Fatigue in menopause: causes and what actually helps

Name: Fatigue in menopause: causes and what actually helps
Creator: MenoWoman

Feeling tired or drained is one of the most common complaints in perimenopause, often driven by poor sleep, night sweats and mood changes. Because tiredness has many causes, it is worth checking for treatable ones such as anemia or thyroid problems.

Researched by the MenoWoman team. Edited by Marcela Sat. Updated 7 November 2026. We may earn from links.

See a doctor if tiredness lasts more than a few weeks or keeps getting worse. Also see one if it comes with heavy bleeding, breathlessness, weight change, low mood or loud snoring. Get urgent care for chest pain, fainting or sudden severe weakness.

What it is and how common it is

Menopause fatigue is a lasting sense of tiredness or low energy that rest does not fully fix. It often comes with poor focus and low motivation.¹

It is very common. In a global survey of over 12,000 women aged over 35, 83% reported fatigue. Among those in perimenopause, 93% did, far more than reported hot flashes.¹

That survey used volunteers from a health app, so it may overstate the true figure. Even so, it suggests fatigue is far more common than many women expect.¹

The same survey grouped poor memory, low concentration and forgetfulness with exhaustion. This shows how closely tiredness and brain fog are linked.¹

Why it happens in menopause

Poor sleep is a major driver. About 40 to 60% of women have sleep problems around menopause, most often waking in the night.²

Insomnia is common too. In one phone survey of about 1,000 women, 26% of those in perimenopause met the criteria for insomnia disorder.²

Hot flashes and night sweats play a big part. In one analysis, about 69% of night-time hot flashes coincided with waking up. Hot flashes accounted for about a quarter of the time spent awake.²

Tiredness then spills into daily life. Poor sleep makes it harder to eat well, stay active and cope with other symptoms.⁷

Mood and sleep affect each other. Depression becomes more likely during the transition, and fatigue is one of its main symptoms.^2,3

Midlife pressures add to the load. Caring for children or aging parents, bereavement and work or relationship changes can all drain energy.³

What else can cause it

Tiredness is not specific to menopause, so other causes should be considered.⁴

Iron deficiency and anemia. Heavy periods are common in perimenopause, often due to fibroids. Low iron causes fatigue, low mood and poor concentration that can look like menopause.⁵
Thyroid problems. These are more common in women and often appear between ages 45 and 55. A blood test can check.⁶
Sleep apnea. Breathing problems during sleep become more common after menopause. In women they often look like insomnia and are often missed.²
Depression. Fatigue overlaps with both depression and perimenopause, which can delay diagnosis.³

Your doctor may suggest blood tests. If tiredness continues after low iron is corrected, menopause becomes a more likely cause.⁵

Everyday measures

Protect your sleep. Keep regular hours and a cool bedroom. CBT for insomnia is the main treatment for long-term sleep problems.^2,7
Keep moving. Menopause organizations advise regular activity, even when energy is low.⁷
Go easy on alcohol. It may help you fall asleep, but it can trigger night sweats and leave you unrested.⁸
Look after your mood. CBT-based approaches can help with low mood, stress and fatigue.⁹
Pace yourself. Break big tasks into smaller steps, and plan demanding work for when you feel most alert.

If night sweats are ruining your sleep, treating them may help. Hormone therapy modestly improves sleep, mainly in women whose hot flashes also improve.²

Hormone therapy is not right for everyone. Estrogen tablets raise the risk of blood clots, so a doctor needs to weigh up your own risks and benefits.²

Some non-hormonal prescription medicines, such as low-dose SSRI or SNRI antidepressants, modestly reduce insomnia symptoms.²

What helps: options rated

Option	Evidence	What the research shows
CBT for insomnia	Some evidence	The main treatment for long-term insomnia. In a trial of midlife women with hot flashes, it beat menopause education and the gains lasted six months. NICE says CBT helps menopause-related sleep problems.^2,10
Hormone therapy (HRT)	Some evidence	Modestly improves sleep, mainly when hot flashes and night sweats also ease. It is not proven to treat fatigue on its own.^2,4
Testing and treating low iron or thyroid problems	Some evidence	If a blood test finds one of these, treating it targets the cause of tiredness. If symptoms persist after iron is restored, menopause becomes more likely.^5,6
Regular physical activity	Some evidence	Advised by menopause organizations for energy, mood and sleep. Rated on guideline support, because trials of exercise for menopausal fatigue are limited.⁷
Cutting down on alcohol	Weak evidence	Sensible for better sleep, since alcohol can trigger night sweats and night waking. It has not been tested as a fatigue treatment.⁸

Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.