Fatigue can be described as a unusual feeling of tiredness, without an obvious cause like extreme exercise, or a missed night’s sleep. It is an extremely common problem- at any given time, one in five people in the UK feels unusually tired, and one in 10 have prolonged fatigue, according to the Royal College of Psychiatrists [1].

Most of the time, fatigue is not caused by a physical illness, but by an accumulation of stress, or low mood. There’s more chance of a medical reason for tiredness if there are other symptoms as well, such as heavy periods, weight loss, constipation, diarrhoea, hair loss, or extreme thirst (an indicator of diabetes) [1].

Women tend to feel tired more often than men, for various physical, psychological, and sociological reasons (e.g. women are more likely to have extra care-giving responsibilities and housework on top of paid employment [2], and are more at risk of low mood [3], and insomnia [4]) . Fatigue is one of the most common menstrual cycle-related symptoms- occurring as frequently as period pain during menstruation [5].

Conditions to rule out first, under medical supervision [1];

• Coeliac disease– a type of food intolerance, where your body reacts badly when you eat gluten – a substance found in bread, cakes and cereals.
• Anaemia– one of the most common medical reasons for feeling constantly tired is iron deficiency anaemia.
• Chronic fatigue syndrome– a severe and disabling tiredness that goes on for at least six months. There are usually other symptoms, such as a sore throat, muscle or joint pain, and headache.
• Sleep apnoea– a condition where your throat narrows or closes during sleep and repeatedly interrupts your breathing. The difficulty in breathing means you wake up often in the night and feel exhausted the next day.
• Underactive thyroid– An underactive thyroid gland means you have too little thyroid hormone (thyroxine) in your body. This makes you feel tired.
• Diabetes– One of the main symptoms of diabetes is feeling very tired. The other key symptoms are feeling very thirsty, going to the toilet a lot, and weight loss.
• Glandular fever– a common viral infection that causes fatigue, along with fever, sore throat and swollen glands.
• Depression– As well as making you feel very sad, depression can also make you feel drained of energy. It can stop you falling asleep or cause you to wake up early in the morning, which makes you feel more tired during the day.
• Anxiety– As well as feeling worried and irritable, people with anxiety often feel tired.

Note: If your symptoms are caused by your hormonal medication, we suggest that you discuss your options with a doctor. These steps may reduce symptom severity, but are unlikely to be able to stop them completely whilst you remain on the same medication.

TOP TIPS! Go to bed and get up in the morning at the same time every day; avoid naps through the day, and take time to relax before you go to bed.

Eat regular meals and healthy snacks every three to four hours, rather than a large meal less often.

Sometimes you feel fatigued simply because you’re mildly dehydrated. A glass of water will do the trick, especially after exercise.

Managing hormone-related fatigue:

Try a hormone-balancing diet– As outlined in this blog, a vegetable-based ‘anti-inflammatory’ diet can significantly improve all hormone-related symptoms. We highlight a few of the key steps that are especially relevant for those suffering from fatigue, below;

Avoid alcohol- Although a glass of wine in the evening may help you fall asleep, you sleep less deeply after drinking alcohol. The next day you’ll be tired, even if you sleep a full eight hours [6].

Avoid caffeine– Anyone feeling tired should cut out caffeine. The best way to do this is to gradually stop having all caffeine drinks (this includes coffee, tea and cola drinks) over a three-week period [6]. Try to stay off caffeine completely for a month to see if you feel less tired without it.

Try nutritional supplements– Iron is an obvious choice if you have been found to have iron-deficiency anaemia as a result of heavy menstrual bleeding [7]. Some people prefer liquid iron-rich supplements e.g. Spatone, to tablets, since they are less likely to cause side-effects such as constipation or headaches [8].

Perk up with exercise- You might feel too tired to exercise, but regular exercise will make you feel less tired in the long run, and you’ll have more energy [6]. Even a single 15-minute walk can give you an energy boost, and the benefits increase with more frequent physical activity.

Start with a small amount of exercise. Build up your physical activity gradually over weeks and months until you reach the recommended goal of two-and-a-half hours of moderate-intensity aerobic exercise, such as cycling or fast walking, every week. Read more about starting exercise.

Lose weight to gain energy- If your body is carrying excess weight, it can be exhausting. It also puts extra strain on your heart, which can make you tired. Lose weight and you’ll feel much more energetic [6]. Apart from eating healthily, the best way to lose weight is to be more active and do more exercise. Read more about how to lose weight.

Talking therapy beats fatigue– There’s some evidence that talking therapies such as counselling or cognitive behavioural therapy (CBT) might help to fight fatigue. See your GP for a referral for treatment on the NHS, or for advice on seeing a private therapist [6].

Reduce stress to boost energy – Stress uses up a lot of energy. Try to introduce relaxing activities into your day. This could be working out at the gym, or a gentler option, such as listening to music, reading or spending time with friends. Whatever relaxes you will improve your energy [6]. Read more about how to relieve stress.

If you have tried the suggested tips and tricks for at least 3 months, and your symptoms do not improve, please consult your doctor.

If you have any suggestions, or tips, for managing fatigue- please let us know– we can share them with others!

Further information:

• NHS information on fatigue; http://www.nhs.uk/livewell/tiredness-and-fatigue/Pages/tiredness-and-fatigue.aspx

Page last reviewed and updated: June 2018

References:

1. NHS. (2015) Why am I tired all the time?. [ONLINE] Available at: http://www.nhs.uk/Livewell/tiredness-and-fatigue/Pages/why-am-I-tired.aspx [Accessed 20 April 2017]
2. Bensing JM, Hulsman RL, Schreurs KM. (1999) Gender differences in fatigue: biopsychosocial factors relating to fatigue in men and women. Med Care Oct;37(10):1078-83. PubMed PMID: 10524374
3. Freeman, D, & Freeman J. (2013) The Stressed Sex: Uncovering the Truth about Men, Women, and Mental Health Oxford: Oxford University Press
4. Zhang B, Wing YK. (2006) Sex differences in insomnia: a meta-analysis. Sleep  Jan;29(1):85-93. PubMed PMID: 16453985
5. Scambler, A & Scambler, G. (1985) ‘Menstrual symptoms, attitudes, and consulting behaviour’ Social Science and Medicine 20:1065-8
6. NHS. (2015) Self-help tips to fight fatigue. [ONLINE] Available at: http://www.nhs.uk/Livewell/tiredness-and-fatigue/Pages/self-help-energy-tips.aspx [Accessed 20 April 2017]
7. DeLoughery TG. (2017) Iron Deficiency Anemia. Med Clin North Am Mar;101(2):319-332. doi: 10.1016/j.mcna.2016.09.004. Epub 2016 Dec 8. Review. PubMed PMID: 28189173
8. Nelson’s Natural World. (2015) Why Spatone? [ONLINE] Available at: http://www.nelsonsnaturalworld.com/en-gb/uk/our-brands/spatone/about%20spatone/why-spatone [Accessed 20 April 2017]