Why You're So Exhausted During Perimenopause

What Your Body Is Trying to Tell You

Exhausted no matter how much you sleep? Perimenopause can affect your energy in ways that go far beyond feeling tired. Here's what may be happening — and what your body could be trying to tell you.

There is tired.

And then there is perimenopause tired.

I'm talking about the kind of tired where you wake up in the morning and already feel like you've used up half your energy for the day. The kind where making dinner feels like an enormous logistical exercise, your patience has disappeared by 4pm and the idea of doing anything after work feels completely impossible.

You might be sleeping for seven or eight hours and still waking up exhausted.

You might need coffee just to feel vaguely human in the morning and then spend the afternoon counting down until you can go to bed.

Perhaps you used to exercise regularly but now can't seem to find the energy. Maybe you're eating reasonably well but your body feels heavier, slower and more difficult to manage. Or perhaps you're simply wondering how on earth you're supposed to keep doing everything you've always done when you feel like you've got nothing left in the tank.

And then comes the inevitable question:

“What is wrong with me?”

Here's what I want you to know.

You are not lazy. You're not weak. And needing more rest doesn't mean you've suddenly lost your motivation.

Perimenopause can affect energy in a number of different ways, and often there isn't one single explanation.

Your hormones may be changing. Your sleep may be deteriorating. Your stress load may be enormous. Your periods may have become heavier. Your nutrition may not be giving you what you need. You may be losing muscle and becoming less metabolically efficient.

And sometimes, you're simply trying to do far too much.

So rather than asking how you can push yourself harder, let's ask a different question:

What is your exhaustion trying to tell you?

Is extreme tiredness a symptom of perimenopause?

Yes. Fatigue and low energy are commonly reported during the menopause transition.

But fatigue isn't a uniquely hormonal symptom, which is why I don't want you to automatically assume that every episode of exhaustion is caused by perimenopause.

Your energy is the result of multiple systems working together.

Hormonal changes can affect sleep and mood. Poor sleep can leave you exhausted. Stress can keep your nervous system in a state of heightened alertness. Changes in your periods can contribute to iron deficiency. Eating too little can leave you under-fuelled. A lack of movement can affect fitness and muscle strength.

And all of these things can influence one another.

This is why I think looking at perimenopause symptom by symptom can be so frustrating.

You try to fix your tiredness.

Then your sleep gets worse.

You try to fix your sleep.

Then you worry about your weight.

You try to lose weight.

Then you eat less and have even less energy.

You push yourself to exercise more.

Then you become even more exhausted.

Perhaps the problem isn't that you're failing at all of these things.

Perhaps you're trying to solve a connected problem with disconnected solutions.

Why does perimenopause make you so tired?

There isn't one answer, but there are several common contributors worth understanding.

Hormonal fluctuations

During perimenopause, oestrogen and progesterone can fluctuate significantly. These hormones influence many systems throughout the body, including those involved in sleep, mood and temperature regulation.

That doesn't mean every episode of fatigue can be blamed directly on falling oestrogen.

It means your body is navigating a period of significant biological change, and that change can affect how you feel.

Poor sleep

This one is huge.

You might struggle to fall asleep, wake frequently, wake because you're hot, wake at 3am and lie there staring at the ceiling, or simply find that your sleep isn't as restorative as it used to be.

Even if you're technically spending enough time in bed, disrupted sleep can leave you feeling exhausted the next day.

If this sounds familiar, read Perimenopause and Sleep: Why You Can't Stay Asleep and Why You're Waking Up at 3am in Perimenopause.

Stress and mental load

Midlife can be an extraordinarily demanding stage of life.

You may have a career, children, ageing parents, relationship pressures, financial responsibilities and a household to run, while simultaneously trying to work out what you actually want from the next stage of your own life.

Your brain doesn't get to switch off just because you've finished work.

If you're carrying a huge mental load, your exhaustion may be telling you that your capacity is being stretched too far.

I've written more about this in The Mental Load of Midlife Women (And Why Perimenopause Can Make It Harder).

Changes in your menstrual cycle

Perimenopause can bring changes in the length, frequency and heaviness of your periods.

If your periods have become particularly heavy, iron deficiency is something worth discussing with your GP, particularly if you're also experiencing significant fatigue, weakness or reduced exercise tolerance.

Don't automatically assume that exhaustion is “just hormones”.

Sometimes there is something else worth investigating.

Could your nutrition be making you more tired?

Possibly.

But this is where I want to challenge some of the advice you might have seen online.

If you're exhausted, the answer isn't necessarily to cut out carbohydrates, stop eating after 6pm, fast until lunchtime or survive on salads and protein shakes.

In fact, if you're already under-fuelling, doing more restriction may make you feel worse.

Your body needs energy.

Your brain needs energy.

Your muscles need energy.

And during midlife, I want you thinking about nourishment rather than deprivation.

This is one of the reasons I use my “crowding in” approach to nutrition. Instead of obsessing over the foods you need to eliminate, focus on bringing more of the foods your body needs into your day.

Protein.

Fibre.

Vegetables.

Fruit.

Wholegrains.

Legumes.

Healthy fats.

A wide variety of plant foods.

And enough food overall.

If you'd like to understand this approach in more detail, read What to Eat During Perimenopause.

Does protein help with perimenopause fatigue?

Protein is important during perimenopause, but I don't want to turn it into another magic solution.

Protein helps maintain and repair muscle and is an important part of a balanced diet. It also tends to be satisfying, which can make meals more sustaining.

And maintaining muscle becomes particularly important as we move through midlife.

But eating 120 grams of protein isn't going to fix exhaustion caused by chronic sleep deprivation.

This is the bigger picture I want women to understand.

Your body doesn't need one perfect nutrient. It needs the foundations working together.

What about carbohydrates?

Please don't be frightened of carbohydrates.

Your body uses carbohydrate as an important source of energy, and carbohydrate-containing foods can provide fibre, vitamins, minerals and other beneficial nutrients.

The problem is not that carbohydrates exist.

The more useful question is what type of carbohydrate are you eating, how much, and what are you eating alongside it?

A bowl of sugary cereal eaten on its own is very different nutritionally from oats topped with berries, Greek yoghurt, nuts and seeds.

Both contain carbohydrates.

But one is a much more substantial meal.

This is why I prefer to teach women how to build balanced meals rather than give them lists of foods they're “allowed” or “not allowed” to eat.

Could blood sugar be causing your afternoon crash?

You may have heard people talk about “blood sugar crashes” as though every afternoon slump is evidence of insulin resistance.

It's more complicated than that.

Your body has sophisticated systems for regulating blood glucose, and blood sugar naturally changes throughout the day.

However, meals that are predominantly refined carbohydrate and low in protein and fibre may be less satisfying and can produce a different glucose response from meals that contain a combination of protein, fibre, fat and carbohydrate.

If you're regularly reaching for something sweet at 3pm, don't automatically conclude that you have a blood sugar disorder.

Instead, look at the bigger picture.

What did you eat for breakfast?

Did you eat lunch?

Did your meals contain enough protein and fibre?

How much sleep did you get last night?

How stressed are you?

Your afternoon energy dip might be telling you much more than simply “eat less sugar”.

Is your metabolism slowing down?

This is another area where perimenopause gets blamed for everything.

Metabolic rate does change with age, but the story isn't simply that your metabolism suddenly crashes when you enter perimenopause.

Changes in body composition, particularly loss of muscle and changes in physical activity, can influence how much energy your body uses.

And this is one of the reasons muscle becomes so important during midlife.

Muscle is metabolically active tissue, and maintaining muscle supports strength, physical function and metabolic health.

This is why I don't want you to respond to changes in your body by simply eating less and exercising more.

There is another strategy.

Build and protect the body you want to live in.

Strength training, adequate protein, enough overall nutrition and regular movement all have a role.

You can read more about this in Why You Need to Get Stronger in Perimenopause and Why Your Body Is Changing During Perimenopause — And What You Can Actually Do About It.

Could you actually be doing too much?

There is another possibility that I think we don't talk about enough when we're discussing exhaustion in midlife: you might simply have too much on your plate.

Women in their 40s and 50s are often in a particularly demanding stage of life. You might be working, raising teenagers, supporting ageing parents, managing a household, navigating a relationship and trying to maintain some kind of social life, all while wondering why your own needs seem to have slipped further and further down the list. Even when you aren't physically doing something, your brain can be busy remembering, planning, anticipating and worrying about what needs to happen next.

If you've spent most of your adult life being the person who gets things done, it can be very difficult to recognise when you've reached your limit. Your instinct might be to push harder. Get up earlier. Exercise more. Drink another coffee. Become more organised. Find a better routine.

But exhaustion isn't always a motivation problem.

Sometimes it is a capacity problem.

And there is a difference.

If your body is telling you that it doesn't have anything left to give, asking it to give more isn't necessarily the answer. Sometimes what you need isn't another strategy for squeezing more productivity out of yourself. You need to create some space for recovery.

That doesn't mean abandoning everything or becoming completely self-indulgent. It might simply mean recognising that the way you've been operating for the last ten or twenty years isn't necessarily sustainable anymore.

Perimenopause can be the point at which your body makes that impossible to ignore.

Why exercise can actually help when you're exhausted

I know this sounds like a contradiction. If you're already exhausted, the last thing you probably want to hear is that you should exercise.

But movement is different from pushing your body to exhaustion.

Regular physical activity can support cardiovascular health, mood, sleep and metabolic health, while strength training becomes particularly important during midlife because it helps us maintain the muscle and physical function that naturally become harder to preserve as we age. Exercise can also give you something that has nothing to do with calories or weight: the feeling that your body is strong, capable and yours.

That doesn't mean you need to suddenly start training five days a week. In fact, if you're already depleted, adding an intense exercise regime to your life may be exactly the wrong thing to do.

Think about what your body can handle right now. A walk, a strength session, swimming, cycling, dancing or simply becoming more physically active throughout your day can all contribute. The goal isn't to punish yourself into having more energy. It's to use movement as one of the things that helps your body function better.

And if you're interested in why I'm such a strong advocate for strength training during this stage of life, have a read of Why You Need to Get Stronger in Perimenopause.

What if your exhaustion isn't actually caused by perimenopause?

This is an important one because, while fatigue is extremely common during perimenopause, we shouldn't automatically blame every symptom on hormones.

There are many other reasons you might be exhausted, including iron deficiency, thyroid problems, sleep disorders, depression or anxiety, certain medications, illness or simply not eating enough to meet your body's needs.

Iron is particularly worth considering if your periods have become much heavier. Heavy menstrual bleeding can increase the risk of iron deficiency, which can contribute to fatigue and reduced concentration. If you're exhausted, your periods have changed significantly and you're finding it increasingly difficult to get through the day, it's worth talking to your GP rather than simply accepting that this is what perimenopause feels like.

The same applies if your fatigue is new, severe, persistent or interfering with your ability to work, exercise or manage your everyday life.

You know your body.

If something doesn't feel right, you are allowed to ask questions.

“It's just your age” isn't a particularly helpful medical explanation.

So what is your exhaustion trying to tell you?

This is really the question I want you to take away from this article.

When you're exhausted, it is very easy to go straight into problem-solving mode. You start searching for the best supplement, the perfect breakfast, the right exercise programme or the diet that is finally going to fix your energy.

But before you add something else to your already very long list, stop and look at the bigger picture.

Are you actually sleeping well? Are you waking several times during the night or lying awake at 3am? Are you eating enough, particularly if you've been trying to lose weight? Are your meals providing enough protein and fibre to keep you satisfied? Are you moving your body regularly? Are you carrying an enormous mental load that nobody else can see? Have your periods become heavier? And is there a possibility that something other than perimenopause is contributing to the way you're feeling?

You don't need to answer all of those questions today.

You just need to start noticing.

Because your exhaustion is information.

It is your body giving you clues about what it needs.

You don't need to become a different woman to feel better

I think this is where a lot of the advice around perimenopause goes wrong.

We are given an enormous list of things we are apparently supposed to do. Eat more protein. Stop eating sugar. Fast until lunchtime. Exercise five times a week. Lift weights. Take supplements. Meditate. Sleep eight hours. Track your hormones. Get up at 5am. Drink more water.

And somehow we're expected to do all of this while we're already exhausted.

No wonder women feel like they're failing.

I don't believe you need to become a completely different woman in order to feel better during perimenopause. What you may need is to understand that your body is changing and that some of the strategies that worked for you in your 20s and 30s may need to change with it.

That isn't failure.

It's adaptation.

Maybe your body doesn't need another diet. Maybe it needs enough food.

Maybe you don't need to exercise harder. Maybe you need to build strength.

Maybe you don't need to become more productive. Maybe you need to stop carrying everything yourself.

Maybe you don't need another supplement. Maybe you need to investigate why you're exhausted in the first place.

This is the kind of shift I want women to make.

Not from “I'm doing everything wrong” to “I'm doing everything perfectly”, but from fighting your body to understanding it.

Your exhaustion is information

Perimenopause can make it feel as though your body is suddenly working against you. Your sleep changes, your energy changes, your body changes and things that once seemed effortless can suddenly require much more thought.

But what if we looked at those changes differently?

What if your exhaustion isn't your body failing you, but your body communicating with you?

Perhaps it is telling you that your sleep needs attention. Perhaps your afternoon cravings are telling you that your meals aren't keeping you satisfied. Perhaps losing strength is a sign that your muscles need more attention. Perhaps your irritability is telling you that your mental load has become too much.

And sometimes, your symptoms may simply be telling you that it is time to ask for help.

You don't need to solve all of these things at once. In fact, trying to do that will probably leave you feeling even more overwhelmed.

Start by listening.

Then decide what needs your attention first.

Where do you start when everything feels like too much?

This is exactly why I don't want you to finish this article with another enormous to-do list.

If you're already exhausted, the last thing you need is another person telling you to overhaul your entire life.

Instead, I'd like you to understand where your biggest opportunity might be.

I've created the free Perimenopause Snapshot Assessment to help you do exactly that. It looks at five foundations that have a huge influence on how you feel during perimenopause — energy, nutrition, movement, sleep and stress — and helps you identify where you may need the most support right now.

You don't need to fix everything.

You don't even need to know exactly what's wrong.

You just need somewhere sensible to start.

Take the free Perimenopause Snapshot Assessment →

Frequently Asked Questions

Why am I so tired during perimenopause?

Perimenopause fatigue can have several contributing factors, including hormonal fluctuations, disrupted sleep, stress, changes in mood, nutritional issues and changes in body composition. Heavy periods can also contribute to iron deficiency in some women.

Is extreme fatigue normal during perimenopause?

Fatigue is commonly reported during perimenopause, but severe or persistent exhaustion shouldn't automatically be dismissed as a normal part of hormonal change. If fatigue is significantly affecting your daily life, speak with your GP to investigate possible causes.

Can perimenopause cause low energy?

Yes. Hormonal changes and the symptoms that accompany them, particularly sleep disruption, hot flushes, mood changes and stress, can contribute to low energy during the menopause transition.

Why am I exhausted even when I sleep?

Sleep quality matters as well as the number of hours you spend in bed. Perimenopause can cause night waking, hot flushes and other sleep disruptions that may leave you feeling unrefreshed even if you appear to be getting enough hours of sleep.

Can perimenopause cause afternoon fatigue?

It can contribute to fatigue at any time of day. Your afternoon energy levels may also be influenced by your sleep, meal composition, overall energy intake, stress and physical activity.

Can nutrition help with perimenopause fatigue?

A balanced, nutrient-rich diet can support overall health and energy. Focus on adequate food, protein, fibre, vegetables, fruit, wholegrains, legumes and healthy fats rather than relying on restrictive diets or individual “energy-boosting” foods.

Does protein help with tiredness during perimenopause?

Protein is important for maintaining muscle and supporting a balanced diet, but it isn't a cure for fatigue. Persistent exhaustion may have multiple causes, so it's important to consider sleep, stress, nutrition, movement and potential medical causes.

Can exercise help perimenopause fatigue?

Regular physical activity can support cardiovascular health, mood, sleep, metabolic health and physical function. If you're exhausted, however, more exercise isn't necessarily better. Choose movement that supports your body without leaving you depleted.

Should I take supplements for perimenopause fatigue?

There is no universal supplement that every woman needs for perimenopause fatigue. Supplements may be appropriate when a deficiency or specific clinical need has been identified. Persistent fatigue should be assessed rather than automatically treated with supplements.

Could iron deficiency be causing my fatigue?

Yes. Iron deficiency can contribute to fatigue and reduced concentration, and heavy menstrual bleeding can increase the risk of iron deficiency. If your periods have become significantly heavier and you're experiencing persistent fatigue, speak with your GP about whether testing is appropriate.

When should I see my doctor about perimenopause fatigue?

Speak with your GP if your fatigue is severe, persistent, worsening or interfering with your ability to work and manage everyday life. Other conditions, including iron deficiency, thyroid problems, sleep disorders, mood disorders and medication effects, can also cause fatigue and should not automatically be attributed to perimenopause.