • Improving cardiorespiratory function
  • Helping with weight management
  • Increasing bone mass
  • Reducing stress

Start with stretching and walking throughout the day. Increase the length and intensity of exercise slowly. Choose activities you enjoy.5 Muscle loss, or sarcopenia, is common with aging. Exercise can slow this process, restoring energy and strength, improving mitochondrial function, and improving signaling processes in muscle.

2. Establish a Good Sleep Routine

The odds are against good sleep when you are passing through perimenopause. Hormonal fluxes causing night sweats and hot flashes, insomnia, and nighttime urination urges can make getting restful and restorative sleep difficult.

When trying to improve your sleep, go back to the basics of sleep hygiene. Check whether you can improve in any of these areas:

  • Go to bed and wake up at the same time every day.
  • Ensure your sleeping environment is cool, dark, and quiet.
  • Avoid screens of all types for at least an hour before sleep.
  • Track the correlation between physical activity and sleep. Some people sleep better when they exercise later in the day. Others do not.
  • Avoid large meals and caffeine consumption before bedtime.
  • Try meditation, journaling, or other stress-reducing activities before bedtime.
  • Minimize or stop alcohol use.
  • Avoid taking naps in the daytime.
  • Try melatonin or other supplements if they are not contraindicated based on your medical history.
Several women doing yoga in a gym. Exercise can help with menopause fatigue.

3. Practice Stress Reduction Techniques

Stress can contribute to fatigue during menopause. Incorporating stress reduction techniques, such as meditation, deep breathing exercises, or yoga, into daily routines can help manage stress levels and boost overall energy levels.6

4. Eat a Balanced Diet

Maintaining a healthy and balanced diet is important for managing energy levels during menopause. Consuming nutrient-rich foods, including fruits, vegetables, whole grains, and lean proteins, can provide the necessary fuel for your body and help prevent energy crashes. Foods high in soy protein may help reduce menopause symptoms.

Limit consumption of highly processed foods, saturated fats, and simple carbohydrates. These foods can contribute to weight gain and blood sugar spikes.

5. Stay Hydrated

Dehydration can exacerbate feelings of fatigue. Drinking an adequate amount of water throughout the day can help maintain hydration levels and prevent energy depletion. Limit caffeine and alcohol consumption, as they may contribute to dehydration.

Why Am I So Tired? Understanding Menopause Fatigue

6. Consider Hormone Therapy

Hormone replacement therapy (HT) may be an option for women experiencing severe menopause symptoms, including fatigue. However, it has risks and benefits.6

Talk with your doctor about hormone therapy to learn if it will improve your symptoms and whether, based on your personal medical history, the benefits outweigh the risks.

7. Seek Support and Counseling

Menopause can be a challenging time, both physically and emotionally. Seeking support from friends, family, or support groups can provide a sense of understanding and community. Counseling or therapy sessions can also be beneficial for managing emotional stress and improving overall well-being.

8. Limit caffeine, alcohol, and nicotine use

Caffeine, alcohol, and nicotine can all change brain chemical levels and impact fatigue and sleep.

  • Alcohol: Initially, alcohol acts as a depressant and can cause drowsiness. However, excessive alcohol consumption increases your risk of sleep apnea and disturbed sleep patterns.
  • Nicotine: Nicotine initially increases alertness and energy, but over time, your body develops a tolerance to these effects. Nicotine withdrawal can disrupt sleep patterns.
  • Caffeine: A stimulant, caffeine blocks adenosine, a brain chemical that promotes sleep. Caffeine consumption delays the need for sleep but increases fatigue.

9. Get Regular Check-ups

In some cases, medical conditions like anemia, heart disease, high or low thyroid hormone, nutrient deficiency, or kidney or liver disease can be the cause of fatigue during perimenopause. Talk to your doctor to verify whether your symptoms are consistent with menopause or whether further testing is needed to rule out these medical conditions as a cause of fatigue.

Vitamin B12 deficiency is common, and it causes fatigue. Vitamin B12 deficiency can cause anemia, which decreases oxygen delivery to body cells. This can cause extreme fatigue.


Menopause fatigue is a common symptom that many women experience during the menopausal transition. Understanding the causes and symptoms of menopause fatigue is essential when developing strategies to manage and alleviate this fatigue. By incorporating lifestyle changes, such as engaging in regular exercise, consuming a healthy diet, practicing stress reduction techniques, and seeking appropriate medical support, you can improve your sleep patterns and boost your energy levels, ultimately enhancing your overall quality of life during menopause.

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Frequently Asked Questions

What does menopause fatigue feel like?

Menopause fatigue can feel like an overwhelming sense of tiredness or exhaustion that persists despite getting enough sleep. It often leaves individuals feeling drained, lacking energy, and struggling to complete daily tasks.

How can I overcome menopause tiredness?

Overcoming menopause tiredness involves adopting various strategies, including maintaining a healthy lifestyle, managing stress, getting regular exercise, ensuring a balanced diet, prioritizing quality sleep, and seeking support from healthcare professionals when needed. Hormone therapy may also be an option for some individuals.

What is crashing fatigue during menopause?

Crashing fatigue during menopause refers to sudden and severe episodes of exhaustion that can disrupt daily life. It can be characterized by a sudden and overwhelming feeling of tiredness, often occurring unpredictably.

What are the worst menopause symptoms?

The “worst” menopause symptoms can vary from person to person, as each individual’s experience is unique. However, some common and challenging menopause symptoms include hot flashes, night sweats, mood swings, vaginal dryness, sleep disturbances, fatigue, and changes in libido. These symptoms can significantly impact an individual’s quality of life during this life transition.

Author: Leann Poston, M.D.
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