Feeling Drained? Understanding and Managing Fatigue in Perimenopause and Menopause
- Dr Megan
- Oct 30
- 2 min read
Fatigue is one of the most common and distressing symptoms experienced by women during perimenopause and menopause. Yet, it’s often misunderstood, misattributed to stress or aging, and overlooked in clinical care. As dietitians, we play a vital role in helping women navigate this life stage with energy, clarity, and confidence.
Why Fatigue Happens During Perimenopause and Menopause
Hormonal fluctuations—especially declining levels of estrogen and progesterone—are central to the fatigue many women feel. These hormones influence:
Sleep quality: Lower estrogen can disrupt serotonin and melatonin, leading to insomnia or poor sleep.
Mood and cognition: Hormonal shifts can cause brain fog, low motivation, and emotional sensitivity.
Metabolism and energy regulation: Changes in insulin sensitivity and mitochondrial function can lead to energy crashes and sluggishness.
Muscle mass: Sarcopenia (age-related muscle loss) reduces metabolic rate and physical stamina.
Other contributing factors include:
Poor nutrition
Blood sugar imbalances
Thyroid dysfunction
Vitamin deficiencies (especially B12, D, iron, and magnesium)
Chronic stress and adrenal fatigue
Sleep apnea or other sleep disorders
Nutrition Strategies to Combat Fatigue
Here’s how dietitians can support women in reclaiming their energy:
1. Balance Blood Sugar
Avoid the “sugar rollercoaster” by encouraging:
Regular meals and snacks every 3–4 hours
Protein at each meal (e.g., eggs, legumes, fish, tofu)
High-fibre carbohydrates (e.g., oats, quinoa, sweet potato)
Healthy fats (e.g., avocado, nuts, olive oil)
Stable blood sugar helps prevent energy dips and mood swings.
2. Prioritise Protein
Protein supports muscle maintenance, hormone production, and satiety. Aim for:
25–30g of protein per meal
Lean meats, dairy, legumes, tofu, and protein-rich grains
3. Support Mitochondrial Health
Mitochondria are your cells’ energy factories. Nutrients that support them include:
Magnesium (leafy greens, nuts, seeds)
CoQ10 (organ meats, fish, supplements)
B vitamins (whole grains, eggs, legumes)
Zinc (pumpkin seeds, seafood)
4. Hydration Matters
Even mild dehydration can impair concentration and increase fatigue. Encourage:
1.5–2L of water daily
Herbal teas and infused water
Starting the day with a glass of water
5. Address Nutrient Deficiencies
Common deficiencies in midlife include:
Iron (especially if periods are still occurring)
Vitamin D (sunlight, fatty fish, fortified foods)
Vitamin B12 (animal products or supplements)
Magnesium (dark chocolate, nuts, leafy greens)
Consider testing and supplementation where appropriate.
6. Embrace the Mediterranean Diet
This anti-inflammatory, nutrient-dense pattern includes:
Colourful vegetables and fruits
Whole grains
Healthy fats (olive oil, nuts)
Moderate protein (fish, legumes)
Limited processed foods and sugars
It’s linked to improved energy, mood, and long-term health outcomes.
Lifestyle Tips to Complement Nutrition
Sleep hygiene: Encourage consistent sleep routines and screen-free wind-down time.
Movement: Gentle exercise like walking, yoga, or resistance training boosts energy and mood.
Stress management: Mindfulness, journaling, and breathing exercises can reduce cortisol and improve resilience.
Connection: Social support and community engagement are powerful antidotes to fatigue and isolation.
Work with a healthcare provider to check hormone levels if weight changes feel unexplained
If fatigue is persistent and debilitating, refer to a GP or specialist to rule out:
Thyroid disorders
Anaemia
Sleep apnea
Depression or anxiety
Chronic fatigue syndrome
Final Thoughts
Fatigue during perimenopause and menopause is real—and it’s not just “getting older.” With the right nutritional strategies, lifestyle support, and compassionate care, women can feel energised, empowered, and in control of their health.
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