Menopausal fatigue is no joke. It can take a toll on your quality of life and affect your personal relationships, job, and ability to do daily tasks. Feeling tired is one of the most common symptoms of perimenopause. In a large study published in the journal Menopause, 83 percent of women surveyed reported that they experienced fatigue and exhaustion.

“I am tired all of the time, so much fatigue,” one woman surveyed by ThisIsMenopause wrote. Someone else said, “Feeling very fatigued and I’m not able to do anything.”

Several factors can contribute to fatigue during perimenopause. Understanding the causes can help you manage it and get the right treatment.

Here’s more on why you may be feeling more tired than usual if you’re currently in perimenopause.

Hormonal Changes, Perimenopausal Symptoms, and Fatigue

During perimenopause — the transition into menopause when your menstrual periods permanently stop — your body goes through significant hormonal changes. Levels of estrogen and progesterone go up and down during perimenopause before declining in menopause. Estrogen helps regulate serotonin and dopamine, two chemicals in the brain that help control mood and energy.

Menopausal Sleep Disturbance

Progesterone has mild calming effects on the brain that may help support sleep. A decrease in progesterone during perimenopause is believed to affect sleep quality. It’s one reason menopause is associated with poor sleep.

“The fatigue and sleepless nights are debilitating,” a woman told ThisIsMenopause. Another wrote, “I am not sleeping well. I am fatigued all the time.”

Lower estrogen levels can affect other functions, including the body’s circadian rhythms and the body’s temperature regulation. Circadian rhythms are cycles that occur in the body during each 24-hour period and help control sleep patterns.

“My sleep pattern was messed up. I was always tired, fatigued,” another woman reported. “I couldn’t do things I was used to doing.”

Poor Sleep and Hot Flashes

Thermoregulation is a natural process that helps control body temperature. Body temperature can fluctuate during perimenopause and cause hot flashes and night sweats. Night sweats frequently cause sleep disturbances throughout the night. They’re a common cause of fragmented sleep and daytime sleepiness. Interestingly, many women wake up right before a hot flash happens.

“I get hot flashes. I get fatigued really easily. And I have lost my sex drive,” a woman told ThisIsMenopause.

Higher Cortisol Levels in Perimenopause

At the same time, cortisol, often called the stress hormone, may become unbalanced and rise in the evening. Cortisol can intensify feelings of anxiety and stress that can keep you up at night, leading to sleep problems.

Metabolic Shifts and Fatigue

During perimenopause, there’s a significant risk of weight gain, increased visceral fat (belly fat), and metabolic syndrome. Due to limited studies, researchers don’t yet understand whether these changes occur because of hormonal changes, aging, or other factors. Metabolic syndrome increases the risk of cardiovascular disease and can cause many symptoms, including fatigue.

Women in midlife also have a higher risk of thyroid disorders such as hypothyroidism, which causes metabolism to slow down. A slow metabolism can lead to weight gain, brain fog, and fatigue.

Heavy Menstrual Periods and Feeling Tired

Perimenopause is also associated with irregular menstrual periods that may be heavier than usual. A large study showed that heavy periods or prolonged periods can be a cause of fatigue in perimenopausal women. Heavy menstrual bleeding can lead to a deficiency in iron and iron-deficiency anemia, which is a common cause of fatigue.

Emotional Distress and Fatigue

Mood swings, irritability, anxiety, difficulty concentrating, and depression are some of the symptoms of perimenopause that can affect your mental health. Psychological distress and mental health challenges can cause mental exhaustion that can lead to symptoms such as fatigue, muscle tension, and poor sleep.

Hormonal fluctuations are one cause of emotional symptoms, such as depression, during perimenopause. Other factors that may contribute to these draining symptoms include:

• A history of depression
• Hot flashes and night sweats
• A history of poverty, abuse, or other difficult life events
• Stress from managing physical symptoms such as vaginal or urinary symptoms, low sex drive, and sleep problems

Midlife is often a time of stress and fatigue from life pressures, such as family responsibilities or the demands of work.

Managing Menopausal Fatigue

Menopausal symptoms such as fatigue can be treated. If you’re in perimenopause and suffering from low energy that affects your daily life, it’s important to discuss treatment options with a doctor who has expertise in menopause. Everyone’s experience with perimenopause is unique, and many health professionals advise individualized care that considers your particular symptoms, preferences, and potential risk factors.

An effective treatment plan for menopausal fatigue may include medication, such as hormone replacement therapy, nonhormonal medications, and complementary therapies. Psychotherapy and lifestyle changes may also help improve sleep and energy levels.

Menopause Hormone Therapy

For many, menopause hormone therapy (also called hormone replacement therapy or HRT), which includes estrogen with or without progesterone, can help improve sleep quality and your energy levels. Hormone therapy is often an appropriate treatment option for hot flashes, night sweats, and mood symptoms that frequently contribute to fatigue.

Hormone therapy is not advised for everyone, so be sure to discuss your risk factors with your healthcare providers.

If hormone therapy isn’t appropriate for you, ask your doctor about nonhormonal treatment options for perimenopause symptoms that may be draining your energy.

Psychotherapy

Talk therapy, such as cognitive behavioral therapy (CBT), can help control negative thoughts during perimenopause that may be causing mental exhaustion or poor sleep. CBT can help you with coping strategies to better manage the psychological burdens you may be experiencing with perimenopause.

Your doctor can give you a referral for CBT or another type of mental health counseling if you need help managing emotional symptoms of perimenopause.

Healthy Lifestyle Changes

You can help manage menopausal symptoms and improve your overall well-being by making healthy lifestyle choices. Here are some steps you can take:

• Maintain a healthy weight with a balanced diet and regular exercise and physical activity to help boost your energy.
• Avoid excessive alcohol, which raises your risk of breast cancer and can interfere with quality sleep.
• Quit smoking, which is linked to hot flashes.
• Adopt healthy sleep hygiene to improve sleep, such as maintaining a consistent sleep schedule, keeping your bedroom at a comfortable temperature, avoiding electronic screens before bedtime, and avoiding caffeine in the late afternoon or evening.

If you need help with a healthy diet or an exercise routine that’s appropriate for you, be sure to ask your healthcare team about a referral to a registered dietitian or physical therapist.

Always get medical advice before trying dietary supplements, which may have unwanted side effects or interfere with medication you’re taking.