Low energy levels, sleepless nights and poor-quality shuteye are all common complaints during menopause. But how does HRT fit into this picture? Can HRT make you tired, or will it help your energy levels? Let’s find out…
Why does menopause cause fatigue?
Fatigue during menopause is a common problem and research suggests that just under 50% of those aged 45-65 are affected.
It can be tricky to pinpoint the exact cause of tiredness. For many, it happens for a combination of reasons which could be directly or indirectly related to menopause. Read more about menopause and fatigue in our symptoms library.
Hormonal changes
Menopause is a time of dramatic hormonal change during which your oestrogen and progesterone levels drop. This causes your periods to slow down and eventually stop. It can also have a big impact on your energy levels and tiredness.
If your tiredness is due to menopause, HRT could help.
Problems with sleep
You may find that the amount and quality of your sleep heads downhill during menopause. Night sweats, aches and pains and many of the other annoying symptoms of menopause all combine to cause broken, unsatisfying sleep.
For many people struggling with sleep issues at menopause, HRT is an effective treatment. But HRT isn’t suitable for everyone. Learn more about the risks and benefits of HRT.
Low mood and depression
The hormonal changes of menopause can also cause low mood and increase your risk of depression. This is significant if you’re struggling with tiredness. In fact, one of the most common symptoms of depression is low energy levels. Some may find themselves spending hours in bed or on the sofa, struggling to muster the energy to move. Others can feel like they are never refreshed, even after a full night’s sleep.
If you think depression might be the cause of your tiredness, speak to your doctor.
Many people with depression also struggle with thoughts about harming themselves or others. It’s difficult to discuss, but this is a common part of depression and a sign that you need urgent help.
Health professionals are there to help if you’re feeling this way. Discuss your low mood with a professional as soon as possible, if you haven’t already.
Getting help
- Contact your doctor or NHS 111
- Samaritans Helpline, available 24/7 – call 116123
- Mind
Emergency help
If you feel that you can’t keep yourself or others safe, call 999 or go to A&E for emergency help.
Anaemia
Anaemia can be caused by low iron levels, and this is a common cause of tiredness around menopause. It can also cause pale skin, dizziness, thinning hair and a feeling of cold hands and feet.
This often happens because your periods tend to get heavier and last longer during perimenopause. Signs of heavier periods include:
- Needing to change your pads or tampons more often
- Flooding
- Passing blood clots
- Bleeding through your clothes
This increased blood loss causes your body’s iron stores to deplete, especially if you experience heavier periods for months or years. Check in with your doctor if this is the case for you, as they might be able to help reduce bleeding and give you treatment to replenish your iron stores.
Signs of severe anaemia include shortness of breath, chest pain, feeling lightheaded and palpitations. If you have any of these, you should seek urgent medical assistance.
Read more about menopause and heavy periods.
Other issues
It’s also important to ensure that nothing else is responsible for your fatigue. For example, common conditions like hypothyroidism, diabetes and B12 deficiency can all cause tiredness.
Speak to your doctor if fatigue is an ongoing issue for you. They will be able to run some tests to check for any other underlying problems. More serious conditions, including some types of cancer, can also cause unusual tiredness so it’s important to be proactive and get checked out.
Does HRT make you tired?
For some, HRT improves the tiredness associated with menopause. If your nights are disrupted by hot sweats, you’re likely to find that your sleep quality improves after starting treatment, which should have a positive knock-on effect on your energy levels the following day. Feeling more rested can also help with brain fog and generally help you to feel less overwhelmed and more in control.
Others may find that HRT actually makes them feel more tired. This can be a temporary side effect, or may last longer.
Why does HRT make you tired?
Tiredness can be a side effect of progesterone. This hormone is an important component of HRT for many users.
While oestrogen is the key ingredient needed to treat your menopause symptoms, it needs to be used alongside progesterone for those who still have their womb. This is because oestrogen, when used alone, can cause abnormal thickening and even cancer of the womb lining. Progesterone protects the womb lining and removes this risk.
Progesterone can cause tiredness with some authors even calling it a ‘mild sedative’. For this reason, doctors usually recommend taking your progesterone at bedtime if possible. This approach may also have the convenient side effect of giving you a better night’s sleep!
Oestrogen, including patches, tablets, gels and sprays, can also affect your energy levels although it is less common. Some report a general feeling of low energy, known as asthenia, when taking this hormone although this is balanced out by the beneficial effects of HRT for most.
Side effects of HRT tend to improve as your body gets used to the hormones. For most people, things ease off by the three-month mark. If you are still struggling with tiredness by this point it might be time to rethink your treatment plan.
Find out more about the side effects of HRT.
What can I do if my HRT is making me tired?
Don’t assume that you will need to give up on HRT if tiredness is an issue. Here are a few simple steps to take before throwing in the towel.
1. Speak to your doctor
It’s sensible to rule out any other issues before blaming the HRT! They may want to examine you or run some blood tests as a starting point.
2. Give it time
Side effects are common with HRT, and tend to improve by the three-month mark. If things are no better by this point, speak to your doctor.
3. Think about when you take your HRT
If you take HRT tables, do they contain a combination of both oestrogen and progesterone, or progesterone on its own? If so, taking your medication at bedtime might help.
4. Consider switching to a different type of HRT
Your doctor will be able to advise on the best options for you. One popular alternative is to use a Mirena coil to deliver progesterone instead of a pill or patch. It sits inside the womb and gradually releases progesterone to protect the lining. This way, you get the protective effect of progesterone without the hormone and its side effects affecting the rest of the body.
5. Try changing the way you take your HRT
For example, try changing from a gel to a patch.
6. Think about lifestyle changes.
Small but powerful changes to your diet, exercise routine and other habits can give your energy levels a real boost!
Final word
While HRT can improve tiredness for many, it can also contribute to the problem. Check in with your doctor if this is a new or persistent symptom for you, so that they can help you identify the cause and possible solutions.
- Currie H, Moger SJ, 2019 (Dec) Menopause – Understanding the impact on women and their partners. Post Reprod Health, vol 25, issue 4, pp. 183-190.
- Hillard, T. et al (2017). Management of the Menopause. ed. London: British Menopause Society, pp. 73-76
- BMJ Group and Pharmaceutical Press, Joint Formulary Committee, British National Formulary.
Try our menopause clinic
The latest
The news may have you believe you can now buy your HRT from your pharmacist. Spoiler alert! That’s not quite right as it’s not for all HRT. Find out more here.
Do antibiotics, D-mannose or cranberry juice treat UTIs? Why do UTIs happen after sex during menopause and how can you minimise infections? Find out…
Black cohosh, devil’s claw, red clover, evening primrose oil and flax seeds – do these natural supplements for menopause work and are they worth the money?
If you are under 55 or not postmenopausal, you still need contraception to prevent pregnancy. You also need it to prevent STIs.
Hormonal changes during menopause may contribute to constipation. Nutritional therapist Jo Lyall explains how to prevent this uncomfortable condition.
Could GLP-1 drugs like Wegovy and Ozempic help menopausal weight gain? We explore who can take these drugs and if they can relieve other menopause symptoms.
Hormonal changes and life milestones make low mood common during menopause. Here’s when to get help and what treatment can help bring back your usual self.
