Published 31st August 2022

Possible causes of fatigue in women

Fatigue is a common symptom, and there can be many causes. 

It’s easy to confuse “fatigue” with “tiredness.” The main difference is that tiredness improves with rest, but fatigue persists even after you rest. 

Fatigue is a constant feeling of tiredness, weariness, or a lack of energy for day-to-day activities. It can be a vague symptom, so pinpointing the cause can be challenging. 

While fatigue may be related to an underlying medical condition, diet and lifestyle changes can sometimes help. 

This article will explore the most common medical and nonmedical reasons that women feel fatigued. 

Causes of fatigue 

Sometimes, there is a clear medical cause. 

1. Menstruation

Fatigue is a common symptom during your period and is entirely normal. Its severity and duration can vary from person to person, based on several factors. 

When estrogen levels decrease, it leads to reduced levels of some neurotransmitters, including acetylcholine, dopamine, and serotonin. These neurotransmitters are important for maintaining healthy sleep and energy levels.

Heavy periods can lead to fatigue because the increased blood loss causes a reduction in iron levels.

When iron levels in the blood are low, less oxygen reaches your cells. This means that your body must work harder to produce the energy it needs.

Premenstrual syndrome, or PMS, symptoms around the time of your period may lead to sleep disturbances and then fatigue.

2. Menopause

During menopause, levels of certain hormones, such as estrogen and progesterone, fluctuate. 

These changes can cause fatigue, as well as other common symptoms, like hot flashes and night sweats.

Fluctuations in hormone levels can also affect your sleep pattern, resulting in fatigue during the day.

3. Thyroid disorders

Fatigue is one of the main symptoms of an underactive thyroid, or hypothyroidism. This affects more women than men.

Often, symptoms develop slowly and progress gradually over several years. Other symptoms of hypothyroidism include sensitivity to the cold, joint and muscle pain, depression, and weight gain. 

Hyperthyroidism — an overactive thyroid — can also cause fatigue. Other symptoms include an irregular heart rate, twitching or trembling, swelling in the neck, and weight loss.

4. Iron deficiency anemia

Fatigue is also a symptom of iron deficiency anemia

Blood loss is a common cause of an iron deficiency. So, heavy periods are a risk factor, due to the loss of blood. 

Other possible causes of iron deficiency anemia include:

  • pregnancy

  • internal bleeding, for instance, due to a stomach ulcer

  • gastrointestinal diseases that affect the body’s ability to absorb iron, such as celiac disease

Doctors typically treat iron deficiency anemia with iron supplements, which help restore iron levels. 

Also, healthcare professionals often recommend that you add iron-rich foods to your diet. Some sources of iron include fortified breakfast cereals, green leafy vegetables, dried fruits and nuts, and red meat. 

5. Depression

Depression is a common mental health condition characterized by persistent feelings of hopelessness, sadness, or emptiness. Fatigue is also a common symptom of depression. 

Women are twice as likely as men to develop depression. This condition is often linked with sleep disturbances, which can worsen fatigue. 

6. COVID-19

Fatigue is one of the most reported symptoms during and after COVID-19. It’s more common than the classic symptoms of a cough, a fever, and a loss of smell.

Fatigue during COVID-19 typically feels more intense than regular tiredness. It’s an extreme tiredness that persists even after a restful night’s sleep.

On average, the fatigue lasts 5–8 days, but for some people, it may last 2 weeks or longer.

For those with long COVID, a review of 21 studies found that 13–33% of participants reported fatigue at 16–20 weeks after they had first experienced COVID-19 symptoms. 

7. Diabetes

Fatigue is a common symptom of both type 1 and type 2 diabetes.

There are many ways that diabetes can cause fatigue. Lifestyle factors, nutrition, endocrine issues, and certain medications may be involved.

Because people with diabetes have higher blood sugar levels, less sugar reaches the cells. This can sometimes cause weakness and fatigue.

Also, people with diabetes are more likely to experience depression. And as we mentioned above, fatigue is a common symptom of depression.

8. Chronic fatigue syndrome

Chronic fatigue syndrome is a complex, long-term health condition.

It causes extreme tiredness that doesn’t improve with rest. This may get worse after daily activities involving physical or mental effort. 

Scientists don’t know what causes chronic fatigue syndrome. However, many people report symptoms after an infection, such as Q fever or influenza, or infections with coronaviruses or the Epstein-Barr virus. 

Chronic fatigue syndrome affects more women than men, with a ratio of about 4:1.

Sleep disturbances are also common in people with chronic fatigue syndrome, and these may worsen feelings of fatigue.

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Other causes of fatigue

Women may also feel fatigued for many nonmedical reasons. These are below.

9. Not eating the right foods

Research has linked some nutrient deficiencies with feelings of fatigue. This includes deficiencies of vitamin C, iron, magnesium, and some B vitamins.

Having a healthy, diverse, and balanced diet is important to ensuring that you meet your nutritional needs.

Focus on a plant-based diet with a broad range of fruits, vegetables, whole grains, beans and pulses, nuts and seeds, and herbs and spices.

Understanding how your blood sugar and blood fat levels respond to certain foods can help you increase your energy

The ZOE at-home test analyzes these unique blood sugar and blood fat responses. Along with a breakdown of your gut microbiome, we use this information to help you find the best way to eat for your body.

To get started, take our free quiz.

10. Poor sleep

Both sleep quality (how well you sleep) and sleep quantity (how long you sleep) are important for preventing fatigue. 

Experts recommend that adults get 7–9 hours of sleep each night.

Research shows that getting regular exercise improves sleep. Limiting alcohol and caffeine in the hours before bedtime can also promote better sleep. 

Make consistency a priority. Aim for similar sleep and wake times on a day-to-day basis, even on weekends. At night, keep your bedroom cool to mimic the drop in body temperature

Look after your gut health. Scientists have found that having a diverse gut microbiome is linked to better quality sleep and more sleep. 

11. Stress

Stress can be acute (short term) or chronic (long term). While acute stress is temporary, chronic stress is often linked to persistent feelings of fatigue. 

A study of nearly 8,000 people found that fatigue was linked with work-related stressors. Chronic stress can also disrupt sleep and increase the risk of developing insomnia

Try and manage stress levels through relaxation techniques, such as yoga, mindfulness, or diaphragmatic breathing.

12. Certain medications

Some medications can cause feelings of fatigue. This includes certain:

  • antihistamines 

  • antidepressants

  • antihypertensives

  • opioids

  • muscle relaxants

For people taking some of these medications, the fatigue may improve over time.

13. Low activity levels

Studies show that regular physical activity reduces feelings of fatigue. Scientists have observed this effect in different populations, including people with multiple sclerosis, cancer, and inflammatory bowel disease

Aim for 150 minutes of moderate-intensity physical activity each week, including cardio-based and strength-based exercises.

14. Dehydration

Water is essential for all bodily functions. If you haven’t had enough fluids, you may feel more fatigued than usual.

You may be able to avoid some feelings of fatigue by making sure you're hydrated throughout the day. 

Try these tips to help you stay hydrated:

  • drinking water before each meal

  • keeping water nearby throughout the day

  • adding fruits or herbs to your water for flavor

  • starting your day with a big glass of water

  • drinking tea and coffee if you like them

  • eating foods that contain plenty of water, like soup and cucumbers

Summary

Fatigue can have a variety of causes.

Some conditions that cause fatigue include thyroid disorders, iron deficiency anemia, diabetes, chronic fatigue syndrome, and COVID-19.

Some other causes of fatigue may involve your diet, sleep, and levels of stress. Lifestyle changes can often improve feelings of fatigue in these situations. 

If you’re experiencing continuous fatigue, and it’s affecting your quality of life, speak with your healthcare provider to rule out different causes.

Sources

Anaemia — iron deficiency: what is it? (2021). https://cks.nice.org.uk/topics/anaemia-iron-deficiency/background-information/definition/

Association of depressive and anxiety disorders with diagnosed versus undiagnosed diabetes: An epidemiological study of 90,686 participants. Psychosomatic Medicine. (2016). https://pubmed.ncbi.nlm.nih.gov/26452174/ 

Associations of fatigue to work-related stress, mental and physical health in an employed community sample. BMC Psychiatry. (2017). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5420158/

Cellular dehydration acutely degrades mood mainly in women: a counterbalanced, crossover trial. British Journal of Nutrition. (2021). https://pubmed.ncbi.nlm.nih.gov/33077017/

Chronic and daily stressors along with negative affect interact to predict daily tiredness. Journal of Applied Gerontology. (2017). https://journals.sagepub.com/doi/abs/10.1177/0733464817741684

Chronic fatigue syndrome and sleep disorders: Clinical associations and diagnostic difficulties. Neurología. (2018). https://www.sciencedirect.com/science/article/pii/S2173580818300038

COVID-19 and post-infectious myalgic encephalomyelitis/chronic fatigue syndrome: a narrative review. Therapeutic Advances in Infectious Disease. (2021). https://journals.sagepub.com/doi/full/10.1177/20499361211009385

Depression — overview. (2022). https://www.nimh.nih.gov/health/topics/depression

Diabetes fatigue syndrome. Diabetes Therapy. (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064586/

Diabetes symptoms. (2021). https://www.cdc.gov/diabetes/basics/symptoms.html

Fatigue: An overview. American Family Physician. (2008). https://pubmed.ncbi.nlm.nih.gov/19035066/

Fatigue in the COVID-19 pandemic. The Lancet – Healthy Longevity. (2022). https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(22)00029-0/fulltext

Gender differences in chronic fatigue syndrome. Reumatología Clínica. (2016). https://pubmed.ncbi.nlm.nih.gov/26190206/

Hypothyroidism: How common is it? (2021). https://cks.nice.org.uk/topics/hypothyroidism/background-information/prevalence/

Improvement of fatigue and quality of life in patients with quiescent inflammatory bowel disease following a personalized exercise program. Digestive Diseases and Sciences. (2021). https://link.springer.com/article/10.1007/s10620-020-06222-5

Iron deficiency, fatigue, and muscle strength and function in older hospitalized patients. European Journal of Clinical Nutrition. (2020). https://www.nature.com/articles/s41430-020-00742-z 

Long COVID and post-infective fatigue syndrome: A review. Open Forum Infectious Diseases. (2021). https://academic.oup.com/ofid/article/8/10/ofab440/6367589?login=false

ME/CFS in women and men. (2015). https://www.meresearch.org.uk/sex-differences-in-mecfs/

Physical activity — adults. (2022). https://www.cdc.gov/physicalactivity/basics/adults/index.htm

Premenstrual syndrome. StatPearls. (2022). https://www.ncbi.nlm.nih.gov/books/NBK560698/

Scenario: management of iron deficiency anaemia. (2021). https://cks.nice.org.uk/topics/anaemia-iron-deficiency/management/management/

Sleep and premenstrual syndrome. Journal of Sleep Medicine and Disorders. (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5323065/

Sleep timing, sleep consistency, and health in adults: A systematic review. Applied Physiology, Nutrition, and Metabolism. (2020). https://cdnsciencepub.com/doi/full/10.1139/apnm-2020-0032

Symptoms — overactive thyroid (hypothyroidism). (2019). https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/symptoms/

Symptoms — underactive thyroid (hypothyroidism). (2021). https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/symptoms/

The dynamics of stress and fatigue across menopause: attractors, coupling and resilience. Menopause. (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866170/

The impact of menstrual symptoms on everyday life: A survey among 42,879 women. American Journal of Obstetrics and Gynecology. (2019). https://pubmed.ncbi.nlm.nih.gov/30885768/

The impact of physical exercise on the fatigue symptoms in patients with multiple sclerosis: a systematic review and meta-analysis. BMC Neurology. (2020). https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-020-01654-y

The impact of stress on sleep: pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. Journal of Sleep Research. (2018). https://onlinelibrary.wiley.com/doi/10.1111/jsr.12710

The prevalence and impacts heavy menstrual bleeding on anemia, fatigue and quality of life in women of reproductive age. Pakistan Journal of Medical Sciences. (2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500811/

The role of physical activity in managing fatigue in cancer survivors. Current Nutrition Reports. (2018). https://link.springer.com/article/10.1007/s13668-018-0234-1

The temperature dependence of sleep. Frontiers in Neuroscience. (2019). https://www.frontiersin.org/articles/10.3389/fnins.2019.00336/full

Tiredness/fatigue in adults: What is it? (2021). https://cks.nice.org.uk/topics/tiredness-fatigue-in-adults/background-information/definition/

Vitamins and minerals for energy, fatigue and cognition: a narrative review of the biochemical and clinical evidence. Nutrients. (2020). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019700/

Why is depression more common among women than among men? The Lancet – Psychiatry. (2017). https://www.sciencedirect.com/science/article/abs/pii/S2215036616302632

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