Why Am I So Tired All The Time? 5 Common Causes Of Fatigue In Midlife Women

Understanding the nutrition and lifestyle factors that affect energy during perimenopause and menopause, and what can help.

5 Key Areas We Look At First At Crabtree Nutrition

Feeling constantly tired or low in energy is something I see in so many midlife women when they first come to work with me. Many women assume it is just part of getting older, being busy, or navigating hormone changes. While life stage can absolutely play a role, constant fatigue is usually your body trying to tell you something is out of balance.

The good news is that there are some very common and very fixable reasons behind low energy. When I work with clients, I usually start by looking at five core areas.

1. Blood Sugar Balance - The Foundation Of Steady Energy

One of the biggest drivers of fatigue is unstable blood sugar levels. When blood sugar rises quickly and then drops, energy often follows the same rollercoaster pattern.

This can happen if meals are:

• Low in protein

• Low in fibre

• High in refined carbohydrates or sugar

• Skipped or eaten irregularly

As blood sugar spikes, the body releases insulin to bring it back down. If it drops too quickly, it can leave you feeling exhausted, foggy and craving quick energy foods such as sugar or caffeine.

Because blood sugar balance is so fundamental to both energy and overall health, it is one of the core areas I explore with most clients.

Signs blood sugar may be affecting your energy

• Mid-morning or mid-afternoon crashes

• Feeling shaky, irritable or very hungry between meals

• Strong sugar or caffeine cravings

• Feeling sleepy after meals

• Waking during the night and struggling to get back to sleep

What helps

Building meals around protein, fibre, healthy fats and wholefood carbohydrates can dramatically stabilise energy levels. For many people, this is often the single biggest change that improves fatigue, and improvements in energy are often noticed within just a few days.

2. Nutrient Levels - The Building Blocks Of Energy

Your body relies on a steady supply of vitamins and minerals to produce energy inside your cells. Even mild nutrient deficiencies can leave you feeling drained.

This can become even more important during midlife, when hormone changes can increase the body’s need for protein, certain vitamins and minerals, and overall nutrient density.

Some of the most common nutrients linked to fatigue include:

Iron - helps carry oxygen around the body. When iron levels are low, less oxygen reaches your cells and muscles, which can leave you feeling tired, weak and short of breath. During perimenopause, some women experience heavier or more frequent periods, which can increase iron loss and make fatigue more likely if levels are not replenished.

B Vitamins - help your body turn the food you eat into usable energy and support your brain and nervous system. When levels are low, you may feel tired, mentally foggy, low in mood and lacking motivation.

Vitamin D - supports immune health, muscle function and mood regulation. Low levels are linked with fatigue, frequent infections, low mood and reduced physical strength.

Magnesium - helps regulate energy production, muscle relaxation and sleep quality. When levels are low, you may feel tired but wired, struggle with sleep and notice muscle tension or headaches.

My approach with nutrients is always food first. If needed, testing can then help ensure any supplements are personalised and targeted, so you are taking what your body actually needs rather than guessing.

3. Sleep Quality - Not Just Sleep Quantity

Many people tell me they are getting “enough” sleep but still waking feeling unrefreshed. That often suggests sleep quality needs attention.

Things that can affect restorative sleep include:

• Blood sugar dips overnight

• Stress hormones remaining elevated

• Alcohol or caffeine intake

• Late heavy meals or, sometimes, going to bed underfuelled

• Poor sleep routines or excessive evening screen exposure

Sleep is when your body repairs, regulates hormones and restores brain function. If sleep is fragmented or shallow, fatigue often follows, no matter how many hours you spend in bed.

4. Stress And Nervous System Load

A certain amount of stress can be positive and motivating. It helps us respond to challenges and stay alert. The problem tends to arise when stress becomes constant or chronic, which is when it can start to drain energy and affect how the body functions.

Interestingly, stress does not always feel like anxiety. It can show up as:

• Feeling wired but tired

• Energy crashes in the afternoon

• Reliance on caffeine to function

• Feeling overwhelmed but unable to switch off

• Muscle tension, headaches or digestive symptoms

Supporting the nervous system is not just about relaxation techniques. Blood sugar stability, regular meals, adequate protein and key nutrients all help the body become more resilient to stress.

5. Are You Actually Eating Enough?

This often surprises people, but undereating is a very common cause of fatigue, particularly in women trying to manage weight. If calorie intake, protein or nutrient density is too low, the body simply does not have enough fuel to produce energy efficiently.

Some common patterns I see include:

• Skipping breakfast

• Very light lunches

• Relying on snacks instead of proper meals

• Low protein intake

• Limited variety of plant foods

• Diets high in ultra-processed convenience foods

Your metabolism, hormones, immune system and beneficial gut bacteria all rely on regular nourishment. When food intake is inconsistent, energy levels often become inconsistent too.

Many women are surprised to find that simply eating regular, balanced meals can noticeably improve energy, reduce cravings and support steadier moods, which can be especially helpful during perimenopause.

How I Approach Ongoing Fatigue

When someone comes to me feeling constantly tired, we start by strengthening the foundations. That means looking closely at food, blood sugar balance, protein intake, sleep quality and stress levels. In many cases, improving these core areas creates significant changes in energy within weeks.

If progress is slower than expected, or symptoms suggest something deeper may be going on, targeted testing can help us understand what your body specifically needs. This allows any supplement support to be personalised and precise, rather than relying on guesswork or taking taking supplements unnecessarily.

Nutritional therapy works very effectively alongside medical care, and the goal is always to support your body in the most appropriate and evidence-based way.

If you are struggling with ongoing fatigue and would like personalised support to understand what your body needs, you can book a free Health and Energy Review Call where we can talk through your symptoms, goals and next steps.

Book a free health and energy review call here

*When Tiredness Needs Further Investigation

Persistent fatigue should always be discussed with your GP, particularly if it is new, worsening or severe. Medical causes such as thyroid conditions, anaemia, sleep disorders or chronic infections sometimes need to be ruled out.