Why Am I Always Tired? 3 Hidden Causes of Fatigue in Perimenopause & Menopause

If you’re a woman over 35 and constantly asking:

·       Why am I always tired—even after coffee?

·       Why does exercise make my fatigue worse instead of better?

·       Why do my labs look “normal” but my energy feels anything but?

You’re not imagining it.

Chronic fatigue in women during perimenopause and menopause is extremely common — and it’s rarely fixed with more caffeine or harder workouts.

In functional medicine, we see this pattern every day.Here are three hidden hormonal reasons fatigue doesn’t improve with coffee or exercise — and what actually restores energy.

1. Cortisol Rhythm Disruption: The “Tired but Wired” Trap

Cortisol is your main stress and energy hormone.It’s supposed to follow a daily rhythm:

·       High in the morning → wake you up

·       Gradually declining during the day

·       Low at night → allow sleep and recovery

Wired at night, exhausted during the day...

During perimenopause and menopause, cortisol rhythms often flatten or flip — especially under chronic stress, under-eating, or over-exercising.

Signs of cortisol rhythm disruption:

·       Feeling tired but wired

·       Fatigue that doesn’t improve with caffeine

·       Afternoon crashes

·       Trouble falling or staying asleep

·       Feeling worse after intense workouts

Why coffee and workouts stop working:

Coffee and high-intensity exercise raise cortisol.When cortisol is already dysregulated, stimulation only worsens fatigue.

What actually helps:

·       Morning light exposure to reset circadian rhythm

·       Protein-rich breakfast within 60 minutes of waking

·       Nervous-system-friendly movement before intense exercise

·       Stress regulation (breathing, walking, sleep consistency)

·       Functional testing that evaluates cortisol timing, not just levels

This is one of the most overlooked causes of hormonal fatigue in women.

2. Under-Fueling Protein and Calories (Especially After 35)

One of the most common drivers of fatigue in perimenopause and menopause is simple — but rarely acknowledged:

You’re not eating enough.

Not enough protein.Not enough total calories.Not enough early in the day.

This is especially common in women who:

·       Eat “clean”

·       Diet chronically

·       Intermittent fast aggressively

·       Work out hard without increasing fuel

Signs of under-fueling fatigue:

·       Fatigue despite healthy eating

·       Cravings late at night

·       Muscle loss or stalled strength

·       Exercise intolerance

·       Cold sensitivity or low body temperature

Why exercise makes fatigue worse:

Without adequate protein and calories, workouts become energy drains, not energy builders.

What actually helps:

·       20–30 grams of protein at breakfast

·       Adequate total calories (not chronic restriction)

·       Balanced meals with protein, carbs, and healthy fats

·       Adjusting workout intensity to fuel availability

For many women, increasing protein alone dramatically improves low energy and fatigue.

3. Thyroid Conversion Issues (Normal TSH, Still Exhausted)

Many women are told their thyroid labs are normal — yet feel profoundly fatigued.

Here’s why.

Your thyroid must convert:

·       T4 (inactive storage hormone)

·       Into T3 (active energy hormone)

Stress, inflammation, under-eating, nutrient deficiencies, and gut dysfunction — all common in perimenopause — can impair T4 → T3 conversion.

Signs of poor thyroid conversion:

·       Fatigue that doesn’t improve with rest

·       Brain fog

·       Cold hands and feet

·       Hair thinning

·       Constipation

·       Low exercise tolerance

Why coffee doesn’t help:

Caffeine stimulates the nervous system — not cellular metabolism.Without adequate T3, cells simply can’t generate energy efficiently.

What actually helps:

·       Full thyroid panels (TSH, Free T4, Free T3, antibodies when indicated)

·       Addressing cortisol and inflammation

·       Adequate protein, iron, selenium, zinc

·       Gut and liver support

·       Individualized thyroid strategies when appropriate

This is a major reason women experience fatigue despite normal labs.

The Takeaway: Fatigue Isn’t a Motivation Problem

If coffee and workouts aren’t fixing your fatigue, your body isn’t asking for more stimulation.

It’s asking for:

·       Hormonal rhythm

·       Adequate fuel

·       Better thyroid signaling

Energy is a biological outcome — not a mindset issue.

Action Step

If you’re struggling with chronic fatigue:

·       Start with protein at breakfast

·       Reduce reliance on caffeine

·       Match exercise intensity to current energy

·       Consider functional hormone and metabolic testing

Your energy is not gone… it’s blocked.And it can be restored.