Many women between the ages of 35 to 55 come into my office complaining of extreme fatigue or “crashing fatigue” where there is a rush of exhaustion and the feeling of being drained of energy. They typically tell me this crashing fatigue is debilitating because it prevents them from carrying out the simplest of everyday tasks. Along with feeling overwhelmed with deep tiredness, their crashing fatigue can come with its own set of challenging symptoms including irritability, reduced enthusiasm about life, lack of motivation, difficulty concentrating, frequent hunger, inability to sleep well, racing thoughts at night, waking up tired, and feeling overwhelmed, anxious or emotionally stressed. Many say they’re tired throughout the day and find themselves craving naps more often. Fatigue doesn’t seem to be new to these women but the sudden overwhelming and debilitating fatigue that comes over them has them reaching for help.
Could this fatigue be due to hormonal imbalances related to perimenopause or menopause?
Causes of Crashing Fatigue
There are many factors that can induce crashing fatigue including environmental stress, poor eating patterns (i.e., skipping meals, eating too much, eating a poor diet), lack of exercise, and hormonal changes due to perimenopause and menopause. Women in perimenopause often describe their fatigue as a “sudden deep exhaustion that takes over their body even though they haven’t exerted any physical effort.” When they try to do any physical or mental activity, the fatigue often worsens. This exhaustion is always coupled with very little physical stamina that isn’t improved by rest, a situation also made worse by the insomnia experienced in perimenopause.
Hormonal changes occurring in a woman’s body during perimenopause and menopause are a major reason for this debilitating fatigue. Estrogen is key in controlling cortisol, a hormone produced by the adrenal gland released in response to stress which increases blood pressure and blood sugar levels. When estrogen levels dip in perimenopause and menopause cortisol is left uncontrolled, thus causing more intense stress levels and, as a result, increased fatigue. Sometimes the fatigue is caused not by a drop of estrogen but by a decrease in testosterone (a male hormone) in a woman’s body. Furthermore, estrogen can have a calming, drowsy effect, which is weakened when hormone levels drop, thus causing less restful sleep and increased daytime fatigue.
Estrogen dominance, a condition where estrogen is not well balanced with progesterone due to declining levels of progesterone during perimenopause and menopause, is a major contributing factor to crashing fatigue. Progesterone is the primary raw material for producing cortisol. When the adrenal glands (the body’s shock absorbers) are in overdrive, the body will divert progesterone to the adrenals to support cortisol production. Reduced progesterone creates a state of estrogen dominance leading to adrenal exhaustion.
For many women, crashing fatigue also has a confounding side effect: they can’t sleep even though they feel bone tired day after day. As estrogen levels rise and fall during perimenopause, the body can interpret it as a hormonal emergency. This sends a “help!” message to the brain that triggers the release of cortisol and adrenaline. These fight-or-flight adrenal chemicals can make it even harder to achieve refreshing sleep. The adrenal glands help make estrogen with hormones like DHEA (dehydroepiandrosterone), but years of stress can deplete DHEA. That makes it harder for your body to maintain hormone balance during menopause, which makes you more prone to crashing fatigue.
Overtaxed adrenals can lead to hypothyroidism, which has a direct effect on women’s hormonal health. By age 50, one in every 12 women has a significant degree of hypothyroidism. By age 60, it is one woman out of every six. The thyroid, which regulates metabolism, may turn down its hormonal activity in an attempt to reverse adrenal overdrive. This results in symptoms of unwelcomed and hard-to-lose weight gain and crashing fatigue. The vicious cycle of not being able to sleep continues to stress out the adrenal glands, and the stressed-out glands continue to worsen thyroid activity.
How to Regain Your Energy
- Figure out the source of the fatigue. Are you overworked, overexercising? Are you emotionally, physically, or mentally challenged all the time? Have you been checked out by your doctor (physical exams, regular blood work) to rule out any hidden serious medical conditions?
- Get your hormones tested to see what your baseline levels are, for possible hormone balancing. Three forms of hormone testing are saliva, blood, and urine. Saliva testing for estrogen, progesterone, testosterone, DHEA, and cortisol (diurnal) can show imbalances in tissue (where active hormones dwell). Seek out a medical professional specially trained in bio-identical hormone replacement to help you regain your hormone balance.
- Restore adrenal function with adaptogenic herbs, B-vitamins, vitamin C, magnesium, adrenal extracts, zinc, amino acids, tyrosine and phenylalanine.
- Use moderate gentle exercise daily for muscle strength and building energy i.e. yoga, taichi, etc.
- Check your medications to be sure what you’re taking isn’t a culprit; i.e., antidepressants, antianxiety drugs, antihistamines, barbiturates, pain killers, opiates
- Check your diet:
- Stay away from processed sugars, fast food (due to high salt and bad fat content)
- Stabilize your blood sugar to help your adrenal glands heal by eating complex carbohydrates such as whole grain cereals, berries, green leafy vegetables. Add more fiber and protein to your diet. Eat smaller meals to keep your blood sugar stabilized.
- Avoid or cut down on your caffeine intake.
- Stay hydrated with water (I drink lemon/lime water throughout the day.)
- Snack with a handful of almonds (a healthy nut), low fat cottage cheese, raw vegetables (if your digestive system allows).
- Meditate, relax, and rest a minimum of seven hours of restful sleep at night. If you have “noisy brain” and cannot get to sleep at night, we can help. Come by TLC and ask us.
Zoom Heaton is the owner of TLC Medical Centre Inc., an Independent Community Pharmacy and Medical Equipment facility located at 190 Crepe Myrtle Drive off Silver Bluff Road. A pharmacist, she is a graduate of the University of South Carolina. She is a Certified Diabetes Educator and is certified in Immunization; she is also the chief compounding pharmacist at Custom Prescription Compounders, LLC, inside TLC Medical Centre, Inc., specializing in Bio-Identical Hormone Replacement Therapy and Women’s Health. Call 803.648.7800 or visit nooneshoerx.com for more information.