perimenopause fatigue

Perimenopause Fatigue

Fatigue is a common complaint among women during perimenopause. In fact, nearly 50 percent of perimenopausal women report fatigue compared to only 20 percent of premenopausal women (1).

In this article, we’ll review the possible root causes of perimenopause fatigue and tips to reduce this symptom.

What is Perimenopause?

Perimenopause is a time of hormonal transition lasting an average of four years before your periods stop altogether. During this time, you may experience a variety of symptoms, like fatigue, night sweats, hot flashes, brain fog, vaginal dryness, and irregular periods. Menopause is established after at least one year without any periods. 

What May Cause Perimenopause Fatigue?

Perimenopause is a sequence of events involving a variety of hormonal shifts. Fatigue is multifactorial, and there may be a few reasons why you feel more tired during this transitional time.

Low Progesterone

During perimenopause, progesterone levels usually decline first. Progesterone is a reproductive hormone that prepares the body for a potential pregnancy in the event that the released egg is fertilized. Progesterone is known as your calming hormone and has many benefits like lowering anxiety and promoting healthy sleep. Progesterone is only produced by the body after ovulation. Since irregular ovulation is common during perimenopause, there may be months when you do not ovulate. Likewise, even if you do ovulate, your body may still not produce enough progesterone. This often presents as insomnia a few days before or during your period bleed that can lead to daytime fatigue. In this case, bioidentical progesterone therapy may be useful to promote better sleep and prevent insomnia related to low-progesterone levels.

Hot Flashes and Night Sweats

Another cause of perimenopause fatigue stems from sleep disruption due to hot flashes and night sweats. These symptoms are often caused by a combination of low progesterone and higher estrogen levels. This disrupted ratio is commonly referred to as estrogen dominance. Estrogen is one of the main sex hormones in women and regulates puberty, your menstrual cycle, and bone health. Despite what you may have heard, perimenopause is not defined by a gradual decline of estrogen levels. Rather, your estrogen levels may fluctuate throughout perimenopause causing intermittent hot flashes and/or night sweats. 


Hypothyroidism occurs when your thyroid gland does not make enough thyroid hormones to meet the body’s demand. Common symptoms of hypothyroidism include fatigue, weight gain, difficulty losing weight, brittle nails, and constipation. Hashimoto’s, an autoimmune thyroid disorder, is the most common cause of hypothyroidism in the United States. Women are 10 times more likely to have Hashimoto’s thyroid disease than men (2). While Hashimoto’s can certainly occur independently, perimenopause may also amplify hypothyroidism (3). 

If you suffer from fatigue, consider requesting a full thyroid panel from your doctor to include:
  • TSH
  • Free T4
  • Free T3
  • Thyroid Peroxidase Antibodies 

A high TSH with or without a low free T4 first confirms the presence of hypothyroidism. In functional medicine, we prefer a narrower TSH range for what is considered normal. Typically this range is between 1.0 - 2.5 mlU/L. The additional presence of thyroid antibodies in your blood indicates the body’s immune system is attacking the thyroid gland as seen in Hashimoto’s autoimmune disease.

Insulin Resistance 

Insulin is a hormone released by the pancreas that helps to balance your blood sugar levels. Insulin’s main job is to take sugar out of the blood and drive it into the cells for energy. Insulin resistance occurs when insulin is unable to push sugar into your cells causing high insulin and blood sugar levels. Insulin resistance can cause daytime fatigue, sugar cravings, and weight gain or difficulty losing weight. Unfortunately, the hormonal shifts during perimenopause may increase your risk of insulin resistance (4).

Sleep Apnea

Sleep apnea is a serious sleep disorder in which breathing stops repeatedly throughout the night. Untreated sleep apnea causes loud snoring and daytime fatigue even if you think you’re getting a full night’s sleep. One study found the rate of sleep apnea was 21 percent higher in women during perimenopause compared to premenopausal women (5).

Common symptoms of sleep apnea may include:
  • Loud snoring
  • Sore or dry throat upon waking
  • Restless sleep
  • Sleepiness during the day
  • Morning headaches

If you suffer from any of these symptoms, we encourage you to speak with your doctor to see if they recommend a referral for a sleep study.

How to Treat Perimenopause Fatigue

Now that you know some of the root causes of perimenopause fatigue, let’s discuss a few interventions you can use to reduce this symptom.

Follow PFC Balance

The protein, fat, carb (PFC) method is a simple way to plan meals that also balance your blood sugar levels. This is crucial in reducing insulin resistance which may cause perimenopause fatigue, weight gain, and sugar cravings. You can incorporate the PFC method by replacing foods high in added sugar for non-starchy vegetables, legumes, fresh fruit, nuts/seeds, whole grains, and lean protein. 
For a PFC balanced food plan and recipes using our Root Plate Method™, download our Foundational Meal Plan.
meal plan

Root Foundational Meal Plan

A meal plan for life.

Try a Magnesium Supplement

Magnesium is an essential mineral and electrolyte with many vital functions in the body. Unfortunately, most people do not get enough magnesium from their diet alone. Magnesium calms the brain and may promote better sleep quality therefore reducing daytime fatigue. There are many types of magnesium supplements you can purchase over-the-counter. However, we often prefer using magnesium glycinate. This form of magnesium is combined with an amino acid called glycine which works with brain chemicals to promote a healthy circadian rhythm. Try starting with 200 milligrams (mg) of magnesium glycinate one to two hours before bedtime for best results.

magnesium combo

Magnesium Combo

Three forms of highly absorbable magnesium in one capsule.

Optimize Your Lifestyle

While the hormonal fluctuations during perimenopause are not preventable, you can reduce perimenopause fatigue with healthy lifestyle interventions. For starters, make sure you are practicing good sleep hygiene. Sleep loss has significant health consequences, especially for women in perimenopause. 
Start implementing these tips now to promote better sleep:
  • Limit alcohol intake before bedtime.
  • Avoid caffeine after 1pm.
  • Keep your bedroom at a cool temperature and invest in room-darkening blinds or curtains.
  • Avoid screens at least one hour before bedtime and/or invest in blue-light blocking glasses.
  • Go to bed at the same time every night and incorporate a calming bedtime routine.
  • Wear light and breathable pajamas to counteract hot flashes and night sweats.
Furthermore, research shows that regular exercise can not only improve insulin resistance, but may also reduce fatigue and promote better quality sleep during perimenopause (6). Exercise may sound like the last thing you want to try when dealing with fatigue, but even 30 minutes of movement can boost energy levels. 

Implement Stress Management Techniques

Perimenopause often comes during a stressful time in your life due to career advancements, aging parents, teenage kids, or preparing your finances for other life transitions. Like with most conditions, stress makes perimenopause symptoms worse. For example, stress hormones can cause sleep disruptions, sugar cravings, brain fog, and more. While you may not be able to prevent stressful events in your life, you can influence how stress affects your body. Effective ways to reduce stress hormone levels may include yoga, box breathing, journaling, meditation, or mindfulness exercises. Try to implement at least one stress reducing activity into your routine each day. Even five minutes can make a difference in reducing the effects of stress on your body.

Key Takeaways

Perimenopause fatigue may be caused by low progesterone levels, hot flashes or night sweats, hypothyroidism, insulin resistance, and sleep apnea. You can reduce perimenopause fatigue by eating PFC balanced meals, trying a magnesium supplement, and prioritizing healthy lifestyle changes.

We support women one on one through perimenopause symptoms in our functional medicine membership program.

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