By Jennifer Garam
If you feel wiped out a good portion of the time, you are in good company. According to Shilpi Agarwal, M.D., a board-certified family medicine and integrative and holistic medicine physician who specializes in women's health, about half of her female patients in their late 20s through their 40s report some degree of fatigue.
The causes range from thyroid imbalance to depression to an overscheduled lifestyle, but the important thing to know is that you don't have to constantly feel wiped out. Medical treatment and lifestyle changes can help you get your energy back and feel better.
It's normal to feel rundown during hectic periods, of course, and so your tiredness could be circumstantial. But if fatigue persists for more than two weeks, Agarwal recommends seeing your primary care physician to get it checked out.
Here are three common—and treatable—medical conditions that can lead to fatigue:
Agarwal estimates that 7 to 10 percent of her patients have anemia, most typically due to a lack of iron in the diet or very heavy periods. "Both of these cause you to have lower than normal circulating blood, or blood that's not delivering oxygen efficiently, and when that happens you get a sense of fatigue," she says.
Fibroids, which are benign tumors in the uterus, also increase your chances of being anemic, Agarwal says. This is because women who have fibroids can have heavier, longer periods. If you're experiencing ongoing tiredness, let your healthcare provider know if you have a history of heavy periods or fibroids.
A blood test will determine if you're anemic, and the treatment is simple—taking iron supplements and adding iron-rich foods to your diet such as beans, leafy greens, and red meat.
The thyroid gland is responsible for regulating metabolism and energy levels. If you have an underactive thyroid, you might feel extremely tired, or be colder than others around you. You could also notice some hair loss and just have a general sense of lethargy, Agarwal says.
Many people think that an underactive thyroid only develops later in life, but hypothyroidism can impact anyone—Agarwal often sees the condition in women in their late 20s and early 30s. If you already have a slightly overworked thyroid, pregnancy can stress it further: The metabolic demands on your body significantly increase during pregnancy, and the thyroid gland has to produce enough hormone to sustain both you and your developing fetus.
Agarwal suggests asking your doctor to check your thyroid, especially if you have a family history of thyroid problems. Once diagnosed, women with hypothyroidism are given a replacement hormone and tend to do very well, she says. You may need to adjust the dose to get it right, but in general you should start to experience improvement within two to four weeks.
If your symptoms are primarily physical, you can start by seeing your primary care doctor. But if your condition includes a mood component, it's a good idea to seek out a mental heath professional (or ask your primary care doctor for a referral), says Healy Smith, M.D., a reproductive and integrative psychiatrist and clinical assistant professor of psychiatry at New York-Presbyterian Hospital, Weill Cornell Medical College. "If, in addition to tiredness, you have a persistently low or depressed, or even irritable or anxious mood, and find that you're not enjoying yourself much, you might have depression," Smith says.
Other symptoms include insomnia or oversleeping, changes in appetite, loss of interest in activities you used to enjoy, feelings of guilt or low self-worth, difficulty concentrating, low motivation, feeling like it's hard to even move your body, or feelings of helplessness or hopelessness. (“If you are having thoughts of hurting yourself, you should seek help immediately," Smith stresses, "either through contacting your current provider, calling the National Suicide Prevention Lifeline, calling 911, or going to your nearest hospital emergency room.")
If you've received a diagnosis of depression, the outlook is hopeful, Smith says: "A lot of treatments, whether it be medications or psychotherapy or a more holistic approach, can be very helpful in treating depression. The vast majority of people can experience substantial improvement or remission."
When Your Lifestyle Is Wearing You Down
If you've seen your doctor to rule out medical causes of exhaustion, and you aren't depressed, your lifestyle could be the cause of your fatigue. Here are three common drains on your energy:
1. Unhealthy Diet
If you find yourself eating a lot of high-sugar, high-carb refined foods, your fatigue may stem from rapid drops in blood sugar, Agarwal says. Refined carbohydrates quickly elevate your blood sugar, giving you a temporary energy boost, but they are poor sources of sustained energy—so when your blood sugar inevitably drops, you're likely to reach for more sugary foods to get another boost, perpetuating the cycle of eating poorly and feeling tired. Caffeine is the other main offender. Agarwal says that people often either overcaffeinate or caffeinate late in the day, which disrupts their sleep-wake cycle.
To begin eating healthier, Agarwal suggests eliminating refined sugar as much as possible and replacing it with foods that will keep up your energy. For example, if you're really tired at 3 o'clock, have carrots and hummus or apple slices with nut butter instead of grabbing a handful of sweets from the office candy bowl or downing a sugary latte.
And while many people won't want to give up caffeine altogether, moderation can help. Agarwal advises not having caffeine after lunch, and limiting your intake of coffee, tea, and soda to one or two servings a day.
2. Inadequate Sleep
This may seem obvious, but sleep is really important. The optimal amount, according to experts, is seven to eight hours a night, but Agarwal says, "Most women are getting between five or six hours on average, and that's not even good quality sleep."
Hormonal shifts during perimenopause or menopause can also lead to sleep disturbances. These fluctuations can cause changes in the body's temperature regulation, resulting in uncomfortable hot flashes that could keep you awake. When the cause is hormonal, exercising regularly has been shown to improve your ability to fall asleep faster and stay asleep longer.
You might also have habits that hurt the quality of your sleep, such as using your phone right before bed. The blue light from the screen affects your ability to produce melatonin, a hormone that helps you fall asleep. An inconsistent bedtime may also contribute.
Agarwal suggests not charging your phone by your bed, so you won't be tempted to check it, and trying to get to sleep at the same time every night. Reading a book—an actual paper book, not on an electronic device—or meditating for 5 to 10 minutes can help quiet your mind at the end of the day.
3. Chronic Busyness
Agarwal sees many women who don't necessarily have a medical issue and eat fairly well, but are so stressed that they run themselves ragged. The best solution for chronic busyness, she says, is setting aside more time to do things for yourself, like exercising or spending time outside. Breaking up your workday can also help you feel more alert and refreshed: Try not to eat lunch at your desk, and take a couple of breaks throughout the day to go for a quick walk or sit outside to enjoy a snack or watch a short entertaining video on your phone.
Although there's a tendency in our society to downplay chronic busyness as unavoidable, life coach Joanna Lindenbaum says it's actually a very serious concern: "I've seen case after case where chronic busyness leads to burnout, making bad decisions out of exhaustion, and perhaps most important, disconnection from self and others."
Cutting back on obligations and tasks is easier said than done, especially when it involves saying no to others. As difficult as it may be, Lindenbaum says, it's crucial to put your own well-being first: "Remind yourself that you're saying no to the opportunity or obligation in order to create some time for yourself." Making your well-being the priority will help you create the resolve you need to really downsize your external commitments.
Once you cut more out of your schedule, Lindenbaum cautions, it can be tempting to fill it up again, even with things that you can justify as good for you, like yoga and massage. To tap into a slower pace of life, she suggests taking 10 minutes a day to do absolutely nothing. "No yoga, no walking, no technology…simply BE-ing," she says. "Ten minutes of nothing may not seem like a lot, but creating that type of space for yourself each day can have a massive impact in the long run."
If you are taking steps to remedy your fatigue and don't see any improvement after a month, Agarwal advises going back to your doctor. In rare cases, persistent fatigue could be a sign of a more serious condition, so it's important to rule out or diagnose and treat other potential causes as soon as possible.