Why am I Tired all the Time in Perimenopause?

When I was working as a GP, feeling tired all the time was a complaint that I could pretty much guarantee that I would see (at least once), every single day. It’s particularly common when you hit perimenopause. Getting through daily life can feel like wading through treacle. And, if you’re a runner, finding the energy to do any form of exercise can be really hard. Let’s explore why you might be feeling tired all the time in perimenopause and what you can do about it.  

Why do I feel tired all the time? 

Sometimes fatigue is unexplainable. It can happen as a direct result of changing hormone levels. But, more often than not, there are some underlying reasons why you might find yourself feeling permanently exhausted in perimenopause.  

1. Poor sleep. Around 84% of women complain of poor sleep in perimenopause. Waking up with night sweats or to pee more frequently than you used to will of course lead to sleep disturbance. Aside from that, menopause insomnia is a thing. It’s common to experience frequent waking and unrefreshing sleep due to the direct hormonal changes of the menopause, even if you don’t have night sweats or an irritable bladder. Remember too that you can become more sensitive to caffeine and alcohol which may affect you for longer or more severely than they used to resulting in sleep disturbance. 

2. Increased stress. There’s often a lot to cope with at this time of life. You may have children and elderly parents needing your attention. A high pressure job or other work stresses can add to your load, especially if you’re simultaneously struggling to manage menopause symptoms. You may find your coping strategies are lower than usual and be conscious that you’re overreacting to things that wouldn’t normally stress you out. Feeling stressed is exhausting. 

3. Mood changes. It’s not unusual for women in perimenopause to have mental health issues. Both anxiety and depression are more likely to occur. When you feel anxious, you’re in a hyper alert state with raised levels of adrenalin. Your body is constantly on edge, ready to fight or take flight. It’s hard to switch off and relax and if you’ve been there, you will know how draining it is. Similarly, feeling tired is a common symptom of depression, even if you’re sleeping a lot, you can still feel as if you haven’t slept a wink.  

4. Medical conditions. As well as mental health issues, there are other medical conditions that might make you feel tired all the time. It’s never a good idea to put everything down to the perimenopause, you may need to get reassurance or have things ruled out by your doctor. Here are some conditions that can leave you feeling tired: 

• Anaemia. If you have heavy or more frequent periods in perimenopause, you may have low iron levels and low numbers of red blood cells (anaemia).  
• Hypothyroidism. Tiredness is a common symptom of an underactive thyroid. This can often crop up in perimenopause and because symptoms also include weight gain, dry skin, constipation and low mood, it’s easy to see why it could be missed.  
• Other conditions. There are endless other conditions that have tiredness as a feature including an overactive thyroid, chronic fatigue, diabetes, coeliac disease and long Covid.  

5. Over training. Over training doesn’t just mean exercising too much, it can also mean not allowing enough recovery. If you haven’t increased your training, are you battling on with your usual routine and wondering why you can’t seem to cope with it anymore? It’s not unusual to need extra recovery days as we get older and particularly when there are so many menopausal changes going on in our body. And, if you’re battling with poor sleep, increased stress and mood changes as well, then you might just have too much on your plate to keep up your long held training routines. This might not be a permanent thing but it pays to be open to the idea this could be the case for you.  

6. Under fuelling. So much changes in menopause and that can include your digestion, body composition and nutritional needs. A common trap women fall into is to cut down their food intake to try to shed excess fat. Fat tends to accumulate around the waist line and so many women tell me they hate this. Restricting calories and being in a negative energy balance doesn’t always help and can simply leave you feeling hungry and lacking in energy. It may not just be not eating enough it could also be not eating the right foods and not timing your food well, this is particularly important for active women who need high quality, nutrient dense foods and plenty of energy available for training sessions. 

Hopefully that list will give you some insight into why you feel exhausted. To be honest, it’s most likely to be a combination of a few different reasons.  

What can I do to stop feeling tired in perimenopause? 

Find a time when you have enough energy to think straight. Sit down and devote half an hour to think through all the reasons you feel tired. Go through the list above and see which apply to you.  

If you think there may be an underlying medical condition accounting for your tiredness, or your tiredness is severe and persistent, then it’s vital to get checked out by your doctor. After talking to you and examining you they will probably arrange some blood tests to rule out some of the most common conditions causing excessive tiredness. They won’t routinely check your hormone levels as these are unlikely to be helpful unless you are under 45, in which case they may take them to rule out a premature or early menopause.  

Here is a quote from my book, Sorted The Active Woman’s Guide to Health published by Bloomsbury. There is a whole chapter on feeling tired all the time: 

“It can be difficult to know how much fatigue is normal and acceptable.  

See your GP if:  

• you’re losing or gaining weight with no obvious cause
 
• you’re having night sweats and you aren’t menopausal 
•  your periods are heavy  
• your bowel habit has changed, you’ve had blood in your stools, abdominal pain or recurrent bloating 
• you’re more out of breath than normal or you’re getting palpitations, dizziness or chest pains 
•  you notice any lumps or bumps in your neck, arm pits, groins or breasts  
• you’re excessively thirsty or you’re passing lots more urine than normal 
• your tiredness is excessive, interfering with daily life, and nothing helps it.”  

Back to basics

Next, consider what steps you can take to improve things. You’ve probably heard the phrase, ‘control the controllable’. There are many things that are not in our control but there are many that we can influence. This sometimes takes being strict with looking after ourselves, setting boundaries and prioritising our own health. Sharing how you feel with family members, asking for help (so hard to do sometimes) and delegating are useful tactics. Self-compassion is vital. Are you beating yourself up for not being at your best? Can you take a break, even for a few minutes, but preferably longer? Go back to the very basics of sleep, nutrition, movement and relaxation. What positive change could you make in each of these areas to improve things?  

Will HRT help my tiredness?

Hormone replacement therapy (HRT) can be beneficial for reducing the vasomotor symptoms of menopause such as night sweats and many women who start it say they see an improvement in their sleep and energy within a few months. If mood changes are linked to decreasing levels of oestrogen and progesterone, then again HRT may be extremely helpful. 

Getting the energy balance right.

Over training and under fuelling are easier to solve, once you identify them that is. You might need to experiment to find the right balance for you. That balance might change day to day too. Can you make some simple changes to what you eat and when you eat to ensure you have energy when you need it? Don’t start with some drastic overhaul, it’s too tiring to keep up. Just make a simple switch such as adding an extra rest day to your plan or eating a decent breakfast every day.  

You’re probably exhausted just reading all that! Have a think about it and revisit it tomorrow. I hope it might steer you in the right direction towards better energy levels and less tiredness. Let me know what you think might be causing your fatigue and if you’ve resolved it, what worked for you? 

Enjoyed this blog? You might like my weekly tips and advice for peri and post menopausal runners. You can sign up to receive them below. Come and join me! 

Featured image by Engin_Akyurt at Pixabay