Chronic Fatigue — Get Your Energy Back!
PMS and fatigue
When our adrenals struggle to pump out high levels of cortisol, they lose their capacity to do other work, like producing DHEA in sufficient amounts. DHEA (dehydroepiandrosterone) is a precursor hormone to estrogen, progesterone, and testosterone, and is necessary to govern the balance of hormones in your body. Insufficient DHEA contributes to fatigue, bone loss, loss of muscle mass, depression, aching joints, decreased sex drive, and impaired immune function.
Many women describe feeling extremely fatigued for a day or so right before they get their period. This can get worse during 
perimenopause, when hot flashes and night sweats interfere with sleep and hormonal fluctuations increase. Heavy bleeding — which can accompany perimenopause — may contribute to anemia and feelings of fatigue. Again, a simple blood test will gauge your iron levels.
It’s likely that women who experience cyclical fatigue with PMS and do not test positive for adrenal fatigue have physiologies that struggle a little more with the normal hormonal ebb that occurs before menstruation. While this temporary fatigue may be inconvenient, it shouldn’t be a cause for concern — as long as it recedes.
Instead of fighting these feelings when they occur, I encourage you to listen to your body and it’s request for down time. Allow yourself to honor it. In ancient cultures, menstruation was a time for women to retreat from society, often in the company of other women, and rest from their duties. Take a tip from your ancestors and give yourself a break. It’s likely that your responsibilities can wait until your hormones resettle and your energy returns.
Menopause and fatigue
Adequate levels of DHEA are crucial to maintaining sufficient estrogen levels, particularly after menopause when the ovaries play a diminished role. If the adrenals are burnt-out, symptoms of hormonal imbalance are more severe. For this reason, I always test the adrenals of any patient interested in Hormone Replacement Therapy (HRT). Many times a woman’s symptoms will abate once her adrenal function is restored — without the use of supplemental hormones!
What’s more, as with PMS and fatigue, feeling slightly more tired than usual during perimenopause and at menopause may be your body’s way of asking you for some restful time to transition. 
I like to think of this time as a cocooning period, a period of repose in which a beautiful transformation can take place.
The good news is that hormone-related peaks and valleys of fatigue generally disappear completely after menopause. So many of my patients finally get around to identifying and accomplishing many of their goals after menopause because their energy levels remain stable — just one of the many joys of menopause.
But what if your symptoms of fatigue don’t respond to any of the measures we’ve addressed so far? If they are severe and stay constant or worsen no matter what you do, you may be dealing with a more complicated condition called chronic fatigue syndrome.
Chronic Fatigue Syndrome (CFS)
Chronic fatigue syndrome usually comes on suddenly — often clearly related to a stressful experience — and does not get better with rest. In 1994, a panel of international researchers came up with the following criteria for CFS diagnosis: