Does evening primrose oil help with fatigue during perimenopause?

Evening primrose oil is sometimes used for fatigue during perimenopause, but the direct evidence for this specific use is limited. Its potential benefit is indirect, working through anti-inflammatory pathways rather than by directly boosting energy. Understanding what is driving your fatigue in perimenopause matters a great deal before deciding whether EPO makes sense to try.

Fatigue during perimenopause has multiple overlapping causes. Disrupted sleep from night sweats is one of the biggest contributors, but it is not the only one. Fluctuating estrogen also affects cortisol regulation, mitochondrial function, and thyroid activity, all of which influence energy levels throughout the day. Low-grade chronic inflammation, which tends to increase as estrogen declines, is another underappreciated driver of fatigue. Women in perimenopause often describe a bone-deep tiredness that feels different from ordinary sleepiness, and this inflammatory component may be part of the explanation. Immune cells in the body respond to estrogen levels, and when estrogen drops, the inflammatory tone of the body can shift.

Evening primrose oil contains gamma-linolenic acid (GLA), an omega-6 fatty acid that the body converts into dihomo-gamma-linolenic acid (DGLA) and then prostaglandin E1, a compound with anti-inflammatory properties. By shifting the body's prostaglandin balance toward less inflammation, EPO may reduce some of the inflammatory fatigue that can accompany hormonal transitions. GLA also plays a role in cell membrane composition, which affects how efficiently cells produce and use energy at the mitochondrial level.

That said, there are no controlled clinical trials directly testing evening primrose oil for perimenopausal fatigue. The evidence is largely theoretical, drawn from EPO's broader anti-inflammatory effects and from small studies in other conditions including chronic fatigue and fibromyalgia, where results have been mixed. This is not a strong evidence base, and you should go in with realistic expectations. EPO is not a stimulant and should not be thought of as an energy booster in the conventional sense. It works indirectly, if it works at all for this symptom.

In research on EPO for perimenopausal symptoms overall, doses of 3,000 to 4,000 mg per day, divided across two to three meals, have been used. Taking EPO with food reduces the most common side effects, including nausea and loose stools. Talk to your healthcare provider about the right dose for your situation, particularly if you have any underlying health conditions that affect how you process fatty acid supplements.

Evening primrose oil may interact with blood thinners and anticoagulants. It may also lower the seizure threshold, so discuss with your provider if you take any seizure medications. If you take blood thinners, antidepressants, or any prescription medications, check with your provider before adding this supplement.

If you have or have had a hormone-sensitive condition such as breast cancer, endometriosis, or uterine fibroids, discuss evening primrose oil with your healthcare provider before using it.

If sleep disruption is driving your fatigue, addressing that directly through improving sleep hygiene, managing night sweats, or talking to your provider about treatment options, is likely to produce more noticeable results than EPO alone. Regular aerobic exercise, even when energy is low, has stronger evidence for improving perimenopausal fatigue than any supplement currently available. Give any supplement trial at least four to eight weeks before evaluating its effect, since anti-inflammatory changes build gradually.

If you decide to try EPO for fatigue, it is worth pairing it with attention to iron intake, since iron deficiency is one of the most common and overlooked causes of fatigue in perimenopausal women, especially those experiencing heavier periods. Coenzyme Q10 (CoQ10) is another supplement that has been studied in the context of mitochondrial energy production and may complement EPO's cell membrane effects, though evidence for this combination in perimenopause specifically does not yet exist. Talk to your provider before adding multiple supplements at once, since this makes it harder to identify what is helping and may increase the risk of interactions.

Fatigue that is severe, constant, or worsening over time deserves a medical evaluation before attributing it to perimenopause alone. Your provider should check thyroid function, iron levels, blood sugar, and vitamin B12 as a starting point. Sleep apnea is also more common in women after 40 and is frequently missed during perimenopause because its symptoms overlap with hormonal fatigue. These are all treatable conditions, and getting the right diagnosis is the most important step.

The PeriPlan app (https://apps.apple.com/app/periplan/id6740066498) lets you log fatigue daily so you can spot whether patterns shift over time, which helps you and your provider understand what is actually driving your energy levels and whether any intervention is helping.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.