Can being peri-menopausal cause extreme fatigue?

Maybe: The peri-menopausal period can cause a lot of changes. Notably, the introduction of hot flashes. Hot flashes that occur at night often disrupt sleep. It is this disruption in sleep that contributes to fatigue in the day, as well as mood swings. However, other conditions, like thyroid problems, or diabetes can also cause fatigue. I recommend you see your doctor for evaluation.