I developed chronic fatigue in perimenopause - here's what the last 12 years have taught me

The 2026 theme for Menopause Awareness Month as Chronic Pain in Midlife. The condition affects many women during and after the menopause transition in various ways, the International Menopause Society says, yet it remains underestimated in both research and care.

I was diagnosed with Myalgic Encephalomyelitis (ME), also known as Chronic Fatigue Syndrome (CFS), when I was 40. I’d had a bad bout of flu. I didn’t take time to recover because I was freelancing and mum to a toddler. It’s a virus I never fully recovered from.

The diagnosis came after months of exhaustion, joint pain, breathlessness, brain fog, dizziness, migraines, stomach ache, heat sensitivity and tinnitus, all of which I still experience on a near-daily basis, to varying degrees.

After numerous trips to specialists, I was told to do a type of physical rehab called Graded Exercise Therapy (which has since been debunked and isn't recommended anymore), and I was offered a strong opioid medication, which I quickly ditched as it made my symptoms worse.

That was twelve years ago. In the absence of medical support, I’ve spent hours searching for holistic ways to treat what’s now regarded as a serious neurological condition. Back then, it was poorly understood and often dismissed. To top it off, I was in the early stage of perimenopause, which shares some symptoms with ME/CFS. I’ve been in an on-off relationship with chronic fatigue and pain since.

I’ve slowly found a balance over the last decade. If I take an extended walk or travel, get overly stressed, or go to a party, I’ll need to factor in enough time to rest afterwards. While I need to lie down most days, I have mild-to-moderate ME/CFS, so I’ve recovered enough to manage most day-to-day activities: I work part-time, see friends, run a home.

I can’t manage long-term, full-time work, intense or prolonged exercise, or lots of socialising. Having chronic fatigue has affected my career, relationships and family plans. I didn’t try for another child because of it. Even so, I’m one of the lucky ones. About 25% of sufferers have ME/CFS so severe that it leaves them bedbound.

What is chronic fatigue syndrome?

The ME Association describes chronic fatigue as a complex, long-term condition that affects multiple body systems and varies greatly from person to person. Its cause is not fully understood, although it often develops after an infection.

It’s believed that ME/CFS disrupts the body’s energy production, resulting in a host of symptoms. The most common symptom is profound fatigue that doesn't ease with rest or sleep. This makes it very different from perimenopause fatigue.

Women’s health issues are notoriously underfunded and under-researched, and ME/CFS is no different. If you want to learn more, I recommend reading this BBC article, Elinor Cleghorn’s excellent book Unwell Women, and watching Davina McCall’s Sex, Myths and the Menopause.

Until recently, there was limited information or help available for chronic fatigue, even though 400,000 people in the UK have it. The same goes for menopause, even though it affects more than one billion women worldwide. It's no coincidence that both primarily affect women.

In some ways, the pandemic was a blessing for chronic fatigue sufferers. Thanks to Long Covid, which shares many similarities with ME/CFS, there's been more funding and research, such as the Rosetta Stone Study by Imperial College London.

Menopause and chronic fatigue syndrome

The ME Association states that the female-to-male ratio of chronic fatigue sufferers is around 70% female to 30% male, and that there’s an "interaction between immune-system responses and female hormones". In general, autoimmune diseases mainly affect women.

For women, peak onset periods for developing ME/CFS are puberty and their 30s to 40s, both periods of huge hormonal shifts. Some mothers-to-be with ME/CFS find their symptoms significantly improve during pregnancy, indicating that female hormones have a part to play in these conditions.

According to ME Research UK, a 2023 paper suggests that "hormonal changes during the menstrual cycle, particularly prior to menstruation, perimenopause, menopause and post-menopause, may all exacerbate [ME] symptoms, or act as a trigger for disease".

Going through menopause can definitely cause an exacerbation of ME/CFS, confirms Dr Charles Shepherd, an honorary medical adviser to the ME Association for more than 40 years. "A number of menopause symptoms – such as fatigue, night sweats, cognitive dysfunction and headaches – overlap," he says.

Yet, there’s very little research into ME/CFS and menopause, say Gabrielle Humphreys and Nilihan Sanal-Hayes, lecturers in Psychology at the University of Salford and the first author and project lead, respectively, of a study published in 2026.

“Our scoping review found very little research on the relationship between ME/CFS and menopause, with only three studies examining this topic,” confirms Gabrielle. “Importantly, none of these studies looked at how ME/CFS affects menopause symptoms, such as hot flushes or night sweats. Instead, they looked at how menopause affects ME/CFS.”

In a small 2019 study, Nilihan adds, 8% of female ME sufferers felt their symptoms improved during perimenopause, but 38% felt their symptoms worsened.

The lecturer's review found no studies addressing the link between taking HRT and the easing of ME/CFS symptoms. However, a 2025 article examining people with Long Covid found that, as women showed stronger inflammation and different hormone and immune changes from men (including lower testosterone), treatments tailored by sex (possibly including HRT) might be worth exploring, says Gabrielle.

When I started on HRT five years ago, I found it improved some perimenopause symptoms, such as mood swings, waking up at night, and hot flushes. But while it’s continued to help with those symptoms, it hasn’t made much of a dent in ME/CFS fatigue and flare-ups.

What helped my chronic fatigue

Chronic fatigue and perimenopausal symptoms are so varied and variable. Finding what works involves trial and error for women experiencing both. While the following have been useful for me, they may not work in the future, and they may not work for others. Consult your doctor for personalised advice.

Intermittent fasting (16:8)

Intermittent fasting was a game changer for me. I found that eating can trigger ME/CFS symptoms. Though there's some interesting research on the topic, including this study on Long Covid, the benefits are more anecdotal than scientific.

It's thought that fasting for at least 12 hours (preferably 16 or more) triggers the autophagy process, which can clear cellular waste and reduce inflammation.

Intermittent fasting isn't suitable for everyone, though, and it can make some sufferers feel worse. This is just my personal experience.

HRT

HRT hasn't eliminated my chronic fatigue symptoms, but it has prevented my perimenopause symptoms from intensifying them. For that reason alone, I think it's worth trying if you’re perimenopausal and have ME/CFS or Long Covid.

“HRT isn’t normally contraindicated if you have ME/CFS, so discuss this option, which can often help relieve a number of symptoms that overlap with ME/CFS, with your GP,” says Dr Shepherd.

“If you don't want to, or cannot, use HRT, there are other options that may help with symptom relief.”

Supplements

I’ve tried a plethora of supplements in an attempt to reduce symptoms, and found that only a few have been effective. Magnesium helps me with sleep and joint pain, and nicotinamide mononucleotide (NMD) or nicotinamide adenine dinucleotide (NAD+) have partially reduced my fatigue and energy crashes.

Coenzyme Q10 (CoQ10) can also support mitochondria (the parts of cells that turn food and oxygen into energy), so it may be a good choice for ME/CFS.

According to a 2022 study, NAD+ precursors such as nicotinamide mononucleotide (NMN) and nicotinamide riboside (NR) "could be used as potential treatments to correct anxiety disorders, fatigue, and social deficits", but these results are from animal, not human, studies.

However, "raising intracellular NAD⁺ levels can improve the quality of life by improving neurological function, promoting energy production, and lowering fatigue."

“The fall in oestrogen at menopause increases the risk of osteoporosis, and people with ME/CFS who are housebound are at increased risk of vitamin D deficiency, so vitamin D supplementation should also be discussed with your doctor,” adds Dr Shepherd.

While lifestyle changes, mindset shifts, hormonal treatments, and supplements have gone some way to help my chronic fatigue, it's unlikely I'll ever fully recover. I hope it doesn't get worse when I'm post-menopausal, but with such limited research, only time will tell.

Having ME/CFS means it's harder to do things that support my health, such as exercising regularly, but I've adapted, and my fingers are crossed for better treatments in the future.

Spoon theory

Any activity comes with consequences when you have chronic fatigue. The Spoon Theory envisions units of energy as spoons. Healthy people have more spoons than people with chronic fatigue illnesses, who must limit their spoons to a certain number of tasks throughout the day. Some will be more demanding than others.

So, if I have 12 spoons a day and I’ve learned that going to the gym uses 4 spoons, cooking 2, and work 3, that leaves 3 spoons for all other activities. I've found this form of pacing can be very effective.

Visible band

I’ve been really pleased with my Visible band. This device tracks my heart rate and heart rate variability (HRV), so I can pace my daily activities. It also warns me to rest before a flare-up or crash.

The app generates a daily stability score to help me stay within my energy limits, and it acts like a journal for symptoms and triggers.

This year, woman&home's Menopause Awareness Month series explores women's experiences of developing health conditions during perimenopause, and the lasting impact they can have on their lives. From chronic pain and persistent UTIs, to brain fog and struggling to recognise themselves in it all, these experiences go to show that menopause is more than a life stage. It can extend far beyond, affecting women's health, wellbeing and sense of self for years to come.