Understanding Menopause and Persistent Fatigue

Feeling weary every now and then is a normal part of life. When we are overworked or overstimulated, we often just need some rest and can bounce back quickly. However, there's a distinct difference between brief tiredness and the kind of ongoing fatigue that doesn’t resolve with sleep. This persistent lethargy drains mental focus, motivation, and overall energy, ultimately affecting one’s emotional, psychological, and daily well-being.

A large number of women report these symptoms during menopause. According to studies, 85.3% of postmenopausal women and 46.5% of perimenopausal women deal with both physical and mental exhaustion, as opposed to only 19.7% of premenopausal women¹. If you’re experiencing this unrelenting fatigue, the suggestions below—or seeking medical advice—could help reduce how long or how intensely symptoms last.

What Does Menopausal Fatigue Involve?

Menopausal fatigue can be described as never-ending exhaustion that doesn’t lift, even if you’ve had enough rest. It's closely associated with reduced estrogen and other shifting hormone levels during this life stage. This depletion of energy and motivation can severely limit everyday activities, with some women finding it crippling enough to interfere with their usual routines².

Why Does Menopause Often Cause Tiredness?

The primary reason for feeling wiped out during menopause revolves around decreasing hormone levels—especially estrogen. These hormones play a key role in regulating metabolism, the body’s process of converting calories into fuel. When these hormones drop, so do energy reserves, leading to pronounced weariness³.

Main Factors Behind Menopause-Related Fatigue

Hormonal Shifts in the Brain

As menopause approaches, erratic hormone fluctuations can cause the brain to prompt frequent nighttime awakenings, resulting in lingering fatigue. Reduced progesterone levels may also make relaxation more difficult, increasing irritability and interfering with restful sleep⁴.

Disturbed Sleep Patterns

Before menopause, hormones like progesterone and estrogen help shield women from certain sleep interruptions, such as sleep apnea—a dangerous disorder where breathing stops and starts repeatedly. With menopause comes lower progesterone production, diminishing this protective effect and heightening the chances of sleep apnea. The associated lack of oxygen can stir you awake multiple times at night⁵.

Additionally, hot flashes and night sweats often disrupt a sound night’s rest. Changes within the brain that trigger these vasomotor symptoms can spontaneously wake the body during sleeping hours.

Life’s Changing Demands

Beyond the physical factors, societal and personal responsibilities can also lead to heightened stress and depleted energy levels. Many women juggle full-time jobs, care for children and elderly parents, and navigate major life shifts, all while experiencing menopause—amplifying fatigue and reducing sleep quality⁶.

How Can Menopausal Fatigue Be Addressed?

Experts suggest a variety of approaches to improve energy and manage fatigue during menopause:

Paying Attention to Nutrition

Eating foods rich in protein (like chicken, eggs, nuts, and yogurt), healthy fats (such as avocados and oily fish), iron (in red meat, leafy greens, and dried fruits), and fiber (in fortified cereals, whole wheat bread, and lentils) can significantly bolster your energy levels⁷.

Staying Active

When you’re exhausted, hitting the gym or going for a jog might feel daunting, but research indicates that moderate-to-vigorous exercise can lift energy. Staying active also supports bone strength and heart health after menopause⁸.

Try choosing physical activities you actually enjoy, so you’ll be more likely to keep doing them—be it a brisk walk over lunch, a dance class, or short yoga sessions. If you don’t find your chosen workout fun or easy to fit in, switch to something else you’ll stick with for the long haul.

Limiting Caffeine and Alcohol

It may seem harmless to rely on coffee or tea when you’re feeling drained. But too much caffeine can disrupt sleep, making daytime tiredness worse. Similarly, while alcohol might help some people nod off, it often reduces the overall quality of sleep and can spark nighttime hot flashes⁹.

Optimizing Sleep Habits

A regular sleep schedule can enhance both how deeply you doze and how alert you feel the next day. Here are a few foundational tips for better sleep⁹:

• Keep a consistent bedtime and wake-up time—even on weekends if possible.
• Steer clear of long naps during the day.
• Avoid electronic devices right before lights-out.
• Wind down with a soothing beverage or a warm bath in the evening.
• Reserve your bedroom for sleep and intimacy only.

Considering Vitamins

Menopausal women have unique nutritional needs,and deficiencies in certain vitamins and minerals (like B vitamins, iron, magnesium, and vitamin D) become more common or impactful at this stage. These nutrients are crucial for energy production, oxygen transport, and muscle and nerve function, so low levels can directly contribute to fatigue and weakness. For example, iron deficiency - even without full anemia - often causes persistent tiredness,and studies show that treating low iron stores in women can reduce fatigue symptoms by over 50%.

 
Likewise, low magnesium or vitamin D (which are more frequent as we age) can worsen fatigue, muscle aches, and bone loss; correcting these deficiencies has been linked to improved energy and quality of life in menopausal women. Therefore, it's wise for women in menopause to have their nutrient levels checked and address any true deficiencies with a skilled clinician’s guidance, since targeted supplementation can ease fatigue and support overall health.¹¹

Could Hormone Therapy Mitigate Menopausal Fatigue?

Hormone therapy is a leading medical option for menopausal symptoms. By restoring hormones that are in decline, it can reduce fatigue and promote more restorative sleep by easing hot flashes—thereby boosting energy levels. You’ll find hormone therapy in oral forms, topical creams or gels, and patches applied to the skin¹⁰.

References

1. The Dynamics of Stress and Fatigue across Menopause: Attractors, Coupling and Resilience
2. Impact of Menopausal Symptoms on Work and Careers: A Cross-Sectional Study
3. Estrogens and the Regulation of Glucose Metabolism
4. Insomnia in Women Approaching Menopause: Beyond Perception
5. Obstructive Sleep Apnea: Women’s Perspective
6. Stressful Life Events During the Perimenopause: Longitudinal Observations from the Seattle Midlife Women’s Health Study
7. Healthy Eating As You Age: Know Your Food Groups
8. Feelings of Energy are Associated with Physical Activity and Sleep Quality, but not Adiposity, in Middle-Aged Postmenopausal Women
9. Sleep Problems and Menopause: What Can I Do?
10. Hormone Replacement Therapy
11. Wylenzek et al., Archives of Gynecology and Obstetrics, 2024

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