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Menopause is often treated as a single, generic phase in a woman's life. But the truth is that it's much more nuanced. From the early stages of premenopause to the postmenopausal years, the changes happening in a woman's body can vary greatly and play a significant role in symptoms like fatigue. Now a new study published in Menopause, the journal of The Menopause Society, has delved into the connection between menstrual bleeding patterns and the exhaustion many women feel during this time.
Curious to know more about how these shifts in the body can affect energy levels? Click through to uncover the surprising findings that could change the way we think about menopause.
Fatigue is a common symptom of menopause. A previous study, also published in the journal of The Menopause Society, but in 2018, found that while fatigue becomes more prevalent in the later stages of menopause, it is also significant among perimenopausal women—those transitioning into menopause.
Fatigue, which can range from a sudden drop in energy to extreme exhaustion, affects 19.7% of women not yet in perimenopause, 46.5% in perimenopause, and 85.3% in postmenopause, the study found.
Fatigue can also affect people mentally, making it harder to think, concentrate, remember, or make decisions.
Doctors and researchers have suggested that hormonal changes, hot flashes, sleep disorders, pain, and depression could be potential causes of fatigue in menopausal women.
On the other hand, some specialists argue that menopausal fatigue is still widely misunderstood, causing doctors to often respond to women’s concerns by prescribing antidepressants or even narcolepsy medications.
As Dr. Mary James points out in an article for the Women’s Health Network, "these prescriptions offer only a temporary band-aid solution," failing to address the fatigue's root cause.
Many studies on menopausal fatigue mention it broadly. However, menopause unfolds in stages over several years.
While most women experience it in their forties or fifties, the average age in the United States is 51.
These stages include premenopause, perimenopause, menopause, and postmenopause.
Premenopause is the period before menopausal symptoms appear. Women still have menstrual cycles and remain in their reproductive years. Hormonal changes may start in their thirties or forties, but aren’t yet noticeable.
This phase, which literally means "around menopause," is when women first experience hormonal changes and related symptoms. It typically lasts about four years, but can be shorter or longer. Pregnancy is still possible during this stage.
Menopause is defined as the point when a woman has not had a menstrual period for 12 consecutive months. At this stage, the ovaries stop producing eggs and most of their estrogen.
Postmenopause begins once it has been over a year since a woman’s last period, and it lasts for the rest of her life.
The menopausal transition often alters menstrual flow, with prolonged or heavy bleeding, known as abnormal uterine bleeding (AUB), being common.
Episodes of excessive flow often meet the criteria for AUB, a condition defined by vaginal bleeding that is excessive in amount, duration, or frequency during or between menstrual periods within a six-month period.
The Study of Women’s Health Across the Nation (SWAN) found that one in three women going through menopause experience AUB episodes.
Other studies suggest that heavy or prolonged menstrual bleeding is common for about 33% of women transitioning to menopause.
Despite the widespread impact of excessive bleeding on quality of life, limited research exists on whether it is linked to other common menopausal symptoms, according to a new study published March 12, 2025, in The Menopause Society journal.
The report found that experiencing three or more episodes of heavy or prolonged menstrual bleeding within a six-month period is linked to symptoms of fatigue.
According to the authors, this is the first study to evaluate over time the link between heavy or prolonged menstrual bleeding in premenopausal and perimenopausal women and their reports of fatigue or vitality.
"Lack of dialogue about menstruation, particularly the changes in bleeding patterns as women approach menopause, leads to women’s lack of knowledge about what is normal," said Dr. Siobán Harlow, lead study author and professor emeritus of epidemiology and obstetrics and gynecology at the University of Michigan.
The study focused particularly on the perimenopausal stage, "an understudied, underdescribed time," according to Dr. Stephanie Faubion, medical director of The Menopause Society.
During this phase, fluctuating levels of estrogen and progesterone can lead to mood swings, irregular menstrual cycles, and other symptoms, including depression.
The authors reviewed the health data of 2,329 women who, on average, were 47 years old when they enrolled in the Study of Women’s Health Across the Nation in 1996 or 1997.
Participants kept a monthly menstrual calendar, noting their menstrual bleeding until two years after their final period or for up to 10 years.
The authors defined prolonged menstrual bleeding as bleeding lasting more than eight days. Heavy menstrual bleeding was defined as very heavy bleeding for three or more days.
At the first six visits and the eighth visit, the team assessed participants’ vitality and fatigue by asking four questions from RAND’s 36-Item Short Form Health Survey. The questions asked how much time they had felt full of energy, full of pep, worn out, or tired in the past four weeks.
The study found that women who had at least three episodes of heavy menstrual bleeding in the past six months were 62% more likely to feel tired and 44% more likely to feel worn out.
Women who reported three or more instances of prolonged bleeding in the past six months had 32% lower odds of feeling full of pep.
The association between heavy and prolonged menstrual bleeding and fatigue may be linked to iron deficiency or iron deficiency anemia caused by blood loss, both of which are known causes of fatigue and complications of abnormal uterine bleeding.
Although the authors did not have data on participants' blood iron levels, which would have strengthened their case, their findings are supported by a small August 2016 study on menstrual bleeding and iron deficiency anemia in premenopausal African-American women.
With half of the world's population experiencing menopause if they live to midlife, Dr. Leana Wen, an emergency physician and adjunct associate professor of emergency medicine at George Washington University, emphasized the need for far more studies on this stage of life.
Sources: (The Menopause Society) (CNN) (Mayo Clinic) (Women's Health Network) (BMC Women's Health) (Medical News Today)
See also: The truth about menopause
New study uncovers another possible factor for menopausal fatigue
What causes women's extreme exhaustion during menopause?
HEALTH Women
Menopause is often treated as a single, generic phase in a woman's life. But the truth is that it's much more nuanced. From the early stages of premenopause to the postmenopausal years, the changes happening in a woman's body can vary greatly and play a significant role in symptoms like fatigue. Now a new study published in Menopause, the journal of The Menopause Society, has delved into the connection between menstrual bleeding patterns and the exhaustion many women feel during this time.
Curious to know more about how these shifts in the body can affect energy levels? Click through to uncover the surprising findings that could change the way we think about menopause.