Peri-menopause: Crashing Fatigue Treatments

What is peri-menopause?

Menopause, officially, is the first anniversary of the end of the last period. That does make it sound simpler than it really is though, and it is in fact a huge physical, emotional and spiritual transformation.

The period leading up to menopause is known as peri-menopause, and whilst some women get life changing symptoms, others barely notice! Symptoms include:

  • Anxiety
  • Insomnia
  • Weight gain
  • Heavy and/or irregular periods
  • Low libido
  • Hot flushes
  • Aches & pains
  • Skin problems

Can peri-menopause cause crashing fatigue?

One of the most common peri-menopause symptoms is fatigue, although it can vary in severity from mild to very debilitating! When my patients first come to see me with fatigue, we talk about it being normal for energy levels to dip to some extent as we move through life. You probably don’t have the capacity to run around like you did when you were 5! It’s perfectly ok to slow down a little with age, and I expect you deserve some downtime by now anyway. Crippling fatigue which stops you from living normally is not something any of us should have to put up with though, and there are many other ways though if you’re looking for alternatives to HRT.

It’s very common for peri-menopausal women to be diagnosed with Chronic Fatigue Syndrome and/or Fibromyalgia when medical tests have ruled out other causes. That’s partly because blood tests for the thyroid and menopause are notoriously inaccurate, and the real cause of the problem can be easily missed. DUTCH testing is a better way to find out what your hormones are doing over a given period of time.

Fatigue as a spiritual symptom of menopause

Whilst it’s important to get to the bottom of the physical causes, fatigue is also what I describe as a spiritual symptom of menopause. We’ve forgotten that perimenopause is a time where we prepare for our elder or crone phase. We consolidate all the wisdom and life experience we’ve gained so far, ready to serve our community in new ways. This process requires a lot of energy and doesn’t happen overnight! In some cultures they even describe it as a mini death and rebirth, so it’s not surprising you might like to rest a little (or a lot!) more. The same happens in adolescence when teenagers are famous for staying in bed until noon. Transitions like these require rest, and lots of it.

Causes of crashing menopause fatigue

Whilst extreme fatigue is a common peri-menopause symptom, it’s also common in a number of other health conditions too. It’s one symptom which I always recommend gets checked out by your GP, particularly if you’ve noticed anything else out of the ordinary too, like:

  • weight gain or loss,
  • new lumps or skin problems,
  • headaches
  • changes to your vision
  • shortness of breath
  • poor immunity

There are too many underlying causes of peri-menopause fatigue to go through in this blog, but here are a few of the more common ones:

Could Your Lifestyle Be Affecting Your Energy Levels?

Our capacity for spending energy can dip quite a lot during peri-menopause. Often during a patient’s free call we talk about what a typical day in their life looks like. Where they’re working exceptionally long hours, juggling caring for family with a high powered job, or travelling for work, it’s hard to tell to what extent hormone imbalances are responsible for their tiredness. Nutrition, exercise and stress management can also suffer when we’re constantly on the go, and when we reach peri-menopause we simply can’t get away with it anymore.

Hormone changes

Many women notice that they feel more tired than usual just before a period, or in the early stages of pregnancy. This is largely down to the normal hormone changes we see during those times, and it’s important to rest as much as possible if this is a problem.

Non-reproductive hormones can also lead to extreme fatigue in peri-menopause. It’s normal for thyroid function to dip at various points, as your body hands over most of your oestrogen production to your adrenal glands. Other symptoms of low thyroid function include weight gain, hair loss, dry skin, and flaky nails, but whilst your Doctor would most likely test your thyroid function if you went to them with these symptoms, those tests would only partially test your thyroid. If you can, it’s much better to order a full thyroid screen using a company like Medichecks.

Insulin resistance

Insulin resistance is a problem in general nowadays but it often becomes far worse during peri-menopause because of the other hormone changes. Symptoms of insulin resistance include:

  • weight gain around the middle
  • recurrent fungal or bladder infections
  • getting up at night to use the toilet
  • skin tags and Acanthosis nigricans
  • brain fog and physical fatigue


Insomnia is one of the first signs of peri-menopause and most of the usual treatments don’t seem to work! The only effective treatments I know are HRT and/or herbal medicine, combined with good stress management, daily exercise, and diet. My patients have herbs included in their prescriptions both to address the underlying hormone imbalances, and a separate sleep mix to take at bedtime.


Heavy bleeding can often lead to Iron deficiency anaemia and this would normally be managed by your GP using Iron supplements at least to begin with. Taking nettle tea and nettle or beetroot juice every day is also helpful.

New Food Intolerances

Histamine levels can increase along with fluctuating high oestrogen that we see in the early stages of perimenopause, leading to new food intolerances. These may not show up as obvious symptoms initially, but can lead to bloating, water retention and general fatigue. It may help to keep a food diary which tracks your energy levels against what you’re eating.

Worsening of existing conditions

Peri-menopause can magnify existing conditions like Seasonal Affective Disorder (SAD), Fibromyalgia or Lupus, all of which cause fatigue. When I treat peri-menopausal fatigue in my practice, it’s always in the context of the bigger health picture. For example, if a woman has already had fibromyalgia for 20 years, and now peri-menopause on top, I include herbs that will address both. Sharon’s case study beautifully illustrates how this works.

Auto-immune conditions like Lupus and Sjorgen’s Syndrome can manifest around this time too, which is another good reason to get your fatigue checked out by your GP before deciding which treatments to use.

Haemochromatosis is a genetic condition which usually affects people of Celtic descent. It’s where the body hangs onto too much Iron, and during a woman’s reproductive years there are no obvious symptoms because she releases a good amount of Iron at each period. When periods stop, the symptoms can become more apparent, but are often strikingly similar to normal menopause symptoms! They include fatigue, hair loss, fatty lumps under the skin, darkening of the skin (rather like a suntan) and a tendency to break ankles. If left undiagnosed and untreated, it can cause long term damage to the liver, and increase risk of heart attacks and strokes. It’s thought that this is a more common condition than most Doctors realise, so if HRT isn’t helping your symptoms at all, it’s worth mentioning it specifically and asking about a blood test.

Some herbs and foods are unsuitable for people with haemochromatosis, so please ask me or one of my colleagues for advice if you need it.

Self care for menopause fatigue

Start with a life audit.

As I said at the beginning, we often don’t realise how hectic our lives are until we’re forced to by extreme tiredness! It’s highly likely that your energy levels will fluctuate as you move through peri-menopause, and now is a perfect opportunity to create new time and space for yourself. If you feel that your energy levels are in proportion with your lifestyle, look at which commitments you could let go of, at least temporarily so you can put your own needs first. It’s ok to take a break from any voluntary work, or get some help around the house if you need to. Letting go of toxic people who zap your energy is important too!


I saw a brilliant video which explained that partnerships or marriages are never 50:50. Each partner’s capacity to contribute to the day-to-day running of the relationship fluctuates, and working with menopause all day, I can see how so many relationships break down at this time! It’s vital that if you’re feeling depleted and it’s going to affect someone else, you tell them what’s going on. Whether it’s family, friends or colleagues, I’d hope that they’d do their best to support you, knowing that you’d do the same for them if it were the other way around. You could say something like “I’m only on 30% today”, and allow them to either make up your difference, or work on a plan with you if they’re also feeling depleted. There is a more subtle male version of menopause, and fatigue can affect men at this time too. Perhaps your employer could offer you flexible or home working on the days you’re really tired. The occasional takeaway or ready meal isn’t going to hurt if you can’t manage to make tea, and I’m a huge fan of batch cooking so you’ve got something easy on those days too!


Plan for wobbles in your energy! If you’re still having periods and you know you’ll feel tired around then, keep your diary as clear as possible so you can rest then. Default diaries are a great way to block rest time into your day too. Also plan regular breaks and holidays, and if you can, time where you can be completely alone to recharge.

If budget allows, it’s fine to get some extra help around the house too. Having a hand with the childcare, cooking or housekeeping becomes more a necessity then a luxury and it’s well worth the investment!


Good nutrition, both in terms of what you’re eating and how well you absorb your nutrients is key for good energy levels. Most of my patients are not eating in a way that will leave them energised when we first meet, but they certainly are by the time they finish their programme! It’s not difficult, but it does mean you’d have to learn new ways of nourishing your body in order to balance your blood sugar and keep your vitality going throughout the day.

Certain medications like Omeprazole can have a huge impact on your ability to use your nutrients both from food and supplements, resulting in significant deficiencies. Whilst I wouldn’t recommend coming off these medications without proper treatment and supervision, I would suggest looking at whether there are any suitable alternatives available to you in the longer term.

You can find out more about how to eat well for optimum energy in modules 3 and 4 of my Rejuven8 programme.

Gentle Exercise

If you’re on the verge of, or already in burnout, take care over which exercise you choose. Movement is still an important part of your recovery, but vigorous exercise will only make you feel worse. Choose gentle restorative exercise instead, like menopause yoga, tai chi, qi gong, or strolling in the countryside. Movement in water (but not 50 lengths in front crawl!) is really helpful too.

Vitamins for perimenopause Fatigue

Vitamins are not a replacement for a healthy diet, and it’s just as important to focus on your gut health as it is your diet and supplement regime. In addition to a healthy diet, I’d recommend as a minimum taking a good quality:

Natural remedies for peri-menopause fatigue

There are lots of other natural remedies which can help you get your energy back, but given that there are so many possible causes, we really need to establish what’s going on first. Adaptogenic and nervine herbs like Ashwagandha and Oats can be really helpful in gently raising energy levels, along with others to help ensure you get refreshing sleep each night.

Where to get more help with menopause fatigue

If your fatigue is very severe, or you have a chronic condition with a peri-menopause cherry on top, please take a look at my Menopause Rescue Programme. It’s the fastest and best way I know to get back on your feet the natural way!

If your symptoms are milder, you can learn a lot more about what to do at home from my Rejuven8 programme.

Not sure? Do my free assessment to find out which programme would be the best fit for you.

Verified by MonsterInsights