Perimenopause Fatigue: How to Fight Back

If you’ve hit your forties or early fifties and find yourself feeling bone-tired—the kind of fatigue that no amount of sleep seems to fix—you’re not alone. Fatigue during perimenopause is a very real (and very frustrating) experience, and it’s often tied to the hormonal shifts that happen during this transition. Let’s dive into what’s behind perimenopause fatigue and, more importantly, how you can regain some of your energy.

Why Perimenopause Causes Fatigue

Perimenopause fatigue is very common. In a recent study of over 2000 women, 26.6% or women reported feeling tired and 24.2% reported feeling worn out. And no surprise, having prolonged periods or heavy bleeding significantly increased the chance of fatigue.

Hormonal shifts during the menopause transition, can also bring about a cascade of changes in your energy levels.

Let’s break it down:

Sleep disturbances: Hormonal fluctuations can interfere with your ability to fall asleep and stay asleep. Night sweats (hello, 2 a.m. pajama changes!) and increased anxiety make it even harder to get restorative rest. In the SWAN study 37.7% of women reported difficulty sleeping during the menopause transition.

Increased anxiety and depression: The drop in estrogen affects serotonin, the feel-good neurotransmitter, which can lead to mood swings, anxiety, and depression—all of which contribute to feeling exhausted. Studies have shown an increased prevalence of anxiety and depression during menopause.

But it’s not just hormones. Other health conditions often become more common during this phase of life and can add to your fatigue:

Anemia:  As mentioned above, having heavy or prolonged periods can cause fatigue and weakness. It is estimated that 33% of women aged 19-49 have iron deficiency.

Check out Do Women Over 50 Need Iron? What You Need to Know for more info.

Thyroid disorders: Hypothyroidism is more likely to occur in midlife and can drain your energy.

Body composition changes: Changes to our bodies during this time are completely normal. As a dietitian, I often see women restricting their diets too much to fight body changes, especially belly fat. When you don’t provide your body with enough calories and nutrients, you are going to be tired!

And let’s not forget good old-fashioned stress.  Perimenopause often collides with some of the busiest and most emotionally demanding years of our lives—caring for aging parents, managing careers, dealing with teenagers, or just trying to keep up with the daily grind.

 What Does Perimenopause Fatigue Feel Like?

Perimenopause fatigue can feel like more than just being tired after a long day. Many of my clients describe it as a deep, overwhelming exhaustion that doesn’t improve even with rest.

It’s the kind of tiredness that makes getting through daily tasks feel like climbing a mountain.

For some, this experience is sudden and intense, a phenomenon often referred to as “crashing fatigue.”

Crashing fatigue can feel like your body is shutting down, leaving you needing to lie down immediately. It can come out of nowhere and leave you feeling completely drained, both physically and mentally.

This type of fatigue affects your focus, memory, and overall ability to function, adding to the frustration of this already challenging time.

Recognizing these feelings as part of perimenopause, rather than just normal tiredness, is an important first step toward managing and addressing them.

How to Fight Perimenopause Fatigue

The good news? You can take steps to address fatigue and feel more like yourself again. Let’s get practical.

1. Rethink Your Diet

Food is a source of steady, sustained energy when you eat right. Here are some key strategies:

Eat enough. This might sound obvious, but many women in midlife don’t eat enough to support their energy needs, especially if they’re cutting calories to manage weight.

Restrictive eating can backfire, leaving you more fatigued.

Don’t fear carbs. Carbohydrates are your body’s preferred energy source, and they’re crucial for brain function. Choose complex carbs like whole grains, sweet potatoes, quinoa, and legumes to keep your blood sugar stable.

Balance your blood sugar. Speaking of blood sugar, aim for meals and snacks that include protein, healthy fats, and fiber. This combination slows digestion and keeps your energy steady throughout the day—no mid-afternoon crashes.

Iron, B12, and vitamin D. Make sure you are getting what you need. These nutrients play a huge role in energy production. Iron is essential for oxygen transport in the blood, vitamin B12 helps create red blood cells, and vitamin D is key for mood and immune function. If you’re deficient, supplements may be necessary (check with your doctor first).

See: Do woman over 50 need iron? And Understanding the Role of B12 in Menopause [Guide for Women]

Reduce caffeine and alcohol. While that extra cup of coffee might feel like a lifesaver, too much caffeine can interfere with sleep and worsen anxiety. Alcohol can disrupt sleep quality and leave you feeling drained.

Hydrate! Even mild dehydration can cause fatigue. Make water your go-to beverage and aim for at least 8 cups a day, more if you’re active or sweating through night sweats.

Consider adaptogens for stress: Certain herbs like ashwagandha, rhodiola, and holy basil have been shown to help the body adapt to stress.

They’re not a cure-all, but they can be a helpful tool in your stress-management toolkit. Learn more about adaptogens and then talk to a healthcare provider familiar with adaptogens to see if they’re right for you.

2. Move Your Body (Even When You’re Tired)

Exercise might be the last thing you want to do when you’re exhausted, but it’s one of the best ways to boost energy. The trick is to rethink your approach:

Try exercise snacks: If a full workout feels overwhelming, try breaking movement into smaller chunks. A 10-minute walk here, a few squats there—it all adds up.

Gentle movement:  Yoga, stretching, or low-impact activities like swimming can help you feel more energized without leaving you wiped out.

Strength training:  Preserving muscle mass is key during perimenopause. Even two short sessions a week can make a difference.

3. Manage Stress

We have all heard it before but chronic stress is a major energy thief. Managing it might take some experimentation, but here are a few ideas:

Meditation and mindfulness: Even 5-10 minutes a day can help lower stress levels.

Journaling: Writing down your thoughts can help you process emotions and clear mental clutter.

Nature time: Spending time outdoors—even just sitting in the sun—can help you feel calmer and more refreshed.

4. Take time for you-yes,really.

Perimenopause isn’t just a physical transition; it’s also an emotional and psychological one.While this stage of life can feel really difficult, it may also be a time of transformation—much like how the caterpillar becomes a butterfly.

Did you know that for a time, the caterpillar is a mess of goop within the chrysalis before it re-emerges as something entirely new? The menopause transition can be messy, too, but it’s also an opportunity to reshape your priorities and put the focus back on yourself.

So if you're feeling like goop, this might be the perfect time to practice prioritizing yourself. Learning to say no, setting boundaries, and asking for help aren’t just helpful strategies for managing fatigue right now; they’re investments in your future self.

When you emerge from this period, you can be stronger and healthier than ever—ready to take on your dreams, pursue your goals, and fully embrace this new phase of life.

Let’s start to practice by:

Learning to say no. Now is the time to stop overcommitting yourself.

Asking for help. Whether it’s delegating tasks at work or asking family members to pitch in more at home, you can set an example that women don’t have to do it ALL, all alone.

Rediscover joy. Picking up a new hobby or taking a class can be a wonderful way to re-energize and find fulfillment.

But if this feels too overwhelming right now, start by  finding “glimmers.” These are tiny moments of joy or peace that you can focus on throughout the day.

It might be savoring your morning coffee, dancing to a favorite song, or stepping outside for a moment to feel the sun on your face.

These small, positive experiences can help shift your mindset and energy levels over time, making space for bigger dreams and goals down the road.

5. Check In with Your Health

Fatigue during perimenopause can have many causes, and it’s always a good idea to check in with your healthcare provider.

Ruling out underlying issues like thyroid disorders, anemia, or vitamin deficiencies can ensure you’re addressing all aspects of your health.

Your provider can also discuss treatment options, such as hormone therapy that might help alleviate your symptoms and restore your energy.

6. Build Your Support System

Perimenopause can feel isolating, but you’re not alone. Connecting with others who are going through similar experiences can be incredibly validating.

Consider joining a support group, either in person or online, where you can share stories, advice, and encouragement. Talking with trusted friends or family members can also help you feel supported and less alone during this transition.

Perimenopause fatigue is real, but it doesn’t have to take over your life.

By addressing your diet, getting strategic about movement, managing stress, and using this transition as a time to prioritize yourself, you can reclaim your energy and thrive during this phase.

Remember, it’s not about “pushing through”—it’s about listening to your body and giving it what it needs.