Women’s Hormone & Longevity Specialist
You’re not just tired—you’re wiped out.
We’re talking about the kind of fatigue that lingers no matter how early you go to bed, how many supplements you take, or how much coffee you drink. If you’re feeling exhausted during the day, mentally foggy, and emotionally drained, there’s a good chance this isn’t just stress or poor sleep.
It might be fatigue from low hormones.
I’m Dr. Sarah Daccarett, MD, founder of Inner Balance and a specialist in women’s hormone and longevity health. I’ve worked with thousands of women who felt like their energy has evaporated and they felt like a zombie —and I’m here to tell you that you’re not crazy, and you’re not alone.
In this article, I’ll walk you through what this fatigue feels like, why it happens, how to know it’s hormone-related, and what you can do to reclaim your energy again.
The Most Common Symptoms of Hormone-Related Fatigue
Fatigue during perimenopause or menopause is not the same as regular tiredness. It doesn’t go away after a good night’s sleep or a weekend off, or a change in diet. Instead, it can feel like:
- Waking up just as tired as you were when you went to bed
- Brain fog so thick you can’t find simple words
- Feeling like your body is dragging through sand
- Needing a nap by 2 p.m. every single day
- Crying over small things because you’re just “so done”
- Feeling like your nervous system is constantly “on edge”
Many of my patients say:
“I’m so tired I don’t even have the energy to explain how tired I am.”
There’s also often a cognitive and emotional component:
- Difficulty concentrating or remembering words
- Feeling mentally overstimulated and underproductive
- Lack of motivation or excitement for things you used to enjoy
What surprises most women is that this exhaustion shows up many years before their period stops completely. It starts in perimenopause, sometimes even postpartum – when hormones begin to decline.
How Can You Be Sure It’s Not Something Else?
Of course, fatigue can have many causes—and we want to rule out anything serious.
Other possible contributors include, Thyroid dysfunction, Anemia, Vitamin D or B12 deficiency, Depression or Autoimmune issues.
Still, if your hormone labs are “normal” but you don’t feel normal and the other possible causes above have been ruled out – there’s a good chance hormones are playing a big role.
Why Does Perimenopause and Menopause Make You So Tired?
Hormones like estradiol and progesterone don’t just control your cycle—they impact every system in your body, including your brain, metabolism, sleep, and energy regulation.
Estradiol helps regulate and boost:
- Neurotransmitters like serotonin and dopamine
- Body temperature (which is why hot flashes disrupt sleep)
- Mitochondrial function (how your cells produce energy)
- Melatonin formation (so you can get deep, restful sleep)
When estrogen drops, so does your mental clarity, stamina, sleep and mitochondrial function.
Progesterone helps regulate and boost:
- Helps you fall and stay asleep
- Regulates GABA receptors (reducing anxiety)
- Balances cortisol (your stress hormone)
Low progesterone can leave you feeling wired at night and wiped out in the morning.
Lifestyle Load
Let’s be honest: life doesn’t wait for you to figure out your hormones – You may be caring for children, teens, aging parents, managing a career, or navigating big life transitions.
Hormonal fatigue + life demands = exhaustion on a whole new level.
What Can Help?
Here are a few foundational strategies that support energy in menopause:
- Eating a higher protein diet
- Balance blood sugar with protein, fiber, and healthy fats
- Practice boundaries and stress reduction techniques
- Support thyroid health with key nutrients
Hormone Therapy for Fatigue & Brain Fog
If you’ve tried lifestyle changes and still feel like your tank is empty, it may be time to consider bioidentical hormone therapy. At Inner Balance, we specialize in using estradiol and progesterone to restore balance and address the root cause of hormonal fatigue.
Estradiol, Neurodegeneration and Aging
Estradiol is critical to help with fatigue and brain fog. New emerging studies suggest that Estradiol may improve cerebral spinal fluid flow and enhance cognitive resilience. Women who do HRT have higher cognitive performance and outcomes than non-HRT users and this could be in part due to improved CNS cleaning at night. Estradiol appears to support the brain’s nightly cleaning process through its roles in
- Enhancing sleep quality – especially deep NREM sleep
- Modulating astrocyte and AQP4 function
- Reducing inflammation
- Clearance of metabolic waste – such as beta amyloid and tau proteins, found in Alzheimer’s
- Reducing neuroinflammation and improving neuroprotection
Estradiol, Progesterone & Mitochondrial Function
Mitochondria are the powerhouse of the cell – creating ATP, that gives you energy. During (peri)menopause, mitochondrial function deteriorates. Estradiol and progesterone both play critical roles in supporting mitochondrial function, particularly in women. Their impact is especially significant in tissues with high energy demand, such as the brain, muscles, and heart, and is essential for maintaining metabolic resilience, cellular health, and longevity. Here’s how each hormone boosts mitochondrial function:
- Estradiol increases the number and efficiency of mitochondria, especially in the brain and muscle tissues.
- Estradiol upregulates enzymes in the electron transport chain
- Estradiol is an antioxidant to protect mitochondrial integrity
- Estradiol prevents mitochondrial premature death
- Progesterone stabilizes mitochondrial membranes
- Progesterone enhances mitochondrial function
- Progesterone reduces inflammation
Together they work to synergistically protect neurons from metabolic stress and oxidative damage. They enhance brain energy metabolism, memory and mood in mitochondrial pathways. They support metabolic flexibility, reducing insulin resistance and neurodegeneration. And they help preserve mitochondrial DNA.
The mitochondrial connection provides strong scientific rationale for considering bioidentical hormone replacement therapy (BHRT) to support cellular energy, cognitive function, and long-term vitality.
When to Seek out Bioidentical HRT
- You wake up exhausted every day
- You have insomnia that’s affecting your daily life
- Brain fog or forgetfulness is impacting your work or confidence
- You feel emotionally flat, anxious, or overstimulated
- You’ve been told your labs are normal but you don’t feel normal
This isn’t something to power through. Fatigue is a signal.
Addressing the Cause with Hormone Therapy
How HRT Helps
When we restore bioidentical estrogen and progesterone, we often see:
- Deeper, more restful sleep within weeks
- More stable energy throughout the day
- Improved focus and mental clarity
- Better memory, mood and overall well-being
Most of our patients using Oestra begin to feel relief by week 4 to 6, with noticeable improvements in sleep, mental clarity and reduction in brain fog. When they are combined, they recreate the hormonal rhythm your body is missing.
Who Benefits Most?
- Women who get started as soon as they start experiencing symptoms. Prevention of neurodegeneration is key.
- Anyone with sleep disturbances, chronic fatigue, or mood instability
- Women who want to support healthy aging and longevity
What About Safety?
Bioidentical HRT is clinically proven, backed by decades of research, and when personalized and monitored, is very safe. We use effective and safe formulations, regularly monitor progress, and make sure you feel supported every step of the way.
You Deserve to Feel Like Yourself Again
If you’re dealing with fatigue, you don’t have to accept it as your new normal. There are ways to feel energized, rested, and sharp again—and hormone therapy may be one of them.
