In our new Q&A Corner with Dr. Nese Yuksel, each column breaks down the evidence behind common symptoms and treatments. We start with fatigue—why it happens, and what the research actually shows.
- Is fatigue common in perimenopause and what does the evidence show?
Yes, fatigue is a very common symptom during perimenopause. A recent survey of women from 158 countries found that more than 80% of women aged 35 and older report experiencing fatigue during this stage.1 Similarly, in our 2024 clinical trial, fatigue was the most commonly reported symptom, affecting 84% of participants, followed by muscle and joint pain (79%) and brain fog (76%). 2
Fatigue in perimenopause is usually multifactorial, meaning it has more than one cause. Fluctuating hormone levels, such as estrogen and progesterone, can affect sleep, mood and the body’s temperature regulation. When hormone levels shift, this can affect normal sleep patterns, particularly those experiencing night sweats.3
Sleep disruption is one of the main drivers of fatigue in perimenopause. Night sweats and frequent waking can fragment sleep and reduce deep, restorative sleep. As a result, women can feel unrefreshed when they wake up because the sleep quality is poor.4
Mood changes can also play a role. Anxiety, irritability or depressive symptoms can contribute to feelings of fatigue.5 At the same time, ongoing fatigue can worsen mood, creating a cycle that impacts overall quality of life.
It is also important to recognize that not all fatigue in midlife is due to hormone changes. Women who experience heavy menstrual bleeding during this time can have iron loss which can lead to iron deficiency anemia, a well-known cause of fatigue.6 Other health conditions can overlap with menopausal symptoms or mimic them. These include low thyroid levels, sleep apnea, autoimmune disorders, and diabetes. This is why a thorough evaluation is important rather than assuming hormones are the only cause.
Managing fatigue starts with identifying its underlying cause. The goal is to identify what is driving the fatigue and tailor the management based on the cause. For example:
- If the fatigue is linked to night sweats and poor sleep then targeting these symptoms through menopausal hormone therapy or non-hormonal prescription medications may improve energy.
- If heavy bleeding is contributing, then managing the bleeding or treating iron deficiency can help.
The evidence supports an individualized approach rather than a one-size-fits-all solution.
In addition, lifestyle strategies can make a meaningful difference. Regular physical activity is associated with better energy. Even moderate movement such as walking, strength training, or gentle aerobic exercise can be helpful. Supporting good sleep habits (such as consistent sleep schedule, limiting caffeine later in the day, and reducing alcohol intake) is also important. Nutrition plays a key role as well, including adequate protein and balanced meal to support steady energy.
The bottom line is that fatigue in perimenopause is common, but not something you have to simply accept. With proper assessment and targeting the cause of the fatigue, it can often be improved.
References
- Hedges MS, Hewings-Martin Y, Karam J, et al. Global perspectives on perimenopause: a digital survey of knowledge and symptoms using the Flo application. Menopause. Jan 28 2026;doi:10.1097/GME.0000000000002730
- Effica Health Trial Results, Internal Documents Accessed April 29, 2026.
- Huang R, Liu W, Yi Y, Li D, Deng Y. Over 50% of women affected by menopausal sleep disorders: urgent need to integrate sleep management into menopause guidelines. Eur J Endocrinol. Mar 4 2026;194(3):L35–L37. doi:10.1093/ejendo/lvag029
- Haufe A, Leeners B. Sleep Disturbances Across a Woman’s Lifespan: What Is the Role of Reproductive Hormones? J Endocr Soc. Mar 6 2023;7(5):bvad036. doi:10.1210/jendso/bvad036
- Gibson CJ, Ajmera M, O’Sullivan F, et al. A Systematic Review of Anxiety and Depressive Symptoms Among Women Experiencing Vasomotor Symptoms Across Reproductive Stages in the US. Int J Womens Health. 2025;17:537–552. doi:10.2147/IJWH.S491640
- Harlow SD, Gold EB, Hood MM, Mukwege AA, Randolph JF, Greendale GA. Abnormal uterine bleeding is associated with fatigue during the menopause transition. Menopause. Mar 11 2025;doi:10.1097/GME.0000000000002525
Dr. Nese Yuksel
Co-Founder, Chief Health Officer, and Executive Vice-President
Dr. Nese Yuksel is a Professor Emeritus of Pharmacy at the University of Alberta and Co-Founder, Chief Health Officer, and Executive Vice-President at Effica Health. With over 25 years of experience in women’s health, she is a leading expert in menopause care and has dedicated her career to advancing evidence-based practice and improving access to quality care for women in midlife.