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During menopause, many women experience fatigue. And it's usually not your everyday fatigue. This is menopause fatigue which, let us tell you, extends way beyond the occasional yawn. Below, we dive into the science behind why.

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    The science

    Alongside mood and anxiety, fatigue is one of the most interconnected and multi-faceted menopausal symptoms; it impacts physical, emotional, and cognitive health.

    Listing all the possible causes for something as complex as fatigue would be impossible, which is our way of saying that what you’re about to read is in NO way a comprehensive list. However, if we had to drill down to the most prevalent causes, it’d be hormone fluctuations, emotional and physical health conditions, and vitamin and nutrient deficiencies.


    Hormones don’t act in a silo. They’re constantly interacting with each other to produce certain effects. During menopause, hormonal imbalances can have a direct and indirect effect on energy levels.

    Estrogen and progesterone

    As these hormones start to fluctuate during perimenopause, many women experience symptoms like stress, anxiety and sleep disruption. And the downstream effect of those: you guessed it, fatigue. Many women can experience worsened fatigue right before their periods, especially if they suffered from it before, when the levels of these hormones are lowest. It can really feel like a roller coaster, with high I-can-do-anything energy one week and a major crash the next.


    As cortisol (our stress hormone) rises because we’re aging, sleep can be impacted. And voila, you’re left with the perfect storm. Increasing cortisol leads to poor sleep, which leads to fatigue, which causes stress, which leads to more cortisol…it’s a vicious cycle.


    Testosterone, another one of the sex hormones in women, also tends to decrease across the menopausal transition, albeit more slowly. (Interesting fact: it actually starts to declines in our late 20s). Low testosterone is linked to decreased libido and muscle mass. Although some advocate testosterone supplementation for fatigue, unfortunately there is not sufficient evidence of direct improvement in energy with testosterone treatment in women. For now at least, testosterone treatment is typically limited to helping with low libido/desire.


    Although not directly related to menopause, the thyroid hormone plays a key role in metabolism. If your body isn’t producing enough — aka hypothyroidism — you can experience fatigue, weight gain, dry skin, and thinning hair (sound familiar?). Risk of hypothyroidism increases from 3% in your 40s to 10% by the time you turn 65. If you’re experiencing significant fatigue, talk to your doctor about having your thyroid levels checked. It’s a simple blood test.

    Emotional conditions

    Certain emotional conditions can have a marked effect on our energy levels. For more information, refer to our comprehensive guides covering anxiety, depression, and mood changes. And fatigue and emotional health are bidirectional, meaning that depression/anxiety can result in feeling fatigued, while feeling tired all of the time contributes to negative emotions.

    Vitamin deficiencies

    Hormones aside, there are certain vitamin deficiencies that can cause increased fatigue during menopause, including iron (a lack of which causes anemia), B vitamins (especially B12), and vitamin D (the sunshine vitamin).

    Even if you aren’t suffering from a specific medical condition, it may be worth consulting your healthcare provider (or Elektra!) if you identify with one or several of the following:

    • You experience daytime fatigue that interferes with work/home responsibilities.
    • You worry about falling asleep while driving or doing inactive things (e.g., watching television or attending a meeting).
    • You feel the need to nap most days.

    Physical health conditions

    The following physical health conditions may zap your energy in a very real way during menopause:


    Although there are several different causes, anemia results in a lack of sufficient healthy red blood cells to carry oxygen to your body’s tissues.

    Sleep apnea

    Chronic obstructive sleep apnea is marked by abnormal breathing, specifically extended pauses in breath during sleep due to an upper airway obstruction. Central sleep apnea, on the other hand, occurs when our brain simply doesn’t send the correct signals to the muscles in charge of breathing. We may not know we have it — oftentimes, the only symptom is feeling tired even though we may be sleeping through the night.

    Post-viral syndrome

    There are a number of infectious and post-infectious causes of fatigue that may be worth exploring if nothing more routine pops up.  The list is long and can include Epstein-Barr virus (the cause of mononucleosis), the flu, Lyme, or even recent Covid infection. If you are experiencing severe, debilitating fatigue with no clear explanation, talk to your doctor. It may be worth it to rule those out.


    Medication side effects, renal disease (aka kidney disease), liver disease, and cardiac disease may impact energy levels as well.

    The list above is by no means exhaustive, there are many other causes of fatigue. To know if your fatigue symptoms warrant a visit to your healthcare provider, ask yourself the following questions:

    • Are you sleeping 7-9 hours per night and STILL feeling tired?
    • Is your tiredness affecting your quality of life/work performance?
    • Do you worry about falling asleep while driving or doing inactive things (e.g., watching television or attending a meeting)?

    “When your energy is constrained, you get better at saying no to things. And you get better at recognizing that the world doesn't end when you say no to things.”

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    What you can do

    We’re all about equipping you with the know-how to understand your symptoms, and we especially emphasize the specific, tangible ways to manage them. Our goal is to empower YOU to take charge of your menopause journey, starting today.

    A quick note about product recommendations…Elektra Health is not paid to feature any products. We just like them and think you might too, though we can’t guarantee any results.


    If your fatigue is overwhelming or negatively affecting your quality of life, identifying underlying causes is of paramount importance. In parallel, you might want to consider which lifestyle changes around exercise, diet, sleep, and stress are worth considering to pump up the energy level.

    Nutrition & Diet

    To boost our energy, we should be avoiding high-glycemic foods that cause blood sugar levels to spike — the two most common culprits are sugar/artificial sweeteners and refined carbs (i.e. things made with white flour) that quickly convert to sugar in our body. When sugar levels spike, they subsequently crash, leaving you tired.

    Instead, we should focus on getting sufficient supplies of whole, unprocessed foods with adequate protein and healthy fats, which you can read more about in our nutrition guide.

    Here are a few important things to remember:

    • Inadequate nutrition via extreme caloric deprivation over weeks or longer will cause fatigue.
    • Be thoughtful with breakfast! You want a combo of complex carbs, protein and fat through foods like oatmeal with nuts, overnight oats with yogurt, or a spinach omelette.
    • If you can tolerate caffeine, be our guest with that morning cup ‘o Jo! But be careful about drinking it in the afternoon and evening. It’s a stimulant with a half-life of 5-6 hours (or longer if you’re on certain types of medication). This is the amount of time it takes for the quantity of caffeine in the body to be divided in two, which means after 5-6 hours, you’ll still have half the original amount of caffeine in your body. Only after 10-12 hours will it be completely eliminated…there’s more on this in our sleep guide.
    • Skip the energy drinks. Trust us on this one. They’re basically just sugar and caffeine, which will lead you to crash even harder.
    • Hydrate, hydrate, hydrate! Dehydration contributes to fatigue. Drink enough so your urine is pale and clear.

    Lifestyle & Holistic Practices

    Let’s start with the obvious:

    Sleep is, understandably, SO important when it comes to fatigue. We should be targeting 7-9 hours, and yet studies show that 1 in 3 adults is not getting enough shut-eye. Sleep needs to be prioritized — we can’t stress this enough. If you’re not getting adequate sleep, you owe it to yourself to address it. Today. For more information on the science behind why sleep becomes so difficult during menopause — and what you can do about it — refer to our complete guide.

    Because stress can manifest as fatigue, it’s right up there alongside sleep on the list of integrative interventions — although easier said than done when everything and everyone seems to be competing for our attention. Taking steps to manage stress is a form of self-care.

    One way to manage is to schedule in some “me time” and treat it like you would another *very* important appointment. There’s nothing “selfish” about taking time for yourself, especially when it supports your mental health and overall wellness. Think of it as putting your mask on first in an airplane, so you can be better equipped to help others. For more tips on stress management – check out our guide to anxiety.


    Scientists have found that regular movement decreases overall levels of tension, elevates and stabilizes your mood, improves sleep, and boosts self-esteem. Not too shabby, right? According to the World Health Organization, 150 minutes per week of moderate-intensity movement (a brisk walk counts!) is enough to support your health.

    In addition to supporting stress management, regular exercise can also play a direct role in boosting energy. This may sound counterintuitive, but hear us out. If you avoid over-training and instead focus on moderate to low-intensity movement by walking, bike riding, or practicing yoga, it will act directly on the central nervous system to help with symptoms of fatigue. In fact, one study showed that normally-sedentary people who frequently experienced fatigue were able to boost their energy levels by 20% and decrease fatigue by 65% *just* by engaging in low-intensity exercise for 20 minutes, 3 days per week.

    Not sure where to start? Here’s what we suggest.

    1. Kick things off with small goals. A 20-minute walk three times per week seems doable, no?
    2. Team up with a friend for some company and accountability.
    3. Always do something you ENJOY. It has to be fun — or at least tolerable — otherwise you won’t want to do it!

    We’re always keeping an eye out on emerging research and the latest clinical studies. Subscribe to our weekly Elektra Digest for the latest, science-based info direct to your inbox. Something work well for you that’s not listed here? We want to hear it! Shoot us a note at [email protected]. (We’re human, promise.)

    Disclaimer: This information is for general educational purposes, and should not be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem.

    As with anything you put into your body, taking dietary supplements can also involve health risks. You should consult a women’s health medical professional before taking supplements and inform your doctor about any supplements, as well as any medications you already take, since there may be interactions.


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    Depression SYMPTOM

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