Why am I tired? Beating PCOS fatigue

There are many reasons why we could be feeling tired all the time? You have probably tried every method to try to optimise your sleep and despite possibly getting a good night’s sleep you are still feeling totally exhausted. 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 GP with fatigue then it is important they outrule other causes, as fatigue is a common symptom of a variety of other clinical conditions.

Does PCOS cause 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 functions, they have a big influence on sleep and our circadium rhythm (the body’s internal 24-hour cycle that regulate 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. To begin with can be tracking your cycle as closely as you can. 

Depression, Self- Esteem and Body Image 

Diagnosed depression and anxiety are at higher risk in those with PCOS, this can impact on sleep quality and fatigue. 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. 

Iron-deficiency anaemia 

If you are experiencing heavy menstrual bleeds, whether as part of regular or irregular menstrual cycle, this can increase your risk of developing iron-deficiency anaemia. Iron creates the proteins (haemoglobin and myoglobin)  that carry oxygen around the body, so if you’re deficient in iron this can arise in fatigue. 

Prescribed Medications 

Recently new advice was released for monitoring individuals prescribed metformin, a common medication to treat insulin resistance. Low vitamin B12 levels or vitamin B12 deficiency is identified as a common side effect, particularly for those on higher dose and/or prescribed for a prolonged time. If left untreated this can cause fatigue and depressive symptoms.

How can I beat PCOS fatigue?

Sleep is one of the most underrated pillars of health and it affects everything. Ensuring optimal sleep hygiene consistently to maintain an 8 to 9 hour sleeping period regularly. 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. If you still don’t believe me, take a read of Matthew Walker’s book, Why We Sleep. 

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 sluggish. 

Choosing foods rich in dietary fibre such as plant based proteins (beans and pulses, nuts and seeds), wholegrain carbohydrates, and adding in a portion of fruits and vegetables where you can. 

Sometimes easier said than done when overwhelmed with tiredness and fatigue. Planning meals and snacks ahead and having the food staples available at home can make this easier. 

For example, you could have frozen fruit and vegetables, mixed bags of unsalted nuts and raisins, wholegrain cereals or porridge sachets as well as tinned beans and chickpeas.

Is PCOS linked to sleep disorders?

There are few studies supporting the increased risk and likelihood of sleep disturbances and disorders across people with PCOS. These studies support the likelihood of sleep disorders in people with PCOS, independent of body size, weight and BMI. As an endocrine disorder, the endocrine system regulates the release and regulation of all hormones, not surprisingly there are key hormones involved in our sleep-wake cycle, psychological response, metabolic response which all can have involvement in the development of sleep disorders. 

For this reason a multi-dimensional approach to treating PCOS including improving sleep hygiene may then in turn improve other symptoms such as levels of insulin resistance.

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