Energy isn’t only about sleep or how full our days feel—it’s shaped by a complex interplay of hormones, stress, and overall health that can be easy to miss. In midlife, fatigue often develops gradually, becoming something we adapt to rather than question.
In this issue, we take a closer look at energy—what influences it, what disrupts it, and what it may be trying to signal.
We spoke with Keisha Clarke, one of our Clinical Care Leads, for her perspective. Drawing from the patterns she sees across women’s experiences, she shares how fatigue often reflects something deeper—and why understanding the full picture can change how we respond to it.
Keisha Clarke, MN, NP
Collaborative Care Lead | Newfoundland
Keisha Clarke is a Nurse Practitioner specializing in women’s health and midlife medicine. Her approach blends evidence-informed care with a thoughtful, whole-person perspective—supporting women through perimenopause, menopause, and beyond.
She focuses not only on symptom management, but on helping women reconnect with their bodies, understand shifting needs, and move through midlife with clarity and confidence.
Q&A with Keisha
What inspired your work in midlife health?
I’ve always been drawn to learning from women.
Throughout my career, I’ve had the privilege of supporting women in many stages of life, and I’ve developed a deep respect for their resilience. What continues to inspire me is seeing how meaningful shifts can happen when women are supported in the ways they truly need.
That’s shaped my commitment to care that is both evidence-based and deeply attuned to each woman’s experience.
What’s one misconception about fatigue in midlife?
Fatigue is often seen as the problem—but I see it as a signal.
It can reflect shifts in hormones, sleep, stress, nutrient status, or nervous system function. Midlife isn’t simply decline—it’s a transition.
Many women feel they need to push harder, when often the body is asking for something different: awareness, adjustment, and support.
What’s important to understand about what’s driving fatigue in midlife?
Midlife fatigue isn’t always hormonal, although hormonal changes are often part of the picture. In practice, it’s typically multifactorial. Perimenopause and menopause can influence energy, but they’re often occurring alongside changes in sleep quality, increased stress load, cardiometabolic variability, possible nutrient deficiencies, and/or nervous system dysregulation.
As we grow and evolve along a continuum, our physiology shifts, and with that, our capacity can change or vary. Many women are carrying a sustained level of output that their bodies may no longer be able to compensate for in the same way.
Rather than isolating a single cause, I take a comprehensive, whole-person approach, looking at how these factors are interacting within the body as a system, and using that to guide a more individualized and clinically appropriate plan of care.
When is fatigue something to look into more closely?
Fatigue becomes something to explore more closely when it is persistent, disproportionate to lifestyle, or begins to impact daily functioning and overall quality of life. If a woman is waking unrefreshed despite adequate sleep, needing increasing support to move through the day, or noticing additional shifts such as brain fog, changes in mood, or a narrowing of capacity, these can be signals that the body is asking for deeper attention and care, warranting a more thorough assessment.
From a clinical perspective, this is where a comprehensive review is important, looking at contributing factors such as hormonal changes, sleep quality, mental health, cardiometabolic considerations, and potential nutrient deficiencies. It’s less about attributing it to a single cause and more about ensuring we’re not missing an underlying issue and can guide care in a way that is both safe and appropriate.
Where do you begin when someone feels low on energy?
I begin by creating a space where the client feels seen, heard, and understood
From there, I focus on understanding what the fatigue is communicating. I look at sleep, nutrition, stress load, hormonal shifts, and how her current life demands compare to her capacity.
The goal is to create safety and steadiness in the body first. When that happens, energy often begins to return in a more sustainable way.
What’s one small shift that can help restore energy?
One small, realistic shift I often start with, especially for women who already feel stretched thin, is creating even a small pocket of intentional recovery in the day. That might look like 10–15 minutes of true pause without stimulation, gentle movement instead of intense exercise, or simply nourishing our body in a regulated way to support cardiometabolic function.
It’s less about adding more, and more about creating space for the body to come out of overdrive. Those small moments of support can begin to shift energy in ways that feel both manageable and sustainable.
What helps you restore your own energy?
I return to simple forms of restoration.
Slowing down without judgment, prioritizing rest, and creating space away from stimulation. Time in nature, gentle movement, and practices that help me reconnect with my body all play a role.
For me, it’s less about pushing through—and more about returning to rhythm.