For many women in their 40s and 50s, feeling tired isn’t just about a late night or a busy week it’s a deep, ongoing exhaustion that no amount of rest seems to fix. I know this not just from my work, but from my own lived experience too.

I’ve been there myself that bone-deep tiredness where you wake up already worn out, reach for coffee just to get going, and feel like you’re dragging yourself through the day. It’s more than just physical. It affects your mood, your focus, your patience even how you feel about yourself.

And in my clinic, I hear it from so many of the women I work with:

“I wake up tired. I get through the day on caffeine and willpower. And by 8pm, I’m crashing on the sofa.”
Does that sound familiar?

This isn’t laziness. It’s not you “getting old.” It’s a real, biological shift and it’s one of the most common but overlooked symptoms that hits women during perimenopause and menopause.

So what’s really going on? Why does fatigue seem to sneak in and take over just as life gets even busier?

Let’s break it down and look at what’s happening behind the scenes and, most importantly, what actually helps.

Why Fatigue Is So Common for Women Over 40

Fatigue after 40 is multifactorial and it’s rarely just about one thing. It’s the result of many small stressors piling up, both inside and out. For most of the women I work with, there’s usually a combination of physical, emotional and lifestyle factors contributing to that relentless tiredness.

Here’s what could be happening beneath the surface:

1. Hormonal Fluctuations

Perimenopause and menopause bring ongoing shifts in oestrogen, progesterone and testosterone and all of these impact energy. Oestrogen, in particular, influences the adrenal system and neurotransmitters like serotonin and dopamine, which regulate mood, sleep and motivation. When these hormones drop or fluctuate, you can feel flat, foggy and fatigued even if you’re doing everything “right.”

2. Blood Sugar Imbalances

A common but often overlooked cause. If you’re skipping meals, relying on caffeine to keep going, or reaching for quick sugary snacks to get through the day, chances are your blood sugar is spiking and crashing all day long. That leaves you feeling drained, shaky, anxious and desperate for another pick-me-up. Balanced blood sugar is absolutely key to steady energy.

3. Thyroid Dysfunction

The thyroid plays a major role in regulating metabolism and energy production. An underactive thyroid (which becomes more common in women over 40) can leave you feeling tired, cold, low in mood, and struggling with weight changes. The trouble is, many thyroid issues go undiagnosed or dismissed especially if your test results fall into the “normal” range. Always dig deeper if the fatigue doesn’t make sense.

4. Medication Side Effects

Certain medications like antihistamines, antidepressants, blood pressure drugs, or hormonal treatments can impact energy, sleep, or nutrient levels. If your fatigue started after a change in medication, it’s worth reviewing the timing with your healthcare provider.

5. Poor Sleep Quality

Even if you’re “getting enough sleep,” the quality matters. Hormonal changes can cause night sweats, hot flushes, increased cortisol at night, or racing thoughts — all of which disturb sleep architecture. You might be lying in bed for 8 hours but waking up completely unrefreshed. And poor sleep becomes a vicious cycle the more tired you feel, the more everything else becomes harder.

6. Nutritional Deficiencies

Iron, ferritin, B12, folate, magnesium, vitamin D and omega-3s are all essential for energy, brain function and mood stability. These nutrients are often depleted due to stress, poor gut absorption, low intake, or dietary patterns. Even women eating what they think is a “healthy” diet can be running on empty at a cellular level.

7. Stress and Cortisol Dysregulation

This stage of life can be intense work stress, parenting teens, caring for ageing parents, relationship shifts it’s a lot. Chronic stress impacts your nervous system and adrenal health. When cortisol (your stress hormone) is too high or too low at the wrong time of day, it can leave you feeling simultaneously wired and wiped out.

8. Life Load: The Invisible Exhaustion

Sometimes, fatigue isn’t just about what’s happening in your body — it’s also about what’s happening around you. The mental load of managing everyone’s needs, decision fatigue, emotional labour, lack of rest, and never getting a moment for yourself it all chips away at your vitality. Fatigue isn’t always about needing a nap. Sometimes it’s about needing a break from being “everything to everyone.”

9. Undiagnosed Food Intolerances

I’ve seen this time and time again in clinic women struggling with bloating, brain fog and low energy, only to discover that certain foods they regularly eat are actually working against them. Food intolerances especially to gluten, dairy, or even seemingly healthy foods can trigger inflammation, disrupt digestion and drain your energy reserves. Unlike allergies, intolerances can be harder to pinpoint because the effects are often delayed or subtle. If you’re constantly tired despite sleeping and eating well, it’s worth exploring whether something in your diet is quietly contributing to your symptoms.

What Actually Helps — Without the Gimmicks

You don’t need extreme diets, expensive IV drips or miracle powders to feel better. You need realistic, consistent, evidence-based strategies that support your body through this phase of life not work against it.

These are the habits I return to time and again in clinic, both for myself and for the women I work with.

1. Prioritise a Protein-Rich Breakfast

Start your day with protein think eggs, Greek yoghurt, smoked salmon, cottage cheese or chia pudding. It stabilises blood sugar, supports neurotransmitter function and keeps you fuller for longer, preventing that mid-morning energy crash.

2. Balance Your Blood Sugar

Eat regularly and make sure your meals include protein, healthy fats and fibre from vegetables, pulses or whole grains. This keeps your glucose levels steady, supports mental clarity and mood, and prevents those 3pm slumps and cravings.

3. Address Nutrient Gaps

Test, don’t guess. Low energy is often linked to deficiencies I see all the time in clinic, including:

Iron or ferritin
B12 and folate
Vitamin D
Magnesium
Omega-3s

A personalised supplement protocol, tailored to your needs, can be transformative but it needs to be based on your biochemistry.

4. Investigate HRT — It Can Make a Huge Difference

For some women, hormone replacement therapy (HRT) can be a game-changer when it comes to restoring energy, improving sleep, stabilising mood and supporting overall quality of life. It’s not right for everyone and it’s not the only solution but it’s worth having an open, informed conversation with your healthcare provider.

5. Improve Sleep Hygiene

Quality sleep is essential for hormone regulation and energy. Try:

Avoiding screens before bed
Keeping your room cool and dark
Using magnesium glycinate
Reducing caffeine
Creating a wind-down ritual (bath, book, breathing)

If hot flushes or night sweats are an issue, try layered bedding, cotton sleepwear, and cut back on alcohol.

6. Support Your Stress Response

Stress is a major energy drain. Support your nervous system with:

Deep breathing
Journalling or reflection
Time outdoors
Yoga or stretching
EFT or acupressure
Adaptogens (like rhodiola or ashwagandha with guidance)

Even five minutes a day can help calm your system and restore resilience.

7. Move Your Body — Gently and Consistently

You don’t need intense workouts. Focus on sustainable, joyful movement like:

Brisk walking
Yoga or Pilates
Resistance training
Swimming or dancing

Movement boosts energy, mood, and metabolism even in short bursts.

8. Stay Hydrated

Dehydration is a hidden energy zapper. Aim for 1.5–2 litres of water daily, or try herbal teas. Add a pinch of sea salt or lemon for better absorption.

9. Review Caffeine and Alcohol

Caffeine can worsen anxiety and poor sleep. Consider herbal alternatives. Alcohol may disrupt hormones and liver function cutting back helps energy and sleep quality.

10. If You’re Vegan or Vegetarian — Check Your Nutrients

Key nutrients to focus on:

Iron (pair with vitamin C)
Vitamin B12 (must be supplemented)
Zinc
Omega-3 (algae supplements if not eating fish)
Protein variety (lentils, tempeh, tofu, quinoa, nuts)

Even small adjustments can support energy and hormonal balance.

11. Give Yourself Permission to Rest

One of the most powerful things you can do? Honour your need for rest. Fatigue is a signal, not a weakness. A nap, a boundary, or a slow weekend isn’t selfish it’s self-preservation.

Final Thoughts: You’re Not Lazy. You’re Likely Running on Empty

If you’re constantly exhausted, please know this: it’s not a personal failing. Your body is asking for support not more pressure.

Feeling energised again is possible but it takes more than just pushing through. It takes understanding what’s really going on beneath the surface, and giving your body the nourishment, rest and rhythm it’s been craving.

You deserve to feel like you again vibrant, focused and full of life.

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Why You’re So Tired After 40 – And What Actually Helps