· By Amy Suzanne Upchurch, Founder + CEO of Pink Stork, Certified Health Coach, INHC
Why Do Energy Levels Often Drop Years Before Other Perimenopause Symptoms Appear?
Energy decline is one of the most commonly reported perimenopause experiences, and research suggests it often precedes the symptoms most people associate with the transition. A large Mayo Clinic-led global study found that among women who identified as being in perimenopause, 95 percent reported exhaustion and 93 percent reported fatigue, both reported far more often than hot flashes.† Part of the explanation lies at the cellular level, where declining ovarian function affects mitochondrial energy production well before other signs become noticeable.
Why energy declines before other symptoms show up
According to Mayo Clinic News Network, hormone changes during perimenopause may affect the body's natural rhythms and restorative sleep long before other symptoms are recognized as being connected to the transition.1 Because fatigue and exhaustion are common, nonspecific experiences, many women and even some providers attribute them to stress, work, or aging in general, rather than hormonal changes specifically.
A peer-reviewed review on ovarian aging found that declining ovarian function is linked to broader cellular changes, including mitochondrial dysfunction, well before menopause itself occurs.2 Separately, a 2026 study found the steepest declines in a membrane lipid needed for efficient mitochondrial energy production occurred in women specifically during their hormonal transition years, a pattern not observed to the same degree in other groups studied.3
"I want to be able to chase my grandkids."
— Dominique Landry, Founder of Fit Enough
What the National Institute on Aging says about this transition
According to the National Institute on Aging, ongoing research using data from the Study of Women's Health Across the Nation has helped distinguish the effects of the menopausal transition itself from general chronological aging, finding that some changes are specifically tied to ovarian aging rather than age alone.4 This distinction matters because it means energy decline during perimenopause is not simply "getting older," it is a distinct physiological process worth addressing on its own terms.
What actually supports cellular energy during this transition
NAD+ (nicotinamide adenine dinucleotide) is a coenzyme required for cellular energy production, and NAD+ levels decline with age in a pattern documented across multiple research contexts.† Because this decline overlaps with the hormonal energy shifts happening during perimenopause, some women choose to support both pathways at once rather than waiting to see which one is driving their fatigue.
- Supports healthy NAD+ levels in the body†
- Supports cellular energy production†
- Supports cognitive function and mental clarity as part of healthy aging†
Pink Stork NAD+, designed to support healthy aging and cellular repair, delivers 500 mg of Nicotinamide Riboside (NR) per capsule, the dose used across the clinical research on NAD+ elevation. It is formulated without resveratrol, which research suggests can interfere with NR's bioavailability.
"I have six children and I know what it means to run on empty. I believe your energy is not vanity, it is what lets you show up for the people and the calling in front of you."
— Amy Suzanne Upchurch, Founder and CEO of Pink Stork
Our NAD+ supplement with 500 mg clinically studied NR is third-party tested in cGMP-certified laboratories and available at Target, Walmart, and CVS. For the nutrient side of the perimenopause picture, see our pillar guide on how perimenopause changes what nutrients your body needs, and for the sleep-specific angle, our guide on why perimenopause affects sleep before it affects your period.
Frequently asked questions
Is fatigue really an early sign of perimenopause?
Research suggests fatigue and exhaustion are among the most commonly reported perimenopause experiences, often more prevalent than hot flashes, and can appear well before other recognized symptoms.
Why does this get mistaken for normal aging?
Because fatigue is a common, nonspecific symptom, research distinguishing perimenopause-specific changes from general chronological aging has only become clearer with long-term studies like SWAN.
What is the connection between hormones and cellular energy?
Declining ovarian function is linked to mitochondrial changes at the cellular level, and some research has found the steepest declines in mitochondria-supporting compounds occur in women during their hormonal transition years specifically.
Is NAD+ decline the same thing as perimenopause fatigue?
They are related but distinct. NAD+ decline is an age-related cellular process, while perimenopause fatigue is tied to hormonal fluctuations. Both can contribute to overall energy levels during this life stage.
At what age should I pay attention to energy changes?
Perimenopause can begin in the mid-30s for some women, so unexplained energy changes in your late 30s or 40s are worth mentioning to your healthcare provider, even if your cycle still seems normal.
What else supports energy during perimenopause besides NAD+?
Whole-food nutrient density and stress support are also commonly addressed alongside cellular energy support during this transition. Always consult your healthcare provider about your individual needs.
† These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Always consult your healthcare provider before starting any new supplement, especially during pregnancy, breastfeeding, or while managing a medical condition. Keep out of reach of children.
