Perimenopause fatigue: Symptoms, causes & how to treat

Particularly with perimenopause, the hormonal changes happening in our bodies and the symptoms associated with that change can make it very difficult to get a good night’s sleep, often leading to full-on perimenopause fatigue.

In this article, we’ll go over the specific causes of perimenopause fatigue, what you can expect with fatigue in terms of how it feels, and how long you can expect you to last. We'll also cover what you can do to take control of your health and support better sleep patterns.

Why does perimenopause cause fatigue?

Perimenopause is a time in our lives when we experience the symptoms associated with menopause (hot flashes, irregular periods, brain fog, and yes — fatigue too) but our period hasn’t completely stopped yet. Menopause is reached when you haven’t had your period for 12 months, so perimenopause is the name for this transitional time associated with the physical symptoms and irregular periods leading up to menopause. It can last several years (usually between the ages of 45 and 55) and have a severe impact on daily life, relationships, and work. [2]

Perimenopausal symptoms such as fatigue are likely caused by declining hormone levels, particularly the estrogen hormone. Throughout perimenopause and into menopause, estrogen levels gradually decline in the body. Estrogen has a few functions that contribute to healthy sleep:

• Sleep rhythm: It can help you fall asleep faster, wake up less during the night, and stay asleep longer.
• Brain activity: It influences certain neurotransmitters in the brain including norepinephrine and serotonin, both of which contribute to sleep patterns.
• Temperature regulation: It helps keep your body temperature lower at night.
• Mood regulation: It has an antidepressant effect.

When estrogen starts to decline during perimenopause, all of these factors that contribute to healthy sleep start to diminish, making tiredness and fatigue more likely. [3]

How does perimenopause make you feel tired?

Aside from the estrogen drop, common perimenopausal symptoms such as hot flashes and night sweats can also indirectly disrupt your sleep. Remember how estrogen keeps your body temperature low at night? Without that help, it’s common to experience hot flashes and excess sweating at night during perimenopause. This can wake you up at abnormal times and disrupt your sleep schedule. [3]

What does perimenopause fatigue feel like?

You may be wondering if you’re experiencing full fatigue symptoms associated with menopause or if you’re just not getting a good night’s sleep every now and then. Words like “tired,” “sleepy,” and “fatigue” are often used interchangeably, but fatigue is actually different from normal feelings of sleepiness we all experience now and then.

Fatigue can be thought of as a persistent state of exhaustion and lack of energy that affects your ability to concentrate or participate in everyday activities, usually for multiple days or weeks in a row. It doesn’t seem to go away over time, even with enough rest. [4]

Perimenopausal fatigue specifically may also be associated with hot flashes and night sweats — all of which work together to make it very difficult for you to feel rested. But fatigue can affect you at any point in life. It may even be a side effect of hormonal birth control.

Is it normal to feel so tired during perimenopause?

Yes, up to 47% of perimenopausal women have reported physical and mental exhaustion as a symptom of the transition, and up to 60% report sleep disorders postmenopause. It’s one of the most common (and disruptive) symptoms associated with this time of life, so it’s important to be informed on what’s happening in your body and how you can support yourself during this time. [5]

How long does perimenopause fatigue last?

The good news is that your fatigue may subside after the menopause transition is over, although this may take a few years. It’s also important to note that the fatigue might be caused by something else, in which case it won’t go away until the underlying cause is treated (we’ll get into this more later on). 

But, if your fatigue is caused by the hormonal changes associated with perimenopause, particularly symptoms like hot flashes and night sweats, you can expect it to go away within a few years. [8]

Causes of perimenopause fatigue

As we’ve discussed, the hormone fluctuations associated with perimenopause and the menopausal transition are the main cause of fatigue. However, it’s important to consider other possible causes of sleep disturbances as well. There may be underlying conditions (diagnosed or not) or situational stressors that can affect your sleep. Let’s go through a few common causes of fatigue that may not actually be related to perimenopause: [4]

• Prolonged periods of stress
• Sleep apnea
• Thyroid gland malfunction
• Autoimmune disorders
• Cardiac issues
• Diabetes
• Mental health issues 

Given that you may be in perimenopause while also experiencing one of the above causes, it can be difficult to pinpoint the exact culprit of the fatigue. 

Fun fact: “Tiredness” is the number one symptom logged by users of Natural Cycles app, no matter what stage of life they’re in. Sleepiness can be caused by a wide variety of factors, including perimenopause. It’s important to discuss all potential causes with your healthcare provider to make sure you’re getting the proper attention and treatment for your fatigue. 

Treatments for perimenopause fatigue

Fatigue associated with some of the conditions above should be treated by your healthcare provider, and we always recommend consulting with them before making any large lifestyle changes. However, below we’ve outlined some small, practical shifts you can make in your everyday life that may help alleviate perimenopause fatigue. 

(P.S. While these sleep-specific tips can help you get a better handle on your fatigue, check out these 15 ways to naturally balance your hormones too — integrating some or all of these lifestyle changes can contribute to an overall healthier life).

1. Nutrition

The food we eat and the nutrients we consume have a huge influence on all of our bodily functions, including the sleep cycle and the aging process. A diet that’s high in protein with plenty of vegetables, and low on processed food and added sugar, will contribute to healthier sleep. It’s also best not to eat for about two hours before bedtime to help with digestion, and to eat at regular times each day to support your body’s natural circadian rhythm and metabolism. [9]

2. Hydration

Short sleep duration (6 hours or less) has been associated with inadequate hydration and reduced kidney function. Dehydration can also cause headaches and irritability, which are common perimenopause symptoms. With this in mind, it’s important to be sure that you’re drinking enough water throughout the day, and integrating water-rich foods like cucumbers and watermelon into your diet. [7] 

3. Exercise

Regular exercise has many benefits, including better sleep quality, quicker onset of sleep each night, and less risk for diseases. Even during your period, there are exercises you can do to support your body. Try not to exercise within 90 minutes of going to bed, as that might actually delay sleep onset, but getting about 150 minutes of moderate activity each week should help improve sleep quality overall. [7,11]

4. Routine

Going to bed and waking up at the same time each day may seem like a large feat, but it can do wonders for your sleep quality. If it seems like too much all at once, start by waking up at the same time every day (and see if your body eventually does this without an alarm!). Creating a morning routine that you look forward to can help with this change.  

Once you’ve cleared that hurdle, try aiming for a bedtime that works for you throughout the week (yes, even weekends). You may also want to try a wind-down routine to support this if you’re having trouble committing to the same time each night. Think: reading a book, taking a hot shower, and/or drinking a cup of non-caffeinated tea at the same time each night before bed. [6]

5. Meditation

Part of your wind-down routine may also include meditation. There are free meditations available online or on many phone apps that are specifically designed to help you fall asleep quickly and peacefully. Utilizing these resources can improve your sleep routine and the quality of your sleep. [6]

6. Mindfulness

Besides meditation, there are a few more mindfulness practices you can integrate into your day to reduce stress and thus regulate your hormones and sleep quality. These include yoga (getting out of our heads and grounded back into our body), talking to someone you trust about anything that’s concerning you, and/or journaling.

It’s a bit ironic that these practices are called “mind-full” practices, because they all have the intention of emptying the mind throughout your day, which helps clear the path to peaceful sleep later on. If we’re having trouble falling asleep and our thoughts are keeping us awake, making sure that we have outlets for the things that are on our mind can make a big difference. [6]

7. Your sleep sanctuary

Making sure you have the right sleep environment can also have an impact on your ability to fall and stay asleep. The general guidelines include a quiet, dark, cool room, but some people may need some adjustments like a white noise machine, a night light, or cozy blankets to feel their most comfortable. Try a few different combinations of sleep setups to find your ideal sanctuary where you feel relaxed and at ease. [5] You can also take steps to limit your time spent awake, such as keeping a change of pajamas and a glass of cold water closeby to your bed. [11]

8. Avoid caffeine and alcohol before bed

Stimulants and depressants like caffeine, nicotine, and alcohol are common causes of sleep problems. While it’s common to have at least one of those close to bedtime, it’s best if you can avoid them altogether. Try a decaf coffee or a mocktail if you’re out with loved ones and want to partake while working on your sleep hygiene. [6]

9. Hormone therapy

Hormone therapy, particularly estrogen therapy, has been shown to be an effective treatment for the vasomotor symptoms (hot flashes and night sweats) and mood disorders (depression) associated with perimenopause that may be causing fatigue. It’s also been shown to improve sleep quality, help you fall asleep faster, and decrease nighttime wakefulness. If you’re open to hormone therapy, it can be an effective solution for perimenopause fatigue. [3]

10. Cognitive behavioral therapy 

You may find a therapeutic method like cognitive behavioral therapy (CBT) useful if you find yourself ruminating on certain thoughts or struggling with your mood in addition to your fatigue symptoms. CBT involves the process of reframing unhelpful thoughts with various techniques to  help you cope with life’s challenges in a healthy and effective way, empowering you to take control of your mental health. This can be done either with a therapist or via self-help resources like these from the NHS. [6]

Get to know your body with Natural Cycles

Thanks for reading! Did you know you can use the Natural Cycles app to track symptoms like fatigue, irregular periods? This can help you feel empowered by getting to know your body and its cycles better. Natural Cycles has tools and resources available to support you during your reproductive health journey. See if Natural Cycles is right for you.