Fatigue is prevalent in today’s 24/7 world. You’re constantly on, juggling work, family, friends, volunteering, and much more. It’s no surprise that your energy levels feel like they’re constantly low. But perimenopause can make it feel like your energy has bottomed out. Some days, it isn’t just “I don’t want to exercise today” tired, it’s “I’m not sure I can get out of bed today” tired.

Feeling fatigued all the time regularly tops the list of symptoms every time we survey women. About 85 percent of women report experiencing exhaustion that isn’t relieved with more sleep. Of those 66 percent said fatigue interfered with their quality of life.

What causes fatigue during menopause?

Like so many symptoms, menopausal fatigue is due in a large part to hormone changes and the downstream effects.

The levels of estrogen and progesterone are changing all at once and these interact with the endocrine hormones associated with energy from the adrenal and thyroid. This instability can be hard for the body and can lead to crushing fatigue.

Your brain has a lot of estrogen receptors, and when estrogen declines, so does some of the regulation that it provides. For example, estrogen helps control cortisol, the stress hormone. When that regulation is weakened, the increased stress response can result in crushing fatigue.

And feeling tired goes hand-in-hand with another common perimenopausal symptom—trouble sleeping. When you’re waking up frequently at night or have trouble falling asleep, it’s little wonder that the next day you feel drained.

How to improve fatigue in menopause

Like so much else in perimenopause, fatigue is likely temporary, but that temporary can be years long. Here are some ways to feel more energized in the meantime.

Get moving. It’s probably the last thing that you want to do, so start with just a simple walk. Being physically active raises your energy levels and helps you sleep better (just don’t do strenuous workouts within a few hours of bedtime). It can also boost the feel-good hormones that may be in short supply at this time. And you don’t have do a body-drenching workout. Yoga and tai chi have been found to help with menopausal fatigue, according to research in the journal Maturitas.

Hydrate. Even low levels of dehydration can leave you feeling drained. “I slam two big glasses of water in the afternoon to fight fatigue,” says Laura Boulay of One Million Women Walking. And then, not surprisingly, she goes for a walk. Water is your best choice for hydrating. In addition, eating more fruits and veggies—many are over 80 percent water—can add some serious fluids along with important nutrients.

Keep your blood sugar levels even. Unfortunately, some of things you might do when you’re feeling exhausted—grabbing a doughnut or sipping a sugary-laden coffee drink—can upset your blood sugar levels and your energy. Refined carbs (white bread, crackers) and sugar cause spikes in blood sugar that result in a burst of energy. But it’s short lived, and you quickly crash, often feeling worse. To keep your blood sugar—and energy—levels on an even keel, eat plenty of whole grains, vegetables, fruit, lean protein, and healthy fat. Aim to have a mix at each meal.  Eating smaller meals more frequently might also help keep your energy up.

Our registered dietitian nutritionists will help create a lifestyle, nutrition, and fitness plan for you and be by your side every step of the way. Sign up for our Integrated Care plan to get the benefits of our RDNs and doctors in one great package.

Rediscover naps. Maybe you haven’t napped since your mom made you, but now might be the time to reinstitute nap time. While you should still take steps to get enough sleep, during this time when a good night’s rest may be elusive, a quick snooze during lunch may be the pick-me-up you need. Research shows that naps can improve your energy and mood and increase alertness and performance.  Just keep them to under 30 minutes so you’ll be less groggy when you wake up.

Get a blood test. A variety of nutrient deficiencies can lead to fatigue or conditions that cause it like anemia (low iron levels). Heavy and/or more frequent periods can put you at risk for anemia. Low levels of  vitamin D, omega 3s, B vitamins, and magnesium can also lead to fatigue.

Check your meds. Some prescription and over-the-counter medications, or combinations of, may be making you tired.

When to see a doctor about fatigue  

There are other issues that could be causing or contributing to your fatigue, such as thyroid problems, autoimmune disorders like arthritis or chronic fatigue syndrome, diabetes, or heart conditions. If fatigue is extreme, a recent onset, or generally disrupting your day-to-day life, check with a doctor to identify and treat all the factors.

We can help you with fatigue in menopause

  • Meet with a Menopause-certified Doctor to understand why you are experiencing fatigue in menopause, and support you with a personalized treatment plan to help you find relief.
  • Vitality is our daily multi-vitamin supplement for women in menopasue. It supports mood, energy, stress response, immune health, joint pain, and inflammation.
  • Magnesium is our super-power. It can help you relax, supports better sleep and calms anxiety.


The information on the Gennev site is never meant to replace the care of a qualified medical professional.  Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev's telemedicine doctors before beginning any new treatment or therapy.


Shannon Perry

June 3, 2021
Director of Programming & Media

Medically Reviewed By

Dr. Cynthia Netherton

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