Why am I so exhausted in perimenopause?

Because perimenopause loads extra demands onto a body that's often already running on depleted reserves. Exhaustion isn't a disease in itself; it's a symptom, and in midlife it usually has several drivers stacked together: hormonal changes, disturbed sleep, chronic stress, nutrient shortfalls (iron above all) and sometimes thyroid or blood sugar issues. It's also extraordinarily common: in a 2024 study of perimenopausal women, feeling tired or lacking in energy was the single most prevalent symptom of the menopausal transition (Zhang et al., Menopause, 2024).

Exhaustion is the complaint I hear more than any other, and even my clients with chronic pain often tell me the tiredness affects their day more than the pain does. Common, yes. Normal, no. And definitely not something you just have to put up with.

How does your body make energy?

Each of our cells has tiny power stations called mitochondria, hundreds to thousands of them in nearly every cell, turning the food you eat into energy molecules; across a day they produce roughly your body weight in energy molecules. Mitochondria are sensitive little things: chronic stress, a nutrient-poor diet, toxins and ageing all impair them, and when energy production can't meet demand, you feel it as exhaustion.

The encouraging part: mitochondria respond to how you live. Movement is one of the strongest signals for building more of them, and the nutrients below are what they run on. When stress is chronic, it depletes those nutrient stores, keeps your nervous system in fight or flight, and drives the inflammation that damages mitochondria, which is why "just go to bed earlier" never fixes this kind of tired.

What nutrients does your energy system run on?

The energy process needs specific raw materials, and shortfalls show up as fatigue long before they show up on a standard blood test. The big ones: CoQ10, B vitamins, protein (especially carnitine), healthy fats, and the minerals iron and magnesium.

CoQ10: the spark plug

CoQ10 helps get energy production going and protects mitochondria from damage. You make less of it as you age, and cholesterol-lowering statins block the same pathway that makes CoQ10, so if you take a statin, talk to your naturopath or pharmacist about supplementing. Food sources: meat, poultry, fish, olive oil, broccoli, cauliflower, lentils, sesame seeds, spinach and strawberries. (And yes, cholesterol rising in perimenopause is its own story: here's why.)

B vitamins, protein and healthy fats

B vitamins are co-drivers of the energy process, and protein supplies carnitine, which ferries fuel into the mitochondria. Healthy fats belong at every meal: avocado, extra virgin olive oil, macadamias, walnuts, eggs, chia and flax seeds, and fatty fish like sardines, mackerel and salmon. Two eggs for breakfast, a drizzle of olive oil on your veges, a palm-and-a-bit of protein at each meal: simple, doable, effective.

Iron: the one that's missed most

If you're exhausted, foggy, breathless on stairs or losing hair, iron deficiency belongs at the top of your list, especially with heavy or frequent periods. I've written a full guide to iron in perimenopause, including why "normal" bloods can still mean you're running on empty.

Which blood tests should you ask for when you're exhausted?

Ask your GP for this panel, and ask for the actual numbers rather than "all fine": iron studies including ferritin (your iron stores; the most commonly missed cause of midlife exhaustion), full blood count (anaemia and B12 clues), thyroid panel with free T3 and free T4, not just TSH (your metabolic accelerator), fasting glucose and insulin (blood sugar swings masquerade as fatigue), B12 and folate (energy and nerve function), vitamin D (low levels drag energy and mood), and CRP (inflammation, which also blocks iron absorption).

All are standard, most are bulk-billed, and together they cover the most common fixable drivers of exhaustion. I want your results compared to optimal ranges, not just within range; the difference between a ferritin of 20 and 80 is the difference between surviving your day and living it.

The 10 easy meals

Simple, slow-cooked or well-cooked meals are easiest for a stressed, tired body to digest. Cold and mostly raw foods ask more of your digestion right when it has the least to give. Here's my actual list, tested on my own exhausted nights.

1. Slow cooker stew. Chuck everything in, add herbs and spices, and come home to dinner already made. Use my easy beef stew recipe as a guide and sub lamb, chicken, chickpeas or lentils. Skip recipes built on store-bought sauces and tinned soups (sugar, salt and additives).

2. Whole chicken and vegetable soup. Makes heaps, easy to digest, family friendly. Double it and freeze lunch and dinner portions.

3. Meat + three veg. There's nothing wrong with basic food. A palm-size piece of meat or fish, colourful steamed veges, a good extra virgin olive oil or organic butter, lemon juice, salt and pepper. Aldi does a great affordable organic extra virgin olive oil.

4. Eggs. Scrambled, omelette or perfectly soft-boiled, with whatever veges you can wave at them: baby spinach, spring onions, parsley, rocket, my kid-approved pickled beetroot.

5. Upside down day. Breakfast for dinner. Porridge on a busy night is completely legitimate. Check out my seedy porridge recipe for a gluten free, nutrient dense version.

6. Fake-away (planned leftovers). Cook once, eat more than once. A big slow cooker (mine is 7L), double batches, half in the freezer for a fake-away night. We have a leftovers or freezer-meal night at least once a week.

7. Curry in a hurry. Keep curry pastes or marinades in meal-size portions in the freezer, or use a good curry powder. Paste + liquid + protein + veges, and dinner is nearly served.

8. Jacket potatoes. Comforting carbs, minimal effort. Slow cooker or low oven; steam them in a covered baking dish with a little water and they go creamy inside. Top with kale pesto and a sprinkle of nitrate-free bacon, veges on the side.

9. Faster pasta. Passata + chopped onion, carrot, zucchini and spinach + dried herbs, simmered soft, with a tin of wild-caught tuna or salmon stirred through. Buckwheat or legume pasta to serve.

10. Tinned treasures. My Mum's jazzed-up sardines: drain wild-caught sardines, add a tablespoon each of extra virgin olive oil and apple cider vinegar, mash, season. On good bread or seedy crackers with a cup of bone broth. Still hungry? Greek yoghurt with berries and seeds.

When should you see your GP about exhaustion?

And take the blood test list above with you.

You deserve to feel like you again

Could you manage one of these meals this week? Start there. And if you're sick of feeling exhausted, you've been told everything's "normal", but you know something isn't right, please don't keep white-knuckling it. Book a free Clarity Call and let's find out what's actually draining you. It is possible to go through perimenopause feeling calm, happy and energetic.

Frequently asked questions

References

1. Zhang T, Wan Y, Geng L. Unraveling the core and bridge menopausal symptoms of perimenopausal women: a network analysis. Menopause. 2024;31(11). doi.org
2. Zhang et al. Updating the diagnosis and management of iron deficiency in the era of routine ferritin testing of blood donors by Australian Red Cross Lifeblood. Medical Journal of Australia. 2024;221(7). mja.com.au