Fatigue and Stress in Perimenopause. The Role of Hormones.

by | Jun 18, 2022 | health, Hormones

As you approach perimenopause, you may experience a marked lack of energy and mood changes, which can significantly impact your quality of life. You’re not alone – these are common symptoms during the menopause transition. But what’s causing it? And more importantly, what can you do about it? In this article, we’ll look at the role of hormone levels in menopause fatigue and stress and discuss some strategies for managing them.

(The terms perimenopause and menopause transition are often used interchangeably, as they will be here. Technically, menopause occurs one year after the absence of a period. Perimenopause/menopause transition is the phase before the last period.)

Hormones in the Reproductive Years

In the years before perimenopause, hormone fluctuations during the menstrual cycle are fairly predictable for many women. Follicle-stimulating hormone (FSH) signals the ovaries to produce estrogen and mature a follicle for release in ovulation.

Once the follicle is released, progesterone is produced by the empty follicle, which thickens the uterine lining, preparing for pregnancy. (1) For even more detail, see this article by Harvard Health.

Hormonal Changes in Perimenopause

During perimenopause, the production of estrogen and progesterone by the ovaries begins to decline because there are fewer viable follicles to mature. Because estrogen and progesterone (among other hormones) regulate so many processes in our bodies, this decline often results in a cascade of symptoms, including menopausal fatigue and stress.

Estrogen and progesterone also affect cortisol and thyroid hormones which are responsible for the regulation of cellular energy. This has a direct effect on our energy during the day. Insomnia or disrupted sleep due to hot flashes and night sweats is also common, affecting how alert we feel the following day.

What are the effects of estrogen on the symptoms of menopause?

During perimenopause, as estrogen begins to decline, levels can fluctuate significantly. Because estrogen also helps to regulate metabolism and energy production in the body, these fluctuations can cause many symptoms, including fatigue and stress (weight gain, brain fog, hot flashes, and night sweats are also common). When estrogen levels are low, it can lead to increased levels of the stress hormone cortisol. This can make you feel more tired and stressed.

What is cortisol?

Cortisol is a hormone that is produced by the adrenal gland. It is sometimes called the “stress hormone” because of its role in the body’s stress response. Cortisol levels usually increase in response to illness, injury, and other stressors or perceived threats.

What effect does menopause have on cortisol?

Cortisol helps to regulate blood pressure and blood sugar levels and also plays a role in the body’s immune response. When estrogen levels dip, cortisol levels can rise in an attempt to compensate. (2)

Cortisol also has a distinct pattern. It rises in the morning, signaling the body to be alert and awake. It falls gradually throughout the day, reaching its lowest point in the evening, which signals the body that it is time to sleep.

A surge in cortisol can lead to many symptoms, including fatigue, anxiety, and difficulty sleeping. Long-term elevated cortisol resulting from chronic stress can impair cortisol performance, causing it to rise and fall throughout the day outside of its optimal pattern.

Below is a graph illustrating a normal cortisol pattern (area in beige) and what it looks like when cortisol is elevated or too low.

Stress in perimenopause


Having a clear picture of how cortisol is performing for us as individuals can help inform treatment and facilitate healing, resulting in greater energy, more efficient sleep, and mood regulation.

What is the role of progesterone?

Progesterone helps to balance estrogen levels in the body. When progesterone levels are low, it can cause estrogen levels to increase, which can lead to fatigue and stress.

Progesterone is known as a “calming” hormone, so when it’s low, it can exacerbate feelings of stress and anxiety. This calming action also affects sleep quality. So its fluctuation can cause insomnia and disrupt sleep patterns. This can lead to fatigue during the day.

As you can see, hormones fluctuate significantly during perimenopause, but that does not mean that there is nothing that can be done. There are many ways you can work to stabilize your symptoms.

What can you do to boost your energy and improve symptoms of menopausal fatigue and stress?

Physical Activity:

Exercise can help to reduce stress levels and improve energy. A word of caution: If you exercise in the evening, this can negatively impact sleep, so make sure to schedule a workout a few hours before bedtime. (ps: exercise can also help with hot flashes).


Eating a diet that is rich in fruits, vegetables, and whole grains can help to improve energy levels and reduce stress. Shooting for servings of protein, fat, and fiber at each meal can help stabilize energy all day long.

Reduce stress:

Stress can worsen fatigue during menopause. Exploring ways to reduce stress in your life, such as yoga, meditation, or deep breathing exercises, can be very helpful.

Improve sleep quality:

Going to bed and rising at similar times each day can help to improve sleep quality and reduce fatigue. Practicing good sleep hygiene by putting electronics away an hour before bedtime and keeping your bedroom environment cool and dark can promote restful sleep.

Avoid alcohol:

Unfortunately, it is a misnomer that alcohol helps us sleep. While it can help you to fall asleep, it interferes with the onset of deep sleep, which is essential to feeling rested during the day.

Check-in with Caffeine Consumption:

Caffeine consumption is best before 12 pm. If consumed in the afternoon, it can interfere with sleep. Some people are very sensitive to caffeine, and for those, even small amounts may be negatively contributing to stress and fatigue. 


Many supplements can help alleviate menopause symptoms. Supplements can help with symptoms such as hot flashes, menopause fatigue, sleep disruption, mood changes, night sweats, and more. Your nutritionist can help guide you on what would work best for you.

Hormonal Therapy:

If you think you are going through the menopause transition, it is always a good idea to talk to your doctor about the best type of treatment for you. Hormonal therapy can be very effective for menopausal women for whom it is safe to take.

How a DUTCH Test Can Help with Creating a Treatment Menopausal Symptoms

If you’re struggling with symptoms of fatigue and stress during perimenopause, a DUTCH test can help. The DUTCH test is a hormone assessment that includes measures of estrogen, progesterone, melatonin, and cortisol levels in the body. This test also measures whether these hormones are performing effectively.

The DUTCH test results can help create an individualized treatment plan to address fatigue and stress, and other perimenopause symptoms.

If you’re interested in learning more about the DUTCH test, please contact me. I’d be happy to answer any of your questions!


  1. “Perimenopause: Rocky Road to Menopause.” Harvard Health, 14 Apr. 2020, https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause. 
  2. Woods, Nancy Fugate et al. “Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study.” Menopause (New York, N.Y.) vol. 16,4 (2009): 708-18. doi:10.1097/gme.0b013e318198d6b2
  3. What can the Dutch Plus Tell Us That the Dutch Complete Cannot?, 2022, https://dutchtest.com/info-dutch-plus/

Fatigue and Stress in Perimenopause. The Role of Hormones.

by | Jun 18, 2022 | health, Hormones