Does Menopause Cause Fatigue?

3 minute read

By: Barbara Brody|Last updated: May 10, 2022
Medically reviewed by: Sharon D. Malone

You knew the hot flashes were coming. Ditto the irregular periods and moodiness. But why are you suddenly so tired all the time? Could your unrelenting fatigue be related to the fact that you’re peri- or postmenopausal?

In a word, maybe. Persistent, chronic fatigue can be a symptom of countless different problems, including anemia, diabetes, cancer, autoimmune disease, and so on. But fatigue is also exceptionally common during the menopausal transition. Some research has found that a whopping 85% of postmenopausal women and 46% of perimenopausal women experience physical and mental exhaustion.

Menopause and fatigue often overlap for several reasons, starting with the fact that going through menopause means you’re getting older, and it’s normal to have a little less energy as you age (though aging alone shouldn’t be wiping you out). Hormone levels also play a role, as they can mess with your rest as well as raise your risk of other health problems that are associated with fatigue.

7 Reasons Menopause Can Cause Fatigue and Weakness

Here are 7 reasons that might explain why you feel extra tired during the menopausal transition and beyond.

Night sweats are interrupting your sleep.

Night sweats are hot flashes that happen while you’re snoozing, and it’s pretty hard to get a good night’s rest when you wake up drenched in the middle of the night. Also problematic is the fact that brain changes that precede a hot flash or night sweat might be prompting you to wake up. In other words, even if you don’t get sweaty enough to warrant changing into clean pajamas, your brain might still be prompting you to open your eyes.

You’re not getting enough REM sleep.

In order to feel well-rested, you need to go through full sleep cycles that include both REM and non-REM sleep. During menopause, however, some women don’t get enough REM sleep, which is the sleep stage during which you have vivid dreams. That can leave you feeling exhausted and irritable during the daytime.

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You have sleep apnea.

Sleep apnea is a common disorder during which you stop breathing for several seconds at a time while you’re asleep. During those gaps you temporarily fail to get enough oxygen, which can lead to major fatigue the next day—not to mention a higher risk of heart attack, stroke, type 2 diabetes, and other serious health problems.

Women can develop sleep apnea at any age, but young women are less likely to have it compared to their male peers. Around menopause, however, that changes, thanks to the hormonal imbalance that coincide with the end of your periods. In fact, research has shown that postmenopausal women are 3 times more likely to have moderate-to-severe sleep apnea compared to younger women. 

If your partner says you often snore loudly — or if you tend to wake up with headaches or dry mouth or you wake up gasping for air — ask your doctor if you should be screened for this problem.

You have restless legs syndrome.

Restless legs syndrome is a sleep and neurological sensory disorder that causes an overwhelming urge to move your legs while you’re at rest. It can strike when you’re sitting in a chair or tucked into bed at night, and it can make it extremely difficult to drift off and peacefully sleep through the night.

Restless legs syndrome becomes more common as people get older. Hormonal changes also seem to play a role, which explains why women have an elevated risk during pregnancy as well as during menopause. Although this problem is not dangerous, it can be extremely uncomfortable; some people report a crawling, throbbing, or electric sensation. And because it can cause sleep disturbance, it can certainly lead to excessive daytime sleepiness and persistent fatigue.

You’re depressed.

Fatigue is a common depression symptom; more than 90 percent of people with depression report experiencing it. Of course, if you’re depressed, you won’t only be tired: Symptoms include feeling sad, empty or hopeless, as well as loss of interest in activities you used to enjoy. People with depression also often feel worthless or guilty and have trouble concentrating; some have frequent thoughts of death or suicide.

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You can develop depression at any age, but hormonal fluctuations make this issue prevalent among menopausal women because estrogen and progesterone influence serotonin, a “feel good” brain chemical. At the same time, midlife stressors — such as caring for aging parents while dealing with teenagers or becoming an empty nester — may also contribute to anxiety and depression in some people.

While everyone has fleeting moments of sadness, don’t ignore a persistently low mood. If you’ve been feeling bluer than normal for more than two weeks, talk to your doctor or a mental health professional.

You’re stressed out.

The same life challenges and hormonal imbalance  that predispose some women to midlife depression might also cause anxiety levels to skyrocket. That might lead to a diagnosable anxiety disorder, or it might simply mean feeling irritated and frazzled most of the time. Either way, stress can take a toll both mentally and physically.

Research has shown that increasing levels of stress during perimenopause often translates to feeling fatigued. What’s more, once you’re exhausted, any additional stress can further sap your energy.

While there’s no way to totally nix stress, you can take steps to handle it better. Shoring up your social ties, getting regular exercise, and practicing relaxation techniques should all help. Also beneficial: figuring out how to get more (or better) sleep.

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Your thyroid is underactive.

Hypothyroidism, a.k.a. an underactive thyroid, is a common autoimmune disorder. Although menopause certainly doesn’t cause hypothyroidism, prevalence of this problem tends to go up around menopause; many women are diagnosed between ages 45 and 55.

Your thyroid controls your metabolism, so if it’s underactive everything slows down a bit. That might lead to constipation, feeling cold, weight gain, hair loss, and — you guessed it — fatigue.

If you have reason to believe that you might have developed a thyroid problem, see your doctor. You can be screened with a simple blood test.

What to Do About Menopause Fatigue

Just as there’s no singular cause of fatigue, there’s no one fix for it. If you’ve been feeling unusually sluggish it’s wise to talk to your doctor and try to ID the root problem and treat it directly. If you’re suffering from depression, for instance, trying out therapy and/or medication might lift your spirits as well as your tiredness. If it turns out you have hypothyroidism, taking thyroid medication (synthetic hormones that replace what your thyroid should be making) may help you feel more energetic.

If the only underlying cause turns out to be menopause-related insomnia, sleep medication might provide some temporary relief, but be sure to discuss their safe use with your doctor before trying them. In other instances, hormone therapy designed to target menopause symptoms might be a better fit. Your doctor should review the pros and cons of these and other options.

Meanwhile, making some lifestyle changes may help. At Alloy we have lots of tips and tactics[JO1]  to share. Need a new doctor to talk to about your menopause fatigue? We can help with that too.


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  11. Lee, Jinju et al. “Sleep Disorders and Menopause.” Journal of menopausal medicine vol. 25,2 (2019): 83-87. doi:10.6118/jmm.19192

  12. Seeman, Mary V. “Why Are Women Prone to Restless Legs Syndrome?.” International journal of environmental research and public health vol. 17,1 368. 6 Jan. 2020, doi:10.3390/ijerph17010368

  13. Ghanean, Helia et al. “Fatigue in Patients with Major Depressive Disorder: Prevalence, Burden and Pharmacological Approaches to Management.” CNS drugs vol. 32,1 (2018): 65-74. doi:10.1007/s40263-018-0490-z

  14. "Can Menopause Cause Depression?". Johns Hopkins Medicine.

  15. Taylor-Swanson, Lisa et al. “The dynamics of stress and fatigue across menopause: attractors, coupling, and resilience.” Menopause (New York, N.Y.) vol. 25,4 (2018): 380-390. doi:10.1097/GME.0000000000001025

  16. "You Think It’s Menopause, But Could It Be Your Thyroid?". Cleveland Clinic. Nov 6, 2019.

  17. "Dealing with the symptoms of menopause". Harvard Health. Mar 21, 2017.


Written by:

Barbara Brody

Barbara Brody is a freelance writer who specializes in health and wellness. Her work has appeared in a variety of outlets including WebMD, Health, and Prevention.

Medically reviewed by:

Sharon D. Malone

Dr. Sharon Malone is among the nation’s leading obstetrician / gynecologists with a focus on the specific health challenges associated with menopause.