Feeling exhausted lately? It could be perimenopause

Feeling more tired than usual, even after a full night’s sleep? For some women, fatigue is an early sign that perimenopause has arrived.

And between the hormonal swings, sleep disruptions (hot flashes, anyone?), and general mental load of daily life, it's easy to understand why your energy levels might be taking a hit.

The good news is, there are things you can do to get your energy back.

So, if extreme tiredness has crept into your life, this article is for you. Read as we break down what perimenopausal fatigue feels like, why it happens, and how to combat it.

What is perimenopause?

Perimenopause marks the first stage of the end of a woman's reproductive years, and it precedes menopause.

It happens as hormones like oestrogen and progesterone start to fluctuate, leading to a range of physical and emotional changes.

Perimenopause typically starts during the mid to late 40s and lasts, on average, 3-4 years, although every woman is different.

Common perimenopausal symptoms include:

• Hot flashes (or hot flushes)
• Irregular periods
• Mood swings
• Brain fog
• Headaches
• Vaginal dryness
• Night sweats and sleep disturbances
• Fatigue
• Weight gain
• Changes in libido
• Breast tenderness

What does perimenopause fatigue feel like?

Perimenopausal fatigue can make you feel sluggish and physically drained, similar to when you're coming down with the flu. It's also a mental fatigue: you may experience brain fog, lethargy, and an overall low mood.

Plus, perimenopausal fatigue can come with other symptoms, like muscle and joint pain, hot flashes, and mood swings.

But the main difference between this and normal tiredness is that perimenopausal fatigue doesn't improve with just a good night's sleep. It often requires a bit more targeted support, which we'll dive into later in the article.

Common signs your tiredness may be hormone-related

Hormonal fluctuations may be behind your low energy if:

• You feel tired even after sleeping for 7-8 hours
• You have a hard time falling or staying asleep, and usually wake up feeling groggy
• You struggle to concentrate and/or find yourself forgetting things more often
• Your moods fluctuate, and you feel more irritable or anxious than usual
• You're also noticing physical symptoms, particularly changes in your menstrual cycle, unexplained weight gain, low libido, or hair thinning/loss

If you suspect your tiredness is a sign that perimenopause might be around the corner, a doctor can help you get answers and start taking steps to feel more like yourself again.

Is perimenopause fatigue normal?

Yes, it's completely normal to feel more fatigued during perimenopause (and menopause):

• In one Chinese study over 1,220 peri- and postmenopausal women, around 76% reported fatigue as a symptom [1].
• In a smaller study of 220 perimenopausal women, 64% experienced what the authors referred to as "fatigue syndrome" [2]. Interestingly, this was strongly linked with a sedentary lifestyle.
• Another US cross-sectional study of 499 women aged 45-54 found fatigue to be among the most prevalent symptoms in early perimenopause, affecting 69% of the participants [3].

But just because it's normal, that doesn't mean you have to live with it. There are lifestyle changes and treatment options you can follow to restore your energy levels.

What is the link between perimenopause and fatigue?

The main culprit behind extreme tiredness (and other perimenopause and menopause symptoms) is hormonal changes. But there's a bit more to why you may feel so drained.

Hormonal fluctuations

As you enter perimenopause, your oestrogen and progesterone levels start to drop.

Both of these hormones play a role in regulating your circadian rhythm—your body's internal clock, which controls the natural cycles of alertness and sleepiness [4][5]. In other words, it's what tells your body when it's time to sleep and when it's time to wake up.

These hormones also influence the production of melatonin, a hormone that your brain releases during the night to help control how and when you sleep.

When oestrogen and progesterone decline, they lose some of their ability to support these sleep-regulating processes.

The result? Difficulty falling or staying asleep, fragmented sleep patterns, and that lingering fatigue so many perimenopausal (and menopausal) women experience.

Sleep disruptions

There are a few ways sleep disturbances are contributing to your exhaustion. One we've already covered: your hormone levels swing, so your body's internal clock gets disrupted.

On top of this, the hot flashes and night sweats that are characteristic of perimenopause make it harder to sleep uninterrupted.

And, the mental symptoms of perimenopause can also play a role. When you feel more anxious or stressed, your sleep quality takes a hit, since it's hard to fully switch off and rest.

Physical changes like weight gain or increased body fat can also lead to issues like sleep apnoea, which further disrupts your sleep and adds to daytime fatigue.

How long does perimenopause fatigue last?

There isn't one set answer to how long fatigue during perimenopause lasts, because every woman’s journey is different.

Some may not feel particularly fatigued, while others may do so for the entire duration of the perimenopause transition.

That said, the fatigue and sleep problems tend to peak in the last few years before your final period. About a year after you reach menopause, as your hormones stabilise, you may notice these symptoms start to subside [6].

How to manage perimenopausal fatigue

We've mentioned a few times that there are things you can do to ease perimenopause (and menopause) fatigue. These can be as simple as improving your diet or, in more severe cases, turning to medical treatments.

Lifestyle and diet changes that can help

Making simple lifestyle tweaks can be a powerful way to support your body through this life stage:

Improve your sleep hygiene

If you don't have a consistent sleep schedule, it's time to create one. Going to bed and waking up at the same time helps your body regulate its internal clock and improve sleep quality.

Other habits worth adding to your sleep routine include:

• Making your room dark, quiet and cool at night
• Swapping stimulants like nicotine and screen time with relaxing activities like reading or light stretching
• Avoiding large meals and coffee in the afternoon and evening (if you're hungry, opt for a light, healthy snack)

Exercise regularly

Research has hinted at a link between sedentary behaviour and extreme fatigue.

Doing regular exercise, whether running, strength training, or Pilates, helps by releasing "feel-good" hormones that boost energy and reduce stress that contributes to fatigue.

It also supports muscle mass, helping maintain strength, mobility, and overall metabolic health—all factors that can influence energy levels.

Eat a balanced, nutrient-rich diet

The link between what you eat and how fatigued you feel may not be evident at first, but the reality is that your diet can make a big difference in how you experience perimenopause fatigue—and perimenopause symptoms in general.

Focus on:

• Whole foods, including plenty of fruit, vegetables, and whole grains
• Lean proteins like chicken, fish, eggs, tofu, and legumes
• Healthy fats like olive oil, seeds, and avocado

Also, make sure you're getting enough calcium and iron, as all these play a role in energy production, hormone regulation, and metabolic health.

It's also worth eating melatonin-rich foods like tart cherries, pistachios, grapes, eggs, and oats, all of which have sleep-promoting properties.

At the same time, go easy on the caffeine and alcohol, which can mess with your sleep, as well as processed foods, added sugars, and refined carbs that often trigger energy crashes.

Manage stress more effectively

Adopting stress management strategies can be helpful, especially if the reason behind your poor sleep quality is heightened anxiety or a racing mind at night.

A few ideas include meditating, deep breathing, spending time in nature, journaling, or picking up a creative habit—whatever makes you feel calmer and more relaxed.

Medical treatment options

If adopting new habits isn't quite enough on its own, there are treatment options you can explore with the guidance of a doctor:

• Hormone replacement therapy. Now referred to as menopausal hormone therapy, this treatment helps alleviate symptoms of menopause—including increased fatigue—by replenishing the lower levels of oestrogen and progesterone [7].
• Cognitive behavioural therapy, or CBT. This is a type of talk therapy that helps you spot unhelpful thinking patterns and reframe them into more balanced, realistic ones [8].
• CBT-I, in particular, is designed to treat insomnia. One CBT-I study in perimenopausal and postmenopausal women found that it can significantly improve fatigue, with women reporting less daytime tiredness and higher energy levels [9].
• Non-hormonal medications. Sometimes used to alleviate hot flashes and improve sleep quality [10].
• Alternative therapies. Some studies suggest acupuncture may reduce hot flashes, though evidence is mixed [11]. Some women also try herbal supplements like St John's Wort or black cohosh for managing menopausal symptoms, but again, research is limited [10].

When to see your doctor about fatigue

It might be time to book a doctor's appointment if:

• Perimenopausal fatigue is severely impacting your daily life
• It's accompanied by other symptoms like fever, persistent pain, or unintentional weight loss
• You're worried about a potential underlying health condition

They can help diagnose exactly what's making you feel so exhausted and discuss treatment options, so you can start feeling more like yourself again.

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