Feeling Constantly Tired? Let’s Talk About Fatigue

Fatigue. It’s one of the most common and most frustrating symptoms women bring to my clinic—especially those in their 40s and 50s. You wake up tired. You drag yourself through the day. You feel like you’re running on empty, no matter how much you rest. This isn't "normal tiredness" – it's something deeper, and it's often dismissed, especially in women. But your tiredness matters. And more importantly, it has a cause.

What Is Fatigue?

Fatigue is defined as an overwhelming sense of exhaustion that is not relieved by sleep or rest. It's more than being sleepy or overworked. It's a chronic, sometimes debilitating condition that affects your ability to function and enjoy life. It can be physical, mental, emotional, or all three.

Clinically, fatigue is considered "chronic" when it lasts longer than six months and interferes with your daily activities. It's a symptom that cuts across dozens of different medical, psychological, and lifestyle-related conditions, which is why getting to the bottom of it is so important.

Why Is Fatigue So Common in Women in Their 40s and 50s?

Fatigue is particularly common during the perimenopausal and menopausal years, and there are good reasons why:

1. Hormonal Changes

As estrogen and progesterone begin to fluctuate and decline, many women experience disrupted sleep, mood swings, night sweats, anxiety, and brain fog. These hormonal changes can directly affect neurotransmitters like serotonin and GABA, both of which are linked to mood and energy regulation.

Studies show that sleep disturbances affect up to 61% of perimenopausal women and 79% of postmenopausal women. These disruptions dramatically reduce the quality of rest, contributing to persistent fatigue.

2. Iron Deficiency (Even Without Anaemia)

Heavy or prolonged periods are common during perimenopause, and with that comes iron loss. Even if your hemoglobin is normal, your ferritin (iron stores) may be low. A 2023 study published in Menopause found that women with heavy menstrual bleeding were 44% to 62% more likely to report significant fatigue, suggesting a strong link even in the absence of clinical anaemia.

Ferritin levels below 50 ng/mL have been associated with fatigue, and supplementing iron can significantly improve symptoms. Yet, iron deficiency is often overlooked if full anaemia isn't present.

3. Thyroid Dysfunction

The risk of hypothyroidism increases with age, particularly in women over 40. Symptoms like fatigue, cold intolerance, constipation, dry skin, and weight gain may appear gradually and be dismissed as "just aging."

A simple blood test (TSH, free T4, and sometimes T3) can diagnose hypothyroidism, and treatment with levothyroxine can be life-changing.

4. Psychological Stress and Burnout

This phase of life often coincides with peak career responsibilities, aging parents, growing children, and a shrinking window for self-care. Women are twice as likely to experience anxiety and depression, both of which are linked to chronic fatigue.

According to a 2022 review in Women’s Midlife Health, emotional and mental overload significantly contributes to sleep disruption, low motivation, and burnout.

5. Sleep Disorders

Obstructive Sleep Apnoea (OSA) becomes more prevalent after menopause. The drop in progesterone, which has a protective effect on the upper airway, may partly explain the rise in sleep-disordered breathing in postmenopausal women. Night-time awakenings, restless legs, and insomnia all lead to poor sleep quality and, consequently, fatigue.

6. Nutritional Deficiencies

Besides iron, other deficiencies that may cause fatigue include:

• Vitamin D: Low levels are common in the UK, especially in winter. Deficiency is linked to muscle weakness, low mood, and fatigue.

• Vitamin B12: Vital for nerve health and energy production. Deficiency may cause fatigue, memory changes, and tingling.

• Magnesium: Plays a key role in over 300 enzyme reactions. Low levels are associated with poor sleep and muscle cramps.

7. Long COVID and Post-viral Fatigue

Post-viral fatigue is now well-recognised in the wake of COVID-19. Even after mild infections, many women report prolonged exhaustion, cognitive changes, and unrefreshing sleep. Fatigue is a core symptom of Long COVID, which may overlap with or mimic other causes of chronic fatigue.

8. Chronic Conditions

Fatigue can be the presenting feature of many conditions including:

• Type 2 Diabetes

• Autoimmune conditions (e.g. lupus, rheumatoid arthritis)

• Fibromyalgia

• Chronic Fatigue Syndrome (ME/CFS)

• Coeliac disease

• Cardiovascular disease

Scientific Insights: What Does the Latest Research Tell Us?

Beyond clinical experience, recent studies are deepening our understanding of fatigue:

• Menstrual bleeding & fatigue: As mentioned, a recent Menopause study has drawn a direct line between heavy bleeding and fatigue, showing it may be more than just nuisance bleeding—it’s a major quality-of-life issue.

• Multi-stressor fatigue model: A 2023 study in Biomedicines reviewed how chronic fatigue in women often stems from an interplay of physical, cultural, emotional, and medical stressors. It called for an innovative, multidisciplinary approach including lifestyle change, mental health support, and nutritional assessment.

• Symptom clustering: Research from the University of Michigan shows that women experiencing fatigue are also likely to report sleep issues, hot flushes, joint pain, and mood concerns. This clustering suggests the need for a whole-person approach.

What Can You Do About It?

First and foremost, don’t normalise feeling constantly exhausted. It's not just part of getting older. Here’s what I often recommend at Sirona Health:

1. Get a full blood panel – including iron studies, thyroid function, B12, vitamin D, and glucose.

2. Track your symptoms – use fatigue scales like the Multidimensional Assessment of Fatigue (MAF) to measure and monitor changes.

3. Assess hormonal health – including whether HRT might help if you’re in the menopausal transition.

4. Look at sleep quality – including screening for sleep apnoea if symptoms fit.

5. Prioritise rest and recovery – it’s not a luxury, it’s medicine.

6. Build a support team – this might include a GP, women’s health specialist, nutritionist, therapist, or physical therapist.

Let’s Reframe Fatigue

At Sirona Health, we believe fatigue isn’t something to brush off. It’s your body asking for support. And we believe in innovative, compassionate, and evidence-based care to help you feel like yourself again.

So if you're tired of being tired, let's figure it out together.