Dr Riccardo di Cuffa, Thyme GP

Fatigue is a common issue for many women and it’s more than just feeling tired after a long day. Ongoing fatigue can impact your life in many ways, and it’s important to understand the possible causes. A 2023 review of over 90 studies involving 600,000 participants found that more than 18% of women experience some type of fatigue. If you feel constantly drained then it could be worth investigating it.

What Causes Fatigue in Women?

Fatigue can stem from a variety of sources, including medical conditions, hormonal changes, nutritional deficiencies, and lifestyle factors.

1. Medical Conditions

• Chronic Fatigue Syndrome (CFS/ME): This is a serious illness causing extreme tiredness, brain fog, and exhaustion. It’s often linked to recovering from viral infections like COVID-19 or Epstein-Barr virus (EBV).
• Thyroid Issues: Both an underactive (hypothyroidism) and overactive thyroid (hyperthyroidism) can cause fatigue. A simple blood test can determine if your thyroid is the issue.
• Heart Disease: Fatigue is a common but often overlooked symptom of heart disease, especially in women. If you’re in middle age and feeling unusually tired, some blood tests an an assessment by a doctor can determine if you need to see a cardiologist.
• Sleep Disorders: Conditions like sleep apnoea, insomnia, and restless leg syndrome can disrupt your sleep, leaving you feeling exhausted during the day. Sleep apnoea is especially common among women, so if you’re snoring or gasping for air at night, get checked out.

2. Hormonal Imbalances

Hormonal changes throughout life can affect energy levels, particularly:

• Menstrual Cycle: Fatigue can be more noticeable before your period, in the luteal phase, when hormone levels fluctuate. Premenstrual syndrome (PMS) and its severe form, PMDD, are also linked to low energy.
• PCOS: Women with polycystic ovary syndrome are more prone to fatigue, often due to poor sleep or insulin resistance.
• Perimenopause and Menopause: As oestrogen levels drop during perimenopause and menopause, many women experience fatigue, disrupted sleep, and night sweats.

3. Blood tests and Nutritional Deficiencies

Lack of certain vitamins and minerals can leave you feeling drained:

• Baseline bloods: looking at kidney function, Thyroid function HbA1c (long term sugar), Liver and full blood count are all essential. 

• Iron Deficiency: Low iron levels, especially in women with heavy periods, can cause anaemia, making you feel weak and fatigued.
• Vitamin D Deficiency: A lack of this “sunshine vitamin” can contribute to low energy, especially in those who don’t get enough sunlight.
• Vitamin B12: This vitamin is essential for energy. People following vegan diets or those with nutrient absorption issues may be at risk for deficiency.
• Magnesium: Nearly half of adults don’t get enough magnesium, which is important for many body functions, including energy production.

4. Mental Health

Mental health plays a significant role in fatigue. Conditions like depression, anxiety, and chronic stress are strongly linked to low energy levels. Feeling “wired but tired” is a common experience in women dealing with stress or anxiety.

5. Lifestyle Factors

Your habits can greatly influence your energy levels:

• Poor Sleep: Quality sleep is essential, especially during menopause, as oestrogen levels decline and disrupt sleep. Aim for 6-9 hours of good sleep each night.
• Lack of Exercise: Regular movement boosts energy and helps combat fatigue. Try to fit in 150 minutes of moderate exercise per week.
• Alcohol and Smoking: Both smoking and excessive alcohol can drain your energy. Cutting back or quitting can improve how you feel.
• Diet: Improving your nutrition and avoiding poor quality foods can help to boost energy levels. Avoiding Caffeine and too much sugar as well.

How to Boost Your Energy

If you’re feeling fatigued, there are steps you can take to improve your energy levels:

• Get checked for any underlying health conditions.
• Prioritise good sleep.
• Eat a balanced diet rich in vitamins and minerals.
• Exercise regularly, even if it’s just small movements throughout the day.
• Manage stress and practice self-care.

If your fatigue is persistent or unexplained, talk to your doctor. Addressing the root cause can help you get back to feeling your best.