Menopause, Burnout, or Just a Bad Night’s Sleep

Menopause, Burnout, or Just a Bad Night’s Sleep

By Daniela Berg

Intro

If you’re waking up at 3am for no apparent reason, feeling “flat” for days, or wondering why your patience has disappeared overnight, you’re not alone. For many women, the lead-up to menopause can feel like someone quietly swapped your body’s settings while you weren’t looking. One week you’re fine. The next: hot flushes, a racing mind, low mood, brain fog, and a kind of fatigue that coffee can’t touch.

Because these symptoms overlap with stress, burnout and poor sleep (hello, modern life), it’s common to second-guess yourself: Am I just overworked? Is it anxiety? Do I need a holiday? Or is this perimenopause?

Here’s the good news: you don’t have to guess. Understanding what’s happening hormonally—and checking key health markers—can make the whole experience less confusing and a lot more manageable.

The silent epidemic

Perimenopause and menopause can trigger a long list of symptoms: hot flushes, insomnia, fatigue, weight changes, mood swings, anxiety, low mood, brain fog, and reduced short-term memory. Even though menopause is a life stage that most women will experience, many still suffer in silence—often right when careers, caregiving, and day-to-day responsibilities are at their most demanding.

Jean Hailes’ research into menopause symptoms and work found that 17% of mid-life Australian women reported taking an extended break in the last five years due to symptoms attributed to menopause (and 7% reported missing work). That’s not “just a bad week”. That’s a real health issue affecting wellbeing and workforce participation.

Menopause isn’t only about day-to-day symptoms either. Over time, lower oestrogen is linked with changes that can affect bone density and cardiovascular risk factors—two reasons it’s worth taking this transition seriously, even if your main complaint right now is simply “I’m exhausted”.

Menopause 101

Let’s start with the definitions, because most of the confusion begins here.

  • Perimenopause is the transition phase before menopause. Hormone production becomes more unpredictable and your cycle often changes. It commonly starts in a woman’s 40s, lasts on average 4–6 years, and can last anywhere from 1 to 10 years.
  • Menopause is your final period. Clinically, you’re considered “menopausal” after 12 months without a period (if you’re not using hormonal contraception).
  • Postmenopause is the stage after that 12-month mark.

In Australia, most women reach menopause between 45 and 55, and the average age is around 51–52. Women in their 40s can experience symptoms for years before their final period—so if you’re noticing changes now, you’re not “too young” to consider perimenopause.

Menopause, burnout, or both? Why it’s so hard to tell

Menopause and perimenopause can look a lot like “too much life”:

  • Exhaustion, even after a full night’s sleep
  • Trouble falling asleep or staying asleep
  • Mood swings, irritability, anxiety, low mood
  • Brain fog, reduced short-term memory and concentration
  • Weight changes (often around the middle)
  • Headaches
  • A sense of being “wired but tired”

Now layer that onto a busy life and you can see why so many women ask, “Is this me… or my hormones?” The truth is that it’s often a mix: hormonal changes can lower your resilience to stress, and chronic stress can worsen sleep, mood and inflammation—making menopause symptoms feel louder.

The hormonal rollercoaster explained

Perimenopause isn’t a neat, linear decline in hormones. It’s more like a rollercoaster: up, down, sideways, repeat. The biggest players are oestrogen and progesterone, but they don’t act alone.

Oestrogen (oestradiol)

Oestrogen influences temperature regulation, sleep, mood, skin, joints, and bone density. In perimenopause, oestrogen can spike high, drop low, then spike again—often unpredictably. Those fluctuations are strongly linked with vasomotor symptoms like hot flushes and night sweats.

If you’re exploring hormone testing, you can learn more about measuring oestradiol via the Oestradiol (E2) Blood Test (or, for highly sensitive measurement, Oestradiol LCMS).

Progesterone

Progesterone is often described as the “calming” hormone. It interacts with brain pathways involved in relaxation and sleep. As ovulation becomes less consistent in perimenopause, progesterone can drop, which may contribute to anxiety, irritability, and lighter sleep. If you’re still cycling and want to understand where you’re at in your cycle, the Progesterone Blood Test can be one piece of the puzzle.

FSH and LH

As ovarian function changes, the brain tries to “turn the volume up” on signals to the ovaries. That’s why follicle-stimulating hormone (FSH) and luteinising hormone (LH) often rise as menopause approaches. These markers can be helpful in certain clinical situations, but they can also fluctuate—especially in perimenopause. (If you’re looking into this, see the FSH Blood Test and LH Blood Test.)

Testosterone, SHBG and DHEAS

Women also produce testosterone (and DHEAS, a hormone made mostly by the adrenal glands). These can influence libido, mood, energy and muscle maintenance. SHBG (sex hormone binding globulin) affects how much “free” hormone is available. If symptoms like low libido, fatigue, or changes in body composition are part of your picture, testing may include testosterone and SHBG alongside other hormones.

Cortisol (your stress hormone)

Cortisol isn’t a “menopause hormone”, but it matters. Poor sleep increases cortisol. Chronic stress can disrupt sleep. Hot flushes can wake you up. And the loop continues. If you feel anxious, jittery, or like your body can’t switch off, your stress response may be involved. The Cortisol Blood Test can help you assess whether cortisol may be contributing to the “wired-but-tired” cycle.

Thyroid hormones and nutrient status

Midlife symptoms aren’t always menopause. Thyroid dysfunction, iron deficiency and low vitamin D can also cause fatigue, brain fog, mood changes and weight shifts. That’s why a smart approach looks at the whole picture—not just reproductive hormones.

If fatigue, weight changes or temperature sensitivity are prominent, consider a thyroid screen like the Thyroid Function (TSH, Free T3, Free T4) Test. If low energy, poor concentration or “can’t get through the day” fatigue is on the list, iron status matters too (see Iron Studies including ferritin).

Impact on sleep

Sleep is often the first thing women notice changing, and it’s also the symptom that can make everything else feel worse.

Why perimenopause and menopause affect sleep

  • Night sweats and hot flushes can cause sudden awakenings and make it hard to fall back asleep.
  • Lower progesterone may reduce that “sleepy” feeling many women have in the second half of their cycle.
  • Anxiety and a racing mind can increase as hormones fluctuate.
  • Sleep fragmentation (repeated awakenings) reduces time spent in deep, restorative sleep.

If you’re frequently waking during the night, you’re not weak—you’re dealing with biology.

Practical ways to support sleep (without pretending it’s easy)

  • Cool your sleep environment: lighter bedding, breathable fabrics, a fan, and a slightly cooler room can reduce night sweats.
  • Watch triggers: alcohol, spicy food and late caffeine can worsen hot flushes and night waking in some people.
  • Protect your wind-down: aim for a consistent bedtime, dim lights, and screen breaks before bed.
  • Move most days: regular exercise supports mood, sleep quality and metabolic health (even short sessions count).
  • Consider CBT-I: cognitive behavioural therapy for insomnia is one of the most effective long-term approaches for insomnia.
  • Don’t ignore sleep apnoea: if you snore, gasp, or feel unrefreshed despite “enough” sleep, consider an assessment—especially if symptoms worsened with weight changes.

If you want to explore health markers commonly linked with fatigue, stress and sleep quality, browse Sleep Quality & Recovery tests.

Burnout vs perimenopause

It’s not always either/or. Burnout and perimenopause can happen at the same time. But a few clues can help you decide what to investigate.

Signs it could be perimenopause

  • Your cycle changes: shorter, longer, heavier, lighter, or you’re skipping months
  • Hot flushes or night sweats
  • New anxiety or irritability that feels “uncharacteristic”
  • Vaginal dryness, changes in libido, or recurrent UTIs
  • Symptoms that fluctuate week-to-week or track with your cycle

Signs it might be burnout (or something else) driving the bus

  • The strongest trigger is workload, caregiving stress, or relentless “always on” pressure
  • You feel emotionally depleted, cynical, or detached from work
  • Symptoms improve noticeably after rest, then return when the workload returns
  • There are no cycle changes, and no classic vasomotor symptoms

Red flags that deserve a GP review

Regardless of age, seek medical advice if you have:

  • Heavy bleeding, bleeding after sex, or bleeding after 12 months without a period
  • Severe mood symptoms, panic attacks, or thoughts of self-harm
  • Chest pain, unexplained shortness of breath, or fainting
  • Unintentional weight loss, persistent fevers, or severe fatigue

When blood testing helps

A simple blood test can be incredibly useful—but it’s important to set expectations.

Hormone tests aren’t always a “yes/no” answer

In otherwise healthy women over 45, perimenopause and menopause are often diagnosed based on symptoms and menstrual history rather than hormone blood tests alone. That’s because oestrogen and FSH can fluctuate day-to-day in the transition years.

So why test?

Because many symptoms blamed on “hormones” can also be driven by other, treatable factors—and because establishing a baseline is powerful.

Blood tests can help you:

  • Rule out common mimics of menopause symptoms (thyroid dysfunction, anaemia/iron deficiency, B12 deficiency, vitamin D deficiency)
  • Check cardiometabolic markers that become more important after menopause (cholesterol, glucose/HbA1c)
  • Assess vitamin D status and other markers relevant to bone health as part of osteoporosis risk management
  • Look at reproductive hormones when clinically appropriate (e.g., suspected early menopause, symptoms under 45, or when diagnosis is unclear)

What to consider testing (discuss with your health professional)

Depending on your symptoms and age, useful markers may include:

If you’re not sure where to start, browsing the Women’s Health collection can help you match testing options to your goals and symptoms.

Managing the transition into menopause

There’s no single “menopause diet” or one-size-fits-all plan. But there are foundations that reliably support energy, mood, sleep, and long-term health.

Lifestyle habits

  • Nutrition: focus on a well-balanced diet with plenty of fruits, vegetables, whole grains, and protein. Ensuring adequate calcium and vitamin D intake supports bone health.
  • Physical activity: regular exercise can support sleep, mood, and metabolic health. Strength training is especially helpful for maintaining muscle and supporting bone health in midlife.
  • Restful sleep: build a calming bedtime routine and a cool, comfortable sleep environment.
  • Stress management: techniques like yoga, meditation, and breathing exercises can support emotional balance and help dial down the “wired” feeling.

Medical treatment options

Menopausal hormone therapy (MHT)—also commonly called hormone replacement therapy (HRT)—can be effective for moderate to severe symptoms like hot flushes and night sweats. It may also provide bone-protective benefits for some women.

But it’s not for everyone. The decision depends on your symptoms, medical history, and personal risk factors. Your GP can help you weigh benefits and risks, and discuss alternatives if hormones aren’t suitable (including non-hormonal medications and targeted treatments such as vaginal oestrogen for urogenital symptoms).

The key takeaway: you deserve informed, individualised care—not dismissal.

How Bloody Good can help you get clarity

At Bloody Good, we’re big believers in removing the guesswork. The goal isn’t to “prove” you’re in perimenopause with a single number—it’s to understand what’s happening in your body, rule out other causes, and track changes over time.

Sources

Disclaimer: This article is general information only and is not a substitute for medical advice. If you have troubling or persistent symptoms, talk to your GP or a qualified health professional.