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Whether you’ve been dealing with Polycystic ovary syndrome (PCOS) for a number of years or you’re in the same camp as approximately one-third of people who wait two years or more for a PCOS diagnosis and have yet to be diagnosed, one common thread is that you probably feel exhausted all.of.the.time. The PCOS fatigue might feel particularly debilitating around your heavy flow days that seem to chain you to your couch or bed, but you might also feel constantly tired and drained all throughout your cycle, too. It can make it nearly impossible to still get everything done that you need to do in a day.
Is fatigue officially a PCOS symptom, or does it just feel like it’s associated with PCOS? An OB/GYN and reproductive endocrinologist shares more, plus how to work through PCOS fatigue with medication, treatments, and lifestyle changes.
Does PCOS cause fatigue?
“The relationship between PCOS and fatigue is complicated,” explains Jessica Ryniec, M.D., a Massachusetts-based physician who is double board-certified in obstetrics and gynecology and reproductive endocrinology and infertility. “PCOS does not directly cause fatigue, but it is one of the most common symptoms that people with PCOS complain of, and that is because multiple factors associated with PCOS can lead to fatigue.”
Some of the comorbidities of PCOS that also induce fatigue include hormonal imbalances and insulin resistance, and the inability to fully process glucose in the body can cause weight gain or difficulty maintaining a healthy weight. Obesity can be tied to fatigue and sluggishness, daytime sleepiness, and sleep disorders including sleep apnea, says Dr. Ryniec. For example, according to the PCOS Awareness Association, women with PCOS are between 30 and 40 times more likely to have sleep apnea and fatigue in general compared to people without PCOS.
On top of that, PCOS typically presents with heavy periods, and that can lead to fatigue via iron deficiency anemia, Dr. Ryniec explains. Plus, anxiety and depression are common mental health conditions tied to PCOS that can contribute to disruptions in your circadian rhythms, or the natural sleep-wake cycle. A 2022 systematic review confirms that the endocrine system helps the circadian rhythm cycle stay on track. The research has also found that these sleep issues that are connected to PCOS can have negative consequences for your overall health, including decreased memory and judgment, immune health problems, high blood pressure, and heart disease.
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Is it possible to treat PCOS fatigue?
As much as it may help to have your PCOS fatigue symptoms validated, there can be a trial and error period to figuring out that what you’re experiencing is PCOS-related tiredness. “The only way to know for sure is to rule out other common causes for fatigue like thyroid disorders, heart disease, sleep apnea, primary sleep disorders, other mental health disorders, poor diet or nutrient deficiencies, or dehydration,” explains Dr. Ryniec. This may require trips to multiple specialists, but if you do believe you have some of the symptoms of PCOS in addition to fatigue, it’s important to bring it up to your doctor, especially your OB/GYN, and advocate for yourself to get the care you need.
According to Dr. Ryniec, there are some medical remedies that can treat fatigue related to PCOS — they range from working with a nutritionist or dietitian on healthy eating habits that can help boost your energy and help you maintain a healthy weight, to embarking on medical weight loss and taking medications like insulin sensitizers (metformin, for example).
Another way to treat PCOS and its symptoms is by taking hormonal birth control. Often, the birth control pill works to keep your hormones in check and reduce the heaviness of your period by preventing an egg from maturing, descending, and potentially being fertilized, she adds. If you have a designated sleep disorder diagnosis like sleep apnea, a CPAP machine is a remedy that might be helpful if recommended by a sleep specialist.
How can you combat PCOS-related fatigue with lifestyle changes?
The above medications and remedies are first-line treatments from medical professionals, but you can work through exhaustion related to PCOS with some tweaks and habits in your lifestyle.
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Eating balanced. People with PCOS, due to insulin resistance and a decrease in a hormone that regulates fullness, may feel less satiated and get hungry again shortly after a meal, per 2021 research. That’s why it’s important to eat a balanced diet with plenty of satiating protein, filling healthy fats, and complex carbohydrates, like oats, whole grains, fruits, and vegetables, Dr. Ryniec says. If your periods are heavy, you should replenish your iron levels with foods like lean red meat and dark leafy greens, and extra vitamin C-rich foods like oranges to help your body absorb the iron.
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Move in whatever way is comfortable. Dr. Ryniec recommends getting in at least 150 minutes of some kind of physical activity per week to keep your energy levels high and your metabolism going (that’s about 20 minutes or so per day). This can also make a positive difference in your mental health.
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Staying hydrated, and cutting down on caffeine and alcohol. For people with PCOS, being adequately hydrated can not only help your digestion stay regular but can also keep your circadian rhythms and sleep on track (dehydration can disrupt sleep, according to the Sleep Foundation). Stick to water — 64 ounces per day is the gold standard — and stay away from sugary drinks as much as possible. Caffeine in moderation in the morning is fine, but Dr. Ryniec advises staying away from indulging in alcohol as much as possible since it commonly interrupts sleep.
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Make yourself a cozy sleep den. Your sleep hygiene is one way to improve your overall quality of sleep (and how you feel the next day), and a bedtime wind-down routine can serve as a self-care practice too. In addition to the above health habits, improve your sleeping area with darker blinds and comfy, cooling sheets to help you get a better night’s rest, Dr. Ryniec says.
Mara Santilli is a journalist reporting on health and wellness and how social and political systems influence the well-being of certain groups, including but not limited to Black and brown communities, women, and the LGBTQ+ community. Her editorial work has appeared in publications such as Shape, Marie Claire, Cosmopolitan, Women’s Health, InStyle, Glamour, and more. Outside of reading and writing, she enjoys traveling (especially to Italy), singing, dancing, musical theatre, and playing guitar and piano.