Midlife Fatigue? How Could This Be Bile?
- Meredith Paci
- May 3
- 4 min read
When we think of midlife fatigue, most people jump to hormones like cortisol, thyroid, or estrogen (specifically estradiol). But there’s another player quietly at work behind the scenes—bile.
Yep, bile. That golden-green fluid your liver makes and your gallbladder stores.
And if you don’t have a gallbladder and you’re in midlife? Hmm… even more reason to pause and pay attention.
Most people only think about bile when they hear “gallstones,” or maybe if they’ve worked with a functional health coach who brings up “digestion.” But bile is a lot more involved in your day-to-day vitality than you’d expect.
My first real personal awareness of bile came when I tried a higher-fat dietary approach about two years after being induced into surgical menopause. I’d never had any issue before, but suddenly I found myself in the ER with out-of-control upper quadrant pain, nausea, and vomiting. After what felt like a zillion hours, images, and tests, the verdict came back: gallbladder attack with noted sludge.
And the discharge advice? Just one gem: “Don’t eat greasy fried fatty food.”
I stared at the doctor, the intern, and the nurse, baffled—especially after we had just spent hours discussing (1) what I do for a living, (2) my medical history, and (3) my diet and lifestyle.
So why should midlife women—and the coaches who work with them—care about bile?
Honestly, I can’t think of a reason why someone shouldn’t care.
Let’s talk about it!
What’s happening to bile during perimenopause and menopause?
***And because I can’t help myself, let’s just remind everyone—this can apply to anyone with chronically low estradiol.
Although I started this blog mentioning cortisol, thyroid, and estrogen, we really need to talk about that queen hormone, estradiol. It’s not just a reproductive hormone—it has ripple effects all over the body, including the liver and gallbladder.
As estradiol drops (or in my case, plunges suddenly), bile tends to get thicker, sludgier, and more stubborn. The gallbladder—essentially your bile storage tank—doesn’t contract as strongly. Are you getting the picture of a gunky, sluggish mess? Exactly.
On top of that, the liver may slow down production of bile acids, which are critical for breaking down fats.
That sluggish flow sets the stage for what’s called bile sludge—think of it like a traffic jam of cholesterol, salts, and mucus hanging out in the gallbladder. Gross, right? It’s not quite gallstones, but it can easily lead there. And it absolutely messes with how you digest and absorb nutrients.
Why does bile matter for your energy?
Most people think of bile as a “digestion thing”—and yes, it is—but bile is essential for absorbing fat-soluble nutrients like vitamins A, D, E, K, and coenzyme Q10. These are major players in energy production, brain function, hormone balance, and immune health.
Without good bile flow, you can eat the world’s most perfect diet and still feel like garbage—because you’re just… not absorbing.
So yes—your tiredness after meals, your nagging bloating, your skin that’s lost its glow—these can all be tied back to poor bile dynamics.
Signs bile might be part of the problem
Here’s where you or your clients might raise an eyebrow:
Fatigue, especially after meals
Bloating or discomfort when eating fats
Floating stools or pale-colored poop
A history of low-fat dieting or yo-yo dieting
Upper right abdominal pressure or pain (even nausea)
Constipation or sluggish digestion
If two or more of these ring a bell, bile deserves a closer look.
Why midlife makes this worse
Menopause and perimenopause doesn’t happen in a vacuum. Midlife women often layer on:
Increased stress and cortisol (which slows digestion)
Lower stomach acid (common with aging and/or chronic stress)
Less physical activity overall → slower gut motility
Shifts in the gut microbiome that disrupt bile recycling
We’ve written a lot about the estrobolome, dysbiosis, and intestinal permeability—check out those posts if you want to dig deeper. Here is 1 you may enjoy and HERE is our entire library of digestive health blogs.
Bottom line: it’s not just the hormones themselves—it’s the whole environment they create.
What helps get bile moving again?
The goal here isn’t some fancy “liver detox.” It’s about supporting the natural systems already in place. And yes, sometimes supplements are needed, but the specifics of that warrant a more thorough discussion (maybe in a future blog—stay tuned).
Here are some practical starting points:
Eat enough dietary fat → bile needs fat to flow; ultra-low-fat diets make things worse. (Bet you didn’t see that coming, did you?)
Consider bitters or bile-supportive herbs → think gentian, dandelion, artichoke, arugula. We also love digestive bitters tinctures, but be warned—they’re incredibly potent, and not everyone enjoys them.
Use magnesium → helps gallbladder contraction and smooth muscle tone. Minerals, minerals, minerals.
Support digestion upstream → address stress, chew your food thoroughly (!!), and stay hydrated.
Keep fiber in check → not too low, not sky-high. (We have a great blog on that here.)
We also have a lovely LIVER LOVE GUIDE that has tons of solid , applicable information. It is FREE here
If the gallbladder’s been removed, things get trickier—sometimes ox bile, TUDCA, and/or digestive enzymes are needed, but this should always be individualized.
Ready to get clearer on what’s driving your symptoms or how to discuss these things with your clients?
Whether you’re a coach looking to deepen your understanding of women’s health or an individual navigating these changes yourself, this is exactly the kind of work we dig into through our 1:1 consultations and mentorship programs.
If you’re ready to move beyond surface-level fixes and get the education, tools, and strategies you need to create real change, let’s talk.
Coaches: Struggling to bridge the gap between theory and real-world coaching? Mentorship can change that.
Individuals: Book a consultation and get a personalized, evidence-led approach to your health.
