Why am I so exhausted in menopause, and how do I get my energy back?

Your nights get worse for a specific reason. Fatigue is one of the most common symptoms of this stage ^[1]. Sleep problems affect 40 to 60% of women in menopause, and insomnia climbs to 47% in perimenopause and 60% afterward ^[2]. More than one woman in two sleeps badly here. You're not the exception who can't cope.

Two hormones fall: estrogen and progesterone ^[2]. Progesterone acts like a natural brake that helps you wind down at night. When it collapses, sleep gets lighter and more broken. Estrogen regulates temperature, so its drop triggers night sweats (sweats that wake you up). You can spend eight hours in bed while your deep sleep stays fragmented ^[2].

Add cortisol, the wake-up hormone. It should fall in the evening and rise in the morning. With stress and screens, it can stay high at bedtime: your body stays on alert. When night sweats wreck your nights, menopausal hormone therapy (MHT), indicated for vasomotor symptoms, is worth discussing with your doctor ^[11].

The goal: signal to your body that the day is over, so cortisol falls and melatonin, your sleep hormone, can rise. Start with one or two steps; consistency matters more than perfection.

• Dim the lights an hour before bed: bright light and screens delay melatonin and push back sleep onset ^[3].
• Cut screens before sleep, and keep the phone out of the bedroom if you can ^[3].
• Eat lighter and earlier, and keep the bedroom cool: a temperature drop supports deep sleep.
• Reduce evening alcohol: it makes you drowsy faster, but it fragments the second half of the night and worsens night sweats ^[4].

Two supports round out the ritual, without overselling. Magnesium (glycinate form, gentler on the gut) may ease relaxation: a trial in older adults with insomnia showed better sleep onset ^[5], and other work suggests an effect on anxiety, with modest evidence ^[6]. If you take medication or have kidney issues, check with your doctor or pharmacist before starting any supplement. Gentle movement is one of the strongest levers: in the SWAN study, women who kept up regular activity slept better ^[7]. Walking, yoga, stretching: regularity beats intensity, and avoid intense effort right before bed.

If you remember one thing, make it this. For chronic insomnia, the first-line treatment isn't a sleeping pill: it's cognitive behavioral therapy for insomnia (CBT-I), a structured method that retrains your sleep.

The guidelines are unambiguous: CBT-I is recommended first-line for adults, with sleeping pills coming only second, short-term ^[8]. Sedatives tend to lose effect, carry a risk of dependence and, with age, a higher risk of falls and memory problems ^[8].

For menopausal women, it works. In the MsFLASH trial, in women with hot flashes, CBT-I reduced insomnia far more than the control group, with benefits holding at six months ^[9]. This isn't the option "for severe cases": it's the most effective tool, with no side effects. You can access it with a trained therapist or through guided programs.

You've surely seen the video: testosterone sold as the magic energy fix. The appeal makes sense when you're exhausted. But the science tells a different story.

The global consensus of expert societies is clear: the only evidence-based use of testosterone in menopausal women is low sexual desire ^[10]. There is no solid evidence of benefit for energy, mood, or memory ^[10]. On fatigue specifically, the data don't back it up.

There's a safety issue too. In France, no product holds marketing approval (the AMM, the official green light from health authorities) for women in this use, so it stays off-label. It isn't harmless: acne, unwanted hair growth, and long-term effects that are still poorly assessed ^[10]. Self-prescribing a dose found online is a real risk for an unproven benefit. Put your energy instead into the levers that do have evidence.