Fatigue and Restoring Energy During Menopause and Perimenopause

Written and edited by Sarah Bonza MD, MPH, FAAFP, DipABLM, NBC-HWC

Understanding Fatigue and Menopausal Energy Depletion

Many women of perimenopausal and menopausal ages approach me with vague symptoms of fatigue. They often describe feeling constantly tired, lacking energy, and struggling to get through daily tasks. These women are frequently experiencing stress of caring for family and working full time.

Menopause is a natural phase in a woman’s life that marks the end of reproductive years. During this time, hormonal changes occur, including a decrease in estrogen and progesterone levels. This transition, known as perimenopause, can bring about various symptoms such as hot flashes, night sweats, mood swings, and fatigue. One common but often overlooked factor contributing to fatigue during perimenopause and menopause is adrenal fatigue.

Adrenal fatigue is hypothesized to occur when the adrenal glands are unable to keep up with the demands of stress and produce sufficient hormones, leading to a depletion of energy. It often manifests as extreme tiredness, lack of energy, and difficulty coping with everyday stressors. This is different from adrenal crisis or Addison’s disease in which the adrenal glands are completely unable to produce hormones, whereas adrenal fatigue refers to a state of suboptimal function.

It is important to note that adrenal fatigue is not recognized in traditional medicine, but is commonly referenced in Functional Medicine. Fatigue itself can be cause by many medical problems such as anemia, hypothyroidism and cardiac conditions. It is important to rule out other potential causative factors before trying to address adrenal fatigue specifically. Functional practitioners identify adrenal fatigue based on persistent fatigue with chronic stress and otherwise normal workup. They may also check a 24-hour salivary cortisol test to measure adrenal function throughout the day.

The Stages of Adrenal Fatigue per Functional Medicine

Adrenal fatigue is typically classified into three stages based on the severity of symptoms and adrenal gland dysfunction.

Stage 1 Adrenal Fatigue: Alarm Phase

In the initial stage of adrenal fatigue, symptoms may include mild fatigue, occasional sleep disturbances, and difficulty in handling stress. As the condition progresses to the second stage, symptoms become more pronounced, such as consistent fatigue, frequent infections, and decreased ability to handle stress. In the advanced stage, adrenal fatigue can lead to severe exhaustion, chronic fatigue, and a compromised immune system.

Stage 2 Adrenal Fatigue: Resistance Phase

The Resistance phase of adrenal fatigue occurs when stressors fail to remit. With the persistent nature of perimenopausal symptoms and loss of serotonin and GABA due to the drop in estrogen and progesterone that agonize these neurotransmitters, often stage 1 develops quickly into stage 2 as stress resilience declines. Women need a ton of assurance and support during this time as they can also feel a lot of self-blame for not being able to control emotions. The mental landscape shift due to hormone fluctuations can feel scary. Additionally, the body starts to mount protective mechanisms such as lowering thyroid activity and shunting energy away from non-crucial body processes such as growing long and healthy hair, de-prioritizing digestion, etc.

Stage 3 Adrenal Fatigue: Exhaustion Phase

The third stage of adrenal fatigue is the exhaustion phase, where the adrenal glands are no longer able to produce sufficient hormones to meet the body’s needs. These patients require significant time and rest to recover and heal. During menopause and perimenopause, it is crucial to address adrenal fatigue and restore energy levels.

Addressing Adrenal Fatigue through Lifestyle Changes

Implementing lifestyle modifications can help support the adrenal glands and restore energy levels. A balanced diet, regular exercise, and stress management techniques such as yoga and meditation can positively impact adrenal function. Additionally, getting an adequate amount of sleep and prioritizing relaxation are crucial for allowing the adrenals to recover. This is not the time for vigorous exercise regimens, women should focus on gentle exercises when they feel persistently fatigued. Walking or tai chi are productive exercises that keep the body moving without compromising the adrenals further.

Dietary Changes to Support Adrenal Function

Making dietary changes can play a significant role in supporting adrenal function and restoring energy levels during menopause and perimenopause. During this stage, it is important to focus on incorporating nutrient-dense foods into the diet. This includes foods high in vitamins and minerals such as B vitamins, vitamin C, magnesium, and zinc, which are essential for adrenal health. Some examples of foods that support adrenal function include leafy greens, citrus fruits, nuts and seeds, lean proteins, and whole grains. Avoiding caffeine and limiting sugar intake is also important, as these can further stress the adrenal glands.

Supplements for Adrenal Fatigue

In addition to lifestyle changes and dietary modifications, certain supplements can also support adrenal function and restore energy levels during menopause and perimenopause. Supplementing with adaptogenic herbs like ashwagandha, rhodiola, and holy basil can help regulate cortisol levels and improve resilience to stress. (Gs, 1999)(Panossian, 2017)Additionally, supplementation with vitamin B complex can provide essential nutrients for energy production and support adrenal function.

Hormone Therapy

Hormone therapy may also be considered in cases where adrenal fatigue is severe and impacting overall well-being during menopause and perimenopause. Hormone replacement therapy can help restore hormonal balance and alleviate symptoms such as fatigue, mood swings, and hot flashes. It is important to consult with a healthcare professional before starting any hormone therapy or supplementation regimen, as individual needs may vary.

Seeking Support from Healthcare Professionals

While addressing adrenal fatigue, it is essential to consult with a healthcare provider who is familiar with Functional Medicine and specializes in hormone health. They can conduct thorough assessments to rule out other potential causative factors and create individualized treatment plans to support adrenal function.

Conclusion

Understanding the impact of adrenal fatigue during menopause and perimenopause is crucial for effectively managing energy levels and overall well-being. By recognizing the symptoms and implementing targeted lifestyle changes, women can take proactive steps to restore energy and navigate this transitional phase with greater ease.

References

1. Cadegiani, F., & Kater, C E. (2016, August 24). Adrenal fatigue does not exist: a systematic review. BioMed Central, 16(1). https://doi.org/10.1186/s12902-016-0128-4
2. Gs, K. (1999, August 1). Nutritional and botanical interventions to assist with the adaptation to stress.. PubMed, 4(4), 249–65. https://pubmed.ncbi.nlm.nih.gov/10468649/
3. Panossian, A. (2017, June 22). Understanding adaptogenic activity: specificity of the pharmacological action of adaptogens and other phytochemicals. Annals of the New York Academy of Sciences, 1401(1), 49–64. https://doi.org/10.1111/nyas.13399