Endo and Fatigue: A Likely Combination

I recently wrote a post about how those of us with endo- particularly those prone to very heavy and/or prolonged bleeding during menstruation -are more likely to develop iron-deficient anemia. One of the biggest symptom of anemia is overwhelming fatigue. However, for those of us who have been checked and clear for not having anemia, we may still find ourselves exhausted right before and during our periods (and even on and off throughout the rest of the month).

Rest assured, this is not unusual for those of us with endo (and even those without can experience fatigue during their periods and preceding PMS episodes, though it is seemingly less common and less severe). I often feel profoundly tired right before and during my period, as though all the energy and enthusiasm has been leached right out of my body. In its place is often a severe lethargy that endures until usually a couple of days after the bleeding stops. But, I am not alone.

The research on endometriosis-related fatigue

A peer review study released just earlier this year found that fatigue was a common symptom among those who had definitive diagnoses of endometriosis. Specifically, the study collected data from 1,120 women who visited hospitals and clinics in Switzerland, Germany, and Austria between 2010 and 2016. Of these women, 560 had endometriosis.

The study revealed that the women with endometriosis were much more likely to experience fatigue than those without it; in particular, 50.7% of those surveyed with endo suffered from frequent fatigue compared to just 22.4% of those without endo. This indicated that those with endo were more than twice as likely to experience fatigue than those who do not have it. The fatigue experienced by those women were often most associated with insomnia, pain, and occupational stress and were experienced regardless of the patient's age, stage of the disease, or time since diagnosis.¹

PMS and fatigue

PMS can also cause extreme fatigue, and women with endo are often more likely to experience PMS and more extreme symptoms of it. According to a 2007 National Sleep Foundation poll, 33% of women say their sleep is disturbed during their menstrual cycles, with 16% reporting missing one or more days of work in the past month because of sleep problems.²

Right before one's period, hormonal levels of estrogen and progesterone drop dramatically and more or less bottom out during menstruation. This, in and of itself, can cause a "crash" and lead to exhaustion and fatigue. Additionally, many women with endo tend to have higher rates- in some cases, much higher- of autoimmune diseases and other types of illnesses and disorders, of which fatigue is also associated. This makes it seem somewhat inevitable that those with endo will experience significant fatigue at least some of the time during their cycles.

In fact, a 2002 study of women with endo conducted by the National Institute of Child Health and Human Development (NICHD), the George Washington University, and the Endometriosis Association found that women with endo were more than a hundred times more likely to experience chronic fatigue syndrome than the general population of U.S. women. They were also more than twice as likely as other women to experience fibromyalgia and seven times more likely to experience hypothyroidism- both of which are known to cause excessive tiredness.³

If you have endo, fatigue may be a common symptom. However, please check with your doctor to rule out other diagnoses that may be further contributing to your exhaustion. Diagnosing and treating other underlying or intersecting illnesses could help your overall fatigue and give you back some of your energy!