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Perimenopause and Fatigue: Tips for Boosting Your Energy Levels


Perimenopause and Fatigue: Tips for Boosting Your Energy Levels

Certified NAMS menopause practitioner Dr. Emily Stone sheds light on how women can keep their energy up during this transitional time.

Hello Generation X sisters! We are in the thick of it… Caring for children and possibly our parents. Working and potentially reaching the height of our careers. Trying to take care of ourselves and balancing nutrition and exercise, stress and mindfulness. Daily life is A LOT. And then…perimenopause arrives. In full force.

One of the most common complaints from women during this time of their lives is fatigue. So what is the connection between perimenopause and fatigue, and what can we do about it? Let’s dive in.

What is perimenopause?

To better understand perimenopause, let’s work backwards. Your final menstrual period marks the beginning of menopause, though this earmark can only be defined by looking back: Natural (non-surgical and non-hormonally manipulated) menopause is defined as no bleeding (no period) for one full year. This occurs when your ovaries have no more follicles (eggs) remaining, and thus your primary source of estrogen production is gone.

Perimenopause includes both the transition to menopause and the first year following your final menstrual period. The menopause transition is the time of hormonal fluctuations that results in irregular periods and vasomotor symptoms like hot flashes and night sweats. Vasomotor symptoms are the result of your body’s sharp decline in estrogen production.

The average age of menopause is between 51 and 52 years old. The length of time for the transition to the final menstrual period varies greatly – it can last approximately 2-8 years. Learn more about the factors affecting the timing of perimenopause in Dr. Kimberly McMorrow’s blog post, Perimenopause 101: What to Expect.

Does perimenopause cause extreme tiredness?

Many women experience increased fatigue and lack of energy during perimenopause. This fatigue can be the result of a few different causes, including the hormonal changes expected with perimenopause, underlying medical conditions (both diagnosed and not yet diagnosed), and sleep disturbances. These factors may all be intertwined, making it harder to delineate a clear culprit.

Menopause-specific factors, aging, stress and other medical or psychological factors can all contribute to sleep disturbances and ultimately, fatigue. Approximately 50% of women who report sleep disturbances are perimenopausal. Areas of the brain that are influenced by estrogen and progesterone are important in sleep regulation. Both these hormones also likely influence circadian rhythms. Thus perimenopause, its changes in ovulation, and changing pattern of estrogen and progesterone levels, may affect sleep and lead to fatigue.

Difficulty sleeping (the symptom) and insomnia (the disorder) are some of the most common complaints of women going through the menopause transition. Sleep may be disrupted by age-related physiologic changes as well as medical conditions, and differentiating between the two may be difficult.

Common underlying medical issues that may contribute to fatigue include thyroid gland abnormalities, autoimmune disorders, cardiovascular and cardiac issues, diabetes, depression and anxiety. Of these, anxiety has been identified as the strongest predictor of poor sleep quality. It is important to ensure that your general health and underlying medical conditions are discussed with and managed by your primary care provider or the appropriate medical specialist. Treating these underlying medical conditions can not only help with your fatigue but also greatly impact your long-term health.

The major types of insomnia in midlife women include:

1. Menopause-related insomnia: often related to vasomotor symptoms like hot flashes and night sweats

2. Primary insomnia (psychophysiologic): sleeplessness that cannot be attributed to an existing medical, psychiatric or environmental cause such as drug abuse or medications.

3. Secondary insomnia: symptoms arise due to a primary medical illness, mental disorder, or other sleep disorder.

4. Insomnia induced by behavioral, environmental, or psychosocial factors: including social support, marital support, bereavement, or work environment.

Fatigue, lack of sleep and loss of sleep are all considered “life stressors.” To make things more complicated, there is a decisive relationship between the vasomotor symptoms of perimenopause and underlying anxiety and/or depression. Depressed mood, anxiety, vasomotor symptoms, and sleep disturbances involve complex and bidirectional relationships. Emotional distress and vasomotor symptoms of menopause may certainly contribute to disrupted sleep patterns, and it is important to recognize sleep-related complaints and their possible relation to the menopause transition.

How long does perimenopause fatigue last?

Thankfully the sleep disturbances associated with the menopause transition are temporary. They peak during the last few years before your final menstrual period and begin to subside about a year after that. Continued treatment for other medical conditions is important for fighting fatigue that may last beyond perimenopause.

How do you overcome perimenopausal fatigue?

Establishing and/or maintaining healthy lifestyle habits and weight management behaviors are important for fighting perimenopausal fatigue and will also benefit your long-term health.


Focusing your diet on lean protein and complex carbohydrates and avoiding simple sugars is a great foundation for maintaining energy levels. Eating when you are hungry rather than to suppress emotions is challenging, but it’s an important step towards managing your blood sugar and fighting fatigue. See Dr. Stephen Pound’s blog post, Understanding Sugar and Hormones: FAQs and 9 Tips for Feeling Better, for advice on how nutrition can help prevent hormone-related fatigue.


Committing to regular exercise is another key to fighting fatigue and other conditions that you’re more at risk for during this phase of life. Strength training becomes more important during the perimenopausal years, as maintaining muscle and bone mass can protect you from falls and injuries as you age. Check out Dr. Julie Ladocsi’s blog post, How You (and your Mom) Can Fight Osteoporosis, to learn how (and when) exercise can help improve bone health. And as Dr. Pound’s Sugar and Hormones blog post reminds us, even a brief walk after a meal can be very helpful in combating fatigue caused by the relationship between hormones and blood sugar.

Sleep Hygiene and Treatment

Alleviating fatigue often depends on treating underlying sleep-related issues and improving sleep hygiene. Though hormone therapy is not indicated for treatment of primary sleep disorders, treating vasomotor symptoms like hot flashes and night sweats that often lead to sleep disruption with appropriate hormone therapy may aid in improving sleep. The non-hormonal SSRI antidepressant medication Paxil may also be helpful.

Cognitive behavioral therapy (CBG), a type of psychotherapy that focuses on modifying dysfunctional emotions and behaviors, is one of the most effective ways to improve your sleep hygiene and feel more rested during the day – and it works better than medication. A few basic components of CBG include: setting a sleep schedule; eliminating daytime naps; eliminating screen time before bed; and using your bed for sleep and sex (not for watching TV, scrolling on your phone, or snacking). Read Dr. Padmini Santosh’s blog post, How Women’s Hormones Can Affect Their Sleep – And Tips for Improving It!, for more ways to improve your sleep hygiene.

Helping You Navigate Perimenopause

As Dr. Jen Gunter writes in The Menopause Manifesto: “The only predictable thing about the menopause transition is its unpredictability.”

We know perimenopause is a challenging time for many women, and the increased fatigue doesn’t help. We are happy to discuss your questions further and help you on your journey!

As a NAMS certified menopause practitioner, Dr. Emily Stone is fully trained on the latest, scientific-based information for providing quality menopause care and improving the health of women during their menopause transition and beyond. To schedule an appointment with Dr. Stone or any VPFW provider, you can call us at 804-897-2100 or set an appointment online.


Menopause Education Resources

The Menopause Society (formerly the North American Menopause Society)

The American College of Obstetricians and Gynecologists

The Menopause Manifesto by Dr Jen Gunter

Perimenopause 101: What to Expect” by Dr. Kimberly McMorrow

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