Low Energy and Fatigue in Perimenopause?

But here’s the good news: you can take control. By understanding what’s really draining your energy, you can navigate perimenopause with confidence, vitality, and a renewed sense of self.

Understanding Perimenopause Fatigue

Fatigue is one of the most common struggles during perimenopause, and we’re here to support you through it. We’ve built a community to help you navigate this time with strength, and we want you to know that with the knowledge and right support, you can get back to feeling energized. Let’s dive into what could be draining your energy and how you can start feeling better.

Here are four key culprits that could be draining your energy during perimenopause:

1. Hormonal Fluctuations and Sleep Disorders

Ever wake up in the middle of the night and feel like your body just won’t let you rest? Studies show that 40–69% of women experience sleep disturbances during the menopause transition.

Unlike regular insomnia, the issue isn’t falling asleep—it’s staying asleep. Those frequent wake-ups, followed by the struggle to get back to sleep, could be the reason you feel drained and completely wiped out throughout the day.

Sleep issues during perimenopause often result from various menopausal symptoms, like hot flashes that interrupt sleep, frequent urination (nocturia), restless leg syndrome (RLS), and sleep apnea.

What’s behind all this?

Fluctuating estrogen and progesterone levels. Estrogen plays a big role in keeping your sleep cycle on track, and when those hormone levels start bouncing around during perimenopause, your body’s internal clock can get thrown off.

And it doesn’t stop there—melatonin, the hormone that helps you sleep, decreases with age, which adds to the sleeplessness for many women in their 40s and beyond. (2)

2. The Connection Between Depression, Anxiety and Low Energy

It’s well documented that lower estrogen levels are linked to symptoms of depression and anxiety. Women between the ages of 40 and 55 are at a higher risk of experiencing depressive and anxiety symptoms than at any other time in life. Even if depression and anxiety were never challenges for you before, they can appear during perimenopause. (3)

Why? Estrogen plays a big role in producing serotonin, the “happy chemical” that helps regulate your mood. So, as estrogen levels drop, it can trigger feelings of anxiety or depression. While these feelings might not directly cause low energy, they’re often tied to a lack of motivation and those sleepless nights that leave you feeling completely drained.

That’s why any good menopause assessment should include questions about your mental health and well-being. Addressing these challenges can make a huge difference in your energy levels and overall sense of well-being, helping you feel more like yourself again.

3. Reduced Energy and Metabolism Changes

As we move into perimenopause, it’s not just our hormones that shift—our metabolism slows down too, which can leave us feeling more sluggish than usual. On top of that, our bodies start having a harder time absorbing essential nutrients like iron, B vitamins, and even creatine, which play a key role in keeping our energy levels up.

When these nutrient levels drop, you might start noticing symptoms like fatigue, brain fog, and just feeling “off.” Research has shown that low levels of creatine, in particular, can contribute to those frustrating menopausal symptoms like mental cloudiness and lack of energy (4, 5).

4. Iron Deficiency Due to Heavy Menstrual Bleeding

If your periods have become heavier as you approach perimenopause, you might be losing more iron than your body can replace. Over time, this can lead to iron deficiency anemia, which leaves you feeling constantly fatigued, weak, or even dizzy. Without enough iron, your body can’t produce the red blood cells needed to carry oxygen to your tissues, causing you to feel exhausted all the time.

The Ontario government recently set new guidelines for identifying iron deficiency, which should help many women who were previously missed. If you’ve got heavy flow and feel wiped out, it’s worth discussing your iron levels with your healthcare provider—this could be a game-changer for your energy levels.

Six Solid Options to Regain Your Strength and Vitality During Perimenopause:

If you’re feeling like your energy levels have taken a nosedive during perimenopause, don’t worry—you’re not stuck there! Here are sanoMidLife’s clinical team’s top tips to help you feel more energized and vibrant:

1. Cutting Back on Alcohol and Staying Hydrated

While there are many factors that contribute to feeling drained, alcohol can actually make things worse. Even though a glass of wine might seem like a good way to unwind, alcohol can disrupt your sleep patterns and make it harder for your body to stay rested. It can also dehydrate you and interfere with your body’s ability to regulate hormones, leading to increased fatigue.

By cutting back or abstaining from alcohol, you may notice an improvement in your energy levels and overall well-being. Prioritizing good sleep, staying hydrated, and reducing alcohol are steps that can make a big difference in managing fatigue during perimenopause.

2. Sleep hygiene

Establishing a consistent sleep routine is key to getting a good night’s rest. This means going to bed at the same time each night and getting up at the same time each morning. Having a quiet, dark, and cool bedroom helps contribute to a calming sleep-inducing environment. Cutting alcohol, caffeine and even nicotine well ahead of bedtime is crucial to avoid the stimulating effects of these substances. Sleep hygiene practices also encourage you to stop the naps and keep sleep for nighttime only. There are many practices to try with sleep hygiene. Start with 1 or 2 and work yourself into a steady routine. (6)

3. Meditation

Meditation has been shown to have a positive effect for sleep for women in the perimenopause transition along with good sleep hygiene practices. Meditation can come in many forms from silent to guided meditation. There are various apps like Headspace and Calm that provide different meditations that range in time and length. (7)

4. Address Iron Deficiency With Iron-Rich Foods

If heavy periods are contributing to iron deficiency and draining your energy, a simple yet effective solution is to incorporate more iron-rich foods into your diet. Iron from food is more easily absorbed by your body, especially when paired with vitamin C.

Here are some great sources of iron to add to your meals:

• Red meat (like beef and lamb)
• Poultry (chicken or turkey)
• Leafy greens (like spinach, kale, and Swiss chard)
• Legumes (lentils, chickpeas, and beans)
• Pumpkin seeds
• Fortified cereals

Pairing these foods with vitamin C-rich options, like oranges, strawberries, or bell peppers, helps your body absorb more iron. By focusing on your diet and boosting your iron levels, you can help reduce feelings of fatigue naturally.

5. Cognitive Behavioural Therapy (CBT)

Cognitive Behavioural Therapy is a type of therapy that helps you reframe your unhelpful and often negative thoughts patterns into healthier ways to think and behave. There is plenty of research to show that CBT is not only effective for sleep but also for depression in women in perimenopause/menopause. CBT is best done with a qualified health care professional and well worth the investment. (8,9)

6. Hormone Replacement Therapy (HRT)

If night sweats or hot flashes are disrupting your sleep, hormone replacement therapy (HRT) is definitely worth considering. Hormone therapy has been studied extensively and used by millions of women for over 50 years. It remains the most effective treatment for moderate to severe vasomotor symptoms like hot flashes and night sweats, as well as other menopausal symptoms such as vaginal dryness. It’s also considered the gold standard by The Menopause Society. Additionally, HRT can help protect against long-term health issues such as osteoporosis by maintaining bone density.

To learn more about HRT, check out our article, "Understanding Menopause Hormone Therapy: HRT and BHRT," and connect with one of our clinicians to see if it might be the right option for you.

Empowering Your Perimenopause Journey

Perimenopause is a journey, and while it can be tough at times, understanding what’s happening in your body is the first step to navigating it. By learning about the changes you’re going through and incorporating the tips recommended by the sanoMidLife clinical team—like adjusting your nutrition, adding key supplements, or considering hormone therapy—you can regain control and start feeling like yourself again.

And remember, you don’t have to do it alone—speaking with experts and finding the right support can make all the difference. Keep going—you’re stronger than you realize, and there are plenty of ways to get your energy back on track.

References

1. NIH State-of-the-Science Panel. National Institutes of Health State-of-the-Science conference statement: management of menopause-related symptoms. Ann Intern Med. 2005;142:1003–1013. [PubMed]
2. Age-Related Decreases in Melatonin Secretion—Clinical Consequences. Richard J. Wurtman. The Journal of Clinical Endocrinology & Metabolism, Volume 85, Issue 6, 1 June 2000, Pages 2135–2136, https://doi.org/10.1210/jcem.85.6.6660
3. Maki, P. M. et al. Guidelines for the evaluation and treatment of perimenopausal depression. Menopause 25, 1069–1085 (2018).
4.  Smith-Ryan, A. E., Cabre, H. E., Eckerson, J. M. & Candow, D. G. Creatine Supplementation in Women’s Health: A Lifespan Perspective. Nutrients 13, 877 (2021).
5. Nutrients. 2021 Feb; 13(2): 586. Published online 2021 Feb 10. doi: 10.3390/nu13020586 PMID: 33578876 Creatine Supplementation and Brain Health Hamilton Roschel,1,* Bruno Gualano,1,2 Sergej M. Ostojic,3 and Eric S. Rawson4
6. Beomman Ha, Writing – original draft,1 Jisoon Kim, Writing – review & editing,2 Wi-Young So, Writing – review & editing,3,*† and Seonho Kim, Writing – review & editing4,*†Effects of Nonpharmacological Interventions on Sleep Quality and Insomnia in Perimenopausal and Postmenopausal Women: A Meta-Analysis Healthcare (Basel). 2023 Feb; 11(3): 327. Published online 2023 Jan 22. doi: 10.3390/healthcare11030327 PMCID: PMC9914174 PMID: 36766902
7. Portella C.F.S., Sorpreso I.C.E., Assis A.D.S.M., de Abreu L.C., Junior J.M.S., Baracat E.C., Moraes S.D.A., Tanaka A.C.D.A. Meditation as an approach to lessen menopausal symptoms and insomnia in working women undergoing the menopausal transition period: A randomized controlled trial. Adv. Integr. Med. 2021;8:278–284. doi: 10.1016/j.aimed.2020.08.003
8. 31. Green S.M., Donegan E., Frey B.N., Fedorkow D.M., Key B.L., Streiner D.L., McCabe R.E. Cognitive behavior therapy for menopausal symptoms (CBT-Meno): A randomized controlled trial. Menopause. 2019;26:972–980. doi: 10.1097/GME.0000000000001363.
9. Ham O.K., Lee B.G., Choi E., Choi S.J. Efficacy of cognitive behavioral treatment for insomnia: A randomized controlled trial. West. J. Nurs. Res. 2020;42:1104–1112. doi: 10.1177/0193945920914081.