Allison Sayre, MSN, WHNP
Fatigue is one of the most reported, yet often overlooked, symptoms affecting women during menopause. While hot flashes, mood swings, and vaginal dryness typically take center stage in conversations, menopause fatigue is often the silent, energy-draining disruptor that can significantly impact daily life. And it’s not just physical exhaustion, many women also report feeling mentally and/ or emotionally drained, only further amplifying the struggle.
As healthcare practitioners, understanding and identifying the underlying causes of menopause fatigue is important to offering effective solutions to help women navigate this challenging transition. In this article, we will explore the hormonal changes that contribute to menopause fatigue, the importance of both a compassionate and comprehensive approach, as well as integrative strategies that practitioners can utilize to get women feeling their best.
The Hormonal Contributors to Menopause Fatigue
Estrogen
The decline of estrogen that comes along with menopause can disrupt the balance of other certain hormones and neurotransmitters such as melatonin, cortisol, and serotonin. This imbalance can lead to a host of symptoms that can directly and indirectly impact a woman’s energy levels and well-being. Estrogen related symptoms such as insomnia, hot flashes, night sweats, restless leg, and nocturia can lead to a loss of sleep, while other symptoms such as anxiety, depression, and irritability can further fuel the vicious cycle of menopause fatigue.[1], [2],[3]
Progesterone
Progesterone, another key hormone that takes a dive during menopause, has a calming effect in the body and promotes restful sleep. As progesterone levels fall, women may experience mood swings, insomnia, and anxiety, all of which can contribute to menopause fatigue. Additionally, insufficient progesterone can impair the body’s ability to manage stress, resulting in a heightened stress response and increased cortisol levels, only adding to the exhaustion. [1], [3]
Cortisol
Hormonal fluctuations during menopause can lead to a disruption of the hypothalamic-pituitary-adrenal (HPA) axis, leading to higher or dysregulated levels of cortisol. To make matters worse, the stress from juggling work, family, and the changes that come with aging can further disrupt the HPA axis. Elevated levels of cortisol at night can interfere with the ability to fall asleep and stay asleep, while elevated or dysregulated daytime levels can negatively impact mood and leave women feeling both physically and mentally drained. [4], [5]
Thyroid Hormones
When estrogen levels take a dive during menopause, it can lead to an imbalance in thyroid hormones and an elevated risk for thyroid dysfunction—most commonly hypothyroidism. Low levels of estrogen can cause an increase in thyroid stimulating hormone (TSH), as well as a decrease in the conversion of the inactive thyroid hormone thyroxine (T4) to the active thyroid hormone triiodothyronine (T3). Aging also causes a reduction of thyroid iodine uptake, only further increasing odds of disease. Because menopause and hypothyroid can have overlapping symptoms, most notably fatigue, it is recommended that practitioners assess thyroid function with a complete thyroid panel to rule out any underlying thyroid issues. [6]
A Compassionate and Comprehensive Approach
Many women experiencing menopause fatigue feel dismissed or misunderstood, often being told that their tiredness is just a "normal" part of the transition. This type of communication can leave them feeling frustrated and confused as they struggle to get the care and answers they need. Approaching care with compassion and listening to each woman’s unique experiences can build a trusting relationship where women feel heard. Active listening can reduce anxiety and empower them to take an active role in managing their health, ultimately leading to better outcomes.
It is also key that practitioners take a comprehensive approach that addresses a woman’s physical, emotional, and psychological well-being. Starting with a detailed history, including lifestyle factors such as diet, sleep habits, stress levels, and daily activities can help pinpoint potential causes and ensure a more personalized treatment plan. It’s equally important to rule out other potential causes of menopause fatigue, such as anemia, sleep-related breathing disorders, diabetes, hormone imbalance, depression, and chronic disease. These conditions often have overlapping symptoms, and failing to consider them could lead to misdiagnosis or inadequate treatment. [1], [3], [6]
Integrative Solutions to Menopause Fatigue
Optimize Sleep
It should come as no surprise that addressing sleep should be a priority when managing menopause fatigue. Sleep problems during menopause can stem from a range of factors, including hot flashes, nocturia, stress, or a combination of all. Given the complexity, it is essential to focus on identifying and addressing the root cause. Regardless of the source, strategies such as setting a regular sleep routine, limiting screen exposure before bed, ensuring a cool and comfortable sleep space, and engaging in relaxation practices like meditation and deep breathing can all help improve sleep quality. [3], [7], [8]
Eat right
A balanced diet focused on whole foods rich in lean proteins, healthy fats, and leafy greens can help stabilize blood sugar levels and maintain energy throughout the day. Staying hydrated and limiting caffeine, alcohol, and sugar intake can also help to prevent energy crashes and improve sleep quality, supporting overall vitality. [7]
Chill out
Stress reduction techniques such as yoga, tai chi, mindfulness meditation, and deep breathing exercises can help balance cortisol levels and improve sleep, ultimately easing the effects of menopause fatigue. [4], [5], [8]
Move
Regular physical activity is one of the most effective ways to combat menopause fatigue. Exercise increases endorphins, which improve mood and energy levels and engaging in at least 30 minutes of moderate exercise most days of the week can enhance energy, improve sleep, and reduce stress. [7], [8] Reminding patients to distinguish between mental, emotional, and physical fatigue can help initiating activity even on days that menopause fatigue is profound.
Bioidentical Hormone Replacement Therapy (BHRT)
Bioidentical hormone replacement therapy (BHRT), although not for every woman, has been shown to improve sleep quality, reduce stress and anxiety, and enhance overall energy. [1], [3]
Supplements
Personalized supplementation, targeting concerns such as sleep, energy, mood, and stress, can help to mitigate menopause fatigue and its associated effects. [3], [7]
Conclusion
Menopause fatigue is complex and often overlooked, impacting physical, mental, and emotional well-being. A comprehensive, individualized approach to care, addressing hormonal imbalances, lifestyle factors, and emotional health, is essential for effective management. Integrative strategies, such as proper nutrition, sleep optimization, stress reduction, exercise, and personalized supplement and hormone therapy, can significantly improve quality of life. By providing compassionate and comprehensive care, practitioners can empower women to reclaim their vitality and thrive during this stage of life.
Allison Sayre, MSN, WHNP specializes in women's health and functional medicine, blending both traditional and integrative approaches. With over 17 years of experience, she has empowered women to reclaim their health through personalized nutrition and supplementation, hormone balancing, and lifestyle modifications. She received her Bachelor of Science from Mount Carmel College of Nursing and her Master of Science from the University of Cincinnati. She has been a certified women’s health nurse practitioner since 2014 and has continued her education and training in functional medicine from both the Institute of Functional Medicine as well as the American Academy of Anti-Aging Medicine.