Fatigue During Perimenopause and Menopause

1. Thyroid-related fatigue

This type of fatigue is particularly noticeable in the morning after waking up and usually lasts until noon. You feel as if everything is happening in slow motion: your movements, your thoughts. This is often accompanied by a feeling of cold and poor circulation. These symptoms can also manifest through swollen facial features and stiff joints. In the afternoon, the feeling usually improves, and by evening you often feel much better.

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Important Information: Thyroid tests are not always conclusive. Each person has individual "normal values" that are influenced by genetic factors, metabolism, and nutrition.

Treatment

There are two main approaches for this type of fatigue:

• Direct treatment with thyroid hormones: The most effective hormone here is T3.
• Indirect treatment with bioidentical progesterone: Especially when there is too much estrogen involved because ovulation is no longer occurring.

2. Cortisol-related fatigue

This form of fatigue manifests more as a general weakness that predominantly occurs towards evening. Additional symptoms may include trembling hands, eye twitching, and tinnitus. This exhaustion is often diagnosed in conditions such as adrenal insufficiency or states of exhaustion.

Diagnose

Diagnostic Saliva tests at different times of the day (8:00, 12:00, 18:00) or an early morning blood test are very informative. Low DHEAS levels in blood or saliva can also indicate this type of fatigue.

Treatment

There are often two approaches used:

• Bioidentical hydrocortisone: Usually administered in the morning to support natural hormone production, and possibly in a smaller dose at noon, see bioidentical hormones
• Herbal cortisone sources: as alternative treatment.
• Bioidentical DHEA: This is typically taken in the evening, before bedtime.
• Stress adjustment: The dosage can be temporarily increased in stressful situations.

3. Testosterone-related fatigue

This form of exhaustion is characterized by a mental desire for sex, but the body is too weak to actually become active.

Diagnose

A blood test is the gold standard for diagnosis here. It can also be helpful to measure DHEA levels to get a complete overview.

Treatment

• Bioidentical testosterone: This is often the first choice to restore hormone balance.
• Bioidentical DHEA: This can be used in addition to testosterone or as a standalone treatment to alleviate symptoms.

4. Estrogen-related fatigue

This form of fatigue primarily manifests through difficulty concentrating and is often accompanied by a kind of "brain fog." Sleep problems are usually a constant companion. The fatigue is less physical and more focused on sensory and mental perception in the brain.

For more information, please see our guide: Bioidentical Hormones During Menopause

Diagnose

A blood test is the method of choice here to check estrogen levels and determine if there is a hormone deficiency.

Treatment

• Oral intake of bioidentical estrogen: This method is commonly used to balance hormone levels.
• Bioidentical cream with estradiol or estriol: This is applied topically and can serve as an alternative or supplement to oral intake.

We'll Find the Cause of Your Fatigue

If you're suffering from fatigue and suspect a hormonal cause, please schedule an online consultation with Dr. Wilden right away. We'll give you certainty about whether you have one of the diagnoses mentioned above and whether you're a candidate for therapy with bioidentical hormones.