Is menopause making you tired?

By the time you hit perimenopause — which usually begins in your mid-40s — you’re probably used to feeling rundown. Your days are packed, your responsibilities feel huge, and the number of balls you’re juggling can feel impossible at times. “People are doing too much: They’re multitasking, they’re working and stressed, they’re managing families and have aging parents,” says Dr. Rebecca C. Thurston, PhD, assistant dean for women’s health research at the University of Pittsburgh School of Medicine. “Women are stretched thin during this time of life in general.”

Throw menopause into the mix, and suddenly that general tiredness can turn into feeling completely wiped out. But it doesn’t have to be that way. Below, experts explain the link between menopause and fatigue and how to refill your tank again.

What is menopause fatigue?

Fatigue doesn’t simply equate to feeling drowsy or worn out after a long day, though these symptoms can be part of the picture. Thurston says her patients often describe feeling “bone tired” during the menopausal transition. It’s deep-seated exhaustion that interferes with their ability to, say, maintain a high level of responsibility at work, keep up with constant demands from family and friends, and prioritize the basics of self-care like eating, exercising, and sleeping regularly.

It feels inevitable, but it doesn’t have to be. “We’ve almost normalized feeling tired all the time. Sometimes we think about it as a badge of honor — a statement of your productivity or worth,” Thurston says. “However, it’s a terrible way to live.”

Signs and symptoms of menopause fatigue

While fatigue can feel different from person to person, experts say there are common signs to keep on your radar during perimenopause and menopause:

• Persistent weariness, tiredness, or lack of energy
• Deep physical or mental exhaustion
• Trouble concentrating or focusing
• Mental fogginess or frequent forgetfulness
• Difficulty with multi-tasking
• Mood fluctuations and irritability
• Reduced motivation

Is menopause fatigue normal?

Feeling slightly less energized at times is par for the course, but you should not assume it’s normal if you can’t get through your day without completely crashing, enjoy time with your friends, and take care of your basic needs and hygiene.

And yet, fatigue tends to be normalized in midlife because it’s one of the most common symptoms of menopause, per a 2018 review of research. The paper cites a study that found about 85% of postmenopausal women and 46% of perimenopausal women reported feeling physically and mentally exhausted compared to about 20% of premenopausal women.

Another 2016 study that explored the prevalence and severity of menopause symptoms in more than 1,000 Chinese women found that fatigue was the most frequently reported symptom (among 76% of participants), topping insomnia, irritability, heart palpitations, and depression.

Causes of menopause fatigue

The menopause transition can last up to 10 years or longer, and along the way, a slew of related symptoms may crop up that can steal your energy. Experts say these are the most common causes of menopause fatigue to be aware of:

Sleep disturbances

Quality sleep can be hard to come by as your body settles into menopause, says Dr. Kathryn Lee, R.N., PhD, professor emerita with a research program in sleep, fatigue, and women’s reproductive health issues at the University of California San Francisco. And when your sleep is persistently thrown out of whack, it’s only natural for fatigue to follow.

A drop in the hormone progesterone can mess with your ability to fall and stay asleep while less estrogen makes it harder for your body to regulate its temperature, Lee explains. And even if that hasn’t turned into full-blown hot flashes yet, research shows you may toss and turn at night simply because you’re too warm. The hormone changes can also make it harder to fall back to sleep if you wake up, possibly due to higher anxiety.

Another risk to keep in mind: During menopause, you have a higher chance of developing sleep apnea — a form of nighttime disordered breathing and a well-known cause of daytime fatigue. Many women gain weight throughout midlife, an average of 1.5 pounds each year throughout their 40s and 50s. While it’s not the only factor, experts suspect this weight gain can lead to a narrowing of the airways and set the stage for sleep apnea, Lee says. (And if the weight gain leads to overweight or obesity, it can make certain physical movements harder and reduce your quality of life — two things that can also increase feelings of fatigue.)

Mood fluctuations

Perimenopause and menopause can set off mood changes. You may be overwhelmed with newfound anxiety or depression, or, if you’re prone to these conditions in general, notice that they feel more intense. And fatigue is a core symptom of depression, in particular, Thurston explains, since it can negatively impact your sleep and tank your motivation to exercise and eat well.

What’s more, stark changes in sleep and mood can also feed into brain fog, which can be exhausting to deal with. “Women are trying to work through fuzzy-headedness, difficulty with multitasking, forgetting why they walked into a room, and trouble with retrieving words,” Thurston says. “When your brain is working that much harder, it’s tiring.”

Heavy menstrual bleeding

Early in the menopausal transition, “women tend to have longer and heavier menstrual blood flow than at any other time in their reproductive lives,” says Dr. Sioban Harlow, PhD, professor emerita of obstetrics and gynecology at the University of Michigan School of Public Health. “Notably, one in three women transitioning through menopause will experience repeated episodes of abnormal uterine bleeding.”

A recent study authored by Harlow, published in the journal Menopause, found that pre- or early menopausal women who experienced heavy menstrual bleeding that occurred at least three times within six months had a 40 percent to 60 percent higher chance of reporting fatigue.

When you bleed a lot or for a prolonged period (more than eight days), you lose more blood and, therefore, iron, a vital mineral that circulates oxygen via a protein in your blood cells. “Excessive bleeding can lead to iron deficiency and iron-deficiency anemia, well-known causes of fatigue,” Harlow says.

How to manage menopause tiredness

Feeling exhausted all the time is no way to spend the next decade (or longer!) — you deserve to feel good. Plus, poor sleep has also been linked to cardiovascular, mental health, and brain health issues, Thurston notes. Here’s how to get a handle on your fatigue:

Prioritize sleep hygiene

If you conk out as soon as your head hits the pillow at night, you’re probably sleep deprived, Lee says. To get back on track, she recommends tweaking your sleep hygiene first: Keep your bedroom dark and cool, wear breathable pajamas, use lighter linens and blankets, avoid staring at your phone or other screens while you’re in bed, and do your best to go to sleep and wake up around the same time each day. You’ll also want to steer clear of that second (or third) cup of coffee in the late afternoon and alcohol too close to bedtime, as both can make it harder to get good rest.

Mind your nutrition

Since your body uses food for energy, it makes sense you need to ensure you’re eating a certain way. First, eat every few hours. Thurston says she often sees patients who go too long between meals, leading to blood sugar dips that cause drowsiness.

As for what to eat, focus on fiber. Women in midlife usually don’t get enough of the nutrient, which can be found in fruits, veggies, and whole grains, Lee says. These complex carbohydrates keep your blood sugar (and, therefore, your energy levels) stable while supporting your heart health and digestion. And while you’re at it, try limiting foods that will spike your blood sugar, like processed snacks, sugary drinks, or fried foods. Those may give you a quick burst of energy, but you’ll then feel a crash. Packing in protein — including lean meats, fish, poultry, legumes, and dairy — can also help you avoid blood sugar crashes and help ward off age-related muscle and bone loss.

Because iron, vitamin D, calcium, and B vitamins are important for your overall health and energy in midlife — and being too low in any of them can trigger fatigue — get screened for potential deficiencies. If it turns out you’re not getting enough of a certain nutrient, talk to your healthcare provider about adjusting your diet or what to look for in a high-quality supplement. (For a more detailed breakdown, check out the Weight Watchers guide on menopause nutrition.)

Exercise regularly

The more exhausted you feel, the harder it is to motivate yourself to exercise, but moving your body gives you a natural energy boost and helps maintain your weight through menopause. Find a moderately intense activity you enjoy and aim to do it for 150 minutes per week (something like a 30-minute walk, five days per week).

Even better is if you can get moving outside, Lee says. “If you’re feeling fatigued in the afternoon, the best thing to do is to get out in the sunlight and take a walk, not take a nap,” she says. The walk itself will perk you up, and getting plenty of light during the day helps regulate melatonin, the hormone involved in your sleep-wake cycle.

Consider mental health support

Midlife can be stressful! If you’re overwhelmed, anxious, or depressed, speaking with a therapist can help you parse through your emotions and give you the tools to manage them, potentially easing fatigue that’s tied to mental or emotional exhaustion. Thurston says some women may benefit from therapy combined with medications like antidepressants, but it should always be tailored to your symptoms and what you’re comfortable with.

Can HRT help with menopause fatigue?

The short answer is maybe. While there’s some evidence that hormone replacement therapy (HRT), also known as menopause hormone therapy (MHT), may help improve sleep disturbances in general, there’s not enough data to say that it alone can squash menopause fatigue. What HRT is helpful for is treating hot flashes — in some cases, it can reduce heat-related symptoms by up to 85 percent. So your doctor may recommend going this route if night sweats are messing with your sleep, according to both Thurston and Lee.

How long does menopause tiredness last?

Menopause symptoms can last for a few years or more than a decade — it’s highly dependent on the individual. Unfortunately, fatigue can last as long as its trigger does, so if hot flashes are wiping you out because they’re tanking your sleep or you’re experiencing heavy menstrual bleeding and losing too much iron, you may feel drained until you explore treatment options with your doctor. The sooner you have the conversation, the closer you’ll be to feeling more like yourself again.