Understanding Hormonal Fatigue

In this article

“With hypothyroidism, the fatigue isn’t like anything I’ve ever experienced. I feel like I’m walking through a fog all day long, carrying a weight on my shoulders that I can’t shake off.”

“I never understood what true exhaustion was until menopause hit. It’s not just being tired. I feel completely drained, like I haven’t slept for weeks.”

“Some days, it’s as if my body refuses to wake up, even though I’ve had eight hours of sleep. The moment I get out of bed, I already feel like I’m running on empty.”

“Fatigue has become a way of life. There’s no escaping it. It’s there when I wake up, and it stays with me all day, no matter how many naps I take or how much I try to fight through it.”

Sound familiar? You’re not alone. Fatigue is an all-too-common struggle in today’s fast-paced world; for many, it’s a daily battle. You wake up feeling groggy and wiped out despite what should’ve been a full night’s rest. While sleep deprivation is often the go-to culprit, the real issue could be hormonal imbalances. Let’s dive into the science behind this hidden hormonal fatigue—what causes it, how it sabotages your energy even after sleep, and how to reclaim your vitality.

Hormonal fatigue refers to extreme tiredness and exhaustion caused by imbalances in the body’s hormonal system. Hormones are chemical messengers that regulate numerous bodily functions, including metabolism, stress responses, immune function, and energy levels. When these hormones are out of balance, it can lead to fatigue that is not alleviated by sleep.

Hormonal fatigue is different from the kind of tiredness we feel after physical exertion or a poor night’s sleep. It’s often a chronic, persistent exhaustion that can profoundly affect your quality of life. It’s not just feeling sleepy—it’s an innate sense of depletion that can affect your ability to focus, exercise, or even get through a typical day’s activities.

Here are some of the signs and symptoms of hormonal-related fatigue.

• Persistent fatigue: Exhaustion even after adequate sleep. 
• Insomnia or poor sleep: Difficulty falling or staying asleep, frequent waking, or inability to fall back asleep. 
• Morning grogginess: Difficulty waking up, waking up feeling groggy and unrefreshed. 
• Exercise intolerance: Post-workout exhaustion as your body struggles to meet energy demands. 
• Brain fog: Poor concentration and memory. 
• Mood swings: Irritability or depression linked to hormonal fluctuations. 
• Feeling overwhelmed: Reduced stress tolerance. 
• Low sex drive: Due to fatigue and hormonal deficiencies. 
• Hypoglycemia: Episodes of low blood sugar, causing shakiness. 

Several key hormones play crucial roles in regulating our energy levels. The following are some of the most important ones to consider when discussing hormonal fatigue.

Cortisol

Known as the “stress hormone,” cortisol is produced by your adrenal glands and helps the body respond to stress. Cortisol helps regulate metabolism, blood sugar levels, and the sleep-wake cycle. Cortisol follows a natural daily rhythm, peaking in the morning to help you wake up and feel alert, and dropping as the day progresses to prepare the body for sleep. When cortisol levels become dysregulated—whether from chronic stress, adrenal dysfunction, or other factors—it can lead to fatigue, difficulty waking up, and trouble falling asleep at night. Over time, prolonged stress may contribute to adrenal fatigue, a controversial but widely discussed condition where your adrenal glands struggle to maintain adequate cortisol output.

Thyroid hormones (T3 and T4)

The thyroid is a butterfly-shaped gland located in the neck that produces thyroid hormones – thyroxine (T4) and triiodothyronine (T3) – responsible for regulating metabolism and energy production. When your thyroid function is impaired, it can lead to fatigue, weight gain, sluggishness, and other symptoms. Hypothyroidism (an underactive thyroid) is one of the most common causes of hormonal fatigue, as insufficient thyroid hormones can slow down your metabolism, making you feel sluggish and tired, even with adequate sleep.

Estrogen and progesterone

Estrogen and progesterone are key players in the female reproductive system and directly impact energy levels. Estrogen also influences serotonin and norepinephrine, neurotransmitters that affect mood and sleep-wake cycles. Estrogen, which rises during the first half of the menstrual cycle, promotes energy and alertness, while progesterone, which increases after ovulation, can have a calming and sedative effect.

Declining estrogen levels during perimenopause and menopause can lead to insomnia, night sweats, and daytime fatigue. Lower progesterone levels due to age and hormonal shifts can make it harder to fall and stay asleep. 

Testosterone

While primarily associated with men, testosterone is also vital for women, contributing to energy, muscle mass, and mood regulation. Low testosterone levels can lead to fatigue, decreased motivation, and a general sense of low energy. This is particularly noticeable in women as they age or undergo menopause, as testosterone levels naturally decline. 

Insulin

Insulin is a hormone produced by the pancreas that helps regulate blood sugar levels. If insulin is not functioning optimally –as is the case with insulin resistance – energy levels can fluctuate, causing feelings of fatigue and sluggishness. Insulin resistance, often associated with conditions like type 2 diabetes, can prevent your body from effectively using glucose for energy, leading to fatigue even if you’re eating well and getting enough rest.

Melatonin

Melatonin is a hormone produced by the pineal gland in the brain and plays a key role in regulating sleep. Melatonin levels rise in the evening, signaling the body that it’s time to sleep. Melatonin levels decrease in the morning to help you wake up. Disruptions to melatonin production, such as those caused by irregular sleep patterns or exposure to blue light at night, can lead to poor-quality sleep and chronic tiredness. Melatonin, the sleep hormone, decreases with age, particularly during menopause, disrupting sleep rhythms and reducing sleep quality. Lower melatonin levels are also linked to insomnia and fragmented sleep, leaving people feeling tired in the morning. 

Hormonal fatigue can be triggered by a variety of factors. Let’s look at some of the most common causes.

Chronic stress

Prolonged stress can lead to chronic elevation of cortisol, the stress hormone. This constant state of high cortisol can disrupt the body’s normal daily rhythm, making it difficult to wake up refreshed and energized. Over time, this stress response can lead to adrenal fatigue, a condition where the adrenal glands become depleted and unable to produce sufficient amounts of cortisol, leading to feelings of exhaustion and sleep disturbances. 

Hypothyroidism and Hashimoto’s thyroiditis

An underactive thyroid – hypothyroidism – is one of the leading causes of hormonal fatigue. When the thyroid produces insufficient thyroid hormones (T3 and T4), the body’s metabolic processes slow, resulting in symptoms such as fatigue, sluggishness, muscle weakness, weight gain, and cognitive difficulties like memory lapses or difficulty concentrating. Even though you may get a full night’s sleep, you might still feel drained if your thyroid isn’t functioning properly. Hashimoto’s thyroiditis is an autoimmune disease characterized by an ongoing immune system attack against the thyroid gland that usually leads to hypothyroidism. Fatigue is a hallmark symptom of Hashimoto’s thyroiditis.  

Perimenopause and menopause

As women approach perimenopause and menopause, there are significant fluctuations – and eventually drops -- in estrogen, progesterone, and testosterone levels, which can cause a range of symptoms, including sleep disruptions, low energy, and fatigue. Progesterone’s calming effects decrease, while estrogen and testosterone’s energizing effects diminish, which can leave women feeling more tired than usual.

Adrenal fatigue

Adrenal fatigue occurs when your adrenal glands, which produce the hormone cortisol, become overstressed and depleted due to prolonged periods of chronic stress. The adrenal glands help regulate various bodily functions, including the body’s response to stress, metabolism, immune function, and energy production. When these glands are overburdened, they can no longer produce sufficient amounts of cortisol, leading to persistent tiredness, difficulty waking up in the morning, low energy throughout the day, and a general sense of burnout. Many people with adrenal fatigue also experience mood swings, difficulty concentrating, cravings for salty foods, and a weakened immune system. Adrenal fatigue is not officially recognized as a medical diagnosis by all health organizations.

Insulin resistance and diabetes

Insulin resistance occurs when your body’s cells become less responsive to insulin, the hormone that helps regulate blood sugar levels. As a result, your pancreas produces more insulin to compensate for the reduced effectiveness, leading to higher insulin levels in the blood. Over time, this increased insulin production can contribute to higher blood sugar levels, a key factor in the development of type 2 diabetes. Insulin resistance can cause various symptoms, including fatigue, weight gain, difficulty losing weight, and frequent hunger.

As the body struggles to use glucose for energy efficiently, fatigue becomes a persistent issue, as the cells cannot receive the energy they need. Untreated insulin resistance can progress into type 2 diabetes, a condition that significantly increases the risk of complications such as heart disease, stroke, and nerve damage.

Sleep disorders

Conditions like hypothyroidism can increase your risk of sleep apnea, and any hormonal imbalance can increase the risk of insomnia. These sleep disorders lead to poor sleep quality, which in turn disrupts the production of hormones like cortisol and melatonin, further compounding feelings of exhaustion.

Poor diet

A poor diet and nutritional deficiencies can significantly contribute to feelings of fatigue and exhaustion. When the body lacks essential nutrients like iron, vitamin B12, magnesium, and vitamin D, it struggles to produce the energy required for daily activities. Iron deficiency, for instance, can lead to anemia, reducing the oxygen supply to tissues and making individuals feel drained. Inadequate intake of B vitamins can impair metabolism, resulting in sluggishness and tiredness. Additionally, a lack of magnesium can disrupt muscle function and increase feelings of fatigue, while insufficient vitamin D levels may affect mood and energy production. Over time, these deficiencies can compound, leading to chronic tiredness that may affect overall well-being and quality of life.

Various medical tests can help diagnose the hormonal imbalances that cause or contribute to fatigue. They include:

TSH (Thyroid-stimulating hormone): Elevated TSH suggests hypothyroidism, which can contribute to fatigue 

Free thyroxine (Free T4) and free triiodothyronine (Free T3): Measure thyroid hormones. Low T4/T3 with high TSH confirm hypothyroidism. 

Thyroid peroxidase antibodies (TPOAb): Detects autoimmune Hashimoto’s thyroiditis, which can cause fatigue. 

Adrenal function/salivary cortisol: A 4-sample saliva test – morning, noon, evening, and night – can identify adrenal imbalances and adrenal fatigue.

DHEA-sulfate (DHEA-S): Low levels may indicate adrenal exhaustion. 

Estrogen/progesterone: Blood or saliva tests can identify imbalances or significant deficiencies that correlate with fatigue. 

Testosterone (Total/free): Low levels in men/women are linked to fatigue and low energy. 

Fasting glucose/insulin: High fasting glucose and high insulin can suggest insulin resistance, which can cause fatigue. 

Hemoglobin A1c: Evaluates long-term blood sugar control, and elevated HA1C levels can suggest insulin resistance, pre-diabetes, or diabetes. 

Melatonin: Low melatonin disrupts sleep cycles. 

If you suspect that hormonal fatigue may be affecting your energy levels, there are steps you can take to address the issue.

Consult a healthcare provider

If you’re experiencing ongoing fatigue despite getting enough sleep, consulting with a knowledgeable healthcare provider is essential. Your provider can run tests to check for hormonal imbalances, evaluate the results, and recommend appropriate treatments.

Treat hypothyroidism

Hypothyroidism is primarily treated with daily thyroid hormone replacement medication, which replaces the hormone the thyroid gland fails to produce sufficiently. The dosage is carefully adjusted through regular blood tests to monitor thyroid-stimulating hormone (TSH), free thyroxine (Free T4), and free triiodothyronine (Free T3) levels. While some patients experience symptom improvement within weeks, others may take several months to notice changes, particularly in fatigue. A 2023 study demonstrated that levothyroxine significantly reduces fatigue severity, with median Fatigue Severity Scale (FSS) scores dropping from 53 to 36 after six months of treatment.  For many patients, thyroid medication restores energy levels, though adjunct strategies like exercise and addressing nutrient deficiencies may help relieve continuing fatigue. Combination therapy with triiodothyronine (T3) is not routinely recommended due to insufficient evidence of superiority over levothyroxine monotherapy.

Get hormone replacement therapy (HRT) when necessary

In some cases, hormone replacement therapy (HRT) or medications may be necessary to restore balance to your body’s hormonal systems and stabilize estrogen and progesterone levels. This is particularly relevant for women with hypothyroidism and/or perimenopausal and menopausal symptoms. Work with a healthcare provider to determine the best course of action for your specific situation.

Control elevated blood sugar and diabetes

Managing blood sugar and effectively diagnosing and treating diabetes can significantly improve fatigue. When blood glucose levels are consistently too high or too low, the body struggles to use energy efficiently, leading to feelings of exhaustion, brain fog, and reduced stamina. By stabilizing blood sugar through medication, balanced nutrition, regular physical activity, and stress management, the body gains better access to the energy it needs throughout the day. As glucose control improves, many people experience more consistent energy levels, better sleep, and a noticeable reduction in chronic fatigue.

Manage your stress

Practicing stress management can be a powerful tool in relieving hormonal fatigue, a condition often triggered or worsened by chronic stress. When the body is under constant pressure, it activates the hypothalamic-pituitary-adrenal (HPA) axis, flooding the system with cortisol and other stress hormones. Over time, this can disrupt the delicate balance of hormones like thyroid hormones, estrogen, and progesterone, leading to exhaustion, brain fog, and sleep disturbances. Incorporating stress management techniques such as deep breathing, mindfulness meditation, gentle movement like yoga, and prioritizing rest can help calm the nervous system, reduce cortisol levels, and support more balanced hormone production. In turn, this helps restore energy, stabilize mood, and improve overall well-being.

Prioritize sleep

Ensuring high-quality sleep is essential for balancing hormones and fighting fatigue. Practice good sleep hygiene by creating a relaxing bedtime routine, limiting screen time and light exposure before bed, and trying to sleep and wake up at the same time every day to support healthy melatonin production, as well as adrenal balance.

If you have an underlying sleep disorder like sleep apnea or insomnia, diagnosis and treatment can drastically improve energy levels. 

Improve your nutrition

A balanced diet can support hormonal health. Focus on whole foods, healthy fats, lean proteins, and fiber-rich vegetables to stabilize blood sugar and hormone production. Consider working with a nutritionist to address specific dietary needs that may impact your hormone levels. You’ll also want to address nutrient deficiencies with supplements (e.g., magnesium, vitamin D) under medical supervision. 

Exercise regularly

Regular physical activity can help regulate hormones, reduce stress, improve insulin sensitivity, and increase energy levels. Aim for a mix of aerobic exercise, strength training, and flexibility exercises to keep your body balanced and energized.

Hormonal fatigue is a complex condition that can leave you exhausted, even after a full night’s rest. When key hormones like cortisol, thyroid hormones, estrogen, progesterone, and insulin become imbalanced, your body’s energy regulation systems can go off track—resulting in persistent tiredness and burnout. At Paloma Health, we specialize in identifying and treating hormonal imbalances, especially those related to thyroid health, perimenopause and menopause, and hormonal weight gain. Our expert providers take a comprehensive, personalized approach to uncover the root causes of your fatigue and guide you toward effective solutions.

If you’re struggling with ongoing fatigue that sleep doesn’t seem to fix, it may be time to explore whether a hormonal imbalance is to blame. Paloma Health offers convenient testing, virtual consultations with knowledgeable providers, and evidence-based treatment plans that include targeted lifestyle changes, nutritional guidance, and medical therapies to help restore balance and reclaim your energy.

Don’t settle for just “powering through” the day. With the right support, it’s possible to feel like yourself again—and Paloma Health is here to help you every step of the way.

• Hormonal fatigue is a persistent, profound exhaustion caused by imbalances in hormones like cortisol, thyroid hormones, and estrogen and is not relieved by sleep.
• Symptoms include morning grogginess, brain fog, low libido, mood swings, and poor exercise recovery—even when sleep and rest are adequate.
• Cortisol, thyroid hormones, melatonin, insulin, estrogen, progesterone, and testosterone regulate energy levels, and imbalances can disrupt sleep and metabolism.
• Common causes of hormonal fatigue include hypothyroidism, Hashimoto’s, perimenopause/menopause, adrenal fatigue, insulin resistance, and chronic stress.
• Diagnostic tests can identify hormone imbalances, including TSH, free T3/T4, cortisol levels, sex hormone panels, and insulin or glucose markers.
• Treatment includes hormone therapies (like levothyroxine or HRT), lifestyle changes (stress management, quality sleep, diet, and exercise), and targeted nutritional support.