PCOS fatigue: does PCOS make you tired?

Navigating the maze of PCOS symptoms can be daunting. But amidst the hormonal fluctuations and metabolic challenges, there’s another frustrating symptom: PCOS fatigue. Delving deeper into this extreme and persistent exhaustion can shed light on understanding and managing it more effectively. Keep reading to learn more about PCOS and fatigue.

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a widespread hormonal condition observed in 1 in 10 people assigned female at birth, primarily of reproductive age.

This condition, often marked by irregular menstrual cycles, elevated androgen levels, and ovarian cysts, poses unique challenges, with fatigue being one of its notable symptoms.

>> Read more | PCOS 101: a beginners guide

What is fatigue?

Fatigue may be defined as an extreme and persistent tiredness, or exhaustion during or after usual daily activities, or even prior to beginning them, that is not relieved by common strategies that restore energy.

Depending on the duration, fatigue can be classified into acute fatigue and chronic fatigue.

It can also be classified as mental fatigue, referring to impacting your cognition and perception. If you are presenting to your doctor with fatigue then it is important they rule out other causes, as fatigue is a common symptom of a variety of other clinical conditions.

What is the link between PCOS and fatigue?

Although more research is required, there appears to be a link between PCOS and fatigue. In fact, people with PCOS are more likely than people without PCOS to report fatigue as a symptom, a study found. But does PCOS make you tired?

What causes PCOS fatigue?

We cannot say for certain that PCOS is the sole factor of fatigue. But there are various components of PCOS that may contribute to PCOS fatigue.

Insulin resistance

Insulin resistance can cause your body’s cells to find it more difficult to utilise available sugar (or glucose) in the blood, as the insulin (hormone) is not working properly to open the door to the cells.

One article reviewing studies including large sample data found that tiredness and fatigue are more prevalent in conditions associated with insulin resistance, such as PCOS, independent of body size and diagnosed sleep disorders, such as sleep apnoea.

Irregular periods

What we do know is that sex hormones as well as having an important reproductive function, have a big influence on sleep and our circadian rhythm (the body’s internal 24-hour cycle that regulates bodily functions).

Oestrogen has been shown to decrease the length of time it takes to fall asleep, increase total sleep time and has a role in regulating body temperature at night.

Progesterone has anti-anxiety and sedative effects. As the levels of oestrogen and progesterone change during your menstrual cycle. If you are experiencing irregular periods it can be difficult to identify how best to manage effectively.

Managing your irregular periods with general PCOS management and/or taking birth control may be beneficial.

Depression, self-esteem and body image

In people with PCOS, mood disorders like depression and anxiety are at higher risk of developing. These disorders can impact sleep quality and increase the likelihood of fatigue.

In people with PCOS, body image can be impacted because of the way PCOS symptoms challenge societal beauty standards. A recent study including 201 individuals with PCOS found that the strongest effect from a psychological variable which had a negative impact on sleep quality was body image.

Sleep disorders

There are few studies supporting the increased risk and likelihood of sleep disturbances and disorders in people with PCOS including sleep apnea. These studies support the likelihood of sleep disorders in people with PCOS, independent of body size, weight and BMI.

PCOS is an endocrine (hormone) disorder, and the endocrine system regulates the release and regulation of all hormones. So it is not surprising that PCOS may impact key hormones involved in our sleep-wake cycle, psychological response, and metabolic response which all can have involvement in the development of sleep disorders.

Thyroid problems

Although more research is required, thyroid problems and PCOS have been associated with each other.

In people living with an underactive thyroid (hypothyroidism), the body’s metabolism slows down. This can often lead to many symptoms, including lethargy and fatigue. In people with an overactive thyroid (hyperthyroidism), the body’s metabolism speeds up. Again, this may be linked to symptoms like fatigue.

Vitamin B12 deficiency

Vitamin B12 deficiency is linked to decreased red blood cell production, which may induce fatigue.

There is a link between vitamin B12 deficiency, insulin resistance and PCOS. Vitamin B12 levels were lower in people with insulin resistance and PCOS, as seen in a 2009 study.

Although the link between B12 and PCOS requires more research, commonly people with PCOS and insulin resistance are prescribed metformin. Metformin is an insulin sensitiser, and long-term use has been linked to B12 deficiency.

Iron-deficiency anaemia

If you are experiencing heavy menstrual bleeds, whether as part of a regular or irregular menstrual cycle, your risk of developing iron-deficiency anaemia may be increased.

Iron creates the proteins (haemoglobin and myoglobin) that carry oxygen around the body. Iron deficiency can result in fatigue.

Not eating enough

Even though most people with PCOS are told to restrict certain food groups or limit calories to manage symptoms, if you aren’t consuming enough energy daily then this can lead to energy depletion and feelings of fatigue.

What about adrenal fatigue?

Adrenal fatigue is the misconception that our adrenal glands get “exhausted” due to consistent, long-term stress, leading to reduced production of crucial hormones, such as cortisol, the primary stress hormone.

It’s important to note: adrenal fatigue is not a recognised medical condition, and our adrenal glands don’t actually wear out.

Although genuine medical conditions like Cushing’s syndrome and Adrenal insufficiency arise from adrenal gland dysfunction, adrenal fatigue isn’t counted among them.

>> Learn more | Debunking PCOS adrenal fatigue and adrenal PCOS

7 ways to treat PCOS fatigue

How to treat PCOS fatigue

Living with PCOS fatigue can be challenging. There are various medical interventions and lifestyle changes that can help with symptom management.

Speak to a medical professional

Your first stop should always be with a medical expert, who can guide you through the nuances of your PCOS fatigue.

It is important to be tested for deficiencies like iron deficiency and vitamin B12 deficiency. It is particularly important to be tested regularly for vitamin B12 deficiency if you are on metformin, a common medication for PCOS.

Manage your caffeine intake

While caffeine promises instant wakefulness, moderation is key to avoiding potential sleep disturbances. Caffeine is a natural stimulant present in tea, coffee, and cacao plants.

Since caffeine acts as a stimulant, excessive intake or consuming coffee close to bedtime might negatively affect sleep. Recognising your personal caffeine threshold and avoiding coffee near sleeping hours can potentially aid in addressing sleep disturbances.

Eat enough and eat regularly

To stave off fatigue, make sure you’re fuelling your body appropriately. Regular, balanced meals can stabilise energy levels.

Choose fibre-rich foods

From a nutrition perspective, when we are sleep deprived or feeling extremely tired our bodies will tend to crave quick-acting sugar foods. This will tend to give us that burst of energy we’re looking for from the blood sugar spike, which will come down just as quickly. Usually, this cycle repeats with feeling ongoing tiredness and sluggishness.

Fibre stabilises blood sugar, offering consistent energy and combatting fatigue. Where you can, choose foods rich in dietary fibre such as plant-based proteins (beans and pulses, nuts and seeds), wholegrain carbohydrates, and add in a portion of fruits and vegetables.

Enhance your sleep hygiene

Sleep is one of the most underrated pillars of health. Ensuring optimal sleep hygiene consistently to maintain an 8 to 9-hour sleeping period regularly is essential.

Quite often we think we can bank hours of sleep on the weekend to make up for a lack of sleep during the day. However, this has been proven to not be the case.

Focus on creating a good environment for sleep by managing light, noise and temperature where you can.

Stay hydrated

Every cellular function in our body craves hydration. Drinking water can be the simplest fatigue buster.

Staying adequately hydrated is essential for maintaining energy levels and preventing fatigue. Both physical and cognitive functions rely on proper fluid balance, emphasising the importance of regular water intake throughout the day.

>> Read more | Drinks for PCOS: The ultimate PCOS beverage guide

Take supplements

Based on your medical advice, supplements might be the missing piece in your fight against fatigue.

If you discover you have a deficiency of vitamin B12 or iron, and cannot solve this with food, supplements may be advised.

You may also want to consider supplements to manage PCOS generally, which will impact symptoms like fatigue.

>> Read more | Best supplements for PCOS

Key takeaways: PCOS fatigue

PCOS fatigue has many factors affecting its onset and prevalence but consulting with medical professionals and making lifestyle choices may impact how fatigue and other symptoms of PCOS impact your life.

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Sophia Boothby RD Author at The PCOS Collective

Lead Author | Head Dietitian | Registered Dietitian


Sophia is a Registered Dietitian working as a Specialist Community Dietitian within a London NHS Teaching Hospital specialising in gut health such as irritable bowel syndrome (IBS) and the low FODMAP diet, type 2 diabetes, PCOS, and cardiac rehabilitation. Sophia offers 1:1 PCOS support in our virtual PCOS clinic.

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