Why Menopause Makes You Tired

Menopausal fatigue is characterized by general pain in the muscles that is often accompanied by a persistent feeling of tiredness, low stamina, anxiety and poor energy levels. According to a new study reported in the peer reviewed journal Menopause (1), investigators suggested that 60% of women experience fatigue and low stamina after achieving menopause.

It has been believed that fatigue is generally a result of low oxygen tension in the tissues which activates the anaerobic responses in the muscles and lactic acid accumulation. This causes pain and irritation and normally follows after long hours of physical activity. Unfortunately for most menopausal women, this is a persistent gnawing feeling (even at rest or with no activity). The deficiency of oxygen in the menopausal women is attributed to hormonal imbalance (especially declining estrogen and testosterone production).

Persistent fatigue is often associated with:

• Breathing problems

• Metabolism issues

• Weight gain – (see weight loss program)

• High anxiety and sleep issues

• Low productivity and social withdrawal

• Memory lapses

• Inability to concentrate

What are notable causes of Menopausal Fatigue?

Deterioration in the production and serum concentration of various reproductive hormones is the primary pathophysiological cause of menopausal fatigue. The effects of hormonal imbalance and resulting fatigue are mediated by several mechanisms:

1. Negative changes in the quality of sleep:

Improper sleep is responsible for decreasing the restorative energy in the body. It is imperative to mention that approximately 55 to 75% menopausal females report some degree of insomnia or sleep difficulty. Following are some of the reasons that may lead to sleep difficulty due to menopause and in turn increased fatigue

• The decline in female hormones is believed to directly interfere with the normal sleep pattern in this sub-group of female population. For example, a study reported in the Sleep Medicine journal (2) suggested that sleep efficiency is fairly lower in menopausal women when compared to pre-menopausal or reproductive aged women. Inadequate sleep not only affects mood and productivity directly, but also increases the production of stress hormones (like cortisol) to augment the discomfort and pain.

• Hot flashes in menopausal women can affect the rate, rhythm, depth and duration of sleep. A study reported in the Archives of Internal Medicine (3) suggested that the intensity and severity of insomnia and resulting fatigue can be aggravated up to 80% with poorly managed hot flashes.

Various research and clinical studies suggests that hormonal replacement by bio-identical hormones can improve the sleep quality several folds (2, 3).

2. Hormonal dysregulation due to estrogen deficiency:

Impaired production of estrogen due to menopause can directly alter the biochemical balance of reproductive as well as non-reproductive hormones that may deteriorate metabolic balance. For example, secretion of hormones like cortisol increases in menopausal women (thereby promoting fatigue and feeling of tiredness).  This is mainly because estrogen helps in regulating the levels of cortisol in the body. With substantial decline in estrogen, the feedback control on the cortisol is lost, resulting in heightened fatigue, mood disorders and depression. Additionally, high cortisol levels can also deteriorate the effects of hormonal replacement therapy as suggested in a study reported in the peer reviewed journal Neurobiology of Aging (4). In simple words, the positive effects of endogenous or exogenous estrogen are adversely affected if serum cortisol levels are high.

3. Poorly managed stress:

Long standing or poorly managed stress can also lead to tiredness or fatigue. Some sources of stress include work-related stress, relationship stress, and a sedentary lifestyle that may further decrease quality of life by stimulating the release of stress hormones (such as cortisol) in the body.

Other causes include:

• Estrogen and other reproductive hormones generate energy by improving the basal rate of metabolism. With poor estrogen levels, the metabolic rate deteriorates significantly.

• Temporary biochemical changes (in the secretion of enzymes and neurotransmitters) due to shift in the serum level of reproductive hormones.

Secondary medical or metabolic illnesses:

It is very important to delineate and differentiate menopausal fatigue from secondary causes such as chronic diseases, poorly managed metabolic conditions etc.

Other than menopause fatigue can also represent many other diseases such as:

• Diabetes mellitus

• Coronary artery diseases

• Hypertension

• Anemic conditions

• Hyperthyroidism

• Hypothyroidism

• Renal diseases

• Hepatic diseases

How to improve energy levels after menopause

Experts suggests that lifestyle and diet modification helps a great deal in improving the overall energy levels and stamina after menopause. A few tips to reduce the fatigue and tiredness associated with menopausal hormonal changes are:

• Indulge yourself in healthy activities (such as exercise) to maintain steady levels of adrenaline.

• Stress relieving techniques such as yoga and meditation can also help in regaining energy levels.

• Maintain a healthy and functional sleep pattern. Additionally, consume your caffeine early in the day to prevent negative effects on your sleep quality.

• Wear light and breathable clothes at night to prevent hot flashes and agitation.

• Incorporate fresh vegetables and fruits in your diet.

• Maintain proper hydration levels in your body.

These lifestyle modifications can help in improving your quality of life. However, if you are still experiencing severe menopausal fatigue that is interfering with your quality of life, you can always opt for bioidentical hormone replacement therapy – a holistic solution to restore the hormonal tranquility.