Low energy levels, sleepless nights, and poor-quality sleep are all common complaints during menopause. But how does HT fit into this picture? Can HT make you tired, or will it help your energy levels? We explore menopause, HT, and why you might feel more tired right now…
Are you tired, fatigued, or sleepy?
Or all of the above! Many people use these words on a daily basis, but before we delve into the subject, it is important to understand what we really mean by these terms.
- Fatigue is a broad sense of exhaustion that isn’t necessarily relieved by rest. Fatigue is often linked to medical, psychological, or physiological issues
- Sleepiness refers to the feeling or need to sleep and can be a symptom of sleep disorders or lack of sleep
- Tiredness is a general state of feeling a lack of energy or exhaustion that can result from overexertion, lack of sleep, or stress
Why does menopause cause fatigue?
Fatigue during menopause is a common problem and research suggests that just under 50% of those aged 45-65 are affected.
It can be tricky to pinpoint the exact cause of fatigue. For many, it happens for a combination of reasons which could be directly or indirectly related to menopause.
Hormonal changes
Menopause is a time of dramatic hormonal change when your estrogen and progesterone levels drop. This causes your periods to slow down and eventually stop. It can also have a big impact on your energy levels and tiredness.
If your fatigue is due to menopause, HT could help. Find out more about the different types of HT.
Problems with sleep
You may find that the amount and quality of your sleep heads downhill during menopause. Night sweats, aches and pains and many of the other annoying symptoms of menopause all combine to cause broken, unsatisfying sleep.
For many people struggling with sleep issues at menopause, HT is an effective treatment. But HT isn’t suitable for everyone. Learn more about the benefits and risks of HT.
Low mood and depression
The hormonal changes of menopause can also contribute to low mood and increase your risk of depression. This is significant if you’re struggling with tiredness. In fact, one of the most common symptoms of depression is low energy levels. Some may find themselves spending hours in bed or on the sofa, struggling to muster the energy to move. Others can feel like they are never refreshed, even after a full night’s sleep.
If you think depression might be the cause of your fatigue, speak to your healthcare provider.
Many people with depression also struggle with thoughts about harming themselves or others. It’s difficult to discuss, but this is a common part of depression and a sign that you need urgent help.
Health professionals are there to help if you’re feeling this way. We’d recommend discussing your low mood with your healthcare provider as soon as possible, if you haven’t already. This is particularly important if you have any feelings of harming yourself or others.
Getting help
- Contact your healthcare provider or go to the nearest emergency room
- Call or text 988 24/7 to be connected to the national suicide crisis hotline
Anemia
Anemia can be caused by low iron levels, and this is sometimes a cause of tiredness around menopause. Signs and symptoms of anemia include pale skin, dizziness, thinning hair, and a feeling of cold hands and feet.
Periods tend to get heavier and last longer during perimenopause, which can lead to anemia. Signs of heavier periods include:
- Needing to change your menstrual products more often
- Gushes of menstrual blood
- Passing blood clots
- Bleeding through your clothes
This increased blood loss causes your body’s iron stores to deplete, especially if you experience heavier periods for months or years. Check in with your healthcare provider if this is the case for you, as they might be able to help reduce bleeding and give you treatments to replenish your iron stores.
Signs of severe anemia include shortness of breath, chest pain, feeling lightheaded, and palpitations. If you have any of these for more than a few minutes, you should seek urgent medical assistance.
Read more about menopause and heavy periods.
Other issues
It’s also important to ensure that nothing else is responsible for your fatigue. For example, common conditions like hypothyroidism, diabetes, and B12 deficiency can all cause fatigue.
Speak to your healthcare provider if fatigue is an ongoing issue for you. They will be able to run some tests to check for any other underlying problems.
Does HT make you tired?
For some, HT improves sleep and combats the fatigue associated with menopause. If your nights are disrupted by hot sweats, you’re likely to find that your sleep quality improves after starting treatment, which should have a positive effect on your energy levels. Feeling more rested can also help with brain fog and generally help you feel less overwhelmed and more in control.
Others may find that HT actually makes them feel more tired. This can be a temporary side effect, or may last longer.
Why does HT make you tired?
Tiredness and/or sleepiness can be a side effect of progesterone. This hormone is an important component of HT for many users.
While estrogen is the key ingredient needed to treat your menopause symptoms, it needs to be used alongside progesterone for those who still have their uterus. This is because estrogen, when used alone, can cause abnormal thickening of the uterine lining, which can sometimes lead to cancer. Progesterone protects the uterine lining and eliminates this risk.
Progesterone can cause tiredness with some researchers even calling it a ‘mild sedative’. For this reason, healthcare providers usually recommend taking your progesterone at bedtime if possible. This approach may also have the convenient side effect of giving you a better night’s sleep!
Estrogen, including patches, tablets, gels, and sprays, can also affect your energy levels although it is less common. Some report a general feeling of low energy, known as asthenia, when taking this hormone, although this is balanced out by the beneficial effects of HT for most.
Side effects of HT tend to improve as your body gets used to the hormones. For most people, side effects resolve after 4-6 weeks and are usually gone by the three-month mark. If you are still struggling with tiredness at this point, check with your healthcare provider and perhaps rethink your treatment plan.
Find out more about the side effects of HT.
What can you do if HT is making you tired?
Don’t assume that you will need to stop HT if tiredness is an issue. Here are a few simple steps to take before throwing in the towel.
1. Speak to your healthcare provider
It’s sensible to rule out any other issues before blaming HT. They may want to examine you or run some blood tests as a starting point.
2. Give it time
Side effects are common with HT, and tend to improve by the three-month mark. If things are no better by this point, speak to your healthcare provider.
3. Think about when you take your HT
If you take some of your HT by mouth, is that medicine a combination of both estrogen and progesterone, or progesterone on its own? If so, taking your medication at bedtime might help.
4. Consider switching to a different type of HT
Your healthcare provider will be able to advise on the best options for you. One popular alternative is to use a hormonal IUD (Mirena or Liletta) to deliver progesterone instead of a pill or patch. It sits inside the uterus and gradually releases progesterone to protect the lining. This way, you get the protective effect of progesterone without the hormone and its side effects affecting the rest of the body.
5. Think about lifestyle changes
Small but powerful changes to your diet, exercise routine, and sleep habits can give your energy levels a real boost!
Final word
HT can improve tiredness for many, but it can also contribute to fatigue and sleepiness. Check in with your healthcare provider if this is a new or persistent symptom for you – they can help you identify the cause and suggest possible solutions.
- Currie H, Moger SJ, 2019 (Dec) Menopause – Understanding the impact on women and their partners. Post Reprod Health, vol 25, issue 4, pp. 183-190
- Stella, Menopause and fatigue
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