Fatigue
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.
Why is this happening?
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.
Other impacted areas
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
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.
Possible triggers or risk factors
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.
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Treatments & remedies
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.
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Nutrition
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.
Exercise
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.
Mindset
During all phases of menopause, it is essential to take care of yourself and have adequate amounts of rest built into your day. If your energy levels are low, prioritize your life activities and learn to refuse things that are not important or drain your energy. Focus on maximizing your energy increase sources (whether through treatments or lifestyle changes) and reducing those activities that leave you drained. It is essential that you prioritize your sleep hygiene, particularly if you are struggling with fatigue. Arrange an appropriate nighttime routine that encourages 7 - 9 hours of uninterrupted sleep every night. Reducing the overall level of stress in your life will help you to feel better rested and more in control.
Supplements
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.
OTC Products
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.
Prescription
Non- Hormonal
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.
Hormone Treatment
Your doctor may prescribe Hormonal 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.
Holistic Treatment
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FAQ
What are the symptoms of Menopause?
There are roughly 34 symptoms of Menopause with the most commonly experienced being:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Fatigue
- Sleep problems
- Mood changes and irritability
- Weight gain
- Thinning hair and dry skin
Medically reviewed and detailed symptom fact sheets can be found here, and a general overview of what (peri) menopause is and entails can be found here.
References
Greenblum CA, Rowe MA, Neff DF, Greenblum JS. Midlife women: symptoms associated with menopausal transition and early postmenopause and quality of life. Menopause. 2013 Jan;20(1):22-7. doi: 10.1097/gme.0b013e31825a2a91. PMID: 22929034.
Hirose, A., Terauchi, M., Osaka, Y. et al. Effect of soy lecithin on fatigue and menopausal symptoms in middle-aged women: a randomized, double-blind, placebo-controlled study. Nutr J 17, 4 (2018). https://doi.org/10.1186/s12937-018-0314-5
Meyer F, Freeman MP, Petrillo L, Barsky M, Galvan T, Kim S, Cohen L, Joffe H. Armodafinil for fatigue associated with menopause: an open-label trial. Menopause. 2016 Feb;23(2):209-14. doi: 10.1097/GME.0000000000000505. PMID: 26125538.
Puetz TW, Flowers SS, O'Connor PJ. A randomized controlled trial of the effect of aerobic exercise training on feelings of energy and fatigue in sedentary young adults with persistent fatigue. Psychother Psychosom. 2008;77(3):167-74. doi: 10.1159/000116610. Epub 2008 Feb 14. PMID: 18277063.
Ruan X, Cui Y, Du J, Jin F, Mueck AO. Prevalence of climacteric symptoms comparing perimenopausal and postmenopausal Chinese women. J Psychosom Obstet Gynaecol. 2017 Sep;38(3):161-169. doi: 10.1080/0167482X.2016.1244181. Epub 2016 Oct 21. PMID: 27766930.
Taylor-Swanson L, Wong AE, Pincus D, et al. The dynamics of stress and fatigue across menopause: attractors, coupling, and resilience. Menopause. 2018;25(4):380-390. doi:10.1097/GME.0000000000001025
https://www.medicalnewstoday.com/articles/menopause-fatigue#complementary-therapies
https://womensmentalhealth.org/posts/armodafinil-for-the-treatment-of-menopause-related-fatigue/
https://www.bodylogicmd.com/blog/what-is-the-most-effective-treatment-for-fatigue-during-menopause/
Fatigue
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.
Dr. June Tan Sheren
Why this is happening
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.
Other impacted areas
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
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.
Possible triggers or risk factors
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.
Treatments & Remedies
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.
Products
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.
Non- Hormonal
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.
Lifestyle
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.
During all phases of menopause, it is essential to take care of yourself and have adequate amounts of rest built into your day. If your energy levels are low, prioritize your life activities and learn to refuse things that are not important or drain your energy. Focus on maximizing your energy increase sources (whether through treatments or lifestyle changes) and reducing those activities that leave you drained. It is essential that you prioritize your sleep hygiene, particularly if you are struggling with fatigue. Arrange an appropriate nighttime routine that encourages 7 - 9 hours of uninterrupted sleep every night. Reducing the overall level of stress in your life will help you to feel better rested and more in control.
Holistic
TCM
Menopausal symptoms are treated as kidney deficiencies requiring yin/yang rebalancing.
Ayurveda
Natural remedies, including arjuna, cardamom, fennel, guggul, garlic are advisable. Guduchi and pomegranate juice are encouraged. A goal of pitta-reduction and vata-stabilization is recommended, along with dedicated daily time for relaxation.
Acupuncture
Focus on calming yang energy and stimulating yin, to affect qi with positive results.
Mindfulness
Mindfulness and exercises that focus on quiet rest are encouraged. Studies have shown yoga to be highly effective for reduction of menopausal fatigue.
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