Откуда берётся усталость после 40 и как вернуть силы
Вроде бы спите, вроде бы едите как обычно, а сил нет с самого утра. К обеду хочется лечь, к вечеру — ничего не хочется. Первая мысль — «не хватает витаминов». Но чаще всего дело не в них.
Что чаще всего стоит за усталостью
Снижение эстрогена действительно влияет на выносливость. Но усталость в этом возрасте гораздо чаще идёт от другого — и почти всё это можно проверить и поправить:
- Сон. Рваные ночи накапливаются, и никакой кофе это не перекрывает.
- Запасы железа. Обильные месячные в переходе истощают запас, и усталость появляется задолго до того, как изменится обычный анализ крови.
- Щитовидная железа. Её отличает зябкость — в менопаузе обычно наоборот, жарко.
- Настроение. Когда ничего не радует больше двух недель, это не «просто устала».
Поэтому начинать стоит не с баночек «для энергии», а с проверки.
Признаки, с которыми — на анализ, а не «бодриться»
- Железо: обильные месячные, одышка или сердцебиение на лестнице, выпадение волос, бледность, тянет грызть лёд, вечером беспокоят ноги → ферритин и анализ крови.
- Щитовидная железа: зябкость, запоры, редкий пульс, сухая кожа, отёчные веки, осиплость → ТТГ.
- Витамин B12: онемение или покалывание в руках и ногах, «ватные» ноги; риск выше на метформине, на препаратах от изжоги и у веганов → анализ на B12.
- Дыхание во сне: сон не освежает при достаточной длительности, храп с паузами → к сомнологу.
⚠️ Отдельный случай: если после нагрузки на следующий день становится резко хуже — на часы или сутки, — наращивать нагрузку через силу нельзя. С этим — к врачу.
Что возвращает силы
Движение. Самый сильный рычаг энергии из всех известных. Лучше всего работает сочетание: силовые тренировки, короткие интенсивные отрезки с полным отдыхом между ними и лёгкое кардио. Хуже всего — «всё время средне-тяжело». Хорошая новость: в первые годы после менопаузы тело особенно отзывчиво к тренировкам.
Белок с утра. Белковый завтрак в течение часа-двух после подъёма. Пропущенный завтрак и скачки сахара сами подстёгивают гормоны стресса — и днём наступает провал.
Ходьба после еды. 10–15 минут после основных приёмов пищи сглаживают «сахарные качели» и послеобеденную сонливость.
Якорь сна. Подъём в одно и то же время все семь дней и дневной свет утром. Иногда самое простое — лечь на полчаса раньше.
Что убрать
Алкоголь, рафинированные сладости и ультраобработанная еда, хронический недосып, интенсивные тренировки без восстановления — убрать эти «утечки энергии» важнее, чем что-то добавить.
А добавки?
Еда и движение сильнее любой из них. Железо — только по анализу на ферритин, не вслепую. Витамин D можно и без анализа. Магний и витамины группы B добавляют энергии, только если их не хватает. Модные «бустеры молодости» (NMN, NR и подобные) у людей энергию в исследованиях не улучшили — мы их не советуем.
Когда к врачу
- Усталость дольше четырёх недель, несмотря на сон и движение.
- Усталость вместе с необъяснимой потерей веса, проливным ночным потом или увеличенными лимфоузлами.
- Одышка, боль в груди или сердцебиение — срочно.
Что попробовать на этой неделе
- Источник белка в каждом приёме пищи, начиная с завтрака.
- 10–15 минут ходьбы после основных приёмов пищи.
- Две силовые тренировки по 30–40 минут в разные дни.
На чём основано
Статья написана по темам базы знаний VIA-L. За ними стоят опубликованные работы — вот они:
- Cognitive Behavioural Therapeutics for Insomnia Symptoms in the Perimenopause Through to the Early Postmenopausal Period — The Cochrane Database of Systematic Reviews, 2026 doi
- Effectiveness of Non-Pharmacological Interventions for Insomnia Related to Natural Menopause: A Meta-Analysis of Randomized Controlled Trials — Maturitas, 2026 doi
- An Integrated Anti-Aging Framework Targeting NAD+ Homeostasis, Mitochondrial Quality Control, and Redox Stability: Roles of NMN/NR, PQQ, and EGT — Redox Biology, 2026 doi
- Safety and Efficacy of Individualised Exercise and NAD+ Precursor Supplementation in Patients With Friedreich's Ataxia in the USA: A Single-Centre, 2 × 2 Factorial, Randomised Controlled Trial — Neurology, 2026 doi
- A Digital Mindfulness Intervention Improves Sleep Efficiency and Heart Rate Variability in Healthy Adults — Scientific Reports, 2026 doi
- Nutritional Modulators of Sleep: A Narrative Review of Vitamins, Minerals, Amino Acids, and Their Neurobiological and Chronoepigenetic Mechanisms — Chronobiology International, 2026 doi
- Do Menopausal Symptoms Signal Early Biological Aging? Mitochondrial, Endocrine and Clinical Insights — Climacteric : The Journal of the International Menopause Society, 2026 doi
- The Role of Exercise-Mediated Mitochondrial Quality Control Remodeling in Aging — Frontiers in Cell and Developmental Biology, 2026 doi
- Cost-Effectiveness of First-Line IV vs Oral Iron for Iron-Deficiency Anemia in Women With Heavy Menstrual Bleeding — Blood Advances, 2026 doi
- Cognitive-Behavioral, Acceptance-Based, and Mindfulness-Based Interventions for Psychological and Sleep-Related Symptoms During Menopause: A Systematic Review — Acta Psychologica, 2026 doi
- Integrative Approaches to Perimenopause — The American Journal of Medicine, 2026 doi
- Hormonal Modulation With Withania Somnifera: Systematic Review and Meta-Analysis of Randomized-Controlled Trials — Planta Medica, 2026 doi
Показать все (118)
- Insomnia and women: exploring vulnerability, impact, and intervention — Sleep & Breathing = Schlaf & Atmung, 2026 doi
- OSA in Women: Associations With Reproductive Aging and Screening Challenges — Chest, 2026 doi
- Pharmacological and Non-Pharmacological Treatments for Chronic Insomnia in Perimenopausal and Postmenopausal Women: A Systematic Review and Meta-Analysis — Sleep Medicine, 2026 doi
- Reframing menopause and menopause hormone therapy as opportunities for healthy aging — Science, 2026 doi
- Diagnosis of Primary Mitochondrial Diseases — Muscle & Nerve, 2025 doi
- Effects of Exercise Training on Mitochondrial and Capillary Growth in Human Skeletal Muscle: A Systematic Review and Meta-Regression — Sports Medicine (Auckland, N.Z.), 2025 doi
- Effects of Nutrients and Diet on Mitochondrial Dysfunction: An Opportunity for Therapeutic Approaches in Human Disease — Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie, 2025 doi
- The Combination of Physical Exercise and Slow-Paced Breathing on Psychophysiological Indices of Emotion Reactivity, Psychosocial Stress Reactivity and Recovery: A Multimodal Investigation — Behaviour Research and Therapy, 2025 doi
- The Effect of Probiotic Consumption on Fatigue Severity and Sexual Function Among Postmenopausal Women: A Double-Blind Randomized Controlled Trial in the West of Iran — Menopause (New York, N.Y.), 2025 doi
- Role of Circadian Health in Cardiometabolic Health and Disease Risk: A Scientific Statement From the American Heart Association — Circulation, 2025 doi
- Effectiveness of 2 Just-in-Time Adaptive Interventions for Reducing Stress and Stabilizing Cardiac Autonomic Function: Microrandomized Trials — Journal of Medical Internet Research, 2025 doi
- Chrononutrition Interventions for Mental Health: Addressing Atypical Depression, Ultra-Processed Food Use Disorder, and Circadian Dysregulation — Frontiers in Psychiatry, 2025 doi
- Iron Deficiency in Adults: A Review — JAMA, 2025 doi
- Psychiatric and Cognitive Outcomes of Iron Supplementation in Non-Anemic Children, Adolescents, and Menstruating Adults: A Meta-Analysis and Systematic Review — Neuroscience and Biobehavioral Reviews, 2025 doi
- Comparison of diagnostic algorithms used in guidelines on nutritional anaemias in adults — PloS One, 2025 doi
- Adrenal Insufficiency in Adults — JAMA, 2025 doi
- An Integrative Approach to HPA Axis Dysfunction: From Recognition to Recovery — The American Journal of Medicine, 2025 doi
- Elinzanetant for the Treatment of Vasomotor Symptoms Associated With Menopause: A Phase 3 Randomized Clinical Trial — JAMA Internal Medicine, 2025 doi
- Fezolinetant and Elinzanetant Therapy for Menopausal Women Experiencing Vasomotor Symptoms: A Systematic Review and Meta-Analysis — Obstetrics and Gynecology, 2025 doi
- Menopause and Movement: Exercise for Better Sleep and Psychological Well-Being-a Systematic Review — Menopause (New York, N.Y.), 2025 doi
- Omega-3 Fatty Acids and Sleep: Recent Advances in Understanding Effects and Mechanisms — Current Opinion in Clinical Nutrition and Metabolic Care, 2025 doi
- Biomarkers of Mitochondrial Disorders — Neurotherapeutics : The Journal of the American Society for Experimental NeuroTherapeutics, 2024 doi
- The Modern Management of Uterine Fibroids-Related Abnormal Uterine Bleeding — Fertility and Sterility, 2024 doi
- ACR Appropriateness Criteria® Management of Uterine Fibroids: 2023 Update — Journal of the American College of Radiology : JACR, 2024 doi
- A clinical study evaluating low dose ferrous fumarate vs — Scientific Reports, 2024 doi
- Identification and management of preoperative anaemia in adults: A British Society for Haematology Guideline update — British Journal of Haematology, 2024 doi
- Shoden Promotes Relief From Stress and Anxiety: A Randomized, Double-Blind, Placebo-Controlled Study on Healthy Subjects With High Stress Levels — Heliyon, 2024 doi
- Hypopituitarism — Lancet (London, England), 2024 doi
- European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-Induced Adrenal Insufficiency — The Journal of Clinical Endocrinology and Metabolism, 2024 doi
- Performance of Dehydroepiandrosterone Sulfate and Baseline Cortisol in Assessing Adrenal Insufficiency — The Journal of Clinical Endocrinology and Metabolism, 2024 doi
- Components and Delivery Formats of Cognitive Behavioral Therapy for Chronic Insomnia in Adults — JAMA Psychiatry, 2024 doi
- Network Meta-Analysis Examining Efficacy of Components of Cognitive Behavioural Therapy for Insomnia — Clinical Psychology Review, 2024 doi
- Effects of Mind-Body Exercise on Perimenopausal and Postmenopausal Women: A Systematic Review and Meta-Analysis — Menopause (New York, N.Y.), 2024 doi
- Stimulus control for insomnia: A systematic review and meta-analysis — J Sleep Res, 2024 doi
- Social jetlag and obesity: A systematic review and meta-analysis — Obes Rev, 2024 doi
- Potential Biomarkers of Mitochondrial Dysfunction Associated With COVID-19 Infection — Advances in Experimental Medicine and Biology, 2023 doi
- Mediterranean Diet and Mitochondria: New Findings — Experimental Gerontology, 2023 doi
- Impact of Geroscience on Therapeutic Strategies for Older Adults With Cardiovascular Disease: JACC Scientific Statement — Journal of the American College of Cardiology, 2023 doi
- Laboratory Testing for Mitochondrial Diseases: Biomarkers for Diagnosis and Follow-Up — Critical Reviews in Clinical Laboratory Sciences, 2023 doi
- Randomized Crossover Clinical Trial of Coenzyme Q10 and Nicotinamide Riboside in Chronic Kidney Disease — JCI Insight, 2023 doi
- Changes in Cortisol Awakening Responses (CAR) in Menopausal Women Through Short-Term Marine Healing Retreat Program With Specific Factors Affecting Each CAR Index — PloS One, 2023 doi
- The Relationship Between Heavy Menstrual Bleeding, Iron Deficiency, and Iron Deficiency Anemia — American Journal of Obstetrics and Gynecology, 2023 doi
- Oral Gonadotropin-Releasing Hormone Antagonists for the Treatment of Uterine Leiomyomas — Obstetrics and Gynecology, 2023 doi
- Effects of Sleep Fragmentation and Estradiol Decline on Cortisol in a Human Experimental Model of Menopause — The Journal of Clinical Endocrinology and Metabolism, 2023 doi
- Ocimum Tenuiflorum Extract (HOLIXERTM): Possible Effects on Hypothalamic-Pituitary-Adrenal (HPA) Axis in Modulating Stress — PloS One, 2023 doi
- GABA-ergic Modulators: New Therapeutic Approaches to Premenstrual Dysphoric Disorder — CNS Drugs, 2023 doi
- The Effect of Caffeine on Subsequent Sleep: A Systematic Review and Meta-Analysis — Sleep Medicine Reviews, 2023 doi
- Clinical and cost-effectiveness of nurse-delivered sleep restriction therapy for insomnia in primary care (HABIT): a pragmatic, superiority, open-label, randomised controlled trial — Lancet, 2023 doi
- Oral Micronized Progesterone for Perimenopausal Night Sweats and Hot Flushes a Phase III Canada-Wide Randomized Placebo-Controlled 4 month Trial — Scientific Reports, 2023 doi
- Optimizing Sleep Across the Menopausal Transition — Climacteric : The Journal of the International Menopause Society, 2023 doi
- Relationship between daytime napping with the occurrence and development of diabetes: a systematic review and meta-analysis — BMJ Open, 2023 doi
- Impact of Nutraceuticals and Dietary Supplements on Mitochondria Modifications in Healthy Aging: A Systematic Review of Randomized Controlled Trials — Aging Clinical and Experimental Research, 2022 doi
- Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta‐analysis — Cochrane Database of Systematic Reviews, 2022 doi
- Iron Deficiency Anemia: Impact on Women's Reproductive Health — Fertility and Sterility, 2022 doi
- Uterine bleeding: how understanding endometrial physiology underpins menstrual health — Endocrinology, 2022 doi
- Guideline for the laboratory diagnosis of iron deficiency in adults (excluding pregnancy) and children — British Journal of Haematology, 2022 doi
- Iron deficiency screening is a key issue in chronic inflammatory diseases: A call to action — Journal of Internal Medicine, 2022 doi
- Human adaptative behavior to Antarctic conditions: A review of physiological aspects — WIREs Mechanisms of Disease, 2022 doi
- Modulation of the Hypothalamic-Pituitary-Adrenal (HPA) Axis by Plants and Phytonutrients: A Systematic Review of Human Trials — Nutritional Neuroscience, 2022 doi
- Systematic review and meta-analyses on the effects of afternoon napping on cognition — Sleep Med Rev, 2022 doi
- A Portrait of Obstructive Sleep Apnea Risk Factors in 27,210 Middle-Aged and Older Adults in the Canadian Longitudinal Study on Aging — Scientific Reports, 2022 doi
- Disruption of Sleep Continuity During the Perimenopause: Associations With Female Reproductive Hormone Profiles — The Journal of Clinical Endocrinology and Metabolism, 2022 doi
- Chrono-Nutrition: From Molecular and Neuronal Mechanisms to Human Epidemiology and Timed Feeding Patterns — Journal of Neurochemistry, 2021 doi
- Estrogen Deficiency Induces Mitochondrial Damage Prior to Emergence of Cognitive Deficits in a Postmenopausal Mouse Model — Frontiers in Aging Neuroscience, 2021 doi
- A Review of Clinical Guidelines on the Management of Iron Deficiency and Iron-Deficiency Anemia in Women With Heavy Menstrual Bleeding — Advances in Therapy, 2021 doi
- Diagnosis and Treatment of Luteal Phase Deficiency: A Committee Opinion — Fertility and Sterility, 2021 doi
- Effect of Long-term Supplementation With Marine Omega-3 Fatty Acids vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores: A Randomized Clinical Trial — JAMA, 2021 doi
- Omega-3 Fatty Acids for Depression in Adults — The Cochrane Database of Systematic Reviews, 2021 doi
- Omega-3 Long-Chain Polyunsaturated Fatty Acid and Sleep: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Longitudinal Studies — Nutrition Reviews, 2021 doi
- Sleep During Menopausal Transition: A 10-Year Follow-Up — Sleep, 2021 doi
- Effects of a Short Daytime Nap on the Cognitive Performance: A Systematic Review and Meta-Analysis — Int J Environ Res Public Health, 2021 doi
- Improving Diet for Psychiatric Patients : High Potential Benefits and Evidence for Safety — Journal of Affective Disorders, 2020 doi
- Estrogenic Control of Mitochondrial Function — Redox Biology, 2020 doi
- Assessment and Management of Heavy Menstrual Bleeding — JAMA, 2020 doi
- The Allopregnanolone to Progesterone Ratio Across the Menstrual Cycle and in Menopause — Psychoneuroendocrinology, 2020 doi
- Hormone Therapy for Postmenopausal Women — The New England Journal of Medicine, 2020 doi
- Feeding Mitochondria: Potential Role of Nutritional Components to Improve Critical Illness Convalescence — Clinical Nutrition (Edinburgh, Scotland), 2019 doi
- Abnormal Uterine Bleeding in Reproductive-Age Women — JAMA, 2019 doi
- Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding: ACOG COMMITTEE OPINION, Number 785 — Obstetrics and Gynecology, 2019 doi
- Chronotype and Social Jetlag: A (Self-) Critical Review — Biology (Basel), 2019 doi
- Positive Psychological Well-Being and Cardiovascular Disease: JACC Health Promotion Series — Journal of the American College of Cardiology, 2018 doi
- Biomarkers for Mitochondrial Energy Metabolism Diseases — Essays in Biochemistry, 2018 doi
- Antifibrinolytics for heavy menstrual bleeding — Cochrane Database of Systematic Reviews, 2018 doi
- A New Model for Adrenarche: Inhibition of 3β-Hydroxysteroid Dehydrogenase Type 2 by Intra-Adrenal Cortisol — Hormone Research in Paediatrics, 2018 doi
- Effects of Mind⁻Body Exercises (Tai Chi/Yoga) on Heart Rate Variability Parameters and Perceived Stress: A Systematic Review With Meta-Analysis of Randomized Controlled Trials — Journal of Clinical Medicine, 2018 doi
- Effect of Omega-3 Supplements on Vasomotor Symptoms in Menopausal Women: A Systematic Review and Meta-Analysis — European Journal of Obstetrics, Gynecology, and Reproductive Biology, 2018 doi
- Symptoms of menopause — global prevalence, physiology and implications — Endocrinology, 2018 doi
- Effects of Pharmacologic and Nonpharmacologic Interventions on Insomnia Symptoms and Self-Reported Sleep Quality in Women With Hot Flashes: A Pooled Analysis of Individual Participant Data From Four MsFLASH Trials — Sleep, 2018 doi
- Mitochondria and ageing: role in heart, skeletal muscle and adipose tissue — Journal of Cachexia, Sarcopenia and Muscle, 2017 doi
- Mitochondrial Function and Mitophagy in the Elderly: Effects of Exercise — Oxidative Medicine and Cellular Longevity, 2017 doi
- Understanding Adaptogenic Activity: Specificity of the Pharmacological Action of Adaptogens and Other Phytochemicals — Annals of the New York Academy of Sciences, 2017 doi
- Omega-3 Versus Isoflavones in the Control of Vasomotor Symptoms in Postmenopausal Women — Gynecological Endocrinology : The Official Journal of the International Society of Gynecological Endocrinology, 2017 doi
- Surgery versus medical therapy for heavy menstrual bleeding — Cochrane Database of Systematic Reviews, 2016 doi
- Non‐anaemic iron deficiency – a disease looking for recognition of diagnosis: a systematic review — European Journal of Haematology, 2016 doi
- Altered Diurnal Pattern of Steroid Hormones in Relation to Various Behaviors, External Factors and Pathologies: A Review — Physiology & Behavior, 2016 doi
- The Role of Ovarian Sex Steroids in Metabolic Homeostasis, Obesity, and Postmenopausal Breast Cancer: Molecular Mechanisms and Therapeutic Implications — BioMed Research International, 2015 doi
- Estrogen: An Emerging Regulator of Insulin Action and Mitochondrial Function — Journal of Diabetes Research, 2015 doi
- Duration of menopausal vasomotor symptoms over the menopause transition — JAMA Intern Med, 2015 doi
- Pooled Analysis of Six Pharmacologic and Nonpharmacologic Interventions for Vasomotor Symptoms — Obstetrics and Gynecology, 2015 doi
- MicroRNA-23a Mediates Mitochondrial Compromise in Estrogen Deficiency-Induced Concentric Remodeling via Targeting PGC-1α — Journal of Molecular and Cellular Cardiology, 2014 doi
- Efficacy of Omega-3 for Vasomotor Symptoms Treatment: A Randomized Controlled Trial — Menopause (New York, N.Y.), 2014 doi
- Treatment for Mitochondrial Disorders — The Cochrane Database of Systematic Reviews, 2012 doi
- Practice Bulletin No — Obstetrics and Gynecology, 2012 doi
- Cortisol Stimulates Secretion of Dehydroepiandrosterone in Human Adrenocortical Cells Through Inhibition of 3betaHSD2 — The Journal of Clinical Endocrinology and Metabolism, 2011 doi
- Acute Emotional Stress and Cardiac Arrhythmias — JAMA, 2007 doi
- Suppression of the Hypothalamic-Pituitary-Ovarian Axis in Normal Women by Glucocorticoids — Biology of Reproduction, 1993 doi
Доказательная сила у этих работ разная: где-то крупные обзоры и мета-анализы, где-то отдельные небольшие исследования. Шаги в статье — простые меры заботы о себе с низким риском, а не лечение, и подходят не всем.
Это общие сведения, а не назначение. Обследование и лечение подбирает врач.