Tired All the Time? Understanding Perimenopause Fatigue
What Is Perimenopause Fatigue?
You wake up feeling like you haven’t slept. The smallest tasks feel like a marathon. You’re not lazy or unmotivated – your body is shifting.
Fatigue in perimenopause is more than just feeling tired. It can show up as physical heaviness, mental fog, or emotional flatness. Some days you might feel completely drained before the day has even begun. And yet, blood tests often come back "normal," and you're left wondering if this is just part of getting older.
But fatigue is not something you have to live with. It's a signal that your body needs support, not a sentence you have to endure.
Why It Happens
Fatigue during perimenopause often doesn’t have a single cause. It’s usually the result of many small threads woven together – hormonal shifts, nutrient depletion, emotional load, poor sleep, blood sugar crashes, and more.
Let’s look at what might be contributing to your energy drain, and how we gently unravel it.
Hormonal Fluctuations
Oestrogen and progesterone are powerful influencers of your energy, mood, and metabolism. During perimenopause, they don’t decline steadily – they fluctuate unpredictably. This hormonal “yo-yo” can:
Disrupt sleep and mood
Affect how your cells make energy
Reduce your tolerance to stress
Make you more sensitive to blood sugar dips
It’s not just about low oestrogen – it’s about the instability.
Sleep Disruption
Many women notice their sleep becomes lighter or more fragmented in their 40s. You might struggle to fall asleep, wake up too early, or find yourself staring at the ceiling at 3am. Often this is driven by:
Night sweats and poor temperature regulation
Cortisol spikes from stress or blood sugar crashes
Magnesium deficiency or low progesterone
An overactive nervous system that doesn’t switch off
Even if you’re spending 8 hours in bed, it may not feel restorative.
Blood Sugar Instability
If you often feel tired mid-morning or crave sugar in the afternoon, your blood sugar may be swinging more than you realise.
In perimenopause, your cells become slightly less responsive to insulin, meaning glucose doesn’t move into the cells as easily. This can leave you feeling flat, foggy, or irritable – especially if your meals lack protein and fibre.
Many women feel significantly better within a week or two of stabilising their blood sugar through food.
Emotional Load and Mental Fatigue
The invisible weight of life often becomes heavier in your 40s.
You might be:
Caring for children and ageing parents
Navigating work stress, relationships, or identity shifts
Holding space for everyone else while ignoring your own needs
This emotional load can quietly drain your energy even when your body appears "fine." You might feel mentally foggy, easily overwhelmed, or like you’re running on autopilot. Your nervous system is exhausted – not just your muscles.
Nutrient Deficiencies
Iron: Heavy periods or low iron stores (even with a “normal” ferritin) can lead to tiredness, shortness of breath, and brain fog.
B vitamins: Essential for energy metabolism and mood support, often depleted by stress, alcohol, or the pill.
Magnesium: Crucial for nervous system support, sleep, and muscle relaxation. Low levels can worsen fatigue, anxiety, and poor recovery.
Protein: Not technically a vitamin, but often too low in midlife diets, affecting energy, satiety, and blood sugar stability.
A full nutrient picture helps guide tailored support, not guesswork.
Thyroid and Gut Health
Your thyroid controls your metabolism and energy. Even mild under-functioning can cause fatigue, brain fog, and weight gain. It’s often missed unless deeper testing is done, including T3, reverse T3, and thyroid antibodies.
Gut health plays a role in everything from oestrogen detoxification to B vitamin production and iron absorption. A sluggish gut can quietly undermine your energy levels – even if you don’t have overt digestive symptoms.
How We Find the Root Cause
In a naturopathic consultation, we piece the puzzle together through your story, symptoms, and sometimes testing.
Functional testing may include:
Blood tests for iron, B12, thyroid function, and inflammatory markers
DUTCH hormone testing to assess oestrogen, progesterone, cortisol patterns, and hormone metabolism
Comprehensive stool testing to explore microbiome balance, absorption, and inflammation
We don’t just chase a diagnosis – we look for what’s out of rhythm in your body, and what it’s asking for to restore energy.
The Naturopathic Approach
In clinic, I always start by listening to your story. From there, we build a picture of what your body needs to restore energy gently and naturally.
Support might include:
Herbal medicine to support adrenal health and hormonal balance (like Withania, Rhodiola, or Rehmannia)
A protein-rich breakfast to steady blood sugar and kickstart energy
Nutritional support such as B-complex, magnesium, and iron if needed
Gentle movement instead of intense workouts that add to the load
Nervous system nourishment through food, herbs, and rest
Sleep rituals and herbal sleep support to help you fall and stay asleep
It’s not about doing more. It’s about doing less – and doing it wisely.
Clinic Story: Rediscovering Vitality
One client, a busy mum in her late 40s, came to me after months of feeling “completely flat.” She had been told her bloods were fine, but she couldn’t get through the day without multiple coffees and felt wired at night.
We started by adjusting her breakfast, introducing a nourishing herbal formula, and supporting her nervous system with magnesium and calming rituals. Within three weeks, she reported more stable energy and a shift in how she felt about herself. "I’m not snapping as much. I can breathe again."
Healing fatigue is never instant, but even small shifts can ripple through your life.
Rhythms That Restore
Prioritise regular meals with protein, fibre, and healthy fats
Go to bed before 10pm if possible and limit screens after 8
Swap your morning coffee for a herbal tonic a few days a week
Take short breaks during the day to rest your eyes and nervous system
Build in small joys – music, sunshine, a walk without your phone
A Gentle Word
Your body is not failing you. It’s calling for care. Fatigue in perimenopause is real, but it’s also reversible. You deserve to feel well, steady, and alive in your body again.
Ready to Feel Like Yourself Again?
If you’re navigating perimenopause and struggling with fatigue, I invite you to book a free 10-minute Discovery Call. Let’s start by understanding what your body is asking for.
