A very tired looking girl is chained to her bed with an anchor at the end, while a glowing red orb is around her pelvic region.

What Causes Endometriosis Fatigue?

Feeling constantly tired is a common symptom of endometriosis. This isn’t your normal kind of tired that happens after a busy day or after physical or mental exertion which gets better after rest; this sort of tired is never ending and isn’t always better even for rest.

What causes endometriosis fatigue?

Endometriosis is a disease that leads to chronic, low-grade inflammation. Fatigue is a common symptom of inflammatory diseases, whether it’s autoimmune diseases or even cancer; There is a link between chronic low-grade inflammation and fatigue.1 Inflammation is a normal physiological process that plays a crucial role in our health; its’ role is to remove harmful stimuli (such as invading bacteria) and return the body to its’ normal physiological function, however inflammation that persists for weeks, months, or years is harmful.

The reason why chronic inflammation is linked with fatigue isn’t fully understood. However, there are a few mechanisms which may be the underlying cause:

Inefficient energy production

Inflammation causes an increase of the need for rapid generation of energy and to meet this need immune cells move to a type of energy production which is less-efficient (but fast) way to generate energy.1 In a state of low-grade inflammation, there is an extended reliance on this method of energy production, which causes reduced nutrient availability resulting in less energy available for organ system functions within the body. The body also tries to compensate by using fats and protein for energy rather than carbohydrates. However, using fats as energy is a slower process than using carbohydrates; Therefore, the body may be unable to respond quickly to energy requirements and using protein for energy can mean that the other functions of protein such as growth and repair may be compromised.

Oxidative stress

Inflammation also causes an increase in reactive oxygen species (ROS), also known as free radicals, which cause cellular damage. In normal conditions, antioxidants are sufficient in protecting against the damage caused by ROS. However, if there is excessive ROS production it can cause damage to cells which is referred to as oxidative stress. In these conditions, mitochondria which produce majority of cellular energy can be damaged, contributing to mitochondrial dysfunction.

Chronic stress and sleep

Chronic stress and diet can also be contributing factors to inflammation.2 In situations of chronic stress, persistent inflammation may also be due to the result of lowered sensitivity of stress hormone cortisol, which opens the door to an increased inflammatory response (2). Additionally, high levels of ongoing stress can cause depression and anxiety, which are also linked to chronic inflammation and fatigue. Inflammation can also cause alterations in sleep (and vice versa), which can reduce sleep quality leading to fatigue (1).

What can you do about endometriosis fatigue?

Thankfully, there are things you can do to manage and control endo-related fatigue. Following the right diet and lifestyle will support your energy and help manage the effects of inflammation. For example...

  • Eat an anti-inflammatory diet that is rich in antioxidants, fiber, and healthy fats. A Mediterranean diet is a great example because it’s rich in antioxidants.3 Some women who are experiencing food sensitivities may need a more tailored diet by removing foods that are triggering their symptoms. See your health professional for tailored advice.
  • Mindfulness meditation is known to offer a range of benefits including improved pain tolerance and sleep quality.4,5 Try starting with just 5 minutes a day and gradually increase.
  • Talk to a health professional about supplementing with CoQ10, which is an antioxidant that is also involved in energy production.1 Other nutrients which may be helpful for inflammation, oxidative stress, and energy metabolism are magnesium, B6, zinc, fish oil, vitamin E, vitamin C, curcumin and N-acetyl cysteine.

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