Crashing Fatigue & Energy Depletion

What It Is

Crashing fatigue is not regular tiredness. It's a profound, body-deep exhaustion that feels like:

• "I can barely lift my head"
• "I need to lie down right now"
• "My body is made of lead"
• "I'm running on fumes"

It can hit suddenly (the "crash"), or it can be a constant baseline of depletion. It's unrelieved by sleep, caffeine, or willpower. It affects every aspect of life—work, relationships, self-care, joy.

60-70% of perimenopausal women report significant fatigue. It's one of the most debilitating symptoms, yet often dismissed as "just stress" or "normal aging."

Why It Happens

Fatigue in perimenopause is multi-factorial:

1. Sleep Deprivation

• Night sweats wake you repeatedly
• Fragmented sleep prevents deep, restorative sleep
• Anxiety makes it hard to fall or stay asleep
• Cumulative sleep debt over months or years

Sleep deprivation alone can cause profound fatigue, brain fog, mood changes, and physical exhaustion.

2. Hormonal Disruption

Estrogen's role in energy:

• Supports mitochondrial function (cellular energy production)
• Regulates glucose metabolism (energy from food)
• Affects neurotransmitters (dopamine, serotonin) that influence motivation and energy
• Supports thyroid function

When estrogen fluctuates or declines:

• Energy production at the cellular level is impaired
• Glucose regulation becomes less efficient
• Motivation and drive can plummet
• Thyroid function may be affected

Progesterone:

• Low progesterone can disrupt sleep (worsening fatigue)
• Affects GABA receptors (calmness and restorative rest)

3. Adrenal and Cortisol Dysregulation

Chronic stress + poor sleep + hormonal changes = adrenal strain:

• Cortisol (stress hormone) can become dysregulated
• High cortisol at night (interferes with sleep)
• Low cortisol in the morning (hard to wake up, no energy)
• "Wired and tired" pattern: anxious but exhausted

4. Thyroid Dysfunction

Hypothyroidism (underactive thyroid) is common in perimenopause:

• Causes profound fatigue, weight gain, brain fog, cold intolerance
• Often overlooked or misdiagnosed
• Requires blood test (TSH, free T4, free T3)

5. Anemia

Heavy or irregular periods (common in perimenopause) can cause iron-deficiency anemia:

• Low iron = low oxygen delivery to tissues = exhaustion
• Also causes shortness of breath, dizziness, pale skin

6. Metabolic Shifts

Perimenopause changes metabolism:

• Insulin sensitivity decreases
• Blood sugar regulation becomes less stable
• Energy "crashes" after meals or when skipping meals

7. Emotional and Mental Load

Managing intense physical symptoms, life stress, caregiving, and work demands while exhausted creates a massive cognitive and emotional burden that depletes energy further.

Common Experiences

Types of Fatigue

Constant baseline exhaustion:

• Wake up tired, stay tired all day
• No amount of rest helps
• Feel like you're moving through molasses

Sudden crashes:

• Sudden wave of overwhelming fatigue
• Need to lie down immediately
• Can happen mid-day, after meals, or without warning

Post-exertional fatigue:

• Disproportionate exhaustion after minimal activity
• Exercise that used to energize now depletes for days
• "Payback" after any exertion

Wired and tired:

• Exhausted but can't sleep
• Anxious, jittery, but no energy
• Cortisol dysregulation

Impact on Daily Life

Work:

• Difficulty concentrating, completing tasks
• Calling in sick more often
• Fear of job loss or poor performance reviews

Relationships:

• Too tired for social activities, sex, quality time
• Irritability and short temper
• Guilt and shame for not being "present"

Self-care:

• Too tired to exercise, cook healthy meals, shower
• Survival mode: doing the bare minimum

Joy and purpose:

• No energy for hobbies, passions, creativity
• Life feels like just "getting through the day"

What Helps

1. Address Sleep First

Sleep is the foundation. If you're not sleeping, nothing else will fully work.

• Treat night sweats (estrogen, gabapentin, cooling strategies)
• Improve sleep hygiene (cool room, dark, consistent schedule)
• Consider magnesium, melatonin (if appropriate)
• Treat anxiety or racing thoughts (therapy, medication if needed)

2. Test for Underlying Causes

Essential labs:

• Thyroid: TSH, free T4, free T3 (hypothyroidism is common)
• Iron: Ferritin, iron, total iron-binding capacity (anemia)
• Vitamin B12: Deficiency causes fatigue, brain fog
• Vitamin D: Deficiency worsens fatigue, mood
• Cortisol: AM cortisol or 4-point salivary cortisol (adrenal function)
• Blood sugar: Fasting glucose, HbA1c (rule out diabetes/prediabetes)

Treat anything that's low or out of range.

3. Hormonal Support

Estrogen therapy:

• Improves energy, sleep, mood
• Supports mitochondrial function
• Many women report energy as one of the first improvements on HT

Progesterone:

• Improves sleep quality (better sleep = more energy)
• Calming effect on nervous system

Combination HT:

• Often most effective for multi-system fatigue

4. Metabolic and Blood Sugar Support

Eat for stable energy:

• Protein at every meal: Stabilizes blood sugar, supports energy
• Healthy fats: Brain and hormone support (avocado, nuts, olive oil, fatty fish)
• Complex carbs: Whole grains, vegetables (not refined carbs/sugar)
• Frequent small meals: Avoid long gaps that cause crashes
• Limit sugar and refined carbs: Cause energy spikes and crashes

Hydration: Dehydration worsens fatigue. Aim for adequate water intake.

5. Movement (Paradoxically)

Gentle, regular movement can improve energy over time (even though it feels impossible when you're exhausted):

• Start very small: 5-10 minute walks
• Don't push to exhaustion: Gentle yoga, stretching, slow walking
• Consistency over intensity: Daily gentle movement beats occasional intense workouts
• Listen to your body: Rest when needed, don't force

Note: If you have post-exertional malaise (PEM) or suspect chronic fatigue syndrome (ME/CFS), consult a specialist before increasing activity.

6. Stress Reduction

Chronic stress + fatigue = worse fatigue:

• Set boundaries: Say no, delegate, let go of non-essentials
• Reduce commitments: This is not forever, but right now you need space
• Therapy or coaching: Support for navigating this phase
• Nervous system regulation: Breathwork, meditation, gentle yoga
• Treat yourself with compassion: You're not lazy; you're managing a major physiological transition

7. Supplements (Discuss with Clinician)

For energy support:

• Iron: If deficient (take with vitamin C for absorption)
• Vitamin B12: If low (sublingual or injections if severely deficient)
• Vitamin D: 1000-2000 IU daily if deficient
• Magnesium: Supports sleep, energy production, stress response (300-400mg)
• CoQ10: Supports mitochondrial function (100-200mg)
• Adaptogenic herbs: Ashwagandha, rhodiola (if appropriate, not for everyone)

Avoid:

• Relying on caffeine (creates crashes, worsens sleep)
• Energy drinks (sugar, stimulants, crashes)

8. Cognitive and Emotional Support

Reframe expectations:

• You're not "failing"—you're navigating a massive biological transition
• Lower the bar temporarily (not forever)
• Prioritize ruthlessly: What truly matters right now?

Grief and validation:

• It's okay to grieve the loss of your former energy
• Your fatigue is real, not imagined or exaggerated
• You're not alone—this is incredibly common

Duration and Recovery

Fatigue typically:

• Begins or worsens in Electric Cougar or Wild Tide
• Peaks during Wild Tide (worst sleep, most hormonal chaos)
• Improves gradually as hormones stabilize in Pause and beyond
• Largely resolves by Phoenix or Golden Sovereignty (with treatment and support)

Many women report energy returning to near-baseline once:

• Sleep improves (hormone therapy, treating night sweats)
• Hormones stabilize (naturally or with HT)
• Underlying issues are treated (thyroid, anemia, etc.)

When It Might Be Something Else

If fatigue is severe, unrelenting, or accompanied by:

• Severe depression or suicidal thoughts
• Unexplained weight loss
• Fever, night sweats (unrelated to hot flashes)
• Swollen lymph nodes
• Post-exertional malaise (crashes for days after minor activity)
• Joint pain and stiffness (autoimmune signs)

Investigate further:

• Depression or other mental health conditions
• Chronic Fatigue Syndrome (ME/CFS)
• Fibromyalgia
• Autoimmune conditions (lupus, rheumatoid arthritis, MS)
• Sleep apnea
• Cancer (rare, but can cause profound fatigue)

The Bottom Line

Crashing fatigue is:

• Common in perimenopause (60-70%)
• Multi-factorial (sleep, hormones, thyroid, anemia, stress)
• Treatable (address underlying causes)
• Often improves dramatically with hormone therapy, sleep restoration, and metabolic support
• Temporary for most women

You don't have to accept exhaustion as your new normal. Investigate, treat, rest, and trust that energy will return.