Menopause - What Causes Fatigue: Chronic Fatigue
Content provided by the Faculty of the Harvard Medical School
Menopause
The hormonal changes that occur during the years leading up to and following menopause can have a profound effect on sleep and, as a result, can contribute to fatigue. The most common menopausal symptom is hot flashes, which affect between 75%–90% of women undergoing natural menopause. In addition to making you feel like you walked into a blast furnace, hot flashes often leave you flushed and soaked with perspiration. Not surprisingly, hot flashes that occur when you're sleeping (sometimes called night sweats) can awaken you many times during the night. Even if your hot flashes don't wake you up, they can still disrupt your sleep. And a night of insufficient or poor-quality sleep can make you feel fatigued, lethargic, or sleepy the next day, not to mention irritable and moody (see "Sleep difficulties").
Fortunately, hot flashes eventually stop, usually within three to five years and sometimes sooner. In the meantime, there are some simple lifestyle changes you can make to reduce the frequency and intensity of hot flashes, especially at night (see "Tips for improving sleep during menopause," below).
Tips for improving sleep during menopauseAre frequent nighttime hot flashes leaving you fatigued the next day? Here are some simple steps you can take to reduce the frequency and intensity of hot flashes so you can get the rest you need. More general advice on how to get a good night's sleep is included in the section "Sleep difficulties" (see below). Dress lightly. Trade your flannel PJs or synthetic nightgown for a lightweight cotton nightgown or T-shirt, which will keep you cooler and also absorb perspiration. Several companies now sell nightclothes designed especially for menopausal women that are made of moisture-wicking fabrics. Use cotton, not synthetic, sheets and avoid heavy blankets or comforters. Keep your bedroom cool, dark, and quiet. Use a fan or turn on your air conditioner to cool your bedroom and increase air circulation. One study found that women who slept in a cool (68˚ F) room had significantly fewer and milder hot flashes than women who slept in a warmer (86˚ F) room. Pull down your shades or wear a sleep mask to darken the room. Use earplugs or decorate with sound-absorbing heavy curtains and rugs. Watch what you eat. Say no to spicy or acidic foods (such as tomato products), which may trigger hot flashes. Also avoid large meals before bedtime. Eat foods rich in soy (such as tofu, soybeans, or soymilk) or take a soy supplement, which some studies have shown reduce the frequency of hot flashes. If you have been or are being treated for breast cancer, talk with your doctor about the use of soy products, which contain phytoestrogens (plant-based hormones). Reduce stress as much as possible. Stress can trigger hot flashes. Try relaxation techniques, massage, or exercise to reduce your stress level. If you're depressed or anxious, talk to your primary care doctor. |
If lifestyle changes are not enough, talk to your doctor about whether medication may be right for you. The most effective treatment for reducing hot flashes is hormone therapy. Studies show that short-term hormone therapy improves sleep quality in women suffering from night sweats and other menopausal symptoms. Because studies have revealed risks of taking hormone therapy for an extended period, experts recommend taking hormones at the lowest effective dose for the shortest possible duration, to minimize the potential risks.
If you can't or don't want to take hormone therapy, there are other hormonal and nonhormonal options, including birth control pills, certain antidepressants, antihypertensives, and the pain and seizure drug gabapentin (Neurontin). Researchers are also evaluating other types of medications for the treatment of hot flashes.
Another potential cause of menopause-related fatigue is sleep apnea. This is a life-threatening condition in which people stop breathing momentarily during sleep, sometimes hundreds of times a night, awakening each time. Sometimes your spouse will observe this happening to you at night. More often, the possibility of sleep apnea is suspected because of snoring: People with sleep apnea often snore loudly and frequently. Although sleep apnea was once believed to affect primarily overweight men, a recent study by Harvard researchers found that by age 50, sleep apnea affects men and women about equally. Researchers believe that menopausal weight gain and declining levels of estrogen and progesterone, which are believed to protect against sleep apnea, make menopausal women far more likely to have this condition than younger women. Fortunately, there are a number of effective treatments for sleep apnea, including lifestyle changes and special devices. To learn more about these treatments, you can visit a doctor who specializes in sleep health. Studies are now under way to determine if hormone therapy may be an effective treatment for sleep apnea in menopausal and postmenopausal women.
Stress also contributes to persistent fatigue. In midlife, women are often dealing simultaneously with demanding careers, children leaving the "nest," and elderly parents, as well as grappling with issues relating to their own aging — all of which can be stressful. Exercising, eating a nutritious diet, and making other healthy lifestyle changes can help keep stress-related fatigue at bay (see "Boosting your natural energy").
| Last updated: | January 23, 2007 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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