What causes menopause fatigue and what can you do about it?

Changing levels of reproductive hormones during menopause have been linked to both physical and mental fatigue. They can have a knock-on effect on other hormones and can contribute to worse sleep quality, reduced blood sugar control and vitamin or mineral deficiencies, all of which can leave you feeling tired.

Women’s experiences of menopause fatigue can vary widely, from a general feeling of low energy to sudden ‘crashing fatigue’ or brain fog.

There are a number of things that may improve your menopause fatigue and tiredness, from changing your diet and getting regular exercise to taking vitamins and other supplements.

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Sometimes, fatigue can be a sign of an illness. If it continues, or if you have other symptoms, you should talk to your doctor.

Can menopause make you tired?

Menopause is the point 12 months after your last period, when your levels of reproductive hormones like oestrogen and progesterone reach a permanent low. Perimenopause is the years leading up to it, when your hormones are in a state of flux.

Many factors can contribute to tiredness and fatigue but if you’re going through perimenopause, or have reached menopause, and have recently begun to experience these symptoms, there’s a good chance there’s a connection.

One study found that while almost 20% of premenopausal women reported periods of physical and mental exhaustion, this rose to over 46% during perimenopause and 85% after menopause.

Although getting older may be a factor in this, women tend to have a good sense of whether their symptoms are the result of gradual aging or something more immediate.

In a large workplace survey, increased tiredness and difficulty concentrating were the most common problems for perimenopausal women, who identified them as menopause symptoms.

What causes menopause fatigue?

During perimenopause, your levels of reproductive hormones such as oestrogen and progesterone begin to fluctuate, dropping permanently as you head towards menopause.

These changes are involved in many perimenopause and menopause symptoms and, together with lifestyle factors, there are number of ways they may contribute to fatigue and tiredness:

• Cortisol changes: Oestrogen has a complex relationship with the stress hormone cortisol, and changing levels can cause it to rise or fall depending on the circumstances. Low cortisol can lead to fatigue but long periods of high cortisol can tire you out too.
• Poor blood sugar control: Oestrogen also helps your body to respond to insulin, the hormone that keeps your blood sugar levels stable. As oestrogen levels fall, your blood sugar control can worsen, increasing the risk of ‘crashes’ after you eat certain types of food. If you regularly experience post-meal energy slumps, see our tips below on improving your diet.
• Poor sleep: Of course, not getting enough sleep is another potential cause of fatigue. Low oestrogen, and changing levels of progesterone, have been linked to an increased risk of insomnia. Other menopause symptoms like night sweats, anxiety and muscle pain or joint pain can also interrupt your sleep.
• Brain fog: If your fatigue feels more mental than physical, oestrogen could be involved here, too. It’s important for healthy brain function and cognitive abilities, which is why many women experience menopause ‘brain fog’, where they struggle with thinking, memory and concentration.
• Increased responsibilities: For some women, the timing of perimenopause and menopause can also coincide with increased life responsibilities. You may be looking after children, as well as older parents, and working at the same time. Together with hormone changes, it’s no surprise if you’re feeling exhausted.

Other causes of fatigue

It’s important to be aware that fatigue and extreme tiredness can also be symptoms of illnesses, including:

• Sleep apnoea: This is when your breathing stops and starts while you sleep. You may snore loudly and make gasping, snorting or choking sounds. It’s important to treat sleep apnoea to stop it leading to more serious problems.
• Iron deficiency anaemia: One of the causes of this kind of low iron is heavy periods, which can be a symptom of perimenopause. Along with fatigue, you may experience shortness of breath and heart palpitations and your skin may be paler than usual.
• Diabetes: If you have extreme tiredness, regularly feel very thirsty, need to pee a lot – especially at night – and have lost weight, you may have diabetes.
• Hyperthyroidism: Constant tiredness, irritability, nervousness or anxiety, muscle weakness and struggling to keep still are signs of an overactive thyroid gland.
• Chronic fatigue syndrome (CFS): If you’ve had extreme fatigue for 3 months, as well as flu-like symptoms and brain fog, it could be CFS, also known as myalgic encephalomyelitis (ME).

If you think you may have any of these illnesses, it’s important to see a doctor as soon as possible.

What does menopause fatigue feel like?

As with many menopause symptoms, fatigue can come in different forms.

You may have generally less energy than usual, needing more breaks from everyday tasks and recovering less quickly from exercise.

For some women, menopause fatigue is a near-constant feeling of being drained of energy and motivation.

Others experience ‘crashing fatigue’ – sudden intense exhaustion that may include muscle weakness.

Menopause fatigue can be mental as well as physical, involving brain fog symptoms, including short-term memory problems and trouble concentrating and thinking properly.

Dietary changes to improve menopause fatigue

Foods high in refined carbohydrates or sugar release glucose into your bloodstream quickly. This can lead to blood sugar spikes, followed by energy-sapping crashes. Low levels of oestrogen can reduce your sensitivity to insulin and make it harder to control these fluctuations.

If you’re experiencing regular mid-morning or mid-afternoon slumps, try making some healthy swaps that will deliver energy more slowly and help keep your blood sugar stable:

• Breakfast: Switch processed breakfast cereals or white toast for options higher in protein, healthy fats and fibre, like eggs and avocado, or yoghurt with nuts and berries.
• Lunch and dinner: Swap bread, rice or pasta for higher-fibre wholegrains, vegetables and beans, with some healthy protein, like tofu, fish or chicken.
• Snacks and drinks: Snack on fruit, nuts or 70%+-cocoa chocolate rather than cakes and biscuits. Try to avoid sugary drinks and fruit juices.

As we’ll see in the next section, certain vitamin and mineral deficiencies can also cause fatigue, so it’s a good idea to include a range of the foods listed below in your diet.

Vitamins and supplements for menopause fatigue

Not getting enough of certain vitamins and minerals can contribute to tiredness and fatigue, including when it’s caused by the stresses of the menopause transition.

For this section, we’ve looked at studies that have used supplements to improve symptoms. However, it’s a good idea to get your vitamins from whole foods where possible, especially plant options, which also contain a range of other nutrients that are great for your health.

Vitamin B12

B12 (cobalamin) is one of several B vitamins involved in producing energy in your cells.

B12 deficiency is more common as you get older and can lead to anaemia, reduced energy, fatigue and shortness of breath, making physical activity harder. Research has shown that taking B12 supplements can significantly improve these symptoms.

Plant foods don’t naturally contain vitamin B12 but you can get it from these animal products:

• fish
• meat
• poultry
• eggs
• dairy products

Vitamin C

Observational studies have found that people with low blood levels of vitamin C have worse general health and less energy compared to those with higher levels.

There’s good evidence that taking daily vitamin C supplements can improve fatigue over short periods. However, many of these studies used doses much higher than the recommended daily amount.

Alternatively, you can get vitamin C from a wide range of fruits and vegetables, including:

• citrus fruits
• berries, especially strawberries and blackcurrants
• peppers
• green vegetables like broccoli and Brussels sprouts

Iron

If you have heavy periods during perimenopause, it could lead to iron deficiency, which can cause tiredness, lack of energy and shortness of breath.

A review of studies involving premenopausal women with iron deficiency found that taking iron supplements decreased their feelings of fatigue by over 60%, although it didn’t improve measures of physical fitness.

Food sources of iron include:

• red meat and offal
• fish
• poultry
• pulses and legumes, like beans and lentils
• dark green vegetables, such as spinach, kale and broccoli
• nuts and seeds

Probiotics

Probiotics are friendly bacteria that can have beneficial effects all around your body by improving the balance of your gut microbiome.

Certain strains of probiotics have been shown in studies to help with poor sleep quality, night sweats and anxiety, all of which can contribute to tiredness and fatigue.

The Better Gut probiotic supplements contain these strains, along with others that target a wider range of menopause symptoms, including:

• brain fog
• anxiety and depression 
• mood swings
• bloating
• vaginal dryness and inflammation 

To take your first step towards a better menopause, visit The Better Gut. And get 10% off your first order here.

The role of regular exercise

Along with its many other health benefits, regular exercise can help to boost your energy levels and mood, and improve your sleep.

One large observational study found that women who did only small amounts of physical activity were significantly more likely to have a range of menopause symptoms, including fatigue.

If you don’t currently do much exercise, start slowly and build up gradually. Aim to reach at least 150 minutes of moderate physical activity or 75 minutes of vigorous exercise each week, split over several days.

Try to do a range of different exercises, including cardio (such as brisk walking, swimming or aerobics), strength work (weight training, bodyweight exercises or using resistance bands) and activities that involve stretching and balance, such as yoga and Pilates.

In a study published by the Menopause Society, postmenopausal women who followed these recommendations significantly improved their energy levels.

Improving your sleep routine

Trouble sleeping is a common feature of perimenopause and menopause, often partly due to other symptoms, like night sweats, anxiety or pain. It goes without saying that poor sleep can be a major contributor to tiredness and fatigue.

Although improving your sleep is not necessarily straightforward, there are some changes you can make to your routine that could help:

• Go to bed, and get up, at the same time each day
• Avoid caffeine after lunch and limit alcohol before bed
• Ditch your phone or other devices an hour before bed
• Instead, do things that help you relax, like having a bath, meditating or reading
• Keep your room cool, around 18 degrees C
• If you get night sweats, wear light clothing and keep cold water and a fan by your bed

Staying hydrated

Oestrogen helps to regulate your fluid levels, keeping your cells hydrated. As oestrogen drops during menopause, your body finds it harder to hold onto fluid and you may become dehydrated. This can lead to fatigue and dizziness. Excessive sweating due to hot flashes or night sweats can make things worse.

As you get older, you become less sensitive to your body’s thirst signals, so it’s important to make a conscious effort to take on enough liquid.

The NHS recommends 6 to 8 cups of water a day, but if it’s hot or you’ve been sweating, you may need more.

Other drinks like tea and coffee can also help you stay hydrated, as can foods containing lots of water, like fruits and salad vegetables.

How long does menopause fatigue last?

The hormonal changes that happen during the menopause transition are complex and may contribute to symptoms like fatigue and tiredness in different ways.

If you’re experiencing fatigue during perimenopause, when your hormones are fluctuating, it’s possible that your symptoms could improve as you get closer to menopause and things start to stabilise. Perimenopause typically lasts for around 4 to 8 years.

On the other hand, if reduced levels of oestrogen are the main problem, your fatigue may continue into menopause, when hormones settle at a permanent low.

The good news is that, as we’ve seen, there are steps you can take to improve your symptoms, including lifestyle changes that could benefit your overall health.

Does HRT help with fatigue?

Hormone replacement therapy (HRT) replaces reproductive hormones like oestrogen and progesterone lost during the menopause transition. You can take it in the form of pills and tablets or through your skin via gels and patches.  

HRT can help with a range of perimenopause and menopause symptoms. When it comes to menopause fatigue, your doctor will talk to you about which is the right treatment for you.

This is important because, while some forms of HRT have been shown to help with fatigue, others may actually cause it as a side effect.

Summary

Increased fatigue and tiredness are common in both perimenopause and after menopause, with changing levels of reproductive hormones such as oestrogen likely to be involved.

This can lead to worse blood sugar control and reduced sleep quality, which can both contribute to fatigue.

Symptoms can range from general low energy to sudden intense exhaustion, and may also include mental fatigue.

Changes you can make that could help with menopause fatigue include:

• Swapping refined carbohydrates and sugar for healthier whole-food options
• Taking regular exercise
• Making sure you’re getting enough vitamin B12, vitamin C and iron
• Improving your bedtime routine
• Staying hydrated

The Better Gut probiotic supplements could also improve menopause symptoms that contribute to fatigue, including poor sleep, night sweats, anxiety and brain fog.

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