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Our lives are busy and, heading into our 40s and 50s, many women are juggling a demanding career, parenting, social responsibilities and/or caring for elderly relatives. Fatigue is part of life for most people. But, during the transition from pre- to post-menopause, 46% of women report physical and mental exhaustion of an extreme nature. It's the type of fatigue that doesn’t go away, no matter how much downtime, sleep and rest you get. 

46% of women report physical and mental exhaustion of an extreme nature

Fatigue exhibits in several ways, including lack of normal energy levels, sleep disturbance, daytime napping, feeling overexerted after mild exercise, difficulty in mental processing, inability to handle workplace stress. Unfortunately there is no clear evidence that hormonal fatigue will completely recede once a woman’s hormones settle in post menopause. For some it may go away, while for others it may continue to be an issue. The good news is that there are several treatment options available, depending on the root cause and/or contributing causes of the fatigue.

The Lowdown on Fatigue

Why does this happen, how does it impact you, how is it diagnoses and common triggers/ risk profiles.

A woman’s estrogen and progesterone levels fluctuate during peri-menopause. These changes affect endocrine hormones’ activity related to energy regulation, as controlled through the adrenal and thyroid glands. Changes in the endocrine system and hormone levels result in instability that is difficult for the body to incorporate. This leads to the feeling of crashing fatigue and sudden low energy levels. As post-menopause arrives, these hormones will level off and stabilize.

Fatigue is an interconnected and multi-faceted menopausal symptom. It impacts a woman’s physical, emotional, and cognitive health. It isn’t surprising that there is a strong interrelationship between fatigue and sleep disturbance. A woman who is sleeping poorly will feel tired during the day. 

Fatigue impacts a woman’s physical, emotional, and cognitive health.

There are some life conditions that may contribute to feelings of excessive or debilitating fatigue. If you are suffering from conditions such as anxiety disorder or clinical depression, these medical problems can also affect your energy levels. Anxiety, depression, and fatigue may be related to menopause, however they can also originate from other causes (anaemia, thyroid dysfunction, autoimmune disorders, diabetes, and heart conditions). It is important to receive accurate and timely diagnosis, along with appropriate treatment options, as issues such as fatigue and mood-based disorders can compound over time, if left untreated.

Nutritional deficiencies can also contribute to medical causes for low energy and excessive fatigue. Low levels of essential vitamins and minerals, such as iron, B12, vitamin D, should be eliminated as the potential cause of fatigue before other treatments are started. It is important to understand the effects of chronic fatigue which can sometimes become pathological, requiring additional treatment. Chronic fatigue syndrome and clinical depression are correlated to fatigue. Even premature retirement has been linked to under-treated menopausal fatigue.

Fatigue is an interconnected and multi-faceted menopausal symptom. Unfortunately, it has the potential to impact a woman’s physical, emotional, and cognitive health.

Excessive and/or sudden fatigue is also related to the following common menopausal symptoms: 

  • Moodiness
  • Irritability
  • Lowered libido

Diagnosis of clinical levels of fatigue is performed through assessment of self-reported symptoms. This means that if you are feeling more tired than normal, it is essential that you describe your feelings to your doctor and other medical support professionals. Even if your fatigue comes and goes, it can be significant and debilitating, and there are treatment options available. Healthcare professionals are able to grade your level of fatigue according to common self-reporting testing methods.

Poor quality sleep is highly likely to result in an exacerbation of fatigue symptoms. It is important to treat each symptom with suitable medical or lifestyle options, however it would be somewhat counter-productive to focus on treatment for fatigue without also optimizing sleep quality at the same time.

Mental and physical health

Prioritise and say no (sometimes)

During all phases of menopause, it is essential to take care of yourself and have adequate amounts of rest built into your day. Especially when your energy levels are low, you need to prioritise ruthlessly and (learn to) refuse things that are not important and/or drain your energy. Many of us are used to prioritising the needs of our families and others above our own, and it can be hard to find a new balance in this. But it is incredibly important for your overall well being that you look after your own needs - both physically and mentally. A good place to start is to prioritize your sleep hygiene, particularly if you are struggling with fatigue, and reducing the overall level of stress in your life. It will not just help you feel better rested, but also more in control of your life and well being. 

Prevention and Treatment

Learn more about your options for prevention, management and treatment of Fatigue. This is not an exhaustive list of the treatment options available, but a good start.

There are so many possible root causes for excessive feelings of fatigue, it is critical to undergo complete diagnosis before entering into specific treatment. Some treatments can be combined with others and some treatments are ideal if you are suffering from more than one menopausal symptom. Many of the lifestyle treatments described are effective whether you are experiencing mild or moderate fatigue, or if you want to ensure that fatigue does not become a problem.

Whether you are in the midst of menopause or pre-menopause, what you eat will affect your body’s ability to store and sustain energy.

  • Avoid foods that are high in sugar, as they cause a blood sugar spike and crash which leaves you feeling un-energetic.
  • Artificial sweeteners and refined carbohydrates have similar effects on your body’s blood sugar levels, so they should also be avoided.
  • Hydrate. Make sure you are drinking enough water every day. Staying hydrated is an excellent way of protecting the natural energy your body is producing.
  • Try to begin your day with a healthy and balanced breakfast. This will give your body an excellent start each day and will help you to pace your activities, cognition, and moods throughout the day.
  • Remember that caffeine takes up to 12 hours to clear out of the body and may impact your ability to sleep and to pace your day.

Regular exercise plays an important role in increasing energy levels, and indirectly reduces stress and improves sleep quality. The World Health Organization (WHO) physical activity guidelines indicate women between the ages of 40 - 65 should be participating in at least 2.5 to 5 hours of moderate intensity aerobic activity every week. Those participating in vigorous physical activities such as running or swimming can reduce their time to a recommended 1.25 - 2.5 hours/week. It is important to remember to include muscle strengthening activities in your exercise routine as well.

One interesting study showed that even low-level aerobic activity can improve complaints of fatigue and can increase self-reported energy levels. Those participating in light exercise while also reporting high levels of fatigue experienced a 65% decrease in their level of fatigue.

Fatigue is often associated with low levels of essential vitamins.

  • There is value to ensuring that you are receiving the vitamins and minerals your body needs by taking a daily multivitamin.
  • For many women, low levels of iron also contribute to persistent feelings of tiredness and lack of energy. However, therapeutic doses of additional iron should only be taken under the advice of your medical professional as there can be side effects.
  • Rhodiola rosea extract has been found to provide energy boosting hormonal-balancing effects and may provide relief for menopausal fatigue.

There are no over-the-counter medications available to treat menopause fatigue specifically.

  • Self-medication with stimulants such as caffeine, drugs, or other nervous system triggers can exacerbate fatigue consequences if used habitually. 
  • Melatonin, taken in small doses, may improve a woman’s ability to fall asleep and may help with reduction of fatigue through better sleep hygiene.

There is evidence that some non-hormonal medications used to treat sleep disorders may be helpful for menopause fatigue.

  • Armodafinil reduces sleepiness caused by sleep-related diagnosis, including sleep apnea, shift-work sleep disorders, fatigue in multiple sclerosis and stroke. It has been suggested that it might work for menopause fatigue but there is currently limited evidence for this. In a small study, peri-menopausal women reported a 57% reduction in self-reported fatigue indicators. Many peri- and post-menopausal women suffer from Obstructive Sleep Apnea and fatigue.
  • Serotonin Reuptake Inhibitors (SSRI) or Serotonin-norepinephrine Reuptake Inhibitors (SNRI) may be prescribed for sleep improvement. However, these antidepressant medications also have a potential side effect: insomnia.

Your doctor may prescribeHormonal Replacement Therapy (HRT)involving estrogen replacement. Progesterone therapy is also used for some women, depending on the woman’s medical history and severity of symptoms. HRT is a common treatment prescribed for peri- and post-menopausal women. HRT involves systemic additions of estrogen and, if a woman has not previously had a hysterectomy, progestin. In studies, women taking HRT were found less likely to suffer from OSA (obstructive sleep apnea) during post-menopause. HRT can have a positive (direct and indirect) effect on a woman’s quality of sleep by managing symptoms that are causing sleep deprivation. It should be noted, however, that if fatigue is a woman’s primary menopausal symptom, HRT is not considered a suitable first choice for treatment.


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