Low energy and tiredness

2019, Responses from: Leena St Martin and Dr Anna Ponnampalam

I am in my 20s and have a diagnosis of endo. I am always tired. I was tired at school before my diagnosis, I am tired at work. I am tired on the weekends and I am pretty much tired all the time. My blood tests show that my iron count is low but doctors say it’s nothing to be worried about. I take an iron tonic but haven’t noticed that it helps. Can ask an expert help please because everyone I speak to who has endo seems to suffer from low energy and tiredness.

Leena St Martin: Tiredness is very common among women with endometriosis and chronic pelvic pain.   A blood test is just a starting point for broader assessment of this troubling symptom.   Background health issues need to be identified (e.g. past history of glandular fever and other illness affecting the family such as pernicious anaemia).   Diet, exercise, and lifestyle should be addressed along with psychological aspects. There is a plenty of good information about helpful nutrition to ensure both body and brain are being replenished at an effective level.

Fatigue may be part of a depressive disorder which very often goes hand in hand with chronic pain. Having to withdraw from normal life due to pain symptoms over a long period of time makes it even more effortful to participate even if the mind is willing.  Depression affects concentration and energy levels so this needs thorough assessment.  Antidepressant medication can help

Fatigue may arise from poor sleep patterns (insomnia, hypersomnia or a sleep disorder) whether caused by pain interference, depression, or other factors.   Sleep problems can also arise from poor eating patterns, digestive disturbance, environmental impact, so this all needs to be assessed.

It may be a result of faulty breathing patterns and/or absence of exposure to fresh air and sunshine

Fatigue may arise from inadequate physical movement which is common for people immobilised by pain over a long time.  Loss of muscle tone contributes to lethargy and a sense of heaviness with movement.

Conversely, fatigue may arise from a boom/bust pattern to activity as when symptoms are under control, we may overdo activity and pay the price later with fatigue

In summary, tiredness should be taken seriously and  thoroughly assessed so a treatment plan can be instigated!

Dr Anna Ponnampalam: Fatigue is an under recognised but very common symptom of endometriosis. Physical activity is known to reduce pain and could be beneficial in reducing tiredness – even gentle exercise can help.  There are some very good ESIG comments and ideas about exercise written by other experts so check those files out as well.

Prescribing drugs to reduce fatigue in those with endometriosis is not common practice among clinicians yet.

Low iron can also be the cause of tiredness, so it would be worth asking your doctor about this. Iron tablets might have more iron per dose, than iron tonics. Moreover, conventional iron tablets usually have the highest iron absorption as well. Hence it is worth trying iron tablets.

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