Fatigue is insidious. It affects ALL parts of you and your life! Everything feels harder.
Fatigue is one of the most common complaints I hear in my practice. And unfortunately, it’s also one of the most frequently dismissed.
Oftentimes, women are told it’s "just stress," or "part of getting older," or your "labs look normal."
But feeling exhausted (like can’t-get-off-the-couch tired or slept-8-hours-but-still-feel-like-a-zombie tired) is not normal. It could actually be due to many reasons.
FIRST, we need to figure out what kind of tired are you feeling.
A good place to start as you evaluate fatigue is this:
is it mental fatigue? (like, do you have the blahs?)
is it physical fatigue? (like, does your body feel heavy and sluggish?)
is it sleepiness? (like, do you want to nap all the time)
is it related to your mood, eating (or lack thereof!), stress, exercise, or menstrual cycle?
is there anything that makes it better or worse? (like, sleeping makes it better)
is it at the end of the day? (like, have you done a whole lotta things in your day non-stop and are finally slowing down because it's bed time? Feeling tired at the end of a long day is normal!)
This is a good starting point for you to pay attention to your body and perhaps even track your fatigue. Consider rating it on a scale of 0-10 (10 = your best energy, not the Energizer Bunny's!).
There are a lot of reasons why someone can be tired. Some of it is a normal response to all the pressures on your time and life. Some of it can be due to nutrient deficiencies. Some of it can be due to poor sleep ... and this includes delaying sleep (doomscrolling, anyone?). Some of it can be because of discontentment or even related to the goings-on in the world. Then, there are other physiological or medical conditions that can lead to fatigue as well.
Oftentimes, there are a few contributing factors from the following list:
Iron deficiency: this is the most common nutrient deficiency globally and can also lead to hair loss, brittle nails, irritability, restless legs, low mood, palipitations, poor focus, and more. Read this if you're always iron deficient or don't tolerate you iron well.
B12 deficiency: this is quite a common deficiency as well, and can look like fatigue, numbness and tingling, poor concentration, irritability, and more.
Vitamin D deficiency: this is another common nutrient deficiency that can look like fatigue, body aches, low mood, and more. If you're a fellow Canadian, you should get tested and supplement accordingly.
Poor sleep: this could be difficulty falling asleep, staying asleep, sleep apnea, or waking up to pee a few times. Poor sleep can lead to fatigue, headaches, migraines, appetite dysregulation, and so much more. If you have difficulty sleeping, have night sweats or frequent urination that gets in the way of sleeping, or are sleeping "enough" but still feeling sleepy, then it's time to get some medical help!
Thyroid problems: both hypothyroidism and hyperthyroidism can lead to fatigue. A thyroid panel can help shed light if this is part of your fatigue.
Undereating and Irregular eating: A LOT of women in my practice skip breakfast, eat a small lunch, and then wonder why they're so tired during the day. Please eat regularly to have better energy. If you struggle with an eating disorder, then we need to recruit some professional help.
(Unmanaged) Stress: stress is part of life and, in this day and age, we need to have measures in place to combat it--connecting with others, fun, hobbies, meditation, counselling, exercise, sports, nature time, music--we need to make space and time to unwind on a regular basis.
Other: mood and mental health disorders, certain medications, recreational drugs, infections and inflammatory conditions, chronic infections, lifestyle factors like not drinking enough water or not exercising, certain hormone-based conditions, low blood sugar, blood pressure problems, and more
Go through some of the questions listed above and make your way through some of the common causes.
Talk to your health team about what you're experiencing and really share how that's impacting you. Include any other changes your noticing (like headaches, heavy menstrual bleeding, sleep problems, night sweats, etc.) or relevant family history (like thyroid disease, blood pressure problems, etc.).
Blood work is a great place to start for most of us! In my clinical practice, in East Gwillimbury and Innisfil, I run tests all the time for: iron (ferritin), B12, vitamin D, thyroid, and metabolic health.
I also refer patients back to their family doctors for sleep study if I suspect sleep apnea might be part of the picture. Sleep apnea tends to go under-diagnosed in women and can lead to fatigue, headaches, and high blood pressure.
The way we support fatigue depends on what's going on.
If it's a nutrient deficiency, then we correct that. That may or may not help completely with all your symptoms.
I discuss nutrition, sleep, mood, and stress with my patients all the time as these are crucial for you to feel better in your day to day!
If you're in Ontario, feel free to reach out to work together. I offer in-person care in East Gwillimbury (near Newmarket) and in Innisfil (near Barrie) as well as virtual care through telemedicine. You can book an appointment here.
Feeling tired at the end of the day might be normal, but constantly fighting fatigue is not. It really gets in the way of you eating properly, making time for exercise, and even seeps into the decisions you make on a daily basis.
