Tired All the Time in Perimenopause? Common Causes and Where Food Fits In
If you're in your 40s and feel tired in a way that coffee and an early bedtime don't fix, you're in good company. Fatigue is a common complaint we hear from clients in perimenopause, the years leading up to your final period. There usually isn't one single cause. Sleep, hormones, your periods, your mood, and how you're eating can all play a part, and several of those are things you can do something about.
Why Perimenopause Can Leave You So Tired
Your sleep changes. A large U.S. study that followed thousands of women through midlife, called SWAN (the Study of Women's Health Across the Nation), found that more than a third reported trouble sleeping, and waking up during the night was the most common complaint. For many women, sleep troubles were already there before perimenopause. For others, they clearly got worse during this stage. Shifting hormones play a part in a couple of ways. Changing hormone levels can bring on hot flashes and night sweats, and in SWAN, the more nights a woman had them, the more likely she was to have trouble sleeping. Hormone changes can also affect sleep on their own: in the same study, drops in estrogen were linked to more trouble falling asleep and staying asleep. Even if you're in bed for eight hours, broken sleep can leave you feeling like you barely slept.
Your periods may be heavier or last longer. Periods often become unpredictable in perimenopause, and for some women that means heavier or longer bleeding. Heavy bleeding raises the risk of low iron, and fatigue, weakness, and trouble concentrating are classic signs of iron deficiency anemia. The SWAN study mentioned above has looked at this in midlife, too: women who had frequent heavy periods during perimenopause were more likely to report feeling tired.
Your mood may be shifting. The risk of depression is higher during perimenopause than in the years before it.
Other health conditions can look a lot like perimenopause. An underactive thyroid (hypothyroidism) is much more common in women than in men. It can cause fatigue, and it can also cause heavy or irregular periods, which makes it easy to mistake for perimenopause. Low vitamin B12 can also cause fatigue and is more likely in people who eat little or no animal foods and people who take metformin or acid-reducing medications long term. Your doctor can check for both, so they’re good reasons to bring up your fatigue rather than assume it’s “just perimenopause.
How Food Can Support Your Energy
Food won't fix broken sleep or heavy periods on its own, but it can make sure your body isn't running low on fuel and the nutrients it needs.
Eat regularly, even when you're busy. Midlife is often packed with work, kids, and aging parents, and meals are easy to skip. When you're tired, it's common to run on coffee and grab whatever's fastest later in the day. Regular meals and snacks with a mix of carbohydrates, protein, and fat give your body steady fuel. For more on building meals in this stage of life, see our post on perimenopause and nutrition.
Be careful about cutting back on food. Many women start dieting in perimenopause in response to body changes. Eating less than your body needs can leave you low on energy at a time when you already feel drained. If you're feeling pressure to change your body right now, our post on menopause, hormones, and weight changes explains what's happening and why.
Include iron-rich foods, especially if your periods are heavy. Until age 50, women need more than twice as much iron each day as they do after 50. Iron from meat, poultry, and seafood is absorbed most easily. Beans, lentils, tofu, spinach, and iron-fortified cereals also provide iron, and pairing them with a food rich in vitamin C, such as citrus, strawberries, peppers, or tomatoes, helps your body absorb more of it. If you think you might be low, talk with your doctor or dietitian before starting a supplement.
Get enough vitamin B12. B12 comes naturally from animal foods like fish, meat, poultry, eggs, and dairy. If you eat a mostly plant-based diet, fortified cereals and nutritional yeast are reliable sources, and your doctor or dietitian can help you decide whether you need a supplement.
Watch the timing of your caffeine. When you're tired, it's natural to reach for more coffee, but caffeine late in the day can cost you sleep. In one sleep study, a large dose of caffeine taken six hours before bed cut sleep by more than an hour, and the people in the study didn't notice the difference. If sleep is a struggle, try keeping caffeine to the morning and early afternoon. If energy drinks have become part of how you get through the day, our post on Celsius and other energy drinks looks at how much caffeine they contain and how they can affect sleep.
Be skeptical of supplements for hot flashes. Since hot flashes can wreck sleep, many women turn to supplements. The Menopause Society, the leading professional group for menopause care in North America, does not recommend supplements, herbal remedies, soy products, or diet changes for treating hot flashes. Several other treatments do have good evidence, including certain medications and cognitive behavioral therapy (CBT), so talk with your doctor about what fits you.
Where Movement Fits In
Moving your body can help you sleep better. The U.S. Physical Activity Guidelines report strong evidence that regular moderate to vigorous activity improves sleep quality in adults. People who are more active tend to fall asleep faster and get more deep sleep. Regular activity can also ease symptoms of depression. Moderate activity counts, so it doesn't have to be intense to help. Look for movement you enjoy and can keep coming back to, and if you have a health condition, check with your doctor about what's right for you.
When to Talk With Your Doctor
Fatigue that lasts for weeks deserves a conversation with your doctor, especially if you notice:
Periods that are much heavier or longer than usual
Hot flashes or night sweats that regularly wake you up
Feeling down, hopeless, or losing interest in things you usually enjoy
Shortness of breath, dizziness, or feeling cold all the time
Let your doctor know how long you've been feeling this way and what other symptoms you've noticed, so they can decide what testing or treatment makes sense. You can also ask whether hormone therapy might be an option for you. If your mood is a concern, a therapist or psychiatrist can help, too.
When Eating Feels Complicated
Midlife body changes can stir up old struggles with food, or start new ones. If you find yourself skipping meals on purpose, feeling guilty after eating, or caught in cycles of restricting and then feeling out of control around food, you deserve support with that, too.
Want Support With Perimenopause Nutrition?
At Wilfong Nutrition, our registered dietitians help women in perimenopause and menopause eat in a way that supports their energy, sleep, and long-term health, using a weight-neutral, non-diet approach. We see clients in person in Austin and by telehealth across Texas, and we're in-network with BCBS, Aetna, Cigna, United, and Curative. Schedule an appointment today.
Frequently Asked Questions
How do I get my energy back during perimenopause? Start by looking for causes that can be treated. Talk with your doctor about your fatigue, since low iron, low B12, and thyroid problems can all play a part, and let them know if hot flashes or night sweats are waking you up. Eating regular meals and snacks, including iron-rich foods, keeping caffeine to earlier in the day, and adding movement you enjoy can all help, too.
Is it normal to feel exhausted during perimenopause? Fatigue is common in perimenopause, often because of sleep problems, hot flashes, heavier periods, or mood changes. Common doesn't mean you have to live with it, though. Many of the causes can be treated.
Can heavy periods make you tired? Yes, they can. Heavy bleeding can lower your iron, and low iron is a common cause of fatigue. In the SWAN study, women with frequent heavy periods during perimenopause were more likely to report feeling tired.
What vitamins help with perimenopause fatigue? A supplement helps most when you're actually low in a nutrient. Iron and vitamin B12 are two that can cause fatigue when they're low, and a blood test can tell you whether that applies to you. Talk with your doctor or dietitian before starting an iron supplement.
Does caffeine make perimenopause fatigue worse? It can, if it cuts into your sleep. Caffeine late in the day can shorten your sleep even when you don't notice it. Try keeping it to earlier in the day.
When should I see a doctor about fatigue? If you've felt tired for several weeks, or you also have heavy periods, frequent night sweats, low mood, or other new symptoms, check in with your doctor. Thyroid problems, low iron, and low B12 can all cause fatigue and are easy to test for.
