Perimenopause fatigue: nutrition strategies that may help
When tired feels like more than tired
Fatigue is one of those perimenopause symptoms that can really affect day-to-day life. It’s easy to fall into a pattern of waking up tired despite having slept, struggling through the afternoon energy slump and feeling drained after exercise or everyday tasks. Sound familiar?
Sometimes it feels as though no amount of coffee, fresh air or telling yourself to “get on with it” is going to touch the sides.
How does perimenopause affect energy levels?
There are several reasons why energy levels can take a hit during perimenopause and menopause. Fluctuating hormone levels can affect sleep and mood, while hot flushes and night sweats can make good-quality, restorative sleep much harder to come by. At the same time, we naturally begin to lose muscle mass as we age, particularly if we’re not supporting it with regular strength training and enough protein.
Nutrition isn’t going to magically fix menopause fatigue, but eating well can help support energy levels, muscle health and recovery, and it may also highlight areas where your body isn’t getting quite what it needs.
Build meals around protein
Protein becomes increasingly important through midlife because it helps us maintain muscle mass, as well as making meals more satisfying.
I’d suggest including a source of protein at each meal rather than leaving most of it until dinner. Take a look at your usual meals, particularly breakfast, where protein can sometimes be a little lacking, and think about simple ways you could add more.
Eggs, fish, chicken, Greek yoghurt, fortified dairy alternatives such as soya yoghurt, tofu, tempeh, beans and lentils are all useful protein options.
I’d also be a little cautious about the current trend for protein-enriched coffees. There’s nothing inherently wrong with them but check what protein you are actually getting for your money. Some contain collagen, which is an incomplete protein and shouldn’t replace good-quality protein foods in your diet. And some of those little bags of coffee come with a rather impressive price tag too.
Choose carbohydrates that provide steadier energy
Carbohydrates get such bad press and are often one of the first things people cut when trying to lose weight. But carbohydrates are an important source of energy, particularly if you’re active, and cutting them too aggressively may leave you feeling even more tired.
Rather than avoiding them, focus on higher-fibre choices and combine them with protein, vegetables and healthy fats to create satisfying, balanced meals. Think oats, wholegrain bread, brown rice, quinoa, wholegrain pasta, potatoes with their skins on, beans and pulses.
To put this into perspective, the UK Eatwell Guide recommends that potatoes, bread, rice, pasta and other starchy carbohydrates make up just over a third of the food we eat overall, choosing higher-fibre or wholegrain versions where possible.
So no, the potato does not need to be evicted from your dinner plate (just keep the skin on!)
Don’t forget iron
Iron remains important regardless of whether you’re still having periods. It is particularly important if yours have become heavier or more frequent during perimenopause. Low iron stores can develop before someone becomes anaemic, so persistent tiredness is worth investigating rather than simply assuming menopause is responsible.
This one has been a timely reminder for me.
I’ve been feeling particularly tired recently and had been putting it down to a difficult year, training hard and the seemingly endless hot weather. But when I came back from a holiday feeling just as tired as when I left, I decided it was probably worth getting checked.
My blood tests didn’t show anaemia, but my ferritin - the measure used to assess the body’s iron stores - was low. Not below NHS guidelines, but low enough that this could be contributing to my fatigue.
I train hard and am not always as good at following my own advice around rest and recovery as I should be, so I’ve taken it as a gentle reminder to be a little kinder to myself. Apparently, I’m not exempt from needing to take my own advice.
Food sources of iron include lean red meat for those who eat it, shellfish and fish, eggs, lentils and beans, tofu, fortified cereals, nuts, seeds and green leafy vegetables.
The iron found in plant foods is less easily absorbed than iron from animal sources, but you can help your body along by eating vitamin C-rich foods alongside them, for example peppers, tomatoes, berries, kiwi or citrus fruit. Tea and coffee can reduce iron absorption, so it’s also worth leaving a gap between them and an iron-rich meal where possible.
Persistent or significant fatigue is worth discussing with your GP, particularly if it is new, worsening or affecting everyday life. Perimenopause isn't the only possible explanation. Iron deficiency, low vitamin B12 or folate, thyroid problems, vitamin D deficiency, illness, poor sleep, stress, grief and low mood can all contribute to tiredness.
Eat enough
Midlife can bring a lot of pressure around weight, and sometimes the response is to cut calories dramatically while simultaneously trying to exercise more.
That combination isn’t always helpful.
Consistently under-fuelling your body can leave you feeling tired, compromise recovery from exercise and make healthy habits much harder to sustain.
You don’t necessarily need to eat less. Sometimes it is more useful to look at what you’re eating, how much and when.
Quality, quantity and timing all matter.
Hydration matters more than we sometimes realise
Dehydration can contribute to tiredness, headaches and difficulty concentrating, so hydrating regularly throughout the day is another simple place to start.
Try not to leave most of your drinking until the evening in an attempt to catch up, your bladder may have something to say about that at 2am!
Water, herbal teas and other unsweetened drinks all contribute to your fluid intake, as does the food we eat. Fruit and vegetables with a high water content, such as watermelon, cucumber, tomatoes and oranges, can all contribute too.
As a general guide, aim for around 6-8 glasses of fluid a day, remembering that you need more if you are exercising, sweating heavily or the weather is hot.
Be careful with the caffeine cycle
When you’re exhausted, another coffee can feel like the obvious solution.
The trouble is that caffeine later in the day can interfere with sleep in some people, which may leave you reaching for yet another coffee the following morning. And so, the caffeine merry-go-round continues.
Pay attention to how much caffeine you’re having and when. If sleep is an issue, experiment with moving your last caffeinated drink earlier in the day or swapping to decaf.
Support sleep through nutrition - but don’t expect food to fix everything
We’ve heard much of the standard sleep advice before, but there’s a reason it keeps coming up.
Try to maintain reasonably regular eating patterns and, if large or late meals leave you uncomfortable or disrupt your sleep, give yourself a little more time between dinner and bed. Equally, going to bed ravenously hungry because you’ve eaten too little during the day isn’t particularly conducive to a peaceful night either.
Alcohol is another one to watch. While a drink can initially make you feel sleepy, alcohol can disrupt sleep quality, and for some women it may also worsen hot flushes and night sweats.
And then there’s caffeine, again!
This week, while out running with a friend, she told me she’d slept dreadfully the night before. She then casually added that, because she hadn’t had dinner, she’d eaten a bedtime tiramisu instead... I think my laughter said everything! (I know her well and, on this occasion, it was definitely OK to laugh, I promise.)
Coffee, sugar, chocolate and alcohol immediately before bed probably wasn’t quite the sleep supporting combination she’d hoped for!
Importantly, night sweats and menopause-related sleep disturbance may need support that goes well beyond nutrition. If menopause symptoms are regularly affecting your sleep or quality of life, speak to your GP about the options available.
Small changes that can make a difference
If you’re struggling with fatigue, start with three simple things:
Include a source of protein at each meal.
Choose fibre-rich carbohydrates rather than automatically cutting carbohydrates out.
If fatigue is persistent, speak to your GP rather than assuming it is simply part of menopause.
And remember, you don’t need a perfect diet. Consistent, manageable changes are far more useful than trying to overhaul everything overnight.
If perimenopause fatigue is leaving you unsure about what or how to eat, personalised support can help you look at your current diet, lifestyle and symptoms and identify practical changes that work for you.
Take a look at my Rise & Renew programme, designed to support women through perimenopause, menopause and beyond.