PCOS fatigue

PCOS fatigue

PCOS fatigue is an extremely common symptom experienced by women with PCOS. Feeling tired and low in energy can interfere with day to day life and can make it hard to implement changes to improve PCOS symptoms. But don’t worry we are here to help get you back to feeling like yourself again!

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What is PCOS fatigue?

PCOS fatigue can manifest in a variety of different ways. 

Common signs of PCOS fatigue include:
  • Unexplained fatigue
  • Low motivation
  • Sluggishness
  • Tiredness after exercising
  • Tiredness after eating
  • Craving for sugary/starchy food
  • Finding it hard to get going to in the morning
  • Finding it difficult to fall or stay asleep

These symptoms can impact your daily quality of life and can also be connected to feelings of low mood and depression. By understanding your unique PCOS drivers and addressing them at a root cause level, you can restore your energy and vitality.

Causes of PCOS Fatigue

Raised androgens

The main cause of PCOS, in general, is raised androgens or raised androgen metabolites. These raised androgens prevent ovulation from occurring, which in turn leads to irregular or missing cycles.

When ovulation is not occurring, or not occurring every cycle, we can experience low levels of a key reproductive hormone called progesterone. Let’s look at the impact of low progesterone on energy levels to explain the causes of PCOS fatigue.

What is PCOS really?

Low progesterone

One of the main causes of PCOS fatigue is low progesterone. When an egg is released from the follicle during ovulation, the empty follicle will then break down and produce progesterone to prepare the uterus and menstrual lining for pregnancy. 

As seen above, women with PCOS often do not ovulate due to high androgens. This results in irregular or absent menstrual cycles, resulting in low progesterone. 

PCOS bloating and low progesterone

3 ways low progesterone leads to PCOS fatigue

1. Sleep disturbances

Fatigue is linked with the quality of our sleep and women with PCOS have a higher prevalence of poor sleep quality and sleep disorders compared to women without PCOS, due to low progesterone.

Progesterone stimulates your brain to produce a neurotransmitter called gamma-aminobutyric acid (GABA). GABA impacts the nervous system, promoting feelings of calm and relaxation which helps promote sleep.

Low levels of progesterone are also associated with sleep-disordered breathing and obstructive sleep apnoea (OSA) which is more prevalent in women with PCOS than in the general population. 

2. Stress

As a response to stress, the stress hormone cortisol is made and released by the adrenal glands. 

When the body perceives stress, it prioritises making cortisol over progesterone, leading to low progesterone which then impacts energy and sleep. 

High levels of cortisol can also suppress melatonin, a hormone involved in sleep, leading to PCOS fatigue. Interestingly, most women with PCOS have cortisol levels at the higher (or much lower) end due to stress. 

3. Heavy periods

Low progesterone can result in heavy periods (menorrhagia) in women with PCOS. This is because our estrogen levels are usually opposed by progesterone in a healthy, ovulatory menstrual cycle – estrogen causes the lining of the uterus to thicken, while progesterone counters this effect.

If the heavy bleeding lasts for several days then iron deficiency is a possibility. Iron transports oxygen in the blood so when your iron levels are low it can result in fatigue.

Insulin resistance and PCOS

Other causes of PCOS fatigue include:

Vitamin B12 deficiency
Certain medicines commonly used in the treatment of PCOS can deplete nutrients. For example,  Metformin and certain oral contraceptives can affect vitamin B12 adsorption. This vitamin is needed for energy production, so low B12 can lead to fatigue. 

Insulin resistance
The majority of women with PCOS (50%-90%) are insulin resistant. Cells become less responsive to insulin so glucose will not be taken from the blood effectively. This can cause fluctuating blood sugar levels and when blood sugar levels drop or ‘crash’ it can lead to PCOS fatigue. 

Mental health difficulties
A major symptom of depression is fatigue and depression rate is higher in women with PCOS than women without. The development of depression and depressive symptoms may be related to the presence of hyperandrogenism, hyperinsulinemia and elevated levels of inflammation seen in PCOS.  Sleep disturbances in women with PCOS may also be related to psychological distress caused by some of the symptoms of PCOS including weight gain, acne and hirsutism. 

High oxidative stress
Oxidative stress (OS) is the imbalance between oxidants and antioxidants which produces excessive amounts of reactive oxygen species (ROS). OS markers are significantly increased in patients with PCOS compared to those without PCOS. Increased OS can lead to chronic inflammation which can cause you to feel fatigued. 

Neurotransmitter imbalances
Imbalances in neurotransmitters can potentially lead to feelings of fatigue, exhaustion and sluggishness.  For example, dopamine is associated with reward, motivation, and movement but it is also involved in regulating the sleep-wake cycle and low levels of dopamine can lead to increased feelings of fatigue and decreased alertness. Serotonin also plays a role in regulating fatigue and sleep with low levels leading to difficulties falling asleep and staying asleep.

We assess your sex hormone levels, B12 and other nutrients, inflammation, oxidative stress, stress hormones and neurotransmitters in our Advanced Hormone Test to help to understand what is contributing to low energy and fatigue for you. 

How we approach treatment of PCOS fatigue at FUTURE WOMAN

Do I actually have PCOS?

First of all, it’s important with PCOS fatigue to determine that you definitely have the condition. Many women with PCOS have received a PCOS diagnosis based on ultrasound alone, without a test to confirm elevated testosterone or other androgens. This leads to a lot of overdiagnosis of PCOS. 

Testing with our easy at home urine-based Advanced Hormone Test will help to determine if your androgens or androgen metabolites are raised, and if not, whether something else is driving your symptoms. We assess all androgens in the Advanced Hormone Test, including the androgen metabolite 5a DHT, which can be three times more potent than testosterone, and is only detectable in urine testing.

Read more about the benefits of testing hormone metabolism.

What type of PCOS do I have?

Secondly, it is important in PCOS to determine which type of PCOS you have so that your practitioner can address the underlying root causes of your PCOS fatigue. For example, insulin resistance is the most common PCOS type, and we would treat this differently to inflammatory PCOS (driven by inflammation) or adrenal PCOS (driven by stress). The Advanced Hormone Test assesses the full range of adrenal hormones, like cortisol, as well as many markers for inflammation to help us determine your PCOS type.

4 types of PCOS

What factors are contributing to my PCOS fatigue?

As we’ve seen above, there are many factors that could be driving your PCOS symptoms, including PCOS fatigue. In the Advanced Hormone Test, we assess both free and metabolised cortisol and cortisone for a comprehensive assessment of your stress response and HPA (hypothalamus pituitary adrenal) axis functioning. This is especially important in PCOS as increased cortisol can increase overall inflammation in the body, which in turn increases androgen production resulting in the worsening of symptoms. Oestrogen and progesterone are also measured. 

Other possible root causes of PCOS fatigue that would show up in functional testing include nutrient deficiencies (B12, B6), melatonin, neurotransmitter imbalances and oxidative stress/inflammation.

Check your PCOS symptoms now

PCOS fatigue and supplementation

Once we establish the drivers of your PCOS fatigue through testing, one of our expert nutritionists will create a personalised healthplan for you. This will include evidence based supplement, diet and lifestyle recommendations to address your unique drivers and symptoms.

Supplements  can be helpful for PCOS in general but only if they are right for you. For example the supplement myo-inositol has been shown to be hugely beneficial for insulin resistant PCOS but may worsen hormonal symptoms for people who do not need it. That is why it is so important to test first and determine which supplements and dietary changes are right for you.

3 tips to help banish PCOS fatigue for good

To bring about lasting change with PCOS fatigue, here are our top 3 recommendations.

  1. Confirm if you really have PCOS by testing.  We see many women who have been misdiagnosed with PCOS based on ultrasound alone. You need irregular or non ovulatory cycles AND raised androgens to confirm if you have PCOS.
  2. Test ALL androgens and androgen metabolites. It’s not just about testosterone! PCOS can be present if ANY of your androgens or androgen metabolites are raised. Metabolites can only be tested in urine, not blood serum.
  3. Check other hormonal drivers of your PCOS fatigue. Every woman with PCOS is different. As we’ve covered in this article, there are many possible hormonal drivers of PCOS fatigue. Testing with the Advanced Hormone Test can help you understand your unique hormone picture and we can then address those drivers in your free personalised plan.

References

Benjamin, J. J., Kuppusamy, M., Koshy, T., Kalburgi Narayana, M., & Ramaswamy, P. (2021). Cortisol and polycystic ovarian syndrome – a systematic search and meta-analysis of case-control studies. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 37(11), 961–967. https://doi.org/10.1080/09513590.2021.1908254

Ee, C., Pirotta, S., Mousa, A., Moran, L., & Lim, S. (2021). Providing lifestyle advice to women with PCOS: an overview of practical issues affecting successBMC endocrine disorders21(1), 234. https://doi.org/10.1186/s12902-021-00890-8

Fernandez, R. C., Moore, V. M., Van Ryswyk, E. M., Varcoe, T. J., Rodgers, R. J., March, W. A., Moran, L. J., Avery, J. C., McEvoy, R. D., & Davies, M. J. (2018). Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nature and science of sleep, 10, 45–64. https://doi.org/10.2147/NSS.S127475

Haufe, A., & Leeners, B. (2023). Sleep Disturbances Across a Woman’s Lifespan: What Is the Role of Reproductive Hormones?. Journal of the Endocrine Society, 7(5), bvad036. https://doi.org/10.1210/jendso/bvad036

Kahal, H., Kyrou, I., Uthman, O. A., Brown, A., Johnson, S., Wall, P. D. H., Metcalfe, A., Parr, D. G., Tahrani, A. A., & Randeva, H. S. (2020). The prevalence of obstructive sleep apnoea in women with polycystic ovary syndrome: a systematic review and meta-analysis. Sleep & breathing = Schlaf & Atmung24(1), 339–350. https://doi.org/10.1007/s11325-019-01835-1

Kapur, J., & Joshi, S. (2021). Progesterone modulates neuronal excitability bidirectionally. Neuroscience letters, 744, 135619. https://doi.org/10.1016/j.neulet.2020.135619

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