Why does perimenopause make you so tired?
The NHS lists problems sleeping among the common symptoms of menopause and perimenopause, along with night sweats, low mood and anxiety. Each of them can leave you drained during the day, and they often arrive together.
The chain above is the one people describe most. A night sweat wakes you, you lie awake for an hour, and the next afternoon feels like jet lag. By morning you may not remember waking at all, which is why the night can feel complete when it wasn't.
Two other routes are worth knowing:
- Mood. Low mood, anxiety and irritability can all be part of perimenopause, and low mood itself often shows up as tiredness.
- Heavier periods. Flow can get heavier in this stage. Losing more blood each month can lead to iron deficiency anaemia, and tiredness is one of its main signs.
Is it perimenopause, or something else?
Fatigue in your 40s is easy to blame on hormones, and sometimes the real cause is another one a doctor can test for. The NHS names these among the usual checks.
| Possible cause | Often comes with | What a doctor may check |
|---|---|---|
| Iron deficiency anaemia | Heavy periods, shortness of breath, pale skin | A blood count and iron levels |
| Thyroid problems | Weight change, feeling cold or hot, low mood | A thyroid blood test |
| Diabetes | Thirst, passing more urine, weight loss | A blood sugar test |
| Sleep apnoea | Snoring, gasping or choking noises at night | Questions about your sleep, sometimes a sleep study |
| Depression | Low mood most days, losing interest in things | A conversation about mood, sometimes a questionnaire |
What to write down for two 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 two weeks, put the tired days next to the nights before them. If the worst afternoons follow nights with two or three wake-ups, that is 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 GP if:
- you have felt tired for a few weeks and don't know why
- tiredness affects your work, your driving or looking after people
- 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. Tiredness with chest pain or severe breathlessness needs urgent care, without waiting for a pattern.
Tracking it in Her Good Days
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.