September 01, 2026
Exhausted during perimenopause? Learn what research says about perimenopause fatigue, possible causes, and strategies that may help
Where Are You in Your Menopause Journey?
Take Our QuizFatigue and exhaustion are commonly reported during perimenopause . Hormonal changes may contribute, along with disrupted sleep, hot flashes and night sweats, mood changes, heavy menstrual bleeding, stress, and other health conditions.
A 2026 study, Psychological Symptoms During Perimenopause: A Global Perspective , looked at 7,975 women across 20 countries and found psychological symptom scores were 52% higher in perimenopause than premenopause. The biggest increase was physical and mental exhaustion, up 56%, including decreased performance, impaired memory, difficulty concentrating, and forgetfulness.
For Dr. Mary Claire Haver, MD, FACOG, MSCP, board-certified OB-GYN, Menopause Society Certified Practitioner, and author of The New Perimenopause , the findings validate what many women experience: “If you’re in perimenopause and seeing an increase in your psychological symptoms, you are not alone. It is real. It’s likely related to hormones. You deserve a conversation with your clinician.”
Hormones may be part of the picture, but persistent fatigue shouldn’t automatically be attributed to perimenopause. Identifying what’s contributing to your exhaustion can help you and your clinician determine what may help.
What Does Perimenopause Fatigue Feel Like?
Perimenopause fatigue can feel like persistent low energy, physical exhaustion, mental exhaustion or difficulty getting through activities that normally feel manageable. You may wake up tired even after a full night in bed or notice more trouble concentrating, remembering things or staying mentally sharp. Some women describe sudden, overwhelming exhaustion as “crashing fatigue,” though this isn’t a medical diagnosis.
8 Strategies for Perimenopause Fatigue Treatment & Relief
The table below summarizes actionable strategies to treat perimenopause fatigue, lower exhaustion, and restore daily energy:
| Strategy | Why it may help | When it's most relevant |
|---|---|---|
| Rule out other causes of fatigue | Helps identify health conditions, medications, or other factors that may be contributing to exhaustion | Persistent, severe, extreme, or unexplained fatigue |
| Consider Menopause Hormone Therapy (MHT) | Treats hot flashes and night sweats that may disrupt sleep and contribute to daytime fatigue | Fatigue alongside bothersome hot flashes, night sweats, or sleep disruption |
| Protect your sleep and treat sleep problems | Better sleep may reduce daytime tiredness and improve energy | Insomnia, frequent waking, night sweats, or poor sleep quality |
| Eat enough and prioritize nutrient-dense foods | Adequate energy, protein, and nutrient intake support normal body function and help prevent fatigue related to inadequate nutrition | Restrictive eating, weight-loss efforts, or inadequate nutrient intake |
| Be strategic about caffeine and alcohol | Caffeine and alcohol can interfere with sleep quality and contribute to next-day tiredness | Difficulty falling asleep, staying asleep, or waking refreshed |
| Check for deficiencies and consider supplementation | Correcting an identified nutrient deficiency may help when it is contributing to fatigue | Low iron, B12, vitamin D, or another confirmed or suspected deficiency |
| Stay active | Exercise may improve fatigue, sleep quality, and insomnia symptoms | Most women, with activity adjusted for health and fitness level |
| Address chronic stress | Reducing stress and creating opportunities for recovery may support sleep and lessen feelings of exhaustion | Reducing stress and creating opportunities for recovery may support sleep and lessen feelings of exhaustion |
1. Rule Out Other Causes of Fatigue First
Fatigue has many possible causes , so persistent or severe, or extreme fatigue during perimenopause shouldn’t automatically be attributed to perimenopause. Talk with your clinician about the full picture, including changes in your periods, sleep, mood, eating pattern, stress levels, medications, and any other new or changing symptoms.
Several health conditions and other factors can contribute to fatigue , including:
- Anemia or low iron stores
- Thyroid disease
- Diabetes or prediabetes
- Vitamin B12 or vitamin D deficiency
- Depression or anxiety
- Sleep apnea
- Certain medications
Depending on your symptoms, medical history, and exam, your clinician may recommend testing to look for possible contributors. This could include a complete blood count, iron and ferritin studies, thyroid testing, glucose or A1C, or specific vitamin levels when appropriate.
Some conditions can also cause symptoms that overlap with those experienced during the menopause transition. Fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and long COVID can involve fatigue along with other overlapping symptoms . More than one factor may be contributing to how you feel, which is why looking at your overall health rather than assuming every symptom is caused by perimenopause matters.
2. Explore Menopause Hormone Therapy for Perimenopause Fatigue
If hot flashes or night sweats are waking you up, it’s no surprise that you feel drained the next day. Research and major menopause organizations, including The Menopause Society consider hormone therapy the gold standard for treating these vasomotor symptoms . Reducing the frequency and intensity of hot flashes and night sweats, may help you sleep more soundly and have more energy.
MHT isn’t a universal treatment for perimenopause tiredness, and it’s not right for everyone but if exhaustion is happening alongside hot flashes, night sweats, sleep dysfunction and other symptoms, it’s worth a conversation with your doctor.
3. Protect Your Sleep and Treat Sleep Problems
Perimenopause can disrupt sleep through night sweats, body temperature changes, anxiety and insomnia. But fatigue doesn’t always track neatly with the number of hours you sleep, and some women can feel significantly tired even though it appears that they’re getting enough hours of zzz’s. Healthy sleep habits can help support better sleep. Aim for a consistent sleep and wake time, a cool, dark bedroom and wind-down routine that doesn’t involve work or doom-scrolling. If you have persistent insomnia, consider cognitive behavioral therapy (CBT), which has been shown to help with chronic insomnia .
4. Eat Enough and Prioritize Protein
Food is fuel for your body and if you’re not eating enough (maybe you’re trying to lose weight), fatigue can follow . Restrictive eating can also make it harder to get enough protein, iron, vitamin B12 and other nutrients that are key to energy . If you’re trying to lose weight and are constantly tired, consider talking to your doctor and/or a registered dietitian to evaluate your diet.
Build your meals around a combination of protein, fiber-rich carbohydrates, healthy fats and a wide variety of vegetables and fruits. Try to include some protein at each meal; spreading it throughout the day gives your body the consistent supply it needs that can help avoid the dips in blood sugar that may also contribute to fatigue. Good sources of protein include eggs, Greek yogurt, cottage cheese, chicken, turkey or lean meat, fish and seafood, tofu, tempeh, beans, lentils and chickpeas.
5. Be Strategic About Caffeine and Alcohol
That glass of wine may make you feel relaxed and fall asleep more quickly initially but alcohol can delay and reduce REM sleep , the stage involved in memory, learning and emotional processing. As the alcohol wears off, your sleep may become lighter and more fragmented , making you more likely to wake up during the second half of the night. Alcohol can also worsen night sweats, snoring and sleep-disordered breathing, which impacts the quality of your zzz’s and can end up leading to fatigue.
To help figure out the effect alcohol has on you, try avoiding it for a week or if you do drink, limit it and have it earlier in the evening. Then track your sleep, night-sweats and next-day energy.
Caffeine is more nuanced; It may make it harder to fall asleep , increase waking up in the middle of the night and reduce deep sleep. Caffeine stays in your body for hours so limiting the amount you drink and cutting it off a few hours before bed may help prevent or lessen its impact on your sleep. Nicotine can also interfere with sleep and is associated with many other health risks, so it’s best to simply avoid it.
6. Check for Deficiencies and Consider Supplementation
Supplements can be a useful part of a midlife health plan, especially when they help fill nutrient gaps or support areas such as sleep and energy metabolism. The best approach is to choose them with a clear purpose rather than assuming more is always better. Your clinician can help you decide whether testing is appropriate and which nutrients may deserve more attention based on your symptoms, eating pattern, medications, and health history.
A few vitamins and minerals to consider:
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Iron: Heavy or unpredictable periods may lower iron stores, and low iron can contribute to fatigue. If testing shows iron deficiency or low ferritin, iron supplementation may help improve fatigue . Because iron needs vary, supplementation should be guided by your clinician.
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Vitamin B12: Vitamin B12 deficiency can cause fatigue and may also affect neurological function. B12 supports normal energy metabolism, and supplementation may be appropriate when intake is low, blood levels are inadequate, or absorption is impaired.
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Vitamin D: Vitamin D plays important roles in bone, muscle, and immune health, and low levels may contribute to feeling tired. Recent research found improvements in fatigue and mood among perimenopausal women who took vitamin D3 for six months.
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Magnesium: Magnesium supports many processes in the body, including normal muscle and nerve function. It is also commonly used as part of a sleep-support routine. Some research has linked higher magnesium intake with better sleep quality , and a systematic review and meta-analysis found that supplementation may help older adults fall asleep faster , likely by supporting muscle relaxation and a calmer mood. Research on magnesium and sleep is still developing, and findings have not been consistent across all studies.
7. Stay active
When you’re exhausted, exercise can feel like the last thing you need. But regular movement may help your body use energy more efficiently, improve circulation and help you sleep better; all of which can help combat fatigue.
Overall research (not just on perimenopausal and menopausal women) links exercise to small-to-moderate improvements in fatigue and energy . For perimenopause specifically, an analysis of trials found that exercise, including walking, aerobic exercise, yoga and qi gong, improved sleep quality and insomnia symptoms. Mind-body exercises, including tai chi, yoga, Pilates, qigong, baduanjin also helped reduce fatigue among perimenopausal and menopausal women.
Resistance training may also play a role in combating fatigue. Building muscle mass and strength allows the body to move through daily tasks with less relative effort, which can reduce the sense of exhaustion that comes from simply getting through the day. Strength training has also been shown to support better sleep quality, and improved sleep is one of the most direct ways to address persistent fatigue during perimenopause and menopause. Beyond the physical effects, resistance training can improve mood and mental energy, which often feel just as depleted as physical energy during this transition. It doesn’t need to be intense to help. Two to three short sessions a week using basic compound movements, like squats, rows, or presses, can be enough to build strength gradually while easing into a more active routine.
Start with an amount that feels manageable, a 15-minute walk, a gentle yoga session, or two short resistance training sessions a week using basic bodyweight or dumbells, and increase the frequency and intensity gradually. The key is consistency and the best form of exercise is one that you’ll stick to doing.
8. Address Chronic Stress & The Mental Load
If you’re exhausted from taking care of everyone and everything, you don’t need a study to tell you that midlife can be a lot. You may be managing a demanding career or volunteer role, supporting children who still need you, helping aging parents, running a household, and navigating the hormonal changes of perimenopause at the same time. For many women, this is the ultimate sandwich stage of life.
Research backs up just how much can converge during these years. The 2023 Seattle Midlife Women’s Health Study examined stressful life events during the menopause transition, a time when women may be balancing work, family, caregiving, relationships, and changes in their own health. When you’re carrying that much, advice to simply “manage your stress” can feel like one more thing you’re supposed to do.
Instead, look for opportunities to take something off your plate. Share caregiving responsibilities when you can, delegate a household task, say no to a nonessential obligation, or ask for help. Protecting time for activities you genuinely enjoy, whether that’s taking a walk, having dinner with a friend, reading, or simply having some uninterrupted time to yourself, can also create space for recovery.
Structured approaches may help too. In a randomized controlled trial , a mindfulness-based stress reduction (MBSR) program that included breathing meditation, sitting meditation, and yoga improved perceived stress and sleep quality in menopausal women. The goal isn’t to become better at tolerating an overwhelming load. It’s to recognize that the load itself may be contributing to how exhausted you feel.
When to See a Doctor ASAP
One last note: While it’s common to experience fatigue during perimenopause, there are a few circumstances in which you should see your doctor sooner rather than later. If the fatigue you’re experiencing is accompanied by unintentional weight loss, persistent rapid heartbeat or palpitations, shortness of breath, fainting, blood in stool, severe diarrhea, extreme weakness or new neurological symptoms like numbness, vision changes or trouble speaking you should see your doctor asap.
