[Series Part 2] The Deep Connection Between Menopause and Fatigue—Understanding How Hormonal Changes Affect Your Body

Important Notice

This article is provided for informational purposes by a counseling salon with medically knowledgeable staff and is not intended to provide medical diagnosis, treatment, or prescription. If you are experiencing serious physical or mental health symptoms, please consult a healthcare provider. Our services provide counseling, care, and support and are not a substitute for medical treatment.

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Introduction—Review of Part 1 and Today’s Topic

In our previous article, we explained that “unexplained fatigue” has three layers (body, mind, and soul) that are intricately interconnected. Understanding this three-layer structure is the first step toward overcoming chronic fatigue.

We received many comments from readers saying, “My fatigue applies to all three layers” and “I’d like to know more details about the physical aspects.” Your 40s ~60s are a time when your body undergoes significant changes, and these changes very often manifest as fatigue.

So from this installment forward, we’ll explore Layer 1: Physical Fatigue in greater detail over three articles, with practical insights.

Body Fatigue Series (Parts 2-4) Structure:

• Part 2 (Today): Menopause and Fatigue—A Deep Dive into Hormonal Changes
• Part 3: The Autonomic Nervous System and Sleep—Recovery Mechanisms and Practical Approaches
• Part 4: Nutrition and Lifestyle—Practical Self-Care for Physical Well-being

Today, we focus on one of the most important factors for understanding fatigue in your 40s~60s: menopause and hormonal changes.

AzulMar has a physician on staff, and we provide holistic support that integrates medical perspectives with psychological counseling and spiritual care. (Note: We do not provide medical diagnosis or treatment.)

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Why Menopause Is Deeply Connected to Fatigue—Often Overlooked Physical Changes

“Lately, I’ve been tired for no reason.”
“Things that never used to bother me now exhaust me.”
“Even when I rest, the fatigue doesn’t go away.”

If you’re in your 40s~60s and experiencing these symptoms, there’s a good chance that hormonal changes related to menopause are playing a role.

Menopause Is Not a “Disease”—It’s a Natural Life Transition

First, it’s essential to understand that menopause is not a disease but a natural physical change that everyone experiences.

For women, it’s a transition from reproductive years to post-reproductive years. For men, it’s a shift from a period of active hormone production to a more subdued phase. The various symptoms that appear during this transition are what we call menopausal symptoms.

However, just because it’s “natural” doesn’t mean you should simply endure it. When symptoms are severe, appropriate support can significantly improve your quality of life (QOL). This isn’t “weakness”—it’s a wise choice to care for your body.

Menopausal Symptoms Vary Greatly Among Individuals

How menopause manifests varies dramatically from person to person.

Some people barely notice any symptoms, while others experience symptoms severe enough to disrupt daily life. Even for the same person, symptom intensity can vary over time.

This wide individual variation makes menopausal symptoms difficult to understand. Even if others say “menopause is no big deal,” if you’re suffering, that’s your reality and it matters.

Symptom severity is influenced by factors including:

• Physical factors: Baseline hormone levels, body sensitivity, constitution, existing health conditions
• Psychological factors: Stress levels, personality traits (perfectionism, conscientiousness), cognitive patterns
• Social factors: Home environment (caregiving, parenting), work situation, relationships, availability of support
• Lifestyle factors: Sleep, exercise, diet, smoking, alcohol consumption

These factors combine in complex ways to create each person’s unique menopausal experience.

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Women’s Menopause—How Estrogen Decline Affects the Entire Body

Women’s menopause generally refers to the approximately 10-year period around the cessation of menstruation, typically between ages 45 and 55. The average age of menopause for Japanese women is about 50, though this varies—some experience it in their early 40s, others in their late 50s or 60s.

What Is Estrogen?—The Multifaceted Role of “Female Hormones”

When you hear “estrogen” (female hormones), you might think primarily of reproductive functions. However, estrogen is actually involved in various functions throughout the body and is an extremely important hormone.

Estrogen is primarily produced in the ovaries and has these wide-ranging functions:

• Reproductive function: Thickening the uterine lining, promoting ovulation, preparing for pregnancy
• Bone health: Promoting bone formation and maintaining bone density
• Vascular health: Keeping blood vessel walls flexible and preventing atherosclerosis
• Brain function: Contributing to memory, concentration, and mood stability
• Skin health: Promoting collagen production and maintaining skin moisture and elasticity
• Lipid metabolism: Increasing good cholesterol (HDL) and decreasing bad cholesterol (LDL)
• Temperature regulation: Acting on the hypothalamic temperature control center
• Autonomic nervous system: Balancing sympathetic and parasympathetic nervous systems
• Energy metabolism: Supporting energy production in cellular mitochondria

As you can see, estrogen is deeply involved not just in “femininity” but in maintaining overall health. Therefore, when estrogen decreases during menopause, it affects not only reproductive functions but virtually every part of the body.

The Connection Between Estrogen Decline and Fatigue—Why You Become “Tired More Easily”

Why does estrogen decline during menopause increase fatigue? Let’s examine the mechanisms in detail.

1. Decreased Energy Production Efficiency

Our bodies convert nutrients from food into energy (ATP: adenosine triphosphate) in cellular organelles called “mitochondria.” Estrogen actually supports this mitochondrial function.

Estrogen acts on mitochondrial membranes to enhance energy production efficiency. When estrogen decreases during menopause, mitochondrial function declines, and the body can no longer convert nutrients into energy as efficiently as before.

The result? “I’m doing the same things as always, but I tire quickly,” “My body feels heavy,” “I don’t feel like moving.” This isn’t your imagination—it’s an actual physiological change at the cellular level in energy production capacity.

2. Declining Sleep Quality and the Fatigue Cycle

Estrogen promotes sleep quality, particularly “deep sleep” (slow-wave sleep). Deep sleep is essential for physical repair, growth hormone secretion, immune system recovery, and memory consolidation.

When estrogen decreases during menopause, deep sleep decreases and is replaced by lighter sleep. As a result, even if you sleep the same number of hours, your body doesn’t recover sufficiently, leading to “I’m tired even after sleeping.”

Additionally, nighttime sweating (hot flashes) and feelings of warmth—symptoms specific to menopause—can cause frequent nighttime awakenings, further reducing sleep quality.

When sleep quality declines, daytime fatigue increases, which creates stress that further reduces sleep quality—a vicious cycle.

3. Autonomic Nervous System Imbalance Creates a “Body That Can’t Rest”

Estrogen acts on a brain region called the hypothalamus to regulate autonomic nervous system balance. The autonomic nervous system includes the sympathetic nervous system (active during activity) and the parasympathetic nervous system (active during rest), and we live with appropriate switching between these two systems.

When estrogen decreases during menopause, this autonomic balance becomes easily disrupted. A particularly common issue is the sympathetic nervous system remaining overactive.

When the sympathetic nervous system is dominant, your body is constantly in “battle-ready mode”—heart rate increases, blood pressure rises, muscles tense, and digestive function is suppressed. When this state continues, your body can’t rest and keeps consuming energy.

If you find yourself “unable to relax at night,” “always on edge,” or “constantly experiencing neck and shoulder tension,” you may be in a sympathetic-dominant state.

4. Serotonin Decline Affects Mood and Motivation

Estrogen promotes the synthesis of the neurotransmitter “serotonin” in the brain. Serotonin is deeply involved in mood stability, feelings of happiness and security, and motivation—it’s often called the “happiness hormone.”

When estrogen decreases during menopause, serotonin synthesis also decreases, making the following psychological symptoms more likely:

• Depressed mood, feeling blue
• Anxiety, restlessness
• Irritability, anger
• Decreased motivation, “I don’t want to do anything”
• Reduced concentration and memory
• Inability to enjoy things (anhedonia)

These psychological symptoms further amplify physical fatigue. A negative cycle emerges: “I’m tired → my mood drops → I feel even more tired.”

Additionally, serotonin is the raw material for the sleep hormone “melatonin.” When serotonin decreases, melatonin also decreases, creating a double impact that further reduces sleep quality.

5. Temperature Regulation Dysfunction—Hot Flashes and Fatigue

Estrogen acts on the hypothalamic temperature control center to maintain a constant body temperature. When estrogen decreases during menopause, this temperature regulation function becomes unstable, and “hot flashes (sudden feelings of heat and sweating)” can occur.

Hot flashes involve sudden body heat and heavy sweating, occurring not only during the day but also at night. Nighttime hot flashes disrupt sleep and prevent fatigue recovery.

Additionally, when hot flashes occur, your body expends energy trying to respond to rapid temperature changes. This frequent energy expenditure also contributes to chronic fatigue.

Hot flashes can be embarrassing and anxiety-inducing when they happen in public, creating psychological stress that can worsen symptoms.

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The Diversity of Menopausal Symptoms—Understanding More Than Just Fatigue

Menopausal symptoms aren’t limited to fatigue. A wide variety of symptoms appear, with considerable individual variation.

Vasomotor Symptoms

These result from autonomic nervous system imbalance:

• Hot flashes (flushing/sweating): Sudden heat in the face or upper body with heavy sweating. Can occur multiple times daily and disrupt daily activities.
• Heart palpitations: Heart racing without physical exertion, sometimes accompanied by anxiety.
• Dizziness/lightheadedness: Feeling dizzy upon standing (orthostatic hypotension), constant floating sensation.
• Chills: Cold hands and feet, feeling cold to the core. Hot flashes and chills can alternate.

These symptoms reflect your body’s confusion—having lost estrogen as its “commander,” it’s trying to regain balance through trial and error.

Psychological and Neurological Symptoms

These result from changes in brain hormone balance and neurotransmitters:

• Depressed mood: Feeling down for no reason, tearfulness, pessimism
• Anxiety/restlessness: Vague anxiety, anticipatory worry that “something bad will happen,” inability to settle down
• Irritability: Getting annoyed over small things, anger, difficulty controlling emotions
• Insomnia: Difficulty falling asleep, waking frequently at night, early morning awakening
• Memory and concentration problems: Increased forgetfulness, trouble recalling names, difficulty retaining information from books or movies
• Decreased motivation: Not wanting to do anything, unable to enjoy hobbies, reluctance to go out

These symptoms resemble depression, so many people suffer without recognizing them as menopausal symptoms. If you’re in your 40s~60s experiencing these symptoms, it’s important to consider the possibility of menopause.

Musculoskeletal Symptoms

Symptoms affecting bones, muscles, and joints:

• Shoulder and back pain: Chronic stiffness and pain. Massage provides only temporary relief.
• Joint pain: Morning stiffness and pain in finger joints particularly. Knee or shoulder pain.
• Muscle pain: Muscle pain despite not exercising, body feeling heavy.

Estrogen is involved in maintaining bone density, muscle quality, and joint flexibility. When it decreases, these functions decline, manifesting as pain and stiffness.

Skin and Mucous Membrane Symptoms

Estrogen promotes collagen production and maintains skin and mucous membrane moisture:

• Dry skin: Flaky skin, makeup doesn’t apply well, increased wrinkles
• Itching: Body itches for no apparent reason
• Vaginal dryness: Pain or discomfort during intercourse
• Dry mouth: Constant dry mouth, changes in taste

These are often dismissed as “cosmetic issues” but significantly impact quality of life.

Urinary Symptoms

• Frequent urination: Needing to urinate more often, especially at night
• Urinary incontinence: Leaking urine when sneezing or coughing (stress incontinence)

Caused by weakening pelvic floor muscles and estrogen-related changes in urethral and bladder function.

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Severity of Menopausal Symptoms—Understanding and Responding to “Mild, Moderate, and Severe”

The intensity of menopausal symptoms varies greatly among individuals. In clinical settings, several assessment scales are used to evaluate symptom severity.

Simplified Menopausal Index (SMI)

This is a widely used method in Japan for evaluating menopausal symptoms. Ten symptoms are scored for intensity, and total points determine severity:

• 0-25 points: Normal. No treatment necessary.
• 26-50 points: Lifestyle improvements (diet, exercise) recommended.
• 51-65 points: Gynecological consultation and medication therapy recommended.
• 66-80 points: Long-term treatment plan needed.
• 81-100 points: Detailed examination by various specialists needed.

You can perform this assessment yourself, but what’s more important than the score itself is objectively understanding “how much my symptoms are affecting my daily life.”

Mild Menopausal Symptoms

Symptoms that cause little disruption to daily life:

• Occasional hot flashes that resolve quickly
• Feeling a bit more tired than usual, but recovery with rest
• Sometimes irritable but able to control it

At this level, symptom relief often comes from lifestyle improvements (regular routine, moderate exercise, balanced diet, stress management).

Moderate Menopausal Symptoms

Symptoms causing some disruption to daily life but still manageable:

• Frequent hot flashes causing difficulties at work or when out
• Strong fatigue affecting household and work efficiency
• Poor sleep quality with daytime drowsiness
• Irritability or low mood beginning to affect relationships

At this level, in addition to lifestyle improvements, consulting with a gynecologist is recommended. Various options are available: herbal medicine, hormone replacement therapy (HRT), counseling, etc.

Severe Menopausal Symptoms

Symptoms significantly disrupting daily life and work:

• Very frequent hot flashes preventing going out or concentrating at work
• Chronic fatigue making household tasks and work nearly impossible
• Serious sleep disturbance with little to no sleep
• Strong depressed mood with no motivation, suicidal thoughts
• Severe heart palpitations and shortness of breath making daily life difficult

At this level, promptly consult a gynecologist or psychosomatic medicine specialist. Appropriate treatment can significantly improve symptoms. Continued endurance places enormous burden on both body and mind.

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Approaches to Menopausal Symptoms—Medical Support and Options

Menopausal symptoms are neither something you “should endure” nor “weakness.” Receiving appropriate support can greatly improve your quality of life.

Gynecology and Women’s Health Clinic Consultations

If menopausal symptoms are moderate or above, or disrupting daily life, consultation with gynecology or a women’s health clinic is recommended.

1. Hormone Replacement Therapy (HRT)

Treatment that supplements decreased estrogen with medication.

• Effectiveness: Highly effective for hot flashes, sweating, insomnia, low mood. Also expected to prevent bone density loss and reduce cardiovascular disease risk.

2. Herbal Medicine

Herbal medicine takes a whole-body balance approach and is commonly used for menopausal symptoms.

Commonly used formulas:

• Tokishakuyakusan: For those with chills, anemia tendency, fatigue
• Kamishoyosan: For those with irritability, anxiety, insomnia
• Keishibukuryogan: For those with flushing, shoulder stiffness, headaches

3. Psychotropic Medications

When depression, anxiety, or insomnia are severe, antidepressants, anti-anxiety medications, or sleep aids may be prescribed.

4. Placenta Therapy

Treatment using placenta extract injections. Covered by insurance for menopausal disorders.

• Effectiveness: Reported effective for fatigue, shoulder stiffness, chills, insomnia

5. Counseling and Psychotherapy

Psychological and social factors significantly contribute to menopausal symptoms. Counseling and cognitive behavioral therapy are also effective.

Benefits:

• Learning stress coping strategies
• Correcting cognitive distortions
• Organizing and expressing emotions
• Finding meaning in menopause as a life transition

At AzulMar, we leverage our strength of having a physician on staff to provide psychological counseling and spiritual care.

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Summary: Menopause as a “Life Transition”—Listening to Your Body’s Voice

Today, we’ve explored in detail why menopause and hormonal changes cause fatigue in women.

Key Points:

1. Menopause is a natural physical change, not a disease
2. Estrogen is involved in whole-body functions; its decline causes diverse symptoms
3. Symptom severity varies greatly among individuals and should not be endured
4. Symptoms can improve with appropriate support (medical care, counseling, lifestyle improvements)
5. Menopause is also an opportunity for self-reflection as a “life transition”

Viewing Menopause as a “New Beginning,” Not “The Beginning of the End”

Menopause marks the end of reproductive capability, but it absolutely does not mean “the end of womanhood” or “life’s downward slope.”

Rather, it’s a time when energy previously directed toward reproduction and child-rearing can now be directed toward yourself. It’s an opportunity to deeply consider “What do I truly want to do?” and “How do I want to live the rest of my life?”

Your 40s~60s are life’s turning point. Looking back on your life so far and envisioning your future—in this process, confronting the physical changes of menopause connects to transformation at the levels of mind and soul.

At AzulMar, with medically knowledgeable staff on board, we understand the physical changes of menopause while providing psychological counseling to support emotional changes and spiritual care for soul-level meaning-making.

Your Body Is Sending Important Messages

Menopausal fatigue, hot flashes, low mood—these are not “nuisance symptoms.” They’re messages from your body saying, “I need rest,” “Please take care of yourself,” “Stop and take time to connect with yourself.”

Listening to that voice and receiving appropriate support while navigating this period of change is a vital process for understanding yourself more deeply and walking a richer second half of life.

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Coming Next: Part 3 “Male Menopause and Fatigue—Understanding Often-Overlooked LOH Syndrome”

While today we focused on women’s menopause, next time we’ll explore male menopause (LOH Syndrome) in detail.

The fact that men also experience menopause remains relatively unknown. However, many men in their 40s~60s suffer from “unexplained fatigue,” “decreased motivation,” and “irritability.”

Next Topics:

• What is male menopause (LOH Syndrome)?
• How testosterone decline affects mind and body
• Differences from and distinguishing from depression
• Diagnosis and treatment options
• Lifestyle improvements that help
• How to understand and support as a partner

Women readers, please read this too to understand and support your partners and family members.

Next Publication Date: October 31, 2025

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AzulMar’s Integrated Support—To Help You Through Menopause

At AzulMar, we provide the following integrated support for menopausal symptoms and fatigue.

Medically Knowledgeable Staff on Board

With a physician on staff, we can provide support based on medical understanding of the connection between menopausal symptoms and fatigue.

• Assessing whether symptoms are menopause-related or potentially other conditions
• Recommending medical consultation (gynecology, psychosomatic medicine) when needed
• Providing counseling and care alongside medical treatment

We do not provide medical diagnosis or treatment, but medically knowledgeable staff support you as a team.

Psychological Counseling

Menopause is not only a physical change but also a major psychological transition.

• Cognitive Behavioral Therapy (CBT) to change how you view menopausal symptoms (cognition) and reduce stress. We support shifting from “menopause = life’s end” to “menopause = new life beginning.”
• Mindfulness to focus on “here and now,” practicing observation and acceptance rather than being overwhelmed by symptoms.
• Focusing to pay attention to body sensations and understand what your body truly needs.
• Emotional processing to safely express and release suppressed emotions (anger, sadness, anxiety).
• Supporting you through menopause-related psychological stressors (children leaving home, parent caregiving, anxiety about aging).

Physical Care

We provide relaxation and care to ease menopausal physical symptoms.

Medical Aromatherapy:

• Essential oils that balance hormones (clary sage, geranium, rose)
• Essential oils that regulate autonomic nervous system (lavender, chamomile, bergamot)
• Relaxation effects to shift from sympathetic to parasympathetic dominance

Medical Body Treatment:

• Skeletal adjustment and posture analysis to balance your body
• Releasing muscle tension, reducing shoulder and back pain
• Improving circulation, easing chills and swelling

Italian Massage:

• Traditional techniques that release deep tension
• When the body relaxes, the mind relaxes—mind-body unity care

These treatments are not medical procedures but effective complementary approaches to ease menopausal symptoms and improve QOL.

Spiritual Care

Menopause is not only a physical transition but also a major turning point at the soul level.

Spiritual Counseling:

• Exploring new life meaning after the “reproductive” role ends
• Looking beyond roles like “mother” and “wife” to see yourself as “myself”
• Envisioning how you want to live the second half of life

Ryukyu Wisdom:
In Ryukyuan culture, women past menopause become “Noro” or “Yuta”—a time when spirituality heightens. Freed from the biological role of reproduction, they advance to a higher spiritual dimension.

Healing and Channeling:

• Balancing body and soul energy
• Listening to inner wisdom and soul’s voice
• Receiving guidance for life’s next stage

Because we have medically knowledgeable staff, you can safely engage in spiritual exploration—that’s AzulMar’s distinctive strength.

Online Sessions and English Support

When experiencing menopausal symptoms, going out can feel daunting. AzulMar primarily offers online sessions accessible from anywhere nationwide.

Additionally, English-speaking residents of Japan can receive counseling in their native language.

AzulMar provides careful support in English.

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Reservations and Inquiries

You don’t have to struggle alone with menopausal fatigue.

[Languages]
Japanese and English (English sessions available)

[Session Format]
Online (Zoom, etc.) / In-person (starting February 2026)

[Service Area]
Nationwide (online)
Nationwide online sessions available

[Initial Consultation]
online
We’ll listen to your situation and propose an optimal care plan

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[Recommended Articles for Readers]

• [Series Part 1] Unexplained Fatigue—A Sign from Your Heart
• Welcome to AzulMar: Your Journey Back to Your True Self
• Essential Menopause Knowledge for Women in Their 40s~60s
• Lifestyle Habits That Balance Your Hormones

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[Tags]
#WomensMenopause #EstrogenDecline #MenopausalSymptoms #MenopauseFatigue #HotFlashes #Women40s50s60s #UnexplainedFatigue #PhysicianOnStaffCounseling #HolisticCare #HormoneBalance #MenopauseDisorder #OnlineCounseling #AzulMar #ReturnToYourTrueSelf