Yes, fatigue is a common symptom during perimenopause. Shifting hormone levels—especially changes in estrogen and progesterone—can affect sleep, mood, and energy levels. Many people in their 40s and 50s notice they feel more tired than usual, even if their sleep schedule hasn’t changed.
Hormonal fluctuations can lead to poor sleep quality, increased stress, and disrupted circadian rhythms. Over time, this can contribute to persistent fatigue that feels different from ordinary tiredness.
While this is a normal part of the menopausal transition, it’s not comfortable. Prioritizing your sleep, eating nutrient-rich foods, staying active, and managing your stress could help improve energy levels and get you through the day.
What Happens to Your Hormones During Perimenopause?
During perimenopause, your hormone levels, especially estrogen and progesterone, start to fluctuate. These changes don’t happen in a straight line. Instead, hormone levels can rise and fall unpredictably from one month to the next.
Estrogen, which helps regulate the menstrual cycle and supports functions like sleep and body temperature control, often drops during this phase. Lower estrogen levels can lead to hot flashes, night sweats, irregular periods, and a disrupted sleep cycle.
Progesterone, which has a calming effect on the brain and supports sleep, also declines. This can contribute to mood swings, anxiety, and restlessness, especially at night.
It makes sense that these shifts can affect more than just your reproductive system. They have a significant effect on your energy levels, metabolism, mood, and how well you sleep. Understanding that these changes are hormonal—not just psychological or lifestyle-related—can be helpful when deciding how to manage your symptoms.
Perimenopause and Your Energy Levels
Fatigue is a common symptom during perimenopause, and it’s often linked to hormonal changes, not just aging. As estrogen and progesterone levels shift, they directly affect how your body regulates energy and sleep.
How Hormones Affect Energy and Sleep
Estrogen supports the production of serotonin, a neurotransmitter that helps regulate mood and sleep. When estrogen drops, serotonin can drop too, which may contribute to sleep disruptions, low mood, and daytime tiredness.
Progesterone also plays a role. It has a calming effect on the brain, and lower levels can make it harder to fall or stay asleep. Over time, poor sleep adds up to extreme tiredness you just can't shake.
Can Supplements Help?
Certain supplements may help ease perimenopausal fatigue, especially when used alongside healthy lifestyle habits, which are recommended by Dr. Chiti Parikh.
Common options include B-complex vitamins, magnesium, and vitamin D, which support energy metabolism and nervous system function. Some perimenopausal and menopausal women also find adaptogens like ashwagandha or rhodiola helpful for managing stress and improving sleep.
While supplements aren’t a standalone solution, they can be a useful part of a well-rounded approach. Always check with a healthcare provider before starting any new supplement.
How Do You Know if Your Fatigue is Related to Perimenopause?
Extreme fatigue during perimenopause isn’t just about feeling tired at the end of a long day. It can feel persistent and harder to shake, even after rest. Common signs include:
- Waking up tired, even after a good night’s sleep
- Low energy that lingers throughout the day
- Brain fog or trouble concentrating
- Lower motivation or interest in usual activities
- Muscle aches, headaches, or general heaviness in the body
You may experience other symptoms related to your energy as well. This type of fatigue can be both physical and mental, and it often feels different from ordinary tiredness.
If it starts interfering with your ability to function or enjoy daily life, it’s worth checking in with a healthcare provider to rule out other causes, such as thyroid issues, anemia, or chronic fatigue syndrome.
How Long Does Perimenopause Fatigue Last?
Perimenopause fatigue can begin in the early to mid-40s, often as one of the first noticeable symptoms of shifting hormone levels. It tends to come and go as estrogen and progesterone fluctuate, and can vary in intensity over time.
This phase typically lasts between 4 and 8 years, ending when menopause is reached and you stop having periods.
For many women, energy levels improve once hormones stabilize post-menopause. But for others, this can persist to menopause fatigue and beyond, often due to other sleep issues, stress, or unrelated health conditions.
Can Fatigue Continue After Perimenopause?
Yes, in some cases. While hormonal instability is a primary cause during perimenopause, ongoing fatigue after perimenopause may be linked to other factors like poor sleep, thyroid changes, or iron deficiency.
If fatigue lingers, it’s worth discussing with a healthcare provider to identify and address the underlying cause.
Treatment options include menopausal hormone therapy or non-hormonal approaches , which may help regulate menopausal symptoms like fatigue, hot flashes, and mood changes.
How to Manage Fatigue During Perimenopause
Fatigue during perimenopause is normal, and in most cases, it can be managed. A few key lifestyle adjustments can help improve energy levels and support better sleep.
Improve Your Sleep Quality
Start with your sleep routine. Go to bed and wake up at the same time each day, and aim to keep your bedroom cool, dark, and quiet.
Limiting caffeine, alcohol, and screen time in the hours before bed can also make a noticeable difference to how well you rest at night.
If you find it difficult to fall asleep or stay asleep, gentle relaxation techniques like stretching, deep breathing, or guided meditation can be helpful in winding down.
Support Your Energy Through Nutrition and Hydration
What you eat affects how you feel. A diet that includes a variety of vegetables, fruits, lean proteins, and whole grains can help support steady energy. Mediterranean and plant-based diets are often recommended as good options for perimenopausal women, but check in with a healthcare provider before making any significant dietary changes.
Hydration matters, too. Dehydration can make fatigue worse, so aim for around 8 glasses of water per day. If you need variety, herbal teas or electrolyte-rich drinks like coconut water are good alternatives.
Stay Active
Regular exercise supports perimenopause fatigue by assisting with hormone balance, improving sleep, and boosting mood and energy levels.
Aim for at least 30 minutes of moderate physical activity most days—walking, swimming, and cycling are all good options. Strength training and yoga can also help with muscle strengthening, energy, and stress relief.
Supplements That May Help
Some supplements may support energy and stress resilience during perimenopause. Common options include:
- Magnesium: may support sleep and reduce muscle tension
- Adaptogens: (such as ashwagandha) can help with stress regulation
- B-complex vitamins: support energy metabolism
Talk to your healthcare provider before starting any new supplements, especially if you take other medications or have underlying health conditions.
When to Talk to a Doctor
If your fatigue is ongoing, interferes with your everyday life, or doesn’t improve with lifestyle changes, it’s a good idea to speak with your doctor.
They can evaluate for other possible causes, such as thyroid issues, iron deficiency, or sleep disorders, and may recommend treatments like hormone therapy or other medical interventions.
Fighting Fatigue Through Hormonal Shifts
Fatigue is a common symptom during perimenopause, largely due to shifting hormone levels. But that doesn’t mean it should be dismissed or accepted as inevitable.
When you understand the connection between your hormones and energy, you can start to take real, practical steps toward managing your fatigue and feeling like yourself again.
While making some lifestyle shifts could be an easy solution, you may still experience ongoing fatigue. If this is the case, it’s a good idea to speak with a healthcare provider. They can help you identify the cause and recommend the most effective treatment options based on your unique needs.
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Frequently Asked Questions (FAQ):
What does perimenopause fatigue feel like?
Fatigue during perimenopause often feels like persistent exhaustion that doesn’t improve with sleep. You may feel physically depleted, mentally foggy, or struggle to stay alert and focused throughout the day.
What are the seven stages of perimenopause?
There aren’t formally defined “seven stages” of perimenopause. Instead, it’s a gradual transition that begins when hormone levels start to fluctuate and ends with menopause, marked by 12 consecutive months without a period. Symptoms can ebb and flow throughout this time.
How can I get my energy back during perimenopause?
Supporting your energy levels often starts with the basics: regular movement, a nutrient-dense diet, staying hydrated, managing stress, and getting enough high-quality sleep. If those aren’t enough, a healthcare provider may recommend testing, supplements, or hormone therapy based on your individual needs.
What vitamins are good for perimenopause fatigue?
B-complex vitamins, vitamin D, and magnesium are commonly used to support energy, mood, and sleep during perimenopause. But supplements aren’t one-size-fits-all. It's best to talk with your provider before starting anything new to make sure it’s safe and appropriate for you.
