Best Treatments for Low Energy in Women Over 40

The best treatment for low energy in women over 40 depends on what is draining you. Three causes are worth checking first: low iron stores if you still have periods, a vitamin shortfall such as B12, and menopause symptoms like night sweats that wreck your sleep. In a trial of tired women with low iron stores who still had periods, iron pills cut fatigue by almost half in 12 weeks. Hormone therapy treats the menopause symptoms that come with exhaustion. NAD+ is the newer option women try once those are covered.

Why am I so tired all the time after 40?

Menopause is a big part of the answer for many women. Hot flashes and night sweats affect nearly 75% of women and last 7.4 years on average, according to a FIGO position paper on menopause hormone therapy. Night sweats tend to come with poor sleep, fatigue, low mood, memory slips and poor concentration. Brain fog is also a recognized part of the change. Women going through menopause often have trouble with memory, concentration and learning.

Iron is the other common drain. Low iron stores can make you tired even when a blood test says you are not anemic. Researchers think iron deficiency may be an under-recognized cause of fatigue in women who still have periods.

Low energy can also look like losing interest in things you used to enjoy. One 55-year-old CEO, five years into menopause, wrote in r/Menopause: "I can't seem to bring myself to sand and paint the front door, or weed the flower beds, or cook a 'fancy' meal." Another woman replied: "I'm realising I'm going to rely on discipline instead of motivation for (maybe?) the rest of my life."

Which treatment for low energy fits my cause?

Can iron help my energy if I'm not anemic?

Yes, if your iron stores are low. A French trial gave iron or a placebo to women aged 18 to 50 who still had periods and felt very tired. None of them were anemic, and all had ferritin below 50 μg/L. Fatigue dropped by 47.7% on iron and by 28.8% on placebo, so the drop on iron was 18.9 percentage points bigger.

Iron helped the tiredness, but it did not change mood, anxiety or overall quality of life. If you also feel flat or anxious, iron alone may not fix that.

The trial used a low dose of slow-release iron. Women taking iron had no more stomach aches, constipation or diarrhea than women taking the placebo.

The trial only included women who still had periods. Ask your clinical team about checking your ferritin before you buy iron, especially if your periods are heavy or irregular.

Does hormone therapy help with menopause tiredness?

Hormone therapy treats the hot flashes and night sweats that come with poor sleep and fatigue. The FIGO position paper says you get the most benefit if you start soon after symptoms appear, and you can keep taking it while the benefits still outweigh the risks.

If you still have a uterus, estrogen is paired with a progestogen. Under the European Society of Endocrinology menopause guideline, your clinical team checks how you are doing at 3 months. They adjust the dose or form if it is not working well enough or if you have side effects.

The popular herbal routes have weak support. The same guideline found black cohosh had no significant effect on hot flashes, and plant estrogens showed no clear benefit. Regular exercise did make hot flashes less severe.

Hormone therapy is not for everyone. You cannot take it if you have had breast cancer, coronary heart disease, a stroke or a blood clot, or if you have severe active liver disease. Your clinical team asks about these before prescribing.

Hormone therapy may not fix every kind of tiredness. The 55-year-old CEO in r/Menopause wrote: "I've been on HRT for about six years and my doctor doesn't want me to increase it anymore," and she still felt flat. That is why it makes sense to check iron and vitamins first.

Our clinical team can prescribe bioidentical estrogen if it fits your symptoms and your history.

Is NAD+ worth trying for energy?

NAD+ is a molecule your cells use to make energy. In a 6-week trial of healthy middle-aged and older adults, an oral NAD+ booster called nicotinamide riboside raised NAD+ in blood cells by about 60%. People who started with the lowest levels tended to get the biggest rise.

In that trial, exercise capacity, body fat and motor function did not change. So far, the research shows that NAD+ levels go up. It has not yet shown that you will feel more energetic.

People tolerated the oral booster well. Side effects were mild and included nausea, flushing, leg cramps and bruising more easily, and no one quit while taking it. Those results are for the pill, so ask your clinical team what to watch for with injections.

Compounded NAD+ injections are not FDA-approved. In 2017, an FDA advisory committee voted against adding NAD to the list of ingredients pharmacies can use for compounding. The FDA proposed the same in 2019, but that rule has not been finalized.

Our clinical team can prescribe NAD+ if it fits your goal.

Take the quiz and tell us about your energy, your periods and your sleep. Your clinical team uses your answers to plan around what is draining you, whether that turns out to be bioidentical estrogen, NAD+ or another option.