Fatigue is a complex, multi-faceted symptom that can plague people at any stage of life. It is impacted by overall physical and mental health, by daily stresses and life events. But one of the most common and, at the same time, most troublesome times to experience fatigue is during menopause and the preceding perimenopause transition. What’s more, it often lasts for years, and its course is different for every woman.
Menopause-related fatigue can be caused by changing estrogen levels, but it is often compounded by common symptoms. Chief among these are vasomotor symptoms, which are experienced by up to 80% of women and include hot flashes and night sweats that can disrupt sleep. Whatever the point of origin, this fatigue can impact both women’s personal and professional lives. With the proper support, however, treatment for fatigue during menopause can address the cascade of related symptoms and significantly improve quality of life.
How Prevalent is Menopausal Fatigue?
Fatigue and its associated cluster of symptoms are common during the menopause transition. A 2017 study identified fatigue as the most frequent symptom experienced by perimenopausal and menopausal women. However, fatigue is not a simple, straightforward symptom. Rather, it is an experience interwoven into many aspects of life and can manifest as low energy levels, lack of motivation, and even physical weakness. The impact on functionality and quality of life can be so significant that it has been identified as a top symptom relief priority for women negotiating the menopausal transition.
The Complexity and Durability of Menopause-Related Fatigue
Though a frequent complaint for middle-aged women in general, fatigue is especially common in those who are postmenopausal. Menopause, the point at which a woman’s menstrual cycles have been absent for twelve consecutive months, brings a range of common symptoms that includes hot flashes, mood swings, low sex drive, vaginal atrophy, and sleep disturbances. Though fatigue may be a primary symptom related to changing hormone levels, it is also influenced secondarily by other common symptoms such as night sweats, poor sleep quality, and changes in body composition.
While menopause symptoms are short-lived in some women, for others they are enduring, causing discomfort and distress that lasts for years. The Study of Women’s Health Across the Nation (SWAN) found that among the 44% of women who reported frequent menopausal symptoms, more than half of these lasted 7 years or more. The average duration of symptoms ranged from 10.1 years for African-American women to 4.8 years for Japanese women, with other ethnicities falling somewhere in between. These numbers indicate that the uncomfortable symptoms of menopause may disrupt women’s lives for a significant period of time and should be addressed as soon as possible to preserve long-term health and quality of life.
Finding Effective Treatment for Fatigue During Menopause
Though many women try to wait it out and do not seek treatment for menopause symptoms, this could mean years of discomfort. What’s more, addressing these symptoms may be easier than many expect. Today, there is a wide variety of lifestyle modifications and treatments that may positively impact fatigue and the cluster of related symptoms so common during menopause. These include:
Hormone Replacement Therapy
Hormone replacement therapy (HRT) remains the gold standard of treatments for menopausal symptoms since it directly addresses their root cause: changing hormone levels. Thus, HRT may effectively treat fatigue and the symptoms that can exacerbate it. In particular, estrogen replacement is considered the most effective treatment for the vasomotor symptoms that tend to occur in concert with fatigue and can be instrumental in restoring energy levels. In one small study, progesterone therapy was also shown to have a positive effect on insomnia in peri- and postmenopausal women. The specific type of hormone therapy, point of initiation, and duration of treatment will vary case by case, but the key to successful treatment is finding a knowledgeable practitioner who can help you weigh the risks and benefits and provide a personalized treatment plan.
Though somewhat counterintuitive because it involves the expenditure of energy, exercise is an investment in the prevention of and treatment for fatigue. Its influence on fatigue has been proven beneficial for conditions ranging from rheumatoid arthritis to chronic fatigue syndrome to cancer, to name just a few. And benefits may be achieved from a variety of exercise types, allowing you to choose a modality that works for you. One recent study of postmenopausal women aged 60 and over found that Pilates training improved sleep quality and decreased anxiety, depression, and fatigue. Meanwhile, yoga has been found to reduce insomnia symptoms, raise melatonin levels, and aid stress management and mood enhancement in menopausal and postmenopausal women. In fact, a meta-analysis that summarized 13 randomized controlled trials found yoga to be as effective as other exercise interventions for reducing menopausal symptoms.
A variety of dietary supplements may prove helpful for menopause-related fatigue. Rhodiola rosea extracts, for example, have been demonstrated to boost energy and reduce fatigue. Through its hormone-balancing and anti-inflammatory properties, it may also have a protective effect against the cardiovascular disease and osteoporosis risks that increase with menopause. Another promising option is soy protein with isoflavones, which has been well-researched in randomized controlled trials and found to be effective for decreasing hot flashes without negative effects on hormone-sensitive cancers. It may also help to protect menopausal women against cardiovascular disease. Since serum melatonin levels decrease along with estrogen, low dose melatonin supplements have been found to help with menopause-related sleep problems. Better sleep quality can help to prevent fatigue. However, the top supplements for energy differ depending on your specific symptoms.
Cognitive-behavioral therapy and clinical hypnosis are noninvasive treatments that have proven effective in treating the troublesome symptoms of menopause, including insomnia and hot flashes. Another intervention that has shown promise is mindfulness-based stress reduction.
Several psychotropic pharmaceuticals may be prescribed to rapidly and successfully improve the vasomotor symptoms that contribute to sleeplessness and fatigue. These include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), both of which are commonly used as antidepressants. But while highly effective for many women, their potential side effects make them unsuitable for some. As women continue to seek and demand a better quality of life during and after menopause, research scientists will look for additional potential therapies. One such possibility is armodafinil, a long-acting drug primarily used for narcolepsy and has shown promise in the treatment of menopause-related fatigue in an open-label trial.
With this broad range of treatment options, you can address menopause-related fatigue in a way that makes sense for you.
Partnering with an Expert for the Best Results
Women often think that menopausal symptoms are inevitable and just something they must live with. But that may not be the case. With the right strategies, you can take control of your symptoms and feel like yourself again.
Reclaiming your life from menopause-related fatigue is most effective with input from an expert. Finding a practitioner with experience in women’s health issues—specifically one who specializes in hormonal health and menopause—is critical to finding and implementing real, durable solutions. The right provider can prescribe a reasoned, customized solution and advise you on complementary therapies and lifestyle changes that can help you end unnecessary suffering and enhance your quality of life for years to come.
If menopausal fatigue and its associated symptoms are interfering with your life, BodyLogicMD can help. The practitioners in the BodyLogicMD network specialize in hormonal health and are experts in supporting women through the menopause transition using a personalized combination of hormone replacement, lifestyle recommendations, and complementary therapies. Contact a local practitioner to schedule your first appointment, or take the BodyLogicMD Hormone Balance Quiz to learn more about how hormones may be impacting your daily life.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended to diagnose, treat, cure or prevent diseases.
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.