Home Gentle Nourishment & Body Balance Why You're So Tired All the Time (And It's Not Just Perimenopause)

January 31, 2026

Why You're So Tired All the Time (And It's Not Just Perimenopause)

By Michelle Ringin, Dip. Western Herbal Medicine, NHAA Member
Last Updated: January 31, 2026 | Reading Time: 8 minutes

You're waking up exhausted. You push through your day on sheer willpower, counting down the hours until you can collapse into bed. But even after a full night's sleep, you still wake up feeling like you haven't rested at all.

Sound familiar?

If you've mentioned this to your GP and heard "It's probably just perimenopause" or "That's normal at your age," you're not alone. According to research published in Menopause journal, up to 85% of perimenopausal women report significant fatigue, yet many feel their concerns are dismissed.

Here's what I've learned after 14 years of supporting women through this exact experience: your bone-deep exhaustion goes far deeper than hormonal changes alone. Your fatigue is real, it's valid, and most importantly, there are tangible reasons why you feel this way - along with gentle, effective ways to support your body back toward vitality.

What You'll Learn in This Article

The interconnected physiological causes of perimenopause fatigue beyond hormones
How adrenal depletion, thyroid shifts, and nutritional deficiencies compound exhaustion
Evidence-based herbal approaches for each layer of fatigue
When to seek additional medical support
Practical next steps for personalised care

It's Not All in Your Hormones (Though They Play a Part)

Yes, perimenopause and menopause bring hormonal shifts that absolutely contribute to fatigue. Fluctuating oestrogen and progesterone levels affect your sleep quality, mood, energy production, and stress response.

But here's what often gets missed: blaming everything on "hormones" oversimplifies the complex physiological changes happening in your body during this transition.

When healthcare practitioners stop at perimenopause as the sole cause, they often miss the deeper layers of exhaustion that have been building for years - sometimes decades.

The Research Behind Perimenopause Fatigue

Studies show that women in perimenopause experience:

Decreased mitochondrial function (your cells' energy powerhouses)
Altered cortisol rhythms affecting daily energy patterns
Changes in neurotransmitter production impacting mood and motivation
Disrupted sleep architecture reducing restorative rest

But these changes don't happen in isolation. They interact with other physiological systems in ways that compound fatigue.

The Real Reasons You're So Tired

1. Your Adrenal Glands Are Depleted

What's happening: Your adrenal glands produce cortisol, the hormone that helps you respond to stress and maintain stable energy throughout the day. If you've spent years juggling work, family, emotional labour, and the mental load of running a household, your adrenals have been working overtime.

Chronic stress doesn't just make you feel overwhelmed - it physically exhausts the hypothalamic-pituitary-adrenal (HPA) axis responsible for keeping your energy stable.

Common signs of adrenal depletion:

Waking up tired despite adequate sleep
Difficulty getting going in the morning
Afternoon energy crashes (typically 2-4pm)
Feeling "tired but wired" at night
Increased sensitivity to stress
Salt or sugar cravings

Evidence-based herbal support:

Adaptogenic herbs have been extensively studied for their ability to support healthy stress response and adrenal function:

Ashwagandha (Withania somnifera): A 2012 study in the Indian Journal of Psychological Medicine found ashwagandha significantly reduced cortisol levels and improved stress resistance in chronically stressed adults.
Rhodiola (Rhodiola rosea): Research published in Phytomedicine demonstrated rhodiola's ability to reduce fatigue and improve mental performance in stress-related exhaustion.
Licorice root (Glycyrrhiza glabra): Contains compounds that support cortisol levels when depleted, though should be used under professional guidance due to potential blood pressure effects.

Important note: While adaptogenic herbs are generally well-tolerated, they should be prescribed individually based on your unique presentation. Some may not be appropriate if you have certain health conditions or take specific medications.

2. Your Thyroid Function Has Shifted

What's happening: Perimenopause often coincides with changes in thyroid function. Your thyroid controls metabolism, energy levels, body temperature, and mood. When it's underactive - even subclinically - you can experience cold sensitivity, sluggishness, brain fog, and profound fatigue.

Why standard testing misses the picture:

Many women are told their thyroid is "normal" based on TSH (thyroid stimulating hormone) testing alone. However, optimal thyroid function requires looking at:

Free T4 and Free T3 levels
Reverse T3
Thyroid antibodies
Symptoms alongside numbers

Research indicates that subclinical hypothyroidism affects 3-8% of women, with rates increasing significantly during perimenopause.

Evidence-based herbal support:

Bladderwrack (Fucus vesiculosus): Rich in iodine and trace minerals that support thyroid hormone production. Should only be used when iodine deficiency is confirmed, as excess iodine can worsen some thyroid conditions.
Motherwort (Leonurus cardiaca): While not directly thyroid-supporting, this nervine herb helps regulate the cardiovascular and nervous system symptoms that often accompany thyroid imbalance.

When to seek medical support: If you suspect thyroid issues, comprehensive testing with your GP or endocrinologist is essential. Some thyroid conditions require pharmaceutical intervention, and herbal medicine works best as complementary support in these cases.

3. You're Nutritionally Depleted

What's happening: Women in perimenopause are often running on nutritional fumes. The combination of increased physiological demands, years of giving to others, and potentially compromised digestion creates a perfect storm for deficiency.

Common deficiencies causing fatigue:

Iron: Especially common if you're still menstruating or experiencing heavy perimenopausal periods. The WHO estimates that 30% of women globally are anaemic, with iron deficiency being the leading cause.

B vitamins: Essential for cellular energy production. B12 and folate deficiencies are particularly linked to fatigue and cognitive symptoms.

Magnesium: Required for over 300 enzymatic reactions, including energy metabolism, muscle relaxation, and sleep regulation. Studies suggest 50-70% of adults don't meet the recommended daily intake.

Vitamin D: Low levels are strongly correlated with fatigue, low mood, and immune dysfunction. Australian research shows vitamin D insufficiency affects up to 31% of adults.

Evidence-based herbal support:

Nettle leaf (Urtica dioica): Exceptionally mineral-rich, containing bioavailable iron, calcium, magnesium, and silica. A study in the Journal of Herbal Medicine demonstrated nettle's nutritive properties and anti-inflammatory effects.
Dandelion root (Taraxacum officinale): Supports digestive function and nutrient absorption through gentle bitter action. Also provides potassium and other minerals.

Important: Herbal nutrition should complement, not replace, addressing deficiencies through diet and, when necessary, targeted supplementation under professional guidance.

4. Your Nervous System Is Stuck in Overdrive

What's happening: After years of being "on," your nervous system may have lost its ability to downshift into parasympathetic ("rest and digest") mode. You fall into bed exhausted, but your mind races. You wake at 3am unable to return to sleep. You feel anxious without clear cause.

This is nervous system dysregulation - when your body has been in sympathetic ("fight or flight") activation for so long that it no longer recognises safety signals. Rest becomes physiologically difficult, even when you're desperately tired.

The science: Research in neuroscience shows that chronic stress literally rewires neural pathways, making the stress response more sensitive while dampening the relaxation response. This affects:

Heart rate variability
Cortisol rhythms
Sleep initiation and maintenance
Digestive function
Immune regulation

Evidence-based herbal support:

Nervine herbs have been used traditionally and studied for their ability to nourish and restore nervous system function:

Oatstraw (Avena sativa): A gentle nervous system trophorestorative. Research published in Nutrients showed oat extracts improved cognitive performance and reduced stress responses.
Passionflower (Passiflora incarnata): Multiple studies demonstrate passionflower's anxiolytic (anti-anxiety) effects comparable to some pharmaceutical options, without the side effects.
Linden flower (Tilia spp.): Traditional nervine with mild sedative properties. A 2015 study confirmed its anxiolytic and sedative effects through GABAergic mechanisms.

These herbs don't just mask symptoms - they support the restoration of healthy nervous system function over time.

5. Sleep Architecture Has Changed

What's happening: Even if you're "getting enough sleep," the quality may have deteriorated significantly. Perimenopause disrupts sleep architecture - the natural cycling through light sleep, deep sleep, and REM sleep your body needs for restoration.

Common perimenopause sleep disruptions:

Night sweats and hot flushes
Restless leg syndrome
Frequent waking
Lighter, less restorative sleep
Sleep apnoea (risk increases after menopause)

Poor sleep doesn't just make you tired the next day - research links chronic sleep disruption to:

Impaired immune function
Reduced emotional resilience
Metabolic dysregulation
Increased inflammation
Cognitive decline

Evidence-based herbal support:

Valerian (Valeriana officinalis): Multiple clinical trials demonstrate valerian's effectiveness in improving sleep quality and reducing sleep latency (time to fall asleep).
Hops (Humulus lupulus): Often combined with valerian, research shows hops' sedative properties through interaction with GABA receptors.
California poppy (Eschscholzia californica): Gentle sedative and analgesic properties. Studies show it improves sleep quality and reduces night time waking.

Note: These herbs work best when combined with sleep hygiene practices and addressing underlying causes of sleep disruption (such as night sweats, which may need separate herbal or medical support).

6. The Weight of Invisible Labour

Let's acknowledge something rarely discussed in medical consultations: the sheer mental and emotional load you carry.

The research on emotional labour: Studies in occupational health and feminist sociology have documented how the invisible work of remembering, planning, anticipating, and emotional caretaking depletes actual, measurable energy resources.

This cognitive and emotional labour:

Activates the same stress pathways as physical labour
Requires glucose and other metabolic resources
Prevents true mental rest
Compounds physical exhaustion

You're not just tired from doing things. You're tired from holding everything together. And that kind of exhaustion doesn't show up on blood tests - but it's very real.

A Word from the Herbal Community

This integrated approach to perimenopause fatigue isn't just my clinical observation - it's supported by leaders in herbal medicine worldwide.

As renowned herbalist Rosemary Gladstar, author of Herbal Healing for Women, explains:

"Fatigue in midlife women is rarely about one thing. It's a tapestry of hormonal shifts, nutritional depletion, nervous system overwhelm, and years of relentless giving. Herbal medicine excels here because it addresses the whole person—not just isolated symptoms. We're not looking for quick fixes; we're restoring the body's innate capacity to heal and renew itself."

In my 14 years of practice, this whole-person perspective has proven essential. Every woman I work with has a unique pattern of fatigue - and that's exactly why personalised herbal care works where one-size-fits-all approaches fail.

You Deserve More Than "It's Just Your Age"

Fatigue isn't a character flaw, laziness, or something to power through. It's your body communicating - sometimes urgently - that it needs support, nourishment, and rest.

What Holistic Herbal Care Offers

When you work with a qualified herbalist, you receive:

Comprehensive assessment of your unique presentation, including:

Detailed health history
Current symptoms and their patterns
Stress levels and life circumstances
Sleep quality and patterns
Nutritional status and dietary habits
Emotional and mental health
Current medications and health conditions

Personalised herbal formulations addressing:

Your specific pattern of fatigue
Root causes, not just symptoms
Multiple interconnected systems
Your individual constitution and needs

Ongoing support and adjustment:

Regular check-ins to monitor progress
Formula adjustments as your body responds
Education about your herbs and how they work
Empowerment to understand your own health

Integration with conventional care:

Collaboration with your existing healthcare team when appropriate
Recognition of when medical intervention is necessary
Complementary support for conditions requiring pharmaceutical treatment

When to Seek Additional Medical Support

While herbal medicine can profoundly support fatigue recovery, certain symptoms warrant immediate medical evaluation:

Sudden, severe fatigue that significantly impacts daily function
Unexplained weight changes
Persistent fever or night sweats
Chest pain or severe palpitations
Severe or unusual headaches
Shortness of breath
Signs of depression including loss of interest in activities, feelings of hopelessness

These could indicate conditions requiring medical diagnosis and treatment, such as anaemia, thyroid disorders, diabetes, heart conditions, or clinical depression.

Herbal medicine works best as part of an integrated approach to your health, complementing rather than replacing appropriate medical care.

Ready to Feel Like Yourself Again?

You don't have to keep waking up exhausted. You don't have to accept fatigue as your new normal. There is another way - one that's gentle, evidence-informed, and deeply respectful of your body's wisdom.

As an accredited herbalist with over 14 years of experience supporting women through perimenopause, I create personalised herbal protocols that address the root causes of your unique fatigue pattern.

Book a free 10-minute discovery call to explore how personalised herbal medicine can help you reclaim your energy, clarity, and vitality. Together, we'll uncover what's really driving your fatigue and create a plan that works with your body, not against it.

Because you deserve to feel held, supported, and genuinely cared for on your journey back to wellness.

Book Your Free Discovery Call →

Frequently Asked Questions

How long does it take to see results with herbal medicine for fatigue?

Most clients notice initial improvements within 2-4 weeks, with more significant changes by 6-8 weeks. However, deep restoration of depleted systems typically takes 3-6 months of consistent herbal support combined with lifestyle changes.

Can I take herbs while on other medications?

Many herbs can be safely used alongside conventional medications, but some have interactions. This is why working with a qualified herbalist who takes a complete health history is essential. I always check for interactions and collaborate with your GP when needed.

Are herbal remedies safe during perimenopause?

When prescribed appropriately by a qualified practitioner, herbal medicines have an excellent safety profile. However, individualised prescription is key - what works beautifully for one person may not be suitable for another.

Will herbs interfere with HRT or other perimenopause treatments?

Herbal medicine can complement HRT and other treatments very effectively. Some herbs support the same pathways as HRT, while others address different aspects of wellbeing. Full disclosure of all supplements and medications ensures safe, integrated care.

About the Author

Michelle Ringin is an accredited Western Herbalist (Dip. Western Herbal Medicine) and Weight Management Practitioner with over 14 years of clinical experience. She is a member of the National Herbalists Association of Australia (NHAA) and specialises in supporting women through perimenopause, burnout, and chronic fatigue. Michelle practices from her clinic in Lithgow, offering personalised herbal consultations for both humans and their beloved animal companions.

Medical Disclaimer

This article is for educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. The information provided should not replace professional medical advice. Always consult with a qualified healthcare practitioner before starting any new herbal protocol, especially if you have existing health conditions, are pregnant or breastfeeding, or take medications. Individual results may vary.

References

Chedraui P, et al. "Assessing menopausal symptoms among healthy women with the Menopause Rating Scale." Maturitas. 2007;57(3):271-278.
Chandrasekhar K, Kapoor J, Anishetty S. "A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults." Indian J Psychol Med. 2012;34(3):255-262.
Darbinyan V, et al. "Rhodiola rosea in stress induced fatigue—a double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty." Phytomedicine. 2000;7(5):365-371.
Kennedy DO, et al. "Effects of 8 weeks' administration of Korean Panax ginseng extract on the mood and cognitive performance of healthy individuals." J Ginseng Res. 2018;42(4):427-433.
Lopresti AL, et al. "An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract." Medicine (Baltimore). 2019;98(37):e17186.
Mills S, Bone K. "Principles and Practice of Phytotherapy: Modern Herbal Medicine." 2nd ed. Churchill Livingstone; 2013.
Miroddi M, et al. "Passiflora incarnata L.: ethnopharmacology, clinical application, safety and evaluation of clinical trials." J Ethnopharmacol. 2013;150(3):791-804.
World Health Organization. "Worldwide prevalence of anaemia 1993-2005." WHO Global Database on Anaemia; 2008.

Struggling with fatigue, burnout, or perimenopausal symptoms? At Inner Peace Holistic Herbal Therapy, we offer compassionate, evidence-informed herbal care for women navigating this season of life. You're not alone - and you don't have to figure this out by yourself.

Inner Peace Holistic Herbal Therapy
Healing, Naturally. Together.
Located - Lithgow | 0490 335 602 | info@innerpeacehealth.com.au
NHAA Member 155639 | ABN: 30 874 985 213