Introduction

Are you in your forties and have found you seem to be struggling with fatigue? Fatigue both during perimenopause and after is common. Read on to find out how you can improve your energy levels.

How Common is Fatigue During Perimenopause?

Women reach menopause after 12 months without a menstrual period. This usually occurs between 48 and 52 years old, although anywhere between 45 and 55 is normal. The changes that happen in the time leading up to menopause is called perimenopause. Perimenopause usually begins during your forties.

Perimenopause usually lasts between 4 and 5 years. During perimenopause, gradual hormonal changes occur. There is a reduction in ovulation and changes in the menstrual cycle. Perimenopausal symptoms include fatigue, insomnia, increased premenstrual symptoms, and mood changes. The classic menopause symptoms of hot flushes and night sweats can also occur. Symptoms usually continue for 4 years after menopause, but this may be longer.

Fatigue is a very common symptom that occurs around menopause. Almost half of women experience fatigue during perimenopause. Approximately 80% of women are affected after menopause (The Dynamics of Stress and Fatigue across Menopause: Attractors, Coupling and Resilience – PMC (nih.gov)).

For many women, this fatigue impacts their day-to-day lives. It can be overwhelming. Some have crashing fatigue that comes on suddenly as a wave of exhaustion.

If you suffer from fatigue, then you know how important it is to find ways to improve your energy levels.

Causes of Fatigue During Perimenopause

Several factors can interact to cause fatigue during perimenopause and after.

These include:

  • Insomnia and sleep disturbance
  • Stress and anxiety
  • Hormonal changes

Insomnia and Sleep Disturbance

Many women suffer from sleep disruption around menopause. Psychological causes include stress, anxiety, and depression. Hormonal fluctuations are believed to disrupt sleep. Hot flushes and night sweats can cause you discomfort and make you wake during the night. Lack of sleep makes it harder for you to cope with feelings of stress and anxiety.

Stress and Anxiety

Stress, worry, and feeling anxious can make you feel tense and unable to relax. Being unable to switch off can be exhausting. Worrying, or feeling tense and anxious, can also make it difficult to fall asleep. When stressed or anxious, your levels of the stress hormone cortisol rise. This increase can lead to frequent waking during the night. High cortisol can also worsen hot flushes.

Hormonal Changes

During perimenopause, fluctuating hormones, including oestrogen and progesterone, are thought to cause fatigue (Causes of Fatigue during Menopause | Menopause Now). These changes may affect sleep directly, or by causing hot flushes and night sweats (Perimenopause: From Research to Practice – PMC (nih.gov)).

After menopause, reduced oestrogen causes hot flushes, night sweats, and disrupted sleep (Brice-Ytsma, H. & McDermott, A. (2020). ‘Herbal Medicine in Treating Gynaecological Conditions‘ London: Aeon Books).

What Can Help?

You can see how several factors cause fatigue during perimenopause and after. Adopting lifestyle changes to reduce your fatigue is like peeling the layers of an onion. You need to target each factor involved and include other general changes that help fatigue. Introduce changes one by one and monitor to see which helps you.

Whole meal bread made with whole grain wheat provides complex carbohydrates.

Diet

Ensuring that you are eating well is crucial to dealing with any type of fatigue. Aim to eat healthy, home-cooked, wholesome meals often. Eat at least three times per day. Have protein and complex carbohydrates (wholemeal grains) with each meal. This helps to balance your blood sugars. Minimise refined carbohydrates (white flour products, pastries, white rice) and sugars. These cause your blood sugar levels to spike and fall causing you to feel tired when they drop.

During times of high stress, you will need ample B vitamins and so a B complex supplement can help. Vegans and vegetarians must supplement vitamin B12. 

Many people are low in magnesium. Find in green leafy vegetables, whole grains, pulses, and nuts. Magnesium deficiency can make you feel more anxious and result in poor sleep. 

Vegan and vegetarian diets can also be low in iron, which can cause anaemia resulting in fatigue. Some ladies experience heavy menstrual bleeding, which can result in iron deficiency. 

A multivitamin and mineral supplement can protect against any shortfall.

Phytoestrogens in the diet can help to act as a buffer to the lowering oestrogen levels. The best plant sources are soya and flaxseed. But, all seeds and pulses will contain some of these some of the plant oestrogens. Make sure to include them in your diet. Many fruits and vegetables also contain phytoestrogens. Aim to include at least 5 portions each day to gain several health benefits.

Good gut bacteria are essential for absorbing the phytoestrogens in your diet. Probiotics can be useful in the short term to replenish good bacteria. To maintain a healthy gut bacteria, eat plenty of dietary fibre. Find dietary fibre in fruits, vegetables, and pulses. The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease: Cell Host & Microbe

Hydration & Caffeine

Dehydration is also a common cause of fatigue so make sure you keep yourself well hydrated. Aim to drink at least 1 ½ litres of water per day. Herbal teas can count toward your total fluid intake. Caffeinated drinks, such as coffee and tea, can be a little dehydrating. Besides, caffeine can worsen fatigue, and affect sleep. Try reducing your caffeine intake or even cut it out completely. If you have a high caffeine consumption, then cut it down in stages. This will help you to avoid withdrawal effects.

glass of wine
Alcohol can disrupt both your quality and quantity of sleep.

Alcohol & Smoking

Smoking reduces the amount of oxygen in the body, and this can result in fatigue. Alcohol can harm your liver. Poor liver function is associated with fatigue. Drinking alcohol can also disrupt both your quality and quantity of sleep. High alcohol consumption makes anxiety and tension worse. Stop smoking and minimise your alcohol consumption. Stick to the government alcohol guidelines. Consider reducing further, or stopping altogether, if your sleep is an issue.

Exercise

Regular exercise is crucial to help improve energy levels. If you haven’t exercised for a while, then begin gradually and build up. Aim to get half an hour of aerobic exercise five times a week. Getting enough exercise and eating a healthy diet will help maintain your weight. Being overweight is also associated with feeling tired and lacking energy.

Relaxation

Making sure that you manage any stress and tension is very important. Stress can both cause and worsen fatigue plus disrupt your sleep. Make time in your schedule to build in relaxing activities. Try yoga, listening to music, or walking in nature. Be sure to spend time with family and friends. You can find out more about how to relax in My Absolute Top 5 Easy Ways to Empower You to Beat Stress Naturally

A relaxing bath can help you unwind before bed.

Sleep

You need to get enough sleep (7-9 hours per night) and get good quality sleep. This can be challenging when insomnia is an issue.

Paying attention to sleep hygiene is very important here. Put in place a routine of going to bed and getting up at the same time every day. Before you go to bed have a wind-down routine. Switch off electronic devices and try a relaxing activity such as having a bath or reading a book.

Try to make your bedroom a comfortable and relaxing environment. You need to make sure that the temperature is not too hot or cold, 18 degrees centigrade is ideal. Ensure that your curtains block out the light.

If you can, try to avoid daytime naps. This can be especially difficult. Often fatigue can be particularly bad around mid-afternoon. It is tempting to have a quick nap. Do you ever find yourself so exhausted that you must nap? If so, avoid napping late in the afternoon or in the evening. Try to keep naps only 30 minutes long. Any longer and your nap can affect your nighttime sleep. This can become a vicious cycle.

If you cannot sleep because your mind is overactive see How to Fall Asleep Naturally When Your Mind is Racing

Is it Perimenopause Causing Fatigue?

The factors that we have looked at so far can have causes other than perimenopause. Skipping meals, for example, can result in fatigue from low blood sugars. Stress, anxiety, and depression are not always related to perimenopause.

Insomnia can have many causes.

There are also many causes of fatigue. Never assume that your fatigue is due to perimenopause. Always have new, or recently worsened, fatigue assessed by your GP.

Blood tests are essential to rule out other causes such as anaemia or thyroid problems. Sometimes fatigue can indicate serious disease. Your GP will run tests and check your symptoms to identify the cause.

Summary

Many women struggle with fatigue during perimenopause and after. This may be due to hormonal changes. Stress, anxiety, and insomnia can all be contributing factors. Several lifestyle changes can help to improve fatigue and increase your energy levels.

Never assume that fatigue is due to perimenopause. Other issues may be the cause. See your GP for a correct diagnosis.

Find out more about herbal remedies that can help in Best Herbs to Increase Energy and Overcome Perimenopause Fatigue

Cautions

Consult your Medical Herbalist, GP or pharmacist before using herbs if you:

  • Take any medication
  • Have a medical condition
  • Are pregnant or breastfeeding

If you are struggling with anxiety, depression or stress please seek advice from a medical professional. It is best to not try and deal with these difficulties alone.

If you would like to find out more about a herbal consultation please book your free discovery call here

Disclaimer

This article does not substitute for professional medical advice or treatment

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