Hormone fluctuations can make perimenopausal women feel extreme fatigue. But menopause and fatigue don’t have to be inseparable. Lifestyle changes such as proper sleep hygiene, supplements, and exercise can help! Learn more about how to feel better so you can stay active.
Right now, I am coaching a handful of women who are going through perimenopause and struggling with fatigue, making it hard for them to complete their runs. Menopause and fatigue unfortunately go hand in hand—and are a vicious cycle.
As these women battle menopause tiredness, they feel too tired to run. However, exercise like running can improve your sleep quality (and overall health). Therefore, their feelings of fatigue (and stress) can intensify, making the barrier to exercise even larger.
The great news is that there are ways to combat menopause and extreme fatigue. I have seen improvements in the women I coach with small lifestyle changes as well as medical interventions.
I got with Dr. Christine Hart Kress, a certified menopause practitioner, and menopause expert Emma Seville of Your Menopause Toolkit, on ways to conquer peri menopause and fatigue so you can keep doing what you love—run!
Let’s go!
Does Menopause Make You Tired?
It may seem like middle-aged women are tired all the time. That’s due to hormone fluctuations that happen during perimenopause (the 5-10 years before menopause) and menopause (when a woman has not had a period for 365 days).
As Dr. Hart Kress puts it: A woman’s hormone levels are wildly fluctuating until the last menstrual period when the ovaries stop producing the three main hormones: estrogen, progesterone, and testosterone.
These changes can affect mood, sleep, and energy levels. Declining levels of progesterone make sleep a challenge with a lot of women reporting difficulties falling asleep but more often, staying asleep.
Combined with hot flashes and night sweats also due to hormone fluctuations, lack of quality sleep can lead to daytime fatigue.
Seville adds that changing hormones can lead to heavier periods–which can lead to low iron, spurring fatigue. Lower progesterone can also trigger thyroid problems, she warns, which can–you guessed it–make you feel tired.
Related: Running & Menopause: A Survival Guide
The Benefits of Exercise During Menopause
Exercise during menopause can have a very positive effect on menopause symptoms. Indeed, one of the best natural remedies for menopause fatigue is movement.
Dr. Hart Kress and Seville share five main benefits of exercise for menopausal women:
Weight management.
Weight gain is common in menopause up to an average of 5-8 percent of body weight and can continue at a rate of 1.5 pounds a year particularly around the midsection, according to Dr. Hart Kress. It is normal for a woman to shape shift with subcutaneous fat which is the fat in your hips and thighs to move to your abdomen, this is called visceral fat. This occurs even with no change in diet or exercise.
Calorie restriction does not work for midlife weight gain during menopause, but exercise can as it helps maintain muscle mass and bone density while also supporting metabolism.
Improved sleep quality and heart health.
Exercise is great for promoting sleep and for stress reduction as well as cardiovascular health, says Dr. Hart Kress who shares the following suggestions:
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Women should have a minimum of 20-30 minutes of movement daily.
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Sprint interval training of 30 minutes twice weekly is recommended to burn the visceral fat around the organs which accumulates during menopause.
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Meanwhile, Zone 2 training will be more beneficial in menopause for weight maintenance. Zone 3 or moderate intensity is not as effective in weight management.
- Strength training is crucial (30 min 3 times a week) in preventing bone loss and lean muscle mass due to declining estrogen levels.
More energy.
Exercise can improve sleep quality which in turn will help your fatigue as well as boost your energy levels. Daily movement may seem hard, but with consistency, will reduce your level of exhaustion over time. I have seen this in the athletes I coach!
Less inflammation.
Movement helps with insulin sensitivity and reduces inflammation, notes Seville. “These are the two things that drive many menopause symptoms such as fatigue”
Healthier gut.
Movement helps with gut motility, says Seville. This can help women avoid constipation. Exercise also tends to lead people to make healthier food choices. Choosing something nutritious over something with refined sugars will help gut health, energy levels, and inflammation levels!
Related: The Pros & Cons of Running with Menopause
6 Tips to Manage Menopause Fatigue
Tip 1: Take care of yourself.
Good nutrition, exercise, mindfulness, and sleep hygiene are crucial tenets of midlife care, notes Dr. Hart Kress.
Aim to eat balanced meals, exercise half an hour a day, take some time for stillness each day (I like the Calm App!), and set yourself up for success with sleep quality. This entails getting to bed and waking up at the same time every day, keeping your bedroom between 65-68 degrees Fahrenheit, and limiting alcohol and blue light exposure before bedtime. Read more sleep hygiene tips here.
Seville adds women going through perimenopause should take naps as needed, manage stress by walking in nature or doing yoga, delegate chores, and put their health first.
“Think about the food you eat, the things you watch, the people you mix with. What is stressing you out? How can you change these things? Put your health and longevity first!” she urges.
Tip 2: Find your support system.
Seek guidance from a Certified Menopause Practitioner to review your perimenopause or menopause symptoms, says Dr. Hart Kress. You can find one here.
A menopause practitioner will help develop a plan before your fatigue impacts family relationships and work performance.
Related: Running After 40: A Complete Guide
Tip 3: Consider Hormone Replacement Therapy (HRT).
Talk to your doctor or menopause practitioner about hormone treatment or Menopausal Hormone Therapy (MHT) as part of your treatment plan. These medications which include bioidentical hormones can help stabilize hormone fluctuations and reduce fatigue, notes Dr. Hart Kress.
For example,
- Decreasing progesterone is often a culprit for fatigue. So how to combat progesterone fatigue? With progesterone replacement therapy! “Often fixing sleep with progesterone is a simple fix…women do so much better with sleep!” says Dr. Hart Kress.
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Sleep is often interrupted during menopause due to lower estrogen levels which can trigger hot flashes and night sweats. Estradiol therapy is the gold standard for treating these conditions, notes Dr. Hart Kress.
- Also, testosterone, aka our “energizing hormone”, declines during perimenopause commonly leading to fatigue. Again, MHT (or HRT aka Hormone Replacement Therapy) can help stabilize hormone fluctuations and reduce your fatigue.
Related: What You Need to Know About Being a Masters Runner
Tip 4: Know your levels.
Get your blood levels drawn. “Having baseline labs to check for insulin resistance, low ferritin levels, Vitamin D deficiency, and thyroid issues is very important during this stage of life,” Dr. Hart Kress shares. “Often fixing these levels and other nutritional deficiencies is all that is needed to address fatigue.”
I’ve had personal experience with this, with supplements helping very much! I recommend my athletes get their labs done every 6 months.
Tip 5: Hire a Running Coach and Strength Coach.
Working with a running coach (like me!) can help hold you accountable to your fitness goals while also helping you brainstorm solutions for common menopausal health issues such as fatigue.
They can also arrange your running schedule so that you can optimize your training, high-energy days, and recovery—as well as adjust as needed. As noted, consistency in running is important for mitigating menopause symptoms and feeling better. Similarly, a strength coach or physical therapist, can help you safely master weight lifting moves so you get (and stay!) strong, says Seville.
Having someone in your corner, especially when it feels so hard to be active, can be a game changer.
Tip 6: Mind Your Eating Habits.
Food is fuel, and you need to pay attention to the type of fuel you take in and the timing of it, says Seville. Seville advises perimenopausal women to eat a protein-rich meal before 10 a.m. to help with hormone balance.
She also says perimenopausal women should avoid sugar, alcohol, and xenoestrogens which can exacerbate menopausal symptoms. Instead, look for phytoestrogens such as in soy or flaxseed. Also, avoid caffeine after mid-day which could mess with your sleep.
Vitamins for Menopause Fatigue
There are also vitamins for menopause fatigue that can help with your sleep quality and energy levels, particularly if you are deficient in some areas. Dr. Hart Kress and Seville suggest the following (which I have taken and noticed a positive change):
- Magnesium Glycinate or L-threonate is amazing for promoting sleep and relaxation. Dr. Hart Kress recommends 150-300 mg daily, taken after dinner to prep the body for rest.
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If your ferritin is below 50, Vitron-C is a great iron supplement mixed with Vitamin C for better iron absorption and is well tolerated. Vitamin D is commonly low in people and can make you feel fatigued. The nutrient is also important for strong bones and overall mood. Getting your Vitamin D levels from blood work can tell you if you’re deficient and if so, how much you should supplement with. Vitamin D levels below 40 ng/ml require prescription Vit D.
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A joint health supplement such as Previnex Joint Health PLUS (save 15% with TMR15) and collagen such as Modere BIOCELL can help with menopause fatigue and joint pain as it can make your joints feel better and keep you on track with your exercise routine.
- Adaptogenic herbs, such as Maca powder for energy and Ashwagandha for anxiety, can help symptoms a lot. Personally, I use the OM Master blend of mushrooms in my coffee and love it.
Related: How to Manage Menopause Symptoms While Running
Don’t Let Menopause Tiredness Defeat You
I have seen firsthand women overcome perimenopausal and menopausal fatigue with lifestyle changes such as natural supplements, intentional run training for their stage of life, and HRT.
Runners are tough and meant to endure. Like with most challenges we face in life, it takes time to figure out the solution—but it is there if we are patient and don’t give up.
If you’re interested in having a helping hand in your run journey through menopause, please check out my run coaching services. I would love to help you!
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