Hi tiredgirl! I was in medical menopause at 30 and that was a living heck in itself. I have avoided the permanent menopause for now. I have several fatigue causing disorders (fibromyalgia, endometriosis, hypothyroidism) and I feel for you. I find it very hard to do anything above part-time when I am at my worst. Casual time or agency work can be helpful as you can turn down shifts when you have had a rough night (had lots of those)and pick up when you feel alright. If you work part-time but still want some extra hours let the other nurses know (and management) you are willing to do 4 hour shifts so they can leave early, attend appointments etc. I racked up lotsa 4 hour shifts this way when I was flaring and could not last 8 or 12 hours. I'd recommend a slower paced atmosphere to conserve energy. Foot care is good, blood services, clinics...I work on a lighter floor in a LTC facility but am looking to try working elsewhere. Napping on your lunch hour is vital...so is taking all your breaks. I had to force myself to take time to break to help my energy level. As for the hormonal symptoms maybe your HRT needs a tweak? I know my add-back therapy had to be re-adjusted several times and now post endo surgery clean-out #2 my meds were adjusted several times to find the right progesterone dose. My ovaries aren't failing 100% yet but they are pretty damaged so I get some menopause-like symptoms (hot flashes and night sweats mostly). Lady hormones can cause problems in all aspects of your life...sleeping too. I changed up my diets and supplements but still struggle though I consider myself stable. Do you have the book 'Before Your Time: The Early Menopause Survival Guide'? I bought it when I was facing the possibility of a TAHBSO. It's a good read and suggested some good vitamins, minerals and alternative medicines to check out along with your standard medications. *edit* Oh yes! Check out the HysterSisters. Great support group online! http://www.hystersisters.com/