Does omega-3 help with fatigue during perimenopause?

Fatigue is one of the most common and most disruptive symptoms of perimenopause, and it rarely has a single cause. Poor sleep, fluctuating hormones, low mood, and chronic low-grade inflammation all contribute. Omega-3 fatty acids address several of these drivers, which is why some women find meaningful improvement in energy levels after consistent supplementation.

Why fatigue worsens during perimenopause

Estrogen and progesterone both influence the brain circuits that regulate sleep and mood. As these hormones fluctuate unpredictably during perimenopause, sleep architecture is disrupted, night sweats interrupt rest, and the nervous system runs in a higher state of alert. Inflammation also rises during this transition. Elevated levels of pro-inflammatory cytokines like IL-6 and TNF-alpha are independently associated with fatigue, reduced motivation, and low mood, a cluster researchers sometimes call sickness behavior. Anything that reduces this inflammatory load has the potential to improve energy.

How omega-3 targets the drivers of fatigue

EPA, one of the two active omega-3 fatty acids found in fish oil, directly suppresses the production of IL-6, TNF-alpha, and IL-1beta. It does this by competing with arachidonic acid at COX-2 enzymes, shifting the body toward less inflammatory prostaglandins. Reducing systemic inflammation can lift the fatigue that comes with it.

EPA also has well-documented effects on mood. A 2003 study by Su and colleagues found that EPA at 9.6 grams per day significantly reduced depressive symptoms compared to placebo. A 2011 meta-analysis by Sublette and colleagues confirmed that EPA specifically, not DHA, is the active component for mood and anxiety. Since low mood and fatigue are deeply intertwined, improving one often helps the other.

DHA supports neuronal membrane fluidity, which affects neurotransmitter signaling efficiency. Fontani and colleagues (2005) found that 4 grams per day of combined omega-3 improved both mood and subjective measures of mental energy in healthy adults. These were not perimenopause-specific studies, but the mechanisms they illuminate are directly relevant.

What the evidence does not show

There are no large randomized controlled trials looking specifically at omega-3 and fatigue in perimenopausal women. The evidence is mechanistic and extrapolated from related populations. This does not mean it is ineffective, but it does mean expectations should be calibrated. Omega-3 is unlikely to be the complete answer to perimenopausal fatigue, especially if poor sleep or anemia are major contributors.

If fatigue is driven primarily by nighttime hot flashes and disrupted sleep, addressing vasomotor symptoms directly may be more effective than supplementation alone.

Dosage considerations

Research on mood and inflammation has examined EPA and DHA doses ranging from 1 to 9.6 grams per day, with most practical protocols falling in the 1 to 3 gram range of combined EPA plus DHA. Talk to your healthcare provider about the right dose for your situation. Doses above 3 grams per day of combined EPA and DHA may slightly increase bleeding risk, particularly if you take blood thinners, aspirin, or NSAIDs.

Practical guidance

Fish oil is best taken with a meal to improve absorption and reduce digestive side effects. Enteric-coated capsules reduce the fishy aftertaste that some people find off-putting. Choose a molecularly distilled product that has been third-party tested for heavy metals and oxidation. Give it 8 to 12 weeks of consistent use before evaluating its effect on fatigue, since the anti-inflammatory and membrane changes take time.

Algae-based EPA and DHA supplements are a good option for people who do not eat fish. Plant-based ALA (from flaxseed or chia) is not a reliable source of EPA and DHA, as conversion rates in the body are very low.

Tracking your fatigue

Fatigue fluctuates throughout the perimenopausal transition and can be hard to evaluate without consistent tracking. PeriPlan lets you log daily energy levels alongside other symptoms, which helps you and your provider identify patterns, spot potential triggers, and assess whether interventions like omega-3 are making a measurable difference.

When to see a doctor

Fatigue that is severe, persistent, or accompanied by symptoms like unexplained weight change, hair loss, or feeling cold all the time warrants a medical evaluation. Thyroid dysfunction, iron-deficiency anemia, and sleep apnea are all common in midlife women and can masquerade as perimenopause fatigue. Do not attribute all exhaustion to hormonal change without ruling out other causes.

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