Updated: Feb 15
What is menopause fatigue and how to alleviate the symptoms
Menopause Winter & February Fatigue
Do you feel fatigued this February? Maybe you set healthy goals for 2022, set yourself a fitness and food ‘regime’ - and had hoped to feel less lethargic by now?
If this is you, you are not alone - I have spoken to so many women who feel abnormally tired. Although long-Covid can a factor for some, it doesn’t explain the widespread sleepy malaise that seems to be sweeping through many of us – myself included.
However, for women in a stage of the menopause (perimenopause, menopause and post menopause) there are additional factors.
I'm 55-years old, five years into my post menopause and consider my lifestyle a good balance of movement, exercise, nutrition and wellbeing. So, if I'm feeling fatigued this February, I suspect many of you are too! In fact, I know you are because the two Menopause Yoga workshops on fatigue (in person and online) this month are already fully booked.
So what can we do to lift this low mood, sluggish digestion or sleepy sensation?
Below are my suggestions, and I have tried and tested everything that I mention below.
based on research, advice and guidance from menopause doctors, nutritionists, complimentary therapists and, of course, from my Menopause Yoga
This blogpost includes insights into this time of year, why menopausal women need extra support, and general guidance* on exercise, nutrition, natural remedies, Indian Ayurveda, traditional Chinese medicine, Menopause Yoga techniques, including radical rest - to help you get ready for your Second Spring (the post reproductive stage of your life).
But remember: every woman’s body, hormones, lifestyle and experience of the menopause is different. These are just my suggestions. Menopause symptoms can mask serious illness, so please speak to your doctor if your fatigue is long term and lifestyle changes have not been helpful.
*Please note that menopause can mask serious health conditions and you are always advised to consult your doctor.
What causes fatigue?
The dictionary definition of fatigue is, 'extreme tiredness resulting from mental or physical exertion or illness.'
This definition seems so apt considering the two years we have all just been through. Take a moment to reflect on what you have been through in terms of your own physical and mental health – and the wellbeing of those you care for. Chances are you have all been experiencing either illness or heightened prolonged stress and virus or immune system related illness.
Stress puts pressure on your endocrine system especially your adrenal glands. When we are anxious, it triggers our fight or flight response, causing the adrenal glands to produce adrenaline and cortisol in response. This is going to affect your ability to sleep, causing fatigue the next day, lead to weight gain if cortisol levels are sustained, affect and cause a sensation of burn out and emotional and mental fatigue.
Battle fatigued or weariness is also commonplace at the moment as we start to emerge from what has been a gruelling two years and, for many, a tragic or traumatic time. Be kind to yourself and treat yourself with compassion and patience. The world around you may be re-emerging, but you may need a little more time and reassurance before you step back into what we used to consider a ‘normal’ world.
Yoga, breathwork and meditation can help to reduce stress, but so can resting when you need to, taking walks in nature and talking or journaling about thoughts that are worrying you. Seek professional support from a counsellor if the emotions arising or anxiety attacks feel too overwhelming.
In Winter, many of us have either had colds, flu or, more recently, a respiratory virus such as Covid-19. Initial medical research suggests that women in their 50's may be more susceptible to long-Covid fatigue and brain fog, possibly because of low oestrogen levels. If you have long-covid, please take medical advice and guidance from a physio therapist. The latest medical advice is against over-exerting yourself as this will only deplete your energy more. Spend time resting more (see Restorative and Yin yoga practice below).
Oestrogen is an anti-inflammatory that can help keep airways and arteries clear and, alongside testosterone, is a hormone that supports brain function, serotonin levels in our brain that affect mental alertness and mood, as well as muscle mass, digestion and libido. You may need to increase your hormone levels, which shift and fluctuate as we move through the menopause and for an estimated seven years into our post menopause. HRT is available through your GP, although testosterone for women ‘Androfeme’ is only available through menopause private specialists, such as Newson Health and the Harper Clinic, in London. You can read more about this on the Balance App or menopause doctor websites.
Fatigue can sometimes be caused by something as simple as lack of water that we need for our bodies to function properly, including our brains. Drink water not sugary drinks. Avoid caffeine and alcohol as much as possible, or give yourself ‘free’ days and notice how you feel.
Nourish & Nurture
**Food can be a trigger area for many women so please seek the guidance and support of a professional nutritionist or counsellor if you have experienced anxiety around meal management.
If you are feeling lethargic, take a look at your weekly food plan, how much you eat, when and why? If you are less active, you need less fuel, and it can be harder to digest due a sluggish metabolism during the menopause. Switch big meals for easier to digest smaller meals evenly spread throughout the day to ensure that your blood sugar remains even and you avoid cravings.
Aim to eat dinner at 6pm-7pm so that you have plenty of time to digest the food before you sleep. Eat fewer processed foods and try to remove the sugar, excess salt, saturated fats and caffeine as well as alcohol. Women become more sensitive to toxins such as alcohol and caffeine and a slower digestion make it harder to process within 24 hours. Wine is a liquid sugar and caffeine is a false energy booster – both of which lead to a crash in your energy later, and a sugar and carbohydrate craving when you wake the next day. I know this from personal experience!
According to menopause nutritionists Emma Ellice Flint (The Happy Hormone Cookbook) and Severine Menem (Deliciously Healthy Menopause) we need to plan healthy meals that include:
Protein - oily non-farmed fish, organic free-range eggs, tofu, nuts and sprouted seeds)
Iron – same as above plus green leafy vegetables such as kale, spinach, seaweed, cress, collard, parsley, dried figs and apricots.
Phytoestrogens – (see above) plus legumes/ lignans
Vitamin D (sunshine)
B vitamins, (organic if possible and not processed foods),
Low GI carbohydrates – Broccoli, mushrooms, walnuts, cherries, apples, chickpeas, buckwheat, wild rice, beetroot, couscous, wholewheat bread (or Gluten free bread).
Low to medium GI fruits - such as Dark berries and apples and pears, bananas,
Magnesium (bananas and dark chocolate).
Organic cold pressed Olive oil – avoid saturated and trans fats
It is always more effective to gain vitamins and minerals from fresh food, but sometimes we need supplements. Vitamin supplements such as vitamins D is now a government recommendation for everyone in the UK, especially in winter when sunshine is scarce, but we also need B vitamins (B12 especially if you are vegetarian). And we may need iron if we are seriously low
Dr Shahzadi Harper of the Harper Clinic and co-author of ‘The Perimenopause Solution’ with nutritionist Emma Bardwell, says it is wise to get a blood test done to check your ferritin (iron), folate, and B12, and also check your thyroid function that can also cause extreme tiredness, constipation, hair loss and many other symptoms we commonly associate with the perimenopause.
Iron is needed to transport oxygen around your body, so if it is low this can affect your energy, sleep, ability to exercise and long-term heart health. If your blood tests show you are anaemic, you will need an iron spray or patch.
Definition 2: Fatigue is, 'weakness in metal or other materials caused by repeated variations of stress.'
I find this second definition of 'fatigue' interesting from a yoga and eastern wellbeing perspective. Metal is the element associated with Winter in traditional Chinese medicine. And just as you can ‘stress’ metal, we can also become over-stressed. In Indian Ayurveda, Winter is also associated our menopause and older age. After a time of life when it is wise to slow down to conserve energy. After a lifetime of rushing, doing, creating and procreating (for some), this is the stage naturally when we benefit from slowing down and reflecting, resting, preparing to live our lives differently.
So, from an eastern wellbeing perspective, repeated variations of stress can cause us to become physically, emotionally and spiritually fatigued. In other words, listen to your body, go with nature, rest restore, reflect – over exerting in Winter will leave you depleted, burnt out.
February is still in the midst of Winter - a season in the UK of cold and grey skies, where our energy naturally ebbs, because we should be hibernating, resting and restoring energy ready for Spring. Women in the menopause and beyond are especially sensitive to this time of year because Winter is the season associated with menopause (the 12 months without a menstrual period). I have observed that women going through the perimenopause menopause struggle with the uncertainty of their menstrual cycle, the unpredictable haywire hormone peaks and troughs causing tearfulness one day and elation the next, moody depression and then a happy high. They long for the familiarity of their monthly cycle where they could at least plan ahead for the menstruation and ovulation times of their month.
However, women in post menopause no longer have a monthly cycle. I have observed their strong desire to connect with nature and believe this is because women shift their cycles to the Seasons of the year. We are more deeply affected by the changing seasons of the year, the energy of the sun, the calming bath of the full Moon.
In Menopause Yoga, I encourage women to see the Winter as an opportunity to rest, do less, reflect, and then re prioritise what matters most to them in the coming year ahead.
Be kind to yourselves and give yourself time to rest and recover rather than pushing through. If you batteries have run low, then let yourself recharge- or else you’ll have nothing for the coming spring.
Creating a plan for your daily routine, knowing when you want to wake up (try to make this close to sunrise if possible), giving yourself some time (1-2 hours) before consuming food to give your digestive system a chance to wake up). Prepare your meals and stick to the times you intended to eat. Try to make this sociable by eating with family if possible. I know this isn’t always possible.
Schedule when you are going to exercise (avoid over exertion at the start, - build up strength and cardio-vascular ability over time).
Organise social events that feel manageable. Seeing friend, family can lift you spirits and alleviate emotional fatigue. Start with one or a few friends at first and let them know you are not drinking alcohol at the moment. Stay only as long as you feel you have energy – over depletion. Depleting energy if like dehydration – it’s a lot harder to recover from afterwards.
When you feel ready to take the next step then….
Do something NEW! If you have felt enclosed in your homes and working from home, home schooling or self isolating, then your brain and nervous system will have become sluggish due to lack of positive stimulation. You can stimulate your brain and body by eating different foods, trying a different form of exercise, hobby, or just simply changing the direction of your walk.
Step slightly out of your comfort zone. Do something you haven’t done before! Watch, read, listen to something different. Challenge your habits and behaviours. It doesn’t have to be dramatic – small changes can be effective.
Put Energy back on The Grid
This is a phrase used by Lisa Sanfilippo, founder and author of ‘Sleep Recovery.’ When our battery has run low, we need to recharge and restorative yoga, abdominal breathing, Ocean breathing with sound helps you switch into your parasympathetic nervous system (PNS)– the rest and digest response. Sanfilippo uses a similar technique called ‘the Drop’ which is a long sighing sound.
Abdominal breathing allows the belly to soften and relax, which enables the diaphragm to lower into the belly area, making more space for your lungs to expand. This both helps you feel more energised through a deeper inhalation, but most importantly, it helps you to feel more relaxed if you exhale slowly. Research has shown that a longer exhalation helps you to switch to the PNS.
Restorative Menopause Yoga poses
Restorative yoga helps your muscles and nervous system relax so that you are more able to rest and sleep. Remember, stress affects your heart, brain and bones as well as digestion and energy levels. So learning how to rest and drop into an unbroken sleep can considerably support your long term health as well as overcome short term fatigue.
Below are a couple of restorative poses that that can help you put energy back on the grid. They work on a physical and psychological level. Please ensure you use as many comfortable, soft and warm pillows, blankets, cushions to support your body because this physical support will be experienced as a form of emotional support. Ideally you use a yoga bolster too but you can use household alternatives.
Stay in each of these poses for between 5-10 minutes- longer if you feel comfortable. Put a timer on your phone or another device, but make sure the ‘alarm’ is a gentle sound. Be careful to move in and out of these poses slowly so as not to disturb your nervous system. Fast, jagged movement will stimulate your sympathetic nervous system (SNS) or fight and flight response.
What you need:
1x yoga mat
1x yoga bolster or 1-2 firm long pillows/ cushions
1-2x soft blanket
1x yoga strap or a belt
1-2x yoga blocks
Optional eye pillow, cushions or pillows for comfort.
Salamba balasana/ Supported Child’s pose (with blanket)
· Open out one of your blankets onto the yoga mat so that you have a warm soft surface. Comfort is key in restorative yoga.
· Lay your bolster (firm long pillows) on the bolster lengthways.
· Elevate the top end of the bolster with 1-2 yoga blocks (adjust the height to suit your body).
· Place the other blanket over your shoulders and back to keep you warm.
· Kneel and rest the front of your chest along the bolster, turn your head to one side. If this is uncomfortable on your neck, rest your head on a small pillow.
· Relax your arms and shoulders, allow the bolster to take the weight of your upper body. Some people like to hug their arms around the bolster, but this is your choice.
· Stay for at least 2-3 minutes (or longer), then turn your head to the other side and stay for at least another 2-3 minutes (or longer if you find this pose restful).
· Additional props: rest the eye bag or a small weighted sandbag on the back of you shoulders or lower back. This can feel grounding and can help your nervous system to relax.
· Modification: if kneeling causes soreness in your knee joints, you have the option to lie on your back, near to a wall and bend your knees so the feet are flat against the surface of the wall. Hug your arms around the bolster or cushions, and place the eye bag on your forehead or eyes. If you feel cold, cover your body with one of the blankets.
Viparita karani/ legs raised against a wall (with blanket)
· Place your mat close to a wall, or a sofa or bed.
· Keep the blanket open on the mat so that you have a soft, warm surface to lie on.
· Place either the bolster or a block against the wall.
· Wrap the yoga belt around your mid thighs, making sure that the metal buckle is in the middle between your legs, not pressing into your skin. Make the belt tight enough to hold your legs almost together, but with the feet separated at hip distance apart.
· Sit on the bolster or the block close to the wall and roll to your side so that you are lying on your back with your legs raised against the wall. Adjust your position to ensure that the bolster or block is underneath your pelvis not your lower back/ lumber spine.
· Reach your arms up and use your thumb and first fingers to pinch the blanket material. Draw the material down onto the crown of your head and tuck the blanket in around your ears and neck. This creates a warm cocoon around your head that shuts out sounds and other disturbances, so it helps you rest.
· Place the eye pillow on your forehead or eyes.
· Modifications: if you are cold, cover your body with a blanket and maybe wear socks on your feet.
· If having your pelvis elevated gives you a headache, hot flush or throbbing veins, then remove the bolster/ brick and rest your pelvis on the mat instead.
· If having your legs raised causes pins and needles or any nerve pain, bend your knees so the soles of your feet rest against the wall, or roll to the side and come out of the pose.
· Stay for a minimum of 5 minutes and ideally 10-15 minutes. To exit this pose, bend your knees, roll to the side of your body, loosen the belt/ strap and sit up slowly.
Salamba Savasana/ Deep rest pose (with two bolsters)
· Keep the blanket spread out on your mat.
· Place your bolster towards the bottom end of you mat and place the two blocks in front. (if you have 2x bolsters you can place these next to each other instead).
· Lie down on your back and lift your lower legs so that they are resting on the bolster and your feet are on the blocks. Adjust the position – you may prefer to have the bolster underneath your knees instead to take pressure off your lower back.
· If you are cold, cover your body with the other blanket.
· Option to rest the eye pillow on your forehead or over your eyes. (please note, if you wear contact lenses, it is not advisable to place the eye bag on top of your eye lids).
· Stay in this pose for a minimum of 10-15 minutes.
· To exit the pose, hug your knees to chest and roll over to one side to sit up.
Remember: you can practice one of these poses on its own as a daytime restorative snack – or all together as a 30-45 minute session.
They provide conscious rest – not deep sleep. They are less likely to interfere with your circadian sleep cycle than going to bed to take a nap in the daytime. You are more likely to emerge from these poses feel refreshed, energy restored.
And you are more likely to feel able to drop off to sleep at night.
Practice them often and your body will become trained to take rest breaks more efficiently.
Advice: Put a timer on your phone so that you are not worrying about when to come out of the pose – but avoid a loud alarm! Choose a more soothing sound to awaken to.
In my next Blogpost I’ll show you some Yin Yoga techniques for rebalancing kidney, liver, stomach and spleen organs and meridians that can help clear energy blocks.
Thank you for reading.