Feeling Extra Exhausted During Perimenopause? A New Study Reveals an Unexpected Culprit

It’s a well-known reality—perimenopause, the turbulent bridge to menopause, often drags women through relentless waves of exhaustion. The culprit? A multifaceted mix of hormonal upheavals, night sweats, stress surges, and disrupted sleep.

But new research uncovers another surprising factor: the volume and duration of menstrual bleeding. According to a recent study published in Menopause, those enduring heavier or prolonged periods in this transitional phase are significantly more likely to experience severe fatigue.

These findings underscore the underappreciated toll of menstrual blood loss on energy levels, urging both individuals and healthcare providers to rethink their approach to perimenopausal symptoms.

Unpacking the Link Between Bleeding and Fatigue

Menopause-related research has gained momentum in recent years, yet one aspect remains understudied—how fluctuations in menstrual bleeding affect energy levels. “We know that fatigue is a major complaint during the menopause transition, but its precise causes remain elusive,” explained Siobán D. Harlow, PhD, study author and professor at the University of Michigan.

Determined to explore this connection, Harlow and her team analyzed health data from 2,329 individuals aged 42 to 52. Over seven years, participants reported their levels of exhaustion alongside detailed accounts of their menstrual cycles.

The findings? Striking. Experiencing at least three episodes of heavy bleeding within six months correlated with a staggering 44% to 62% higher likelihood of feeling persistently drained. Meanwhile, prolonged menstrual episodes—lasting beyond the usual timeframe—were linked to a 32% drop in reports of feeling “full of pep.”

Even after adjusting for variables like race, BMI, hormone therapy use, mental health, stress levels, sleep disturbances, smoking habits, and discrimination, the connection between excessive bleeding and fatigue remained undeniable.

“This study is a wake-up call,” emphasized Hugh Taylor, MD, chair of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine. “We need to recognize the far-reaching effects of abnormal bleeding on women’s health during perimenopause.”

How Heavy Periods Drain Energy

The hormonal rollercoaster of perimenopause wreaks havoc on menstrual cycles, often leading to erratic, prolonged, and heavier periods. Research suggests that nearly 30% of perimenopausal women experience substantial blood loss—especially those with a history of abnormal uterine bleeding.

Fibroids, common in this age group, further complicate the picture, contributing to excessive menstrual flow. The result? An increased risk of anemia, a condition marked by low red blood cell levels and reduced oxygen transport throughout the body. Anemia alone can induce profound exhaustion, leaving individuals feeling perpetually sluggish and weak.

Add to that the relentless perimenopausal duo—sleep disturbances and stress—and the energy deficit deepens. “The combination of reduced sleep quality and declining blood counts can create a perfect storm of fatigue,” noted Mary Jane Minkin, MD, a menopause specialist at Yale.

Yet, despite these well-documented struggles, gaps remain in understanding how menstrual abnormalities intersect with broader perimenopausal health concerns. “We still have much to learn about how these changes impact women with conditions like fibroids, endometriosis, and PCOS,” Harlow remarked.

Future research, she hopes, will shed light on these interactions, particularly exploring whether heavy bleeding correlates with cognitive fog and sleep disturbances—two other major complaints during menopause.

Taking Control: Managing Heavy Periods and Fatigue

Both researchers and physicians stress the importance of addressing abnormal bleeding, not just as an inconvenience but as a legitimate health concern with tangible consequences.

Harlow urges healthcare providers to proactively discuss menstrual changes with patients, rather than dismissing them as a mere byproduct of aging. Likewise, Taylor encourages individuals to advocate for themselves: “Menopausal symptoms don’t have to be endured in silence—there are solutions.”

Fortunately, various interventions exist. Iron supplementation can combat anemia, hormone therapies may regulate bleeding, and procedures like fibroid removal can provide relief.

Yet, one significant barrier remains—access to knowledgeable, empathetic healthcare providers. “Too often, women struggle to find clinicians who truly understand menopause and its ripple effects,” Harlow acknowledged. “But these conditions are treatable, and suffering in silence isn’t necessary.”

The bottom line? Persistent fatigue and abnormal bleeding aren’t just inconveniences—they impact quality of life in profound ways. By recognizing the connection and seeking appropriate care, women navigating perimenopause can reclaim their energy and well-being.