Why the menopause affects your energy
The fatigue that many women experience during peri-menopause and the menopause is often dismissed as ‘just part of it.’ In reality, multiple biological mechanisms—hormonal, metabolic, and cellular—are at play simultaneously, and these deserve a clearer explanation.
Declining estrogen levels affect your sleep architecture, temperature regulation, and mood, all of which determine how energetic you feel. However, research increasingly indicates that estrogen also plays a role in the function of mitochondria, the powerhouses of your cells. When estrogen fluctuates and declines, cellular energy metabolism can therefore be affected independently of your sleep quality.
The link to cellular energy
Mitochondria contain estrogen receptors. Research suggests that estrogen influences their function, including the activity of the electron transport chain that produces ATP. Some researchers propose that its efficiency declines as estrogen drops during the menopause, which may contribute to the characteristic fatigue.
CoQ10 is a naturally occurring substance involved in energy production within the mitochondria. NAD+ is a coenzyme central to cellular metabolism. Both occur naturally in the body and decline with age. Research is ongoing into whether supporting these pathways is relevant for age-related changes in energy, including those around the menopause.
Iron during peri-menopause
Iron contributes to normal oxygen transport in the body and to the reduction of tiredness and fatigue.
During peri-menopause, cycles are often irregular and sometimes heavier before menstruation stops completely. That additional blood loss can deplete your iron stores—a cause of fatigue that is completely separate from hormonal changes, yet compounds them.
Women over forty experiencing unusual fatigue would do well to get a blood test that also measures ferritin (your iron stores), in addition to the usual hormonal levels. Low ferritin is common, is often easy to address in consultation with your GP, and is frequently overlooked in menopause symptoms.
What the research says about CoQ10 and NAD+
Research into CoQ10 and energy in the context of aging and the menopause is ongoing. A 2025 clinical study (PMC12486408, n=18) showed that liposomal CoQ10 achieved significantly higher plasma concentrations than regular CoQ10 formulations—31.3% higher Cmax and 22.6% higher AUC0-24h. This confirms that the delivery form matters for this fat-soluble molecule.
For NAD+, a study from the University of Washington (Xue et al., 2022, Nutrients) confirmed that supplementation with an NAD+ precursor safely increases NAD+ levels in healthy middle-aged adults. Whether this specifically helps with menopause-related fatigue requires further investigation, although the underlying mechanism is biologically plausible.
The PPH approach
For women with fatigue around the menopause, there are three products with a relevant biological rationale:
- PPH Liposomal CoQ10 100 mg to support energy production in the mitochondria
- PPH NAD+ 300 mg the coenzyme central to cellular energy metabolism
- PPH Liposomal Iron 17 mg for women for whom low ferritin contributes to fatigue
Conclusion and next step
Fatigue during the menopause rarely has a single cause. Addressing it effectively means looking beyond hormones alone: toward cellular energy, your iron status, and your sleep quality. A blood test including ferritin, vitamin D, and thyroid levels is a sensible starting point before you begin supplements.
Because your vitality is not optional—it is essential.
Frequently asked questions
Sources
- Klinge C.M. (2008). Estrogenic control of mitochondrial function and biogenesis. Journal of Cellular Biochemistry. pubmed.ncbi.nlm.nih.gov/18459164/
- PMC12486408 (2025). Impact of liposomal delivery on CoQ10 absorption. Randomised double-blind trial.
- Xue Y. et al. (2022). NAD+ supplementation safely increases NAD+ metabolome. Nutrients. DOI: 10.3390/nu14112219
- WHO (2021). Anaemia. Global Health Observatory. www.who.int/
