Why does perimenopause make you so tired?
The NHS lists sleep problems among the symptoms of perimenopause and menopause, along with night sweats, low mood and anxiety. It notes that sleep problems may be worse if you also have night sweats, and that mood and memory symptoms can feel worse when you're very tired.[2] The NHS also names hormonal changes, menopause included, among the common causes of tiredness.[1]
The chain above is a common one. A night sweat wakes you, you lie awake for an hour, and the next afternoon feels like jet lag. If you only think about the night once you're up, the wake-ups are easy to lose, which is why logging them helps.
Two other routes are worth knowing:
- Mood. Mood swings, low mood and anxiety can all be part of perimenopause,[2] and the NHS lists stress and depression among the common causes of tiredness.[1]
- Heavier periods. Bleeding can get heavier in this stage.[2] Heavy periods are a very common cause of iron deficiency anemia, and tiredness and lack of energy are among its symptoms.[3]
Is it perimenopause, or something else?
Being tired in your 40s is easy to blame on hormones, and sometimes the real cause is something a doctor can test for. The NHS pairs these conditions with these signs:[1]
| Possible cause | Often comes with |
|---|---|
| Iron deficiency anemia | Lack of energy, noticeable heartbeats, shortness of breath, pale skin |
| Overactive thyroid | Finding it hard to stay still, feeling nervous, anxious or irritable, muscle weakness |
| Diabetes | Feeling very thirsty, peeing more often (especially at night), weight loss |
| Sleep apnea | Loud snoring, gasping, snorting or choking noises at night |
Stress and depression are on the NHS list of common causes too. A doctor may order blood tests to check for anemia, diabetes or an overactive thyroid, depending on your other symptoms.[1][3]
What to write down for 2 weeks
Keep it to a few taps a day. The aim is dates you can point to.
- Sleep: bedtime, wake time and each time you woke in the night.
- Night sweats and hot flashes: the time, and whether one woke you.
- Energy: a quick check-in mid-morning and mid-afternoon, low, okay or good.
- Period days: the first day and how heavy the flow was each day.
- Mood: one evening line on how the day felt.
After 2 weeks, put the tired days next to the nights before them. If the worst afternoons follow nights with 2 or 3 wake-ups, that's useful for your doctor to see. If they don't line up with sleep at all, that matters too.
When to see a doctor about tiredness
The NHS suggests seeing a doctor if:[1]
- you've felt tired for a few weeks and don't know why
- tiredness affects your daily life
- you feel tired and also have weight loss or mood changes
- someone has told you that you gasp, snort or choke in your sleep
Mention heavy periods too, including how many days they last and whether you bleed through pads or tampons. Chest pain that doesn't go away, or chest pain with sweating, nausea, light-headedness or shortness of breath, needs emergency help (911 in the US), without waiting for a pattern.[4]
Tracking it in Her Good Days
Tiredness (listed as Fatigue) is one of the built-in symptoms in the app, with strength (mild, moderate or severe), time and a note. Sleep takes bedtime, wake time and wake-ups, and the mood check-in includes energy. Insights then puts sleep next to nights with night sweats, so the pattern shows without a spreadsheet, and the doctor report turns it into a few printed pages.
For the rest of this stage, see perimenopause in Her Good Days and the early signs checklist. Before your appointment, the free menopause symptom checklist gives you one printed page of what you have noticed.