Here, an OB/GYN explains why you might feel really tired before your period and what you can do about it.

What causes extreme fatigue before your period?

1. Natural hormone fluctuations

As with most PMS symptoms, you can likely blame this one on hormones.

Specifically, estrogen and progesterone levels are at their lowest point leading up to menstruation, says integrative gynecologist and functional medicine doctor Anita Sadaty, MD. “These ‘feel-good’ hormones can also cause a drop in serotonin, which is thought to play a role in mood and energy levels,” she says. “This can then result in feelings of fatigue, moodiness, depression, or even anxiety.”

2. Sleep problems

Along with hormonal changes directly causing fatigue, some people have trouble sleeping in the days or weeks before their period, according to the Office on Women’s Health. Indeed, people who menstruate are more likely to experience poorer sleep quality during the premenstrual and menstruation phases, according to a 2018 study in the Journal of Clinical Sleep Medicine. Not getting enough sleep at night could contribute to feelings of extreme fatigue.

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3. PMDD

When PMS symptoms—including premenstrual fatigue—are severe, it could be a sign of premenstrual dysphoric disorder (PMDD), according to the Office on Women’s Health. PMDD affects about 5 percent of people who menstruate, and it comes with other symptoms, such as extreme irritability or anger, feelings of sadness or depression, anxiety or panic attacks, trouble thinking or focusing, and trouble sleeping.

4. An underlying medical issue

In some cases, it’s possible that extreme fatigue before menstruation or feeling extremely tired during your period is a sign of a medical condition such as PCOS, endometriosis, or iron-deficiency anemia. If your energy levels are truly zapped around your time of the month, it’s worth discussing it with your doctor, especially if you have any other symptoms (and if those symptoms also get in the way of your daily life).

How to cope with fatigue during menstruation

Follow these expert-approved tips for fighting fatigue in the days leading up to your period.

1. Cut back on sugar

Even though you might be craving sweets just before you get your period, it’s best not to go overboard, as it can cause you to have an energy crash that leads to extreme fatigue, warns Dr. Sadaty.

Instead, she recommends focusing on nutrient-rich foods that will bolster your energy, such as those high in omega-3 fatty acids, calcium, and vitamin D. (Think: A salad made with dark leafy greens, dressed with EVOO, and topped with sockeye salmon and walnuts.)

2. Exercise regularly

It should be no surprise that exercise can help you feel better and improve your health, but research, including one 2015 study in the Journal of Obstetrics and Gynaecology, has found it can also boost your energy levels, increase your concentration, and even relieve some pesky period symptoms.

You might not be up for high-intensity workouts if you’re feeling drained, so Dr. Sadaty recommends focusing on more mindfulness-based practices like yoga, pilates, walking, and gentle strength-training.

Good to know: The Physical Activity Guidelines for Americans recommend adults get at least 150 minutes of moderate-intensity cardio each week, along with two sessions of muscle-strengthening exercises.

3. Try relaxation techniques

Using mindfulness meditation techniques, deep breathing exercises, and progressive relaxation techniques may help improve mood and energy, Dr. Sadaty says. Why? These can all help you better manage stress, which can drain your energy and have a negative effect on your sleep quality.

What’s more: Maintaining a relaxed state can help balance your hormones and alleviate some of the mood swings often associated with PMS, Dr. Sadaty adds.

4. Optimize your bedtime routine

Dr. Sadaty recommends aiming for eight hours of sleep and taking precautions before bed to maximize your sleep quality, such as avoiding blue light exposure within two hours of bedtime by turning off screens, phones, TVs, and computers; drinking some relaxing tea like chamomile and lavender before bedtime; and avoiding caffeine and alcohol, which disrupt sleep.

“Set your ambient room temperature to cooler settings, like mid-60s, for deeper and more restorative sleep,” she adds.

Can you prevent fatigue before your period?

By optimizing your nutrition, sleep, workout routine, and stress levels, fatigue levels can improve, notes Dr. Sadaty.

However, she also points out that if these interventions don’t help, it’s time to see your doctor for an evaluation.

When to see a doctor

If you’re experiencing debilitating fatigue that’s preventing you from carrying on with your day-to-day responsibilities, it’s a good idea to schedule an appointment with your OB/GYN or primary care provider. They may ask about other symptoms and/or run tests to determine if there’s a more serious condition behind your low energy levels—and if so, you could work together to come up with an effective treatment plan.

It’s also smart to see a doctor if your periods are heavy, irregular, or last longer than a week.

FAQ

When in your cycle are you most tired?

This can vary by person, but you’ll likely feel most tired in the couple of days just before your period starts, when your hormone levels are at their lowest point.

Does PMS get worse with age?

It can. According to the Office on Women’s Health, PMS symptoms may get worse in your late 30s or 40s, as you approach menopause (when your menstrual cycle stops altogether). This transition period before menopause—called perimenopause—can last anywhere from a few years to more than a decade. It can cause your hormones to fluctuate in unpredictable ways, and for some people that can make PMS symptoms worse.

The good news? When your period stops after menopause, your PMS symptoms will go away too.

Should you sleep more on your period?

If you can set aside more time to rest and even sleep during your period, it can only help increase your energy, according to Dr. Sadaty. It may also help alleviate other symptoms that may be plaguing you, like irritability, mood swings, and cramps. “A period is a time of renewal, and ensuring adequate rest can help to ensure this process runs smoothly,” she adds.

—medically reviewed by Andrea Braden, MD, OB/GYN