WHY PERIMENOPAUSE CAN LEAVE YOU MORE TIRED THAN USUAL (SLEEP, IRON AND THYROID FUNCTION AS POSSIBLE CAUSES TO RULE OUT)
Fatigue is among the top five symptoms experienced during the transition to menopause. Before their final period, many women report feeling extremely tired even when they first wake up, and the hormonal adjustments our bodies undergo play an important role in this. Month after month, you may notice that your strength and energy vary depending on where you are in your cycle. But when hormone production begins to become irregular, this feeling can intensify.
Premenopause, or perimenopause, is the transition that takes place before the final menstrual period. During this stage, estradiol and progesterone levels fluctuate irregularly. These changes can affect sleep, mood, thermoregulation and perceived exertion.
Fatigue is just one of the many changes that can accompany this hormonal transition. For a comprehensive understanding of how perimenopause can affect different symptoms, from hot flushes to changes in the skin and body weight, see our complete guide to perimenopause and medicinal mushrooms, which explores the scientific evidence relating to each aspect of this stage of transformation.
Hot flushes and night sweats can cause brief awakenings or prolonged sleep disruptions. According to the SWAN study (Study of Women's Health Across the Nation), a major US research study investigating women's health during midlife and menopause, waking several times on at least three nights per week increased from 24.4% of women before menopause to 40.3% after their final menstrual period. Vasomotor symptoms were associated with a greater likelihood of experiencing these awakenings (Kravitz et al., 2017).
The result can be a cycle that is difficult to break: hot flushes disrupt sleep, lack of sleep increases fatigue and irritability, and stress can make symptoms feel more intense. Even sleeping for seven or eight hours does not necessarily guarantee restorative rest if that sleep is fragmented.
LOW IRON LEVELS DUE TO HEAVY MENSTRUAL BLEEDING
During perimenopause, we begin to notice the body's adjustments as it prepares for a new stage in which the hormonal landscape changes, affecting the body as a whole. During this transition, it is common to experience very heavy menstrual bleeding. According to one of the principal investigators of the SWAN study, Dr Sioban Harlow, “one in three women transitioning through menopause will experience repeated episodes of abnormal uterine bleeding”. In fact, a study published in the journal Menopause, led by Dr Harlow, Professor Emerita of Epidemiology and Obstetrics and Gynaecology at the University of Michigan School of Public Health, showed that women in perimenopause or early menopause who experienced heavy menstrual bleeding at least three times within a six-month period were between 40% and 60% more likely to experience fatigue.
Heavy bleeding lasting more than eight days can therefore lead to iron deficiency or even iron-deficiency anaemia, both of which are closely associated with fatigue. It is advisable to consult a healthcare professional who can assess whether heavy bleeding may be contributing to iron deficiency.
FATIGUE, PERIMENOPAUSE AND THYROID DISORDERS
Persistent tiredness, exhaustion, fatigue… We may use different words for the same feeling, but many women recognise this state, particularly during perimenopause, when it may also be accompanied by insomnia or fragmented sleep, hot flushes or heavy bleeding.
Fatigue is also a common symptom of thyroid disorders, but there are no studies that allow us to attribute this tiredness solely to thyroid function. Some studies do, however, report a higher prevalence of hypothyroidism during the menopausal transition (Frank-Raue and Raue, 2023). Both situations may therefore occur at the same time during midlife and may involve similar symptoms, but healthcare professionals should make a clear diagnosis to avoid incorrect assumptions.
WHAT SCIENCE SAYS ABOUT CORDYCEPS, ENERGY AND MUSCLE TONE
Cordyceps has been used for centuries in Traditional Medicine to combat fatigue and is marketed to support energy and performance. Today, this traditional use can be better understood thanks to studies investigating the activity of its bioactive compounds. These include cordycepin, adenosine, ergosterol and beta-glucans, among others.
A study published in 2015 observed a potential anti-fatigue and anti-inflammatory effect in animal models following supplementation with Cordyceps sinensis extract (Chae et al., 2015). The researchers observed that this effect may occur through the prevention of IL-6 accumulation in the blood, regulation of NK-cell activation in the spleen and alleviation of altered expression of genes related to inflammation, regeneration and actin binding in local muscle tissue. These preliminary findings may help pave the way for future studies and clinical trials in which fatigue is assessed as a primary outcome.
Similarly, in 2019, a systematic review and meta-analysis of 15 studies involving 1,238 participants found that supplementation with Cordyceps sinensis showed benefits in lung function, exercise endurance, quality of life and the improvement of symptoms associated with pulmonary conditions (Yu, X. et al., 2019).
OTHER NATURAL ADAPTOGENS THAT MAY HELP
The term adaptogen is used for substances that may help improve the body's response to stress. In this context, the composition of each extract, the dose and the duration of use can considerably influence the results.
LION'S MANE
Lion's Mane (Hericium erinaceus) is mainly being investigated for its potential effects on cognition and mood. This interest is linked to the effects studied in some of its key compounds: hericenones and erinacines.
There is still much to explore through new research into mushrooms traditionally used in medicine, but some findings are already helping us to better understand applications that date back centuries:
- A small trial involving 30 women found that four weeks of consuming foods containing Hericium erinaceus improved certain mood scores compared with placebo (Nagano M, 2010).
- The review by Chong et al. investigated its potential antidepressant effects, although these have not yet been validated against conventional treatments (International Journal of Molecular Sciences, 2020).
- Another systematic review identified three Japanese trials that found favourable signals in relation to cognitive impairment, although it did not confirm a consistent benefit for depression or anxiety. Nevertheless, the authors observed that incorporating Hericium erinaceus into the daily diet could offer potential benefits by helping to alleviate cognitive decline (Cortonesi et al., 2023).
REISHI
Reishi (Ganoderma lucidum) is one of the most extensively studied mushrooms due to its many applications in Traditional Medicine. Its most notable compounds include beta-glucans, ganoderic acids and terpenes. It is known as the “mushroom of eternal youth”, reflecting the tonic properties historically attributed to it. One of the oldest pharmacological texts, the Compendium of Materia Medica, described its properties for enhancing energy, memory and overall vitality and attributed anti-ageing effects to it (He X, 2023). Its traditional preparations were also believed to support mental clarity, calm the mind and promote kidney function.
Today, a specific authorised health claim concerning its action on the immune system is being assessed by the European authorities and is currently on hold, particularly in relation to the nature and beta-glucan content of Reishi. Nevertheless, there are numerous publications on Reishi, its compounds and its applications. The scientific database PubMed alone contains more than 14,000 articles on this mushroom.
ASHWAGANDHA
Ashwagandha (Withania somnifera) is known as the “sleep berry” and is undoubtedly one of the best-known plants in Ayurvedic medicine, the traditional system of medicine originating in India. Traditionally, it has been used in situations associated with stress, anxiety, tiredness and sleep disturbances.
The trial by Dongre et al. in 2015 evaluated female sexual function following the consumption of ashwagandha root extract and concluded that it could potentially be useful. Six years later, a scientific review identified possible improvements in stress and anxiety, as well as promising findings relating to sleep (Speers et al., 2021).
You can read more about this natural adaptogen from traditional Indian medicine in this article.
WHEN FATIGUE IS NOT “JUST” HORMONAL
Fatigue should not be attributed solely to perimenopause or to hormonal changes and their possible consequences, such as iron deficiency caused by heavy menstrual bleeding. If fatigue lasts for several weeks, progressively worsens or limits your ability to work, exercise or carry out everyday activities, it is advisable to consult a healthcare professional.
Depending on the individual case, a healthcare professional may request a blood count, ferritin, TSH, free T4, glucose and vitamin B12 tests, as well as kidney or liver function tests, while also reviewing sleep, diet and medication.
Adaptogens may be considered as a complementary option once the main potential causes have been assessed, but they should not delay the diagnosis of anaemia, thyroid disease, sleep apnoea or depression. When fatigue occurs during perimenopause, restoring energy begins with identifying what is preventing the body from resting and functioning normally.
HOW TO INCORPORATE SUPPORTIVE SUPPLEMENTS SUCH AS HIFAS-MENOPAUSE
At Hifas da Terra, we offer supplements based on natural adaptogens, botanical extracts, vitamins and minerals, supported by studies investigating their applications and always approached from an integrative perspective to help support the body's homeostasis, or natural balance.
We are a laboratory with more than 25 years of experience developing formulas based on mushrooms such as Reishi, Lion's Mane and Cordyceps, among others. Over the years, we have not only specialised in improving our own production of these species to obtain high-quality, high-purity extracts with high concentrations of bioactive compounds. We have also worked alongside professionals from different fields to develop combined formulas: supplements based on our pure mushroom extracts together with other natural active ingredients, vitamins and minerals that complement the properties of the mushrooms and create targeted synergies to support people's wellbeing.
If you are going through a stage of hormonal change in which tiredness and fatigue have become particularly noticeable, Hifas-Menopause is a comprehensive formula designed specifically for this stage. Its tailored composition includes:
- Cordyceps sinensis extract: to support energy and tolerance to physical exertion
- Reishi extract (Ganoderma lucidum): an adaptogen to support stress regulation and sleep quality
- Lion's Mane (Hericium erinaceus): to support mental clarity and emotional wellbeing
- Vitamins B6 and D and zinc: essential micronutrients during this stage, particularly in cases of heavy menstrual bleeding or changes in nutrient absorption
- Probiotics: to support the gut microbiota, which is associated with energy and mood
- Recommended dosage: 2 capsules a day with meals.
- For best results, supplementation is recommended for a minimum of 3 months, allowing the bioactive compounds to be gradually incorporated into the body.