Fatigue, or a lack of energy, is a potential symptom of menopause. It can range from mild to severe. In some cases, it can be one of the most difficult symptoms to manage.

Menopause refers to the point at which a person who previously menstruated stops having periods. The transition into menopause is known as perimenopause, which typically begins in someone’s mid-to-late 40s. Fatigue can affect someone before and after menopause.

In a cross-sectional study of 300 women, 85.3% of those in postmenopause reported mental or physical tiredness. By contrast, only 19.7% of women who had not yet entered perimenopause reported this symptom.

In this article, we will look at menopause fatigue in more detail, including its causes, signs and symptoms, and treatments that may help.

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Yes, fatigue is a potential symptom of menopause — it is common across all phases of menopause. However, the cross-sectional study of 300 women found that it was increasingly common in the later phases. Fatigue affected:

  • 19.7% of women not yet in perimenopause
  • 46.5% of women in perimenopause
  • 85.3% of women in postmenopause

A larger study of 1,113 Lebanese women found that fatigue or exhaustion affected 73% of participants at various stages of menopause, making it the most commonly reported symptom.

Fatigue as the direct result of menopause may happen because of the hormonal changes that take place during the transition.

During perimenopause, the ovaries stop producing as much estrogen and progesterone. This can have a knock-on effect on other hormones, such as adrenal and thyroid hormones. These hormones regulate cellular energy in the body. If they are imbalanced, a person may feel fatigued.

Another potential cause for menopause fatigue is lower-quality sleep. Other symptoms of menopause, such as hot flashes and night sweats, can cause a person to wake up frequently during the night. Additionally, insomnia is a potential menopause symptom in itself, which may lead to tiredness in the daytime.

The authors of a 2019 study speculate that societal pressures may also affect women at mid-life, which could contribute to stress and fatigue. Specifically, traditional gender roles mean that many women at this age may be caring for children and continuing to work while going through a significant life change.

There are other potential causes for fatigue that can occur at mid-life, too, such as:

  • sleep apnea, which can lower sleep quality and cause daytime tiredness
  • sleep disorders
  • stress or anxiety
  • certain medications

People with menopause-related fatigue may feel they have less energy than usual. This may need to take more breaks while doing tasks, find activities such as walking upstairs more exerting, or take longer to recover from exercise.

Fatigue can affect people mentally, too. People with mental fatigue can have more difficulty thinking, concentrating, remembering, or making decisions.

However, it is worth noting that the signs of menopause-related fatigue can also be symptoms of physical or mental illnesses. It is a good idea to speak with a doctor so that they can determine if menopause is the likely cause.

The main medical treatment for the symptoms of menopause is hormone therapy. This works by replacing lost hormones, which may result in an improvement in fatigue. It may also help someone get better sleep by reducing hot flashes, which could have a positive effect on energy levels.

Hormone therapy is available in oral tablets, or as topical gels or skin patches that a person wears.

Another potential option is nonhormonal medication, such as selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs). Some types of these drugs can improve hot flashes and night sweats, which may improve sleep for those who wake frequently.

However, each of these options has potential side effects. For some people, SSRIs and SNRIs can cause insomnia rather than making it better. It is important for someone to discuss the pros and cons with a doctor who is knowledgeable on menopause before starting treatment.

A number of lifestyle changes and complementary therapies may help tackle menopause-related fatigue.

Exercise

While exercise may feel difficult during fatigue, some studies suggest it can improve energy levels overall in people going through menopause.

A 2015 study of 74 women in postmenopause found that moderate-to-vigorous physical activity was correlated with feeling more energetic. Exercise is also important for preserving bone density and cardiovascular health after menopause.

Avoiding stimulants and alcohol

It is tempting to rely on stimulants such as caffeine when energy levels are low. However, too much caffeine may disrupt sleep. This may mean a person feels more tired during the day.

Similarly, while alcohol can help people feel drowsy when they are having difficulty sleeping, it lowers sleep quality overall. For some, it is also a hot flash trigger.

Bedtime routine

Having a regular schedule for sleeping and waking can help with getting enough sleep, which may help energy levels. Try to maintain a regular routine by:

  • going to bed and waking up at the same time every day, when possible
  • avoiding naps in the daytime
  • avoiding using screens and devices before bed
  • drinking warm drinks, or taking warm baths or showers, in the evening
  • using the bedroom for sleep or sex only

Mind-body practices

Practices such as yoga and tai chi can provide gentle exercise and also lower stress, both of which may help with energy levels and sleep. A 2019 review notes that previous studies on yoga have found that it can improve fatigue and psychological changes associated with menopause.

However, the results of studies on this have been mixed. The authors state that this is because there are many types of yoga, from gentle to vigorous styles. People may want to try out different styles to see what helps them.

Supplements

No dietary or herbal supplement is proven to reliably help with menopause symptoms. However, a limited amount of evidence suggests that compounds derived from soy may benefit some people.

A 2018 double-blind, randomized controlled trial involving 96 women with fatigue found that high-dose soy lecithin increased feelings of vigor, and also lowered diastolic blood pressure. Larger studies are necessary to confirm that this supplement is effective and safe.

If a person is experiencing fatigue, even if they believe it is related to menopause, they should speak with a doctor. Many conditions can cause fatigue, including some that are serious and require treatment, such as cardiovascular disease.

Fatigue and other menopause changes can also take a toll on mental health. If someone is finding the changes difficult to cope with, or they feel they may have anxiety or depression, they can consider speaking with a therapist with experience treating clients who are going through menopause.

Fatigue is a common experience during perimenopause and postmenopause. It can happen for a variety of reasons, including changing hormone levels and sleep disruption. People may feel physically or mentally tired, or both.

Hormone therapy may help to improve sleep quality and energy levels. Staying active, practicing sleep hygiene, and avoiding stimulants and alcohol can also improve fatigue.

It is important to speak with a doctor about unexplained fatigue, as well as any other symptoms that may be menopause-related. They can confirm if a person is entering menopause, and rule out more serious conditions.