Perimenopause Fatigue – Why You’re So Tired and What You Can Do About It

ByBob Burns

Updated March 24, 2025

What Is Perimenopause Fatigue, Exactly?

Perimenopause is the time leading up to menopause when your ovaries start producing less estrogen and progesterone. It can last anywhere from a few years to a full decade. For most women, it begins in the late 30s or 40s, though symptoms often intensify in your 40s and early 50s.

Common symptoms include:

• Irregular periods
• Mood swings or anxiety
• Hot flashes and night sweats
• Vaginal dryness
• Sleep disruptions
• And yes—fatigue

Why Perimenopause Makes You So Tired

Fatigue during perimenopause isn’t “just in your head”—it’s deeply linked to what’s going on hormonally and physically.

Here’s what might be draining your battery:

1. Hormone Fluctuations

Estrogen helps regulate energy, mood, and sleep. When it dips, you may feel sluggish, mentally foggy, or emotionally off. Progesterone—known for its calming, sleep-supportive qualities—also declines, contributing to restlessness and poor-quality sleep.

2. Sleep Disruption

Hot flashes, night sweats, and insomnia can seriously mess with your rest. Even if you’re technically in bed for 8 hours, you might not be getting restorative sleep. And let’s face it—if you’re waking up soaked or restless at 3 a.m., that’s not a recipe for daytime energy.

3. Mood and Mental Load

Anxiety, mood swings, and irritability can creep in thanks to hormonal shifts. For women juggling careers, kids, aging parents, and life stress, this emotional overload adds to the fatigue.

4. Thyroid and Iron Levels

Perimenopause can mask or mimic other issues like low iron or thyroid dysfunction—both of which can cause exhaustion. It’s worth getting lab work done if your fatigue feels intense or persistent.

5. Blood Sugar Imbalances

Hormonal shifts can also mess with insulin sensitivity. If you’re eating lots of refined carbs or skipping meals, your blood sugar may be spiking and crashing—leaving you feeling wiped out.

How to Fight Perimenopausal Fatigue

You don’t have to just “power through.” Here are smart, supportive strategies that can help restore your energy.

Prioritize Sleep (Without Obsessing)

• Aim for a consistent bedtime—even on weekends
• Limit screens an hour before bed
• Keep your bedroom cool and dark
• Try magnesium glycinate or melatonin if needed
• Avoid caffeine after 2 p.m.

Balance Your Hormones Naturally

• Eat plenty of fiber and healthy fats (think avocado, flaxseed, and olive oil)
• Include cruciferous veggies (like broccoli and kale) to support estrogen detox
• Consider hormone-supportive supplements like ashwagandha, maca, or evening primrose oil
• Talk to your doctor about hormone therapy or bioidenticals if symptoms are severe

Move (Even When You’re Tired)

Gentle movement boosts circulation, endorphins, and energy:

• Walk outside for 20–30 minutes
• Try low-impact workouts like yoga, Pilates, or swimming
• Resistance training helps support metabolism and hormone balance

Eat for Steady Energy

• Don’t skip meals (especially breakfast)
• Include protein and healthy fats with every meal
• Avoid excess sugar and alcohol, which can cause crashes
• Stay hydrated—fatigue can be a sign you’re dehydrated

Rule Out Other Causes

If you’ve tried lifestyle changes and still feel exhausted:

• Ask your doctor to check thyroid levels (TSH, Free T3, Free T4)
• Check iron, ferritin, and B12 levels
• Track symptoms to identify patterns

When to Seek Help

Fatigue that interferes with your daily life, mental health, or relationships isn’t something to brush off. If you’re dealing with:

• Intense brain fog
• Depression or anxiety
• Disrupted sleep more than 3–4 nights a week
• Physical symptoms like heart palpitations, dizziness, or unexplained weight changes

…it’s time to talk to a provider. Perimenopause is a real physiological transition, and you deserve care and support.

The Takeaway

If you’re exhausted and in your 30s, 40s, or 50s, perimenopause could be the missing piece of the puzzle. This phase of life brings big hormonal changes—but it also brings a chance to pause, recalibrate, and care for your body in a deeper way.

With the right tools, rest, and support, you can reclaim your energy—and feel like yourself again.