The Science Behind Menopause and Fatigue

Women going through perimenopause and menopause often experience excessive fatigue and low energy levels. This is different from the usual tiredness that one may feel.

Yes, hormonal changes have an impact on physical and mental energy. Sleep complaints skyrocket at the time of menopause.

Sleep, the time when we need to refuel our energy is only part of the story. And hot flashes and night sweats are just a small part of sleep disruption. Cellular changes in our body also can cause low energy levels.

Prevalence of Fatigue in Menopausal Women

But before we explore sleep challenges and cellular changes let’s look at how common perimenopause and menopause fatigue is. A study involving 300 women reported an increase in fatigue as women advance through menopause. Nearly half of women reported the perimenopause symptom of fatigue and 85.3% in post-menopause.

Researchers conducted a larger study with 1,113 Lebanese women. This study found that 73% of these women experienced feelings of tiredness or exhaustion at various points during menopause.

Now, why do you and so many midlife women feel this immense fatigue.

Estrogen and Mitochondrial Function

Estrogen is directly linked to energy production in women. Estrogen is vital for mitochondrial function – the cells responsible for our body’s energy production.

Estrogen is crucial for our bodies’ energy. It helps our mitochondria cells, tiny parts inside our cells that generate energy, to work properly. These mitochondria produce something called ATP, or adenosine triphosphate. ATP is the fuel for our cells, powering everything we do, from thinking to moving. Estrogen also acts like a shield, protecting these energy-making parts.

The Midlife Crunch: Stress and Energy Deficit

Another reason is sheer demands and stress on midlife women. Middle-aged women often juggle career, family responsibilities, and household tasks, leading to a chronic energy deficit. Deloitte’s report says women with a partner and kids do most of the childcare and household tasks. This additional and constant workload demand can result in chronic stress making menopause exhaustion even worse.

Sleep Disturbances During Menopause

Hormonal changes in perimenopause and menopause can disrupt sleep by affecting brain chemicals. The connection between hormones and brain chemistry is complicated. In fact, researchers only recently discovered estrogen’s role in the brain in 1996.

During perimenopause and menopause, the fluctuating and eventually decreasing levels of estrogen and progesterone significantly affect sleep patterns and mood. These hormones play crucial roles in regulating various bodily functions, including the sleep-wake cycle.

Estrogen regulates the sleep-wake cycle. Low estrogen during menopause can disturb sleep, making it difficult to fall asleep and stay asleep. This disruption can lead to a pattern of restless nights and unrefreshing sleep.

Low estrogen levels can also result in less serotonin. Serotonin affects sleep quality and mood regulation in the body. It helps with sleep duration and quality, and acts as a natural mood booster.

Emotional changes can make sleep problems worse. Emotional changes worsen sleep problems. This creates a cycle.

Lack of sleep worsens mood problems. These mood problems make it harder to sleep well.

Progesterone has calming effects and plays an important role in promoting restful sleep. Less progesterone during menopause can cause more sleep problems like insomnia and restless nights.

When progesterone levels fall, it can lead to increased anxiety, moodiness, and feelings of sadness. When progesterone decreases, it can affect sleep and emotions. This can create a cycle where poor sleep makes mood worse, and mood changes make it difficult to sleep peacefully.

Menopause Symptoms and Sleep

Hot flashes and night sweats are common symptoms of perimenopause and menopause caused by hormonal changes. These symptoms can significantly disrupt sleep patterns. Hot nights can make it hard to sleep, waking you up often and suddenly from the heat and discomfort.

By now you are realizing that sleep concerns are like a layer cake. Menopause symptoms, stress, poor sleep habits, pain, and other medical conditions, including mental illness can all cause sleep problems.

Addressing Other Sleep Disorders

Doctors should not make assumptions that menopause tiredness is the sole cause of sleep problems in middle-aged women. They should also rule out other underlying sleep disorders or medical conditions. Some examples are sleep apnea, restless legs, limb movement disorder, insomnia, and chronic pain.

Studies have found that as women age the occurrence of sleep apnea goes up. One study found a incidence of 17% in women 45 to 54 years and 45% in women aged 55 to 70 years.

Gaining weight can lead to sleep apnea, and sleep apnea can also cause weight gain. This creates a difficult cycle to break. Losing weight, even a small amount, can greatly improve sleep apnea. Behavioral or medical treatments can be effective in achieving this.

Survey data shows that 69% of women with restless legs have worse symptoms after menopause. Menopause doesn’t directly cause restless legs, but the sleep problems during menopause can make it worse.

Limb movement disorder is rare, and we don’t know exactly how many people have it. Both men and women get it equally, but after menopause, women tend to have more limb movements during sleep. This becomes more common as people get older.

Women are twice as likely to have insomnia — being unable to fall asleep and stay asleep — as men. It usually involves another medical condition, such the mood disorders – anxiety and depression, and chronic pain.

The Link Between Pain and Menopause

Add to this that women experience more pain conditions than men. The frequency of pain complaints for women begins to increase during midlife. Many people do not widely recognize pain during menopause as a symptom, even though sex hormones do influence it.

The pain conditions that are more common in women include fibromyalgia, chronic fatigue syndrome, complex regional pain syndrome, abdominal pain (irritable bowel syndrome), interstitial cystitis/bladder pain syndrome, chronic pelvic pain of uncertain origin, migraine and orofacial pain.

Strategies for Better Sleep and Energy Management

Finding Relief – good news – fatigue and sleep disturbances caused by perimenopause and menopause its treatable. These include:

First, establishing a consistent sleep routine is crucial. To improve your sleep:

  • Go to bed and waking up at the same time every day, including weekends. This will help regulate your body’s internal clock.
  • Create a sleep-conducive environment is equally important. Ensure your bedroom is cool, dark, and quiet. A comfortable mattress and supportive pillows can alleviate aches and pains. Blackout curtains or a white noise machine might be useful in blocking external disturbances.
  • Minimize caffeine, alcohol, and electronic device usage before bedtime to further promote restful sleep.
  • Incorporate regular exercise can positively affect both sleep quality and mood.
  • Add relaxation techniques like deep breathing, meditation, or yoga can reduce stress and prepare your body for sleep.

Medical Interventions for Menopause Symptoms

If they’re not helpful, talk to one of our medical practitioners about any of these effective medical treatments.

  • For treating moderate to severe night sweats and hot flashes, using Hormone Replacement Therapy (HRT) — either estrogen alone or combined with progesterone — stands as the most effective approach
  • If you take HRT for your disruptive night sweats and hot flashes, HRT may improve your sleep, fatigue, mood, ability to concentrate, and overall quality of life.
  • Non-hormonal medications, such as sleep aids or antidepressants, can also help with hot flashes and night sweats that disturb your sleep.
  • Cognitive therapy helps to improve thoughts, reduce stress, and change behaviors that cause insomnia.

Taking Control of Your Energy During Menopause

Understanding that fatigue is a common symptom of menopause can be the first step in managing it. Rest, lifestyle changes, and medical treatment are all effective ways to addressing low energy levels in women.

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