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Written by Stacy Miller
If you’re in the sandwich generation, ranging in age from the 40s to 60s, you may have noticed yourself thinking, “I don’t know what’s wrong, but I just don’t feel like myself.” Chances are, these feelings are not in your head – they could be due to perimenopause or menopause.
Perimenopause fatigue, feelings of anxiety, brain fog, and mood swings are all common for women throughout the menopausal transition. As estrogen levels drop and your hormones fluctuate, it’s common to feel less energetic and tired. In this article, we’ll explain the science connecting perimenopause and fatigue and provide actionable tips to help you overcome perimenopausal symptoms so you can feel more like yourself again.
- Perimenopause is the transition leading up to menopause and is characterized by fluctuating hormone levels and lowered ovarian function.
- Declining estrogen is the main cause of decreased energy levels and fatigue during perimenopause.
- Tracking your cycle can provide insights into why you may feel the way you do.
- Taking supplements, implementing positive lifestyle habits, and seeking medical help when necessary can help provide relief for perimenopausal symptoms like fatigue.
What does perimenopause fatigue feel like?
If you’ve noticed that you’re waking up tired, feeling fatigued but are unable to sleep, consistently have a midday crash, or can’t shake the brain fog, you may be experiencing perimenopausal-related fatigue. While it’s not common to have extreme tiredness or exhaustion, symptoms like sluggishness and decreased energy are very normal during perimenopause. So, what is perimenopause fatigue, and how does it differ from normal feelings of being tired? To find the answer, we need to look at your hormones.
Why are you so tired in perimenopause?
During your reproductive years, your menstrual cycle is mainly controlled by your primary sex hormones, estrogen and progesterone. Around age 46, these hormone levels begin to drop, and you enter into the normal life transition called perimenopause.
During this time, your hormone levels begin to fluctuate and estrogen declines, causing a range of symptoms like brain fog, sleep issues, mood swings, weight gain, and, of course, fatigue. Many women find that their perimenopause energy levels are lower, even after resting, which is a clear distinction from typical tiredness that can be resolved through sleeping. It’s important to note that extreme fatigue in perimenopause isn’t normal and, in very rare circumstances, could indicate underlying issues like thyroid problems, anemia, or even cancer.
Can low estrogen cause fatigue?
The short answer is yes. Low estrogen can trigger fatigue because this hormone plays a crucial role in regulating the brain’s stress response and cognitive functions. When levels decline, it can lead to mental exhaustion.
Some women can experience a strange, “tired but wired” sensation during perimenopause, where they’re fatigued but unable to sleep. However, please note that it can happen even if you’re not perimenopausal. This feeling is attributed to adrenal function and decreasing estrogen levels. Stress triggers the HPA axis – your body’s stress response system, and leads to an increase in adrenaline and cortisol levels.
While extreme fatigue isn’t normal, when you combine low estrogen levels with a deregulated stress response, you can experience a range of symptoms like anxiety due to lower serotonin levels, brain fog, and insomnia. All of these symptoms can cause perimenopause fatigue.
Track your cycle to pinpoint the crash
Now that we’ve answered the question, “Does perimenopause cause fatigue?” we can talk about ways to start managing your symptoms. One of the best tools when it comes to better understanding your body is a hormone and cycle tracker.
Perimenopause fatigue may not always correlate with your menstrual cycle, and there are many possible reasons you may experience it, like stress during the work week, hot flashes and night sweats, and insomnia. However, symptom tracking can help you identify energy patterns, predict symptoms, and identify possible culprits for your lower energy levels.
The Hormona app is the award-winning hormone tracker that makes it easy to track your cycle, log daily symptoms, and monitor patterns in how you feel over time. You can use these insights to help determine whether your feelings are due to hormone fluctuations, life events, diet, or other causes. With that information, you can make more informed healthcare choices and lifestyle decisions.
How to fight perimenopause fatigue
Perimenopause and menopause fatigue can make your life more challenging, but you don’t have to settle for feeling tired all the time. You can fight perimenopause fatigue with easy relief strategies and lifestyle changes that help boost your energy levels and help you feel more like yourself.
Vitamins and supplements
Introducing supplements into your diet can provide your body with the nutritional support it needs to combat fatigue. We’ve made a list of the best vitamins for perimenopause to keep you energized and balanced.
Magnesium
Magnesium, specifically magnesium glycinate, is very helpful during perimenopause thanks to its ability to help calm the nervous system and promote restful sleep. Magnesium binds to GABA receptors in the brain, which promote relaxation while blocking receptors that stimulate the nervous system, decreasing feelings of anxiety and stress. Magnesium also helps regulate the hormone melatonin, which is essential for circadian rhythm regulation. When your body is relaxed, it’s easier to fall asleep and stay asleep, helping you feel more rested.
Vitamin B12
Vitamin B12 nourishes your nervous system by helping produce neurotransmitters that support mental function and clarity. It also aids in red blood cell creation, allowing more oxygen to travel throughout your body, energizing your brain and muscles. Taking a B12 supplement may improve your energy levels and help you fight perimenopause fatigue.
Iron
Heavy perimenopausal periods can cause an iron deficiency or anemia, which in extreme cases may lead to perimenopausal exhaustion. To avoid this condition, an iron supplement may help avoid deficiencies caused by the extra blood loss and help keep your iron at a safe level.
Lifestyle habits
Along with long-term habits to combat perimenopause fatigue, like taking supplements, there are lifestyle changes you can implement to start finding relief right now.
Practice good sleep hygiene
Sleep hygiene is essential for promoting deep and rejuvenating sleep. Implement habits like:
- Maintaining a consistent sleep schedule
- Limiting caffeine and avoiding coffee after 4 p.m.
- Avoiding screens, nicotine, heavy meals, and intense exercise 30 to 60 minutes before bed
- Creating a quiet, cool, and dark bedroom
- Leaving the bed if you’re awake for more than 20 minutes and performing a quiet activity until feeling sleepy again
- Getting plenty of natural sunlight in the morning
Proper sleep hygiene can help regulate your circadian rhythm and sleep/wake cycle, allowing you to feel more rested and rejuvenated.
Blood sugar balance
During perimenopause, declining estrogen makes your cells less sensitive to insulin, making you more prone to blood sugar spikes and drops. Balancing your blood sugar helps you avoid these spikes and drops for more consistent energy levels throughout the day.
Exercise
Exercise in perimenopause is an excellent way to support your hormone levels and keep you energetic. Under the guidance of a specialist, HIIT training offers a full-body workout while resistance training supports strong bones and muscles. But you don’t have to do hard training to enjoy the benefits of staying active. Gentle exercise like walking, swimming, cycling, yoga, and pilates can also help you feel energized and make sleeping at night easier.
What to do if lifestyle changes aren’t enough?
If you’ve tried supplements and lifestyle changes and perimenopause fatigue is still disrupting your daily life, you may need to see a doctor. Your physician can offer medical advice on whether menopause hormone therapy (MHT) is right for you. MHT reintroduces low levels of estrogen to restore sleep quality and increase energy levels, improving your quality of life.
When speaking with your doctor, your cycle tracker can provide more insights into your symptoms, making it easier to determine the best treatment plan. Soon, you will also be able to use Hormona’s telemedicine feature, which offers access to specialists when you need them most.
How long does perimenopause fatigue last?
A common question from women during the menopause transition is how long perimenopause lasts and the recovery timeline. While perimenopause can be a years-long process, the duration of fatigue symptoms is manageable and often temporary if treated. Depending on the strategies you use, like proper sleep hygiene, you could find relief in days, while treatments like MHT could take 3 to 6 months until you can reap their full benefits. The key to success is consistency, and soon you’ll find you have more energy and feel less tired than before.
FAQs
Does progesterone make you tired?
No, progesterone doesn’t typically make you tired, but it does have some sedative effects when levels are high or when taken as a medication.
Is it perimenopause or thyroid issues?
It can be hard to distinguish whether the symptoms you’re experiencing are related to perimenopause, a thyroid condition, or both. Typical symptoms of an overactive thyroid include:
- Fast or irregular heartbeat
- Weight loss
- Anxiety
- Increased sweating
- Fatigue
- Muscle weakness
- Changes in the menstrual cycle
Symptoms of an underactive thyroid include:
- Fatigue
- Weight gain
- Depression
- Slow heart rate
- Mood changes
- Brain fog
- Cold intolerance
- Digestive issues
If you’re unsure about your symptoms, it’s always best to talk to your doctor.
Can I get my energy back naturally?
Yes, there are numerous ways to naturally increase your energy levels, including exercising, staying hydrated, eating a balanced diet, and practicing proper sleep hygiene. While some women find these methods helpful, others need medical support, and so they may benefit from menopause hormone therapy.
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Dr Singh is the Medical Director of the Indiana Sleep Center. His research and clinical practice focuses on the myriad of sleep.
- Feeling tired but wired? Here’s what may be causing it. (2025). UCLA Health. https://www.uclahealth.org/news/article/feeling-tired-wired-heres-what-might-be-causing-it
- What is Menopausal Hormone Therapy (MHT) and is it Safe? Australasian Menopause Society. https://hub.menopause.org.au/Play?pId=abcfd021-8dd0-49d2-aa7d-91e783ef8b4c
- Woods, N.F., Mitchell, E.S. The Seattle Midlife Women’s Health Study: a longitudinal prospective study of women during the menopausal transition and early postmenopause. womens midlife health 2, 6 (2016). https://doi.org/10.1186/s40695-016-0019-x
- Vitamin B12. Fact Sheet for Health Professionals. National Institute of Health Office of Dietary Supplements. Available online https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
- Pickering, G., Mazur, A., Trousselard, M., Bienkowski, P., Yaltsewa, N., Amessou, M., Noah, L., & Pouteau, E. (2020). Magnesium Status and Stress: The Vicious Circle Concept Revisited. Nutrients, 12(12), 3672. https://doi.org/10.3390/nu12123672
- Coslov, N., Richardson, M. K., & Woods, N. F. (2024). “Not feeling like myself” in perimenopause – what does it mean? Observations from the Women Living Better survey. Menopause (New York, N.Y.), 31(5), 390–398. https://doi.org/10.1097/GME.0000000000002339
- Feeling tired but wired? Here’s what may be causing it. (2025). UCLA Health. https://www.uclahealth.org/news/article/feeling-tired-wired-heres-what-might-be-causing-it
- What is Menopausal Hormone Therapy (MHT) and is it Safe? Australasian Menopause Society. https://hub.menopause.org.au/Play?pId=abcfd021-8dd0-49d2-aa7d-91e783ef8b4c
- Woods, N.F., Mitchell, E.S. The Seattle Midlife Women’s Health Study: a longitudinal prospective study of women during the menopausal transition and early postmenopause. womens midlife health 2, 6 (2016). https://doi.org/10.1186/s40695-016-0019-x
- Vitamin B12. Fact Sheet for Health Professionals. National Institute of Health Office of Dietary Supplements. Available online https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
- Pickering, G., Mazur, A., Trousselard, M., Bienkowski, P., Yaltsewa, N., Amessou, M., Noah, L., & Pouteau, E. (2020). Magnesium Status and Stress: The Vicious Circle Concept Revisited. Nutrients, 12(12), 3672. https://doi.org/10.3390/nu12123672
- Coslov, N., Richardson, M. K., & Woods, N. F. (2024). “Not feeling like myself” in perimenopause – what does it mean? Observations from the Women Living Better survey. Menopause (New York, N.Y.), 31(5), 390–398. https://doi.org/10.1097/GME.0000000000002339
