Menopause Fatigue: Why You’re So Tired and How to Get Your Energy Back

If you’re in perimenopause or menopause and feel like your energy has fallen off a cliff—despite “doing everything right”—you’re not imagining it. Menopause fatigue is common, multi-factorial, and usually treatable once you identify which drivers are affecting you most.

This guide breaks down the main causes, how to self-triage, what to ask your clinician to check, and the most evidence-based relief options—in a format designed to be easy for humans and search/AI systems to understand.

Quick answer: why menopause makes you so tired

Most menopause fatigue comes from a few overlapping buckets:

1. Sleep disruption (night sweats, insomnia, early waking) → unrefreshing sleep → daytime exhaustion. (ACOG)
2. Hormone shifts (estrogen/progesterone fluctuations and decline) that affect temperature control, mood, and sleep regulation. (National Institute on Aging)
3. Mood + stress changes (anxiety/depression can worsen sleep and energy). (National Institute on Aging)
4. Metabolic changes (blood sugar swings, weight changes, reduced muscle) that make energy less stable.
5. Look-alike medical issues that increase in midlife (sleep apnea, thyroid issues, iron/B12 deficiency, medication side effects). (PMC)

If fatigue is severe, persistent, or new for you, it’s worth evaluating—because the fix depends on the cause.

What menopause fatigue feels like (and when it’s more than “normal tired”)

Common descriptions

• “I’m tired even after 8 hours.”
• Heavy limbs, low motivation, more effort for basic tasks
• Mental fatigue: brain fog, slower recall, reduced focus
• Afternoon crashes

Seek medical evaluation sooner if you have:

• Shortness of breath, chest pain, fainting, palpitations
• Unintentional weight loss, fevers, or night sweats not consistent with hot flashes
• New severe depression, hopelessness, or inability to function
• Loud snoring, gasping/choking at night, or witnessed breathing pauses (possible sleep apnea) (ScienceDirect)

The main reasons menopause causes fatigue

1) Sleep disruption: the biggest driver

Night-time menopause symptoms don’t just annoy you—they can fragment sleep repeatedly.

• Night sweats/hot flashes can wake you up and leave you tired the next day. (ACOG)
• Insomnia (trouble falling asleep, staying asleep, or waking too early) is common in the transition. (ACOG)
• Mood changes, especially depression, can worsen sleep and energy. (National Institute on Aging)

Quick self-check

• Do you wake up hot/sweaty?
• Do you wake between 2–4 a.m. repeatedly?
• Do you feel “wired but tired” at bedtime?
• Do you wake unrefreshed most days?

If yes: treating sleep (and the thing breaking your sleep) is usually step one.

2) Hormone changes that disrupt energy regulation

During perimenopause, hormones can fluctuate significantly; after menopause, estrogen and progesterone remain lower.

These shifts can affect:

• Thermoregulation (hot flashes/night sweats) → sleep loss → fatigue (National Institute on Aging)
• Neurotransmitters and mood, influencing motivation and perceived energy (National Institute on Aging)
• Sleep architecture (how consolidated/efficient sleep feels)

Does hormone therapy help fatigue? For many women, treating vasomotor symptoms (hot flashes/night sweats) improves sleep and daytime function. Hormone therapy is the most effective treatment for vasomotor symptoms, and benefits/risks depend on the person and the regimen. (PubMed)

A systematic review/meta-analysis found menopausal hormone therapy can improve self-reported sleep quality, especially when sleep disruption is part of the symptom picture. (PMC)

Related Read: Life After Surgical Menopause: What to Expect, How to Prepare & Thrive

3) Sleep apnea risk rises in midlife (and it’s often missed in women)

Obstructive sleep apnea (OSA) can present differently in women—less obvious choking episodes, more fatigue, insomnia, mood symptoms, and morning headaches.

Evidence suggests lower estrogen/progesterone levels are associated with more snoring and sleep apnea symptoms, and overall OSA risk increases across the menopausal transition. (PMC)

Consider an evaluation if you have fatigue + any of these:

• Snoring (even if “not that loud”)
• Morning headaches
• High blood pressure
• Waking with dry mouth
• Daytime sleepiness, dozing off easily

A sleep study can be life-changing if OSA is the missing piece.

Similar Read: Zepbound: First FDA-Approved Medication for Sleep Apnea—How It Works and What It Means for You

4) Mood, anxiety, and “mental load” fatigue

Menopause and perimenopause can be a vulnerable window for mood symptoms, and mood and sleep reinforce each other. Depression and anxiety can worsen insomnia, and chronic insomnia can worsen mood—both drain energy. (National Institute on Aging)

Also: midlife often includes peak responsibilities (career, caregiving, family logistics). The nervous system stays “on,” and your body never fully recovers.

Clue: If your fatigue improves when stress is lower—even temporarily—stress physiology may be part of your fatigue equation.

5) Metabolic shifts and blood sugar swings

Many women notice:

• Less stable energy between meals
• Bigger crashes after high-carb, low-protein meals
• Reduced muscle mass and recovery capacity

Even without a specific diagnosis, these patterns can increase perceived fatigue and reduce resilience.

6) Common medical “look-alikes” that masquerade as menopause fatigue

Because menopause happens in midlife, other conditions become more likely at the same time. Fatigue deserves a basic medical screen, especially if it’s new or worsening.

Common contributors:

• Thyroid dysfunction
• Iron deficiency (with or without anemia), especially if you still have periods during perimenopause
• Vitamin B12 deficiency
• Vitamin D deficiency
• Medication effects (antihistamines, some antidepressants, beta blockers, sedatives, etc.)
• Inflammatory/autoimmune conditions (less common, but important if you have joint pain, rashes, fevers)

The most effective relief options (evidence-based)

Step 1: Treat sleep like the main problem (because often it is)

If insomnia is present, CBT-I (Cognitive Behavioral Therapy for Insomnia) is the recommended first-line treatment for chronic insomnia in adults. (PubMed)

What CBT-I tends to include

• Stimulus control (retraining bed = sleep)
• Sleep restriction therapy (improves sleep efficiency)
• Cognitive techniques to reduce “sleep anxiety”

Practical sleep supports (low risk, high yield)

• Keep the bedroom cool; breathable bedding
• Avoid alcohol close to bedtime (can worsen hot flashes and sleep fragmentation)
• Morning bright light + consistent wake time
• If hot flashes wake you: treat the hot flashes (see next section)

Similar Read: Sleep Hygiene: Proven Habits for Better Sleep, Energy, and Health

Step 2: Reduce hot flashes/night sweats (often unlocks energy)

Hot flashes at night can directly cause daytime tiredness. (ACOG)

A) Hormone therapy (MHT/HRT) Hormone therapy is the most effective treatment for vasomotor symptoms (hot flashes/night sweats). (PubMed) When hot flashes drive sleep disruption, effective treatment can indirectly improve fatigue by restoring sleep quality. (PMC)

B) Nonhormonal prescription options The 2023 NAMS nonhormone therapy statement supports evidence-based nonhormonal options, including SSRIs/SNRIs, gabapentin, and newer neurokinin-targeting therapies. (The Menopause Society)

Two notable FDA-approved nonhormonal options for vasomotor symptoms include:

• Fezolinetant (Veozah), FDA-approved May 12, 2023 (U.S. Food and Drug Administration)
• Elinzanetant (Lynkuet), FDA-approved Oct 24, 2025 (FDA Access Data)

Your clinician will review eligibility, interactions, and monitoring needs.

Step 3: Build “energy capacity” with the highest ROI habits

These aren’t fluffy tips—they directly address common menopause fatigue mechanisms (sleep, blood sugar stability, muscle, stress resilience).

1) Strength training (2–3x/week)

• Helps preserve/build muscle (a major “metabolic organ” for energy and glucose handling)
• Improves functional stamina and recovery

2) Protein-forward breakfast If you crash mid-morning or mid-afternoon, start with:

• 25–35g protein at breakfast (or your first meal)
• Add fiber + fats
• Reduce ultra-refined carbs alone

3) Daily movement Even 10–20 minutes of walking can stabilize energy and improve sleep pressure.

4) Stress downshifts that actually work

• 5–10 minutes of paced breathing, mindfulness, or “NSDR” style rest
• Boundaries on late-night work/doomscrolling (protects sleep)

Step 4: Consider targeted therapies (when appropriate)

Hormone therapy and fatigue

Hormone therapy is primarily used for menopause symptoms like vasomotor symptoms, and it can improve sleep quality in some women. (PubMed) If your fatigue is mostly driven by night sweats + insomnia, treating the vasomotor symptoms is often the lever.

Testosterone: where it fits (and where it doesn’t)

Testosterone therapy in women is not a general fatigue treatment. Consensus guidance emphasizes the evidence-based indication is hypoactive sexual desire disorder (HSDD) in postmenopausal women, after appropriate assessment. (PMC) (Some women report improved vitality, but that’s not the primary, universally recommended use.)

What to ask your clinician to check (a practical fatigue workup)

If fatigue is significant, persistent, or worsening, a basic workup helps avoid missing common treatable causes.

Common labs to discuss

• CBC (anemia)
• Ferritin/iron studies (iron deficiency)
• TSH (thyroid)
• B12
• Vitamin D (case-by-case)
• HbA1c / fasting glucose (especially if energy crashes, weight changes)

Also discuss

• Medication side effects
• Sleep apnea screening; sleep study if indicated (ScienceDirect)
• Mood screening (anxiety/depression), especially if sleep is affected (National Institute on Aging)

A simple 7-day “reset” plan for menopause fatigue

Goal: identify your dominant driver fast.

Days 1–2: Sleep protection

• Fixed wake time
• Cool bedroom
• No alcohol
• Wind-down routine (same 30 minutes nightly)

Days 3–4: Stabilize daytime energy

• Protein-first breakfast
• Hydration + electrolytes if you wake sweaty
• 15–30 min walk (preferably morning or afternoon)

Days 5–7: Add strength + symptom tracking

• 2 short strength sessions (20–30 minutes)
• Track: night sweats frequency, sleep quality (0–10), daytime energy (0–10)
• If night sweats are the clear driver → discuss VMS treatment options

FAQs 

Is extreme fatigue normal during menopause?

Fatigue is common, but extreme or worsening fatigue deserves evaluation—especially if it affects daily function or comes with red flags.

Why am I exhausted even after sleeping?

Because “time in bed” isn’t the same as restorative sleep. Night sweats, insomnia, and sleep apnea can fragment sleep so you wake unrefreshed. (ACOG)

Does HRT help menopause fatigue?

It can—especially when fatigue is driven by hot flashes/night sweats and sleep disruption. Hormone therapy is the most effective treatment for vasomotor symptoms, and studies suggest it can improve self-reported sleep quality in some women. (PubMed)

What’s the best nonhormonal option for hot flashes that disrupt sleep?

Evidence-based nonhormonal options include certain SSRIs/SNRIs, gabapentin, and newer neurokinin-targeting agents. (The Menopause Society) Fezolinetant is FDA-approved for moderate to severe vasomotor symptoms. (U.S. Food and Drug Administration)

What’s the best treatment for menopause insomnia?

CBT-I is recommended as the initial treatment for chronic insomnia in adults. (PubMed)

Key takeaways

• Menopause fatigue usually has multiple causes, but sleep disruption is often the biggest.
• Treating hot flashes/night sweats can unlock better sleep and better daytime energy. (ACOG)
• Don’t miss sleep apnea, thyroid issues, and iron/B12 deficiency—common, treatable contributors. (ScienceDirect)

Evidence-based options exist across lifestyle, behavioral sleep therapy, hormonal therapy, and nonhormonal medications. (The Menopause Society)