Tired when you go to bed, tired when you wake up. You are tired at work, tired when you get home. Does this sound like a familiar story? Even if you are not a frequent victim of chronic fatigue, you probably know another female or friend who is. Indeed, this is one of the most common complaints for which women consult their doctors. Polls in our Facebook group, and surveys we have conducted on thousands of women, show that fatigue is the most common menopause symptom, way more common than the thermal surges of hot flushes and night sweats.
Different types of fatigue
There are, of course, different types of fatigue. Most of us have experienced fatigue after a period of hard and fruitful work, and then hopefully, noticed a return in our energy after a good night’s sleep or a relaxing holiday. Some of us, however, suffer from fatigue day in, day out, despite the amount of sleep or rest we have. The causes of this problem vary from the physical to the psychological. Both aspects need to be considered in the majority of those suffering from significant fatigue.
What causes fatigue?
There are many causes of chronic fatigue, and unlike more medical conditions, it does not originate from a single state. There are serious and not so serious causes of fatigue, so it is essential to determine into which category an individual falls. Research has shown that up to ten per cent of those with severe fatigue can be found to have some underlying health problem.
Some sufferers may have a physical illness which may not yet be fully developed, some may have recently experienced acute infection, and others may be mainly depressed. The first step must be to eliminate the possibility of any serious underlying cause before progressing to self-help measures.
As a rule of thumb, fatigue which is persistent, or prevents you from working and requires you to make drastic changes to your home life and social calendar, should be regarded as serious. This also goes for fatigue that is associated with weight loss, fever, significant pain or any other troublesome symptoms. These symptoms should always prompt you to check with your doctor as your first course of action.
Causes of fatigue (not so serious):
- lack of sleep
- stress or overwork
- lack of physical fitness
- poor quality diet
- hormone swings
Causes of fatigue (serious):
- physical illness, e.g. heart, liver or kidney disease
- after viral or other infection, e.g. glandular fever or flu
- rarely, a continuing infection, e.g. tropical.
Wide-ranging surveys have revealed a pattern connecting common non-serious health problems with mild to moderate fatigue which includes muscular aches and pains, bowel problems, headaches, premenstrual syndrome and sleeping difficulties including snoring, and allergies. Addressing these problems can often result in a reduction in the associated fatigue.
When a doctor has to assess a new patient with significant fatigue, it is probably best to consider the following four broad groups:
It can accompany any acute infectious illness, such as flu or a cold. Occasionally, an infection is hidden, and this can be the case in some tropical diseases or parasitic infections. If anyone with fatigue has a fever usually measured at more than 37.5 degrees centigrade, then they should be carefully checked for a possible hidden infection.
Fatigue can also follow an infection. After the acute episode has resolved, the individual can be left with fatigue, which continues for months and even years. This condition is sometimes called ‘ME’ (myalgic encephalomyelitis). That mouthful simply means inflammation of the muscles and nervous tissue, and there is now evidence that patients with ME can, at times, have evidence of damage or alteration to either the muscles, the nervous system or immune system (the part of our body that fights infection). It seems in some ways that the infection, after causing an acute illness, goes into a slow or hidden phase which can sometimes reappear. This is particularly true for the glandular fever virus, but may also be true of other virus infections.
The term ME is now commonly replaced with Chronic Fatigue Syndrome (CFS). This is used to describe significant fatigue present for at least three months which typically, but not necessarily, has followed one or more infections. Several of the following features should also be present:
- the fatigue is worse after exercise
- forgetfulness or poor concentration
- muscle aches and pains
- recurrent sore throats
- painful enlarged glands in the neck or elsewhere.
Doctors still disagree about this definition. In practice, if this picture is present, and continuing infection, other underlying illness, drug or alcohol abuse or severe depression are excluded, then this allows at least a working diagnosis of CFS (or ME).
Fatigue can be caused by a wide variety of physical illnesses, including heart conditions, thyroid disease, arthritis, conditions affecting the immune system or nervous system, kidney problems and so on. These conditions should be suspected in older patients, those who experience weight loss or have other unusual symptoms. They will usually be detected by blood and urine tests, together with x-rays. To eliminate the possibility of any underlying sinister problem, it is essential that those suffering from severe fatigue seek medical attention and have a check-up.
Fatigue happens at menopause too. The leading cause of menopausal fatigue is the change in hormone levels. Oestrogen, progesterone, thyroid and adrenal hormones are all involved in regulating cellular energy in the body which, when compromised, can lead to fatigue. By correcting your hormone balance, the fatigue can be reversed.
Physical menopausal symptoms like night sweats and insomnia contribute to fatigue. Many women find themselves suffering from a chronic lack of sleep, and this is a contributory factor in fatigue during the day. The worst part about it is that fatigue exacerbates menopausal symptoms such as anxiety, poor concentration, and a lack of confidence. You can easily find yourself in a spiralling, vicious circle. In addition to getting your hormones back in check, you need to ensure that you are eating the best diet possible.
Fatigue is often caused by nutritional factors. This can either be due to a lack of vitamins or minerals, or sometimes other dietary problems. Research from around the world shows that billions of women have nutritional deficiencies. Low levels of these essential nutrients can affect muscle and brain metabolism and result in loss of energy. This is easily underestimated and overlooked by the medical profession; however, it’s not difficult to correct.
Reports in the UK revealed that up to 20 per cent of adults have a dietary intake below the new minimum recommended by the government’s advisers. The low levels of nutrients apply mainly to the minerals iron, magnesium and potassium, as well as some of the B vitamins. Deficiency of any of these nutrients can cause fatigue. Most are essential to the function of muscles, nerves and the immune system.
There is good evidence that deficiency is particularly common in certain groups. Iron deficiency, for example, causes anaemia in four per cent of adult women of childbearing age in the UK. This is mainly because of heavy or prolonged periods with a further ten per cent of women of childbearing age having evidence of low iron stores, and this may explain why fatigue is more common amongst women. Mild fatigue in such women has long been shown to respond to iron supplements. It is an excellent example of how mild or severe nutritional deficiency can be a cause of chronic fatigue.
The primary deficiencies include:
- Vitamin B
- Vitamin C
- Vitamin D
Iron deficiency is most likely in women who are having periods, mainly if they are heavy, and in vegetarians or people who don’t consume much meat.
Vitamin D is one of the most common deficiencies and can leave us feeling like a bucket with a hole in it. Vitamin D deficiency is now known to have many serious health implications, including fatigue. Dietary sources of vitamin D include egg yolks, fortified milk and cereals, cheese, and oily fish.
Mild deficiency of the B group of vitamins is also quite common, particularly in those who complain of anxiety, depression or mood changes. This may often accompany the fatigue. A poor diet, smoking, and drinking too much alcohol, are all significant risk factors for lack of vitamin B.
The mineral magnesium has attracted considerable interest in recent years. This mineral is essential for nerve and muscle function. Intakes in the UK are acknowledged to be borderline or deficient in some 10 per cent or more of adults. In our own surveys of women with PMS, we have repeatedly found that over 50 percent of women with PMS have low magnesium stores.
Don’t despair; there are plenty of actions you can take to help you overcome fatigue.
Add good sources of magnesium – green leafy vegetables, tofu, almonds, cashews, flaxseed other wholesome foods. Avoid sugar, sweets, and soft drinks which contain hardly any magnesium at all. Women with menopause often have low levels of magnesium, and it seems that the same is often true of people suffering from fatigue.
Many other nutrients, if deficient, are known to affect the function of the immune system. These include vitamins A, C, D, E and the trace element, zinc. A healthy diet and a strong multivitamin supplement with 20 to 30 milligrams of zinc should be adequate. Specialised fats and oils, as found in evening primrose oil and fish oils, have been used to help those with chronic fatigue. In one placebo-controlled trial, a supplement of Efamol Fish Oil helped a high proportion of those whose fatigue was post-infective in type. Again, this should be combined with eating healthily and possibly a multivitamin preparation.
In addition to the deficiency of certain nutrients, sometimes other dietary problems can cause fatigue. There is evidence in those who have certain types of allergy, that fatigue may be one of the associated symptoms. Intolerance to certain foods seems to be a factor, and this can be suspected if there are symptoms of allergy, including eczema, asthma, nettle rash, migraine headaches and bowel problems including irritable bowel syndrome. In one study, allergy to wheat protein was linked with increased complaints of fatigue, headaches and bowel problems. It is not known how commonly this is a cause of chronic fatigue, but it does seem to be worth considering.
Symptoms such as anxiety and depression, often accompany the fatigue. Many physical problems can also cause mental symptoms. Stress, in any form, may also aggravate mental symptoms, and even reduce the ability of the immune system to fight infection. So, if you are feeling stressed, it is vital to find a workable way of overcoming the stressful factors and to spend a little time every day relaxing.
Exercising regularly to the point of breathlessness and losing weight, if you are overweight, can also help mood and stimulate the immune system. You should only exercise regularly if your fatigue is mild, and you have no underlying illness. If you haven’t been doing regular exercise, start gradually, even just with ten minutes dancing to your favourite music.
Frantic modern living is likely to contribute to us feeling tired all the time. Many of us devote insufficient time to preparing food or taking adequate exercise or relaxation. Not enough sleep, stress at home or work, lack of exercise and a poor quality diet can all reduce our energy levels. Addressing the problem directly by taking a much-needed holiday, embarking on a regular exercise programme or taking steps to improve your nutritional intake may well be all that is needed to restore your vitality.
Working long hours and not eating nutrient-dense food regularly is likely to make your blood glucose levels fall, which results in symptoms of tiredness. The solution is not merely to suddenly consume more glucose, as the body finds it hard to adjust to the rapid rise and fall that this causes. Rather eat wholesome food little and often. So, aim for three good meals, with nutritious snacks, such as fruit, or crackers with peanut butter, which give a more sustained rise in blood sugar.
Try to unwind - whether you like to read, take long walks, or meditate, take the time to indulge in your favourite activities. Stress and anxiety could be causing your fatigue, and formal relaxation techniques can be very helpful in learning to overcome them. We recommend using Pzizz. Pzizz has been developed by neuroscientists and helps you to relax and recharge.
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Complementary therapies including herbal medicine and acupuncture, may be worth considering. One report from Doctors Sheila and Robin Gibson from the Glasgow Homeopathic Hospital concluded that dietary change, nutritional supplements, homeopathy and psychotherapy helped in 70 per cent of participants.
Although most of us prefer not to be given a serious diagnosis for our symptoms when the verdict is ‘no apparent underlying cause’ it can be immensely frustrating and worth enlisting the help of one or more complementary practitioners.
Acupuncture would regard symptoms of fatigue as a deficiency syndrome. The practitioner would be looking for deficiency of Qi or the life-force in the blood and will treat the deficiency.
Cranial osteopaths consider that the membranes around the brain and spinal cord can become ‘tight’ and cause ill-health. Relaxation, massage and a consultation with a cranial osteopath may be beneficial.
There is so much you can do to help yourself. However, everyone is unique. There is no one solution for everyone. If you’re suffering from fatigue during menopause, you need to take control, and you can do that by adopting a healthy lifestyle. Eat right, exercise, get adequate sleep, and learn to relax — you will find you have more energy and regain your zest life.
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