Feeling Tired? What Is Perimenopause Fatigue and How to Treat It

3 minute read

By: Alloy Staff|Last updated: May 11, 2022
Medically reviewed by: Sharon D. Malone

You’re feeling off. You’re tired all the time. Your sleep seems to be interrupted and you wake up exhausted. Even when you do sleep it doesn’t seem like enough, and you find yourself nodding off during the day. You’re more irritable and for some inexplicable reason you are gaining weight. To top it all off, your periods have become irregular and painful or heavy.  

Welcome to the world of perimenopausal fatigue!

The average age for menopause, signified by your not having menstruated for a full year, is 51.  The transitional phase that leads up to menopause, known as perimenopause, can start as early as in your 40s and can last 7-10 years. These symptoms you are experiencing are hallmarks of the perimenopausal stage of life. The good news is that perimenopausal fatigue is completely normal and treatable.  

Alloy can help treat symptoms such as perimenopause fatigue. Take our free assessment and we’ll help you find the solution that will best work for you.

Is Perimenopause Fatigue Normal?

Your feelings of being worn-out, exhausted, and being so tired that you can’t make it through the day are normal. Over 95% of perimenopausal and menopausal women complain of fatigue and dream of getting a more restful night’s sleep.

How Does Perimenopause Make You Feel Tired?

During perimenopause your body’s estrogen and progesterone levels begin to fluctuate. These fluctuations cause symptoms that can lead to perimenopause fatigue:  

  • Disordered sleep or insomnia frequently accompany perimenopause—the lack of sleep leads directly to fatigue.

  • Night sweats make you wake up, and these interruptions in sleep can cause fatigue during the day.

You need a good night’s sleep to avoid fatigue, and perimenopause symptoms interfere with that. 

Hormone Imbalance Causes Perimenopause Symptoms

As your estrogen and progesterone levels fluctuate you begin to experience perimenopause symptoms, including sleep disruption. Estrogen plays a role in the metabolism of various neurotransmitters, including serotonin, and in the actions of the hormone melatonin. These neurotransmitters regulate your brain’s sleep-wake cycles. During perimenopause, this cycle is disrupted and you wake up more frequently during the night.

Night Sweats, Hot Flashes, and Poor Sleep Quality

Along with disordered sleep, night sweats and hot flashes can exacerbate your insomnia. 56% of perimenopausal women report suffering from insomnia, and the more severe a woman’s hot flashes are the more likely she is to complain of insomnia. Your body’s internal thermostat (hypothalamus) has suddenly become more sensitive due to changes in your estrogen levels. Night sweats and hot flashes are the result of this increased sensitivity.  Your body goes into overdrive anytime your brain perceives you as being too warm causing you to sweat and flush in an attempt to cool you down.

Increased Cortisol, Increased Stress

As you enter perimenopause, your cortisol levels naturally increase. Cortisol, also known as the “stress hormone”, plays a vital role in regulating your body’s natural clock, or circadian rhythms.  As your cortisol levels rise, you feel more on edge or stressed, your heart rate increases, and your body temperature rises. All of these changes interfere with your ability to sleep soundly. 

Fatigue Is Not Always Caused By Perimenopause—When to Call Your Doctor

Now that you understand all the ways in which perimenopause and fatigue are connected, it is important to know that there are times when fatigue is not caused by perimenopause and may be caused by a more serious underlying condition. 

Fatigue is connected to mental health conditions, such as depression, anxiety, and ADHD. In addition, infections, autoimmune problems, and heart and lung conditions can all lead to fatigue. If your fatigue is accompanied by any of the following symptoms, be sure to talk to your doctor:

  • Shortness of breath 

  • Pain in your chest, arm, or upper back

  • Irregular, fast, or pounding heartbeats

  • Muscle weakness, tiredness in your legs or arms

  • Thoughts of harming yourself or others

  • Abdominal bloating or pain, nausea, vomiting

  • Skin rash

  • Vision changes

  • Persistent headaches

What Helps Treat Perimenopause Fatigue?

You may feel as if perimenopause fatigue is disrupting your life. The good news is there are several steps women can take to alleviate symptoms and increase their energy levels.

Menopause Hormone Therapy Reduces Perimenopause Fatigue

Supplementing your body’s natural hormones with menopause hormone therapy (MHT) is one of the most efficient and effective ways to treat menopause symptoms, including perimenopausal fatigue. MHT has been shown to result in less fragmented sleep and a reduction in arousal and wakefulness during sleep. 

Avoid Spicy Foods that Can Trigger Hot Flashes

You can help to keep hot flashes and night sweats at bay by avoiding spicy foods, limiting caffeine and alcohol, dressing in easy-to-remove layers, and turning the temperature down in your bedroom at night. 

Exercise Helps Treat Perimenopause Fatigue

Your perimenopause fatigue may have you so worn out that you cannot even think of taking a run, going for a walk, or climbing on your exercise bike. You may even think that given how tired you feel you should lay off any strenuous activity. 

Research actually shows that exercise helps treat perimenopause fatigue. Engaging in moderate to vigorous physical activity daily, as recommended by exercise guidelines, has been shown to improve energy levels in women who are going through menopause. 

Sleep Hygiene Can Help With Perimenopause Fatigue

You can help reduce menopause symptoms related to insomnia and mild sleep by practicing good sleep hygiene. Maintaining a regular sleep schedule, avoiding caffeine later in the day, cutting back on alcohol consumption, and avoiding viewing content on electronic devices as you prepare to sleep are all components of good sleep hygiene. 

Alloy Can Treat Your Perimenopause Fatigue 

Perimenopause fatigue can be distressing. We can help you find safe and effective treatment for this and any other perimenopausal symptoms you are experiencing. You don’t have to deal with menopause symptoms on your own—take our free assessment and a menopause-trained doctor will find the right solution for you.


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Written by:

Alloy Staff

Who is Alloy? Alloy exists to help women age healthfully and feel like their best selves. We approach women’s health with radical honesty. We fuse together powerful medical expertise, science backed treatments, and the support of a community that knows how you feel. We don’t just get you - we are you.

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.