PCOS and fatigue – why am I so tired all the time?

I want to talk to you about Elena. Elena is one of my PCOS group coaching clients. She started my group course last December because she was exhausted all the time. She could barely survive 6 hours at work and arrived home feeling knackered. Her biggest concern was that she did not have the energy to cook or clean. So, she resorted to ordering junk food in an attempt to get to bed earlier. Elena also struggled with weight gain and joint pain as well as dark patches of skin on her neck. She was also always constipated and bloated.

Elena’s story

Elena told me:

“I have been visiting an endocrinologist regularly for the past year because I felt something was off in my body. We spoke about how tired I felt and I just could not function. I am just 38 and I feel like I am 90 years old. She kept telling me that was just PCOS and I had to learn to live with it. I felt frustrated after every appointment because I knew deep down this wasn’t right but an authority figure was telling me otherwise. She kept pushing the keto diet, and Metformin (which gave me terrible gastric side effects).  I have tried keto in the past and it wasn’t a good fit for me. It made me feel too restricted and I would find myself binge eating carbs.”

I shared Elena’s story on my Facebook group and I got over 140 women commenting that they went through a similar experience with their health care provider. They felt like no one believed them and their fatigue was affecting their life.

I have good news for you –  this does not have to be your story. You do not need to live with this debilitating fatigue and joint pain.  Like Elena (as well as my own experience and the experience of many of my clients), your quality of life can improve, we need to get to the root cause of your fatigue and work on it through nutrition and lifestyle.

“After following the PCOS blueprint I can play with my son and actually enjoy it and still have the energy and mood to have some romantic time with my husband even after a full day of work. My libido has also improved so much and it has made my relationship with my husband stronger”

Why is fatigue so common in women with PCOS?

This is one of the most common complaints I hear from my clients. I have been there myself too in the past.  As you may know, PCOS has a huge hormonal component. This involves our stress hormones. Elena had a dutch test and we found that her cortisol was through the roof as well as her DHEA and DHT. Insulin resistance is another huge culprit. We often find ourselves on a blood sugar rollercoaster. PCOS in itself also results in several vitamin and mineral deficiencies which are probably due to the poor gut microbiome. The nutritional deficiencies themselves are also probably causing the hormonal imbalance.  The good news is that if we treat the root causes of our PCOS fatigue, joint pain, gut health, sugar balance, and also weight can be significantly improved.  five birds, one stone.

What can cause fatigue in PCOS?

Unfortunately, PCOS fatigue can be the result of several things. However, I will be discussing what I see the most in my patients. I would like to point out that every woman is different so you might be different too.

1. Adrenal fatigue

‘Adrenal fatigue’ (or HPA- Axis dysfunction), is what I see in around 80% of my patients.  What this means is that you feel very stressed for a long period of time. This then causes your stress response to malfunction. In today’s world we all live a high-stress life – whether it’s due to hectic work schedules, family-related issues, health, financial, over-exercising, lack of sleep, or not eating enough.

Then of course many people try to fight off PCOS fatigue by drinking coffee or consuming energy drinks which stimulate our stress hormones even more. This makes their bodies unable to adapt to the stress and the fatigue rapidly sets in.

Long periods of stress have a negative effect on our adrenal glands. These glands are found above our kidneys and are responsible for producing a hormone called DHEA as well as cortisol (our stress hormone).  DHEA  causes many symptoms that are typical of PCOS such as male pattern baldness, hirsutism, acne, irregular periods, accumulation of belly fat, etc. Excess DHEA also gets converted to testosterone.

2. Insulin Resistance

Insulin resistance is a term we hear a lot when it comes to PCOS. What many people do not know is that our stress hormone – cortisol – is actually responsible for signaling our liver to release stored glycogen as glucose and bring our blood sugar up to normal whenever it falls too low. But if your stress response is not working the way it should when your blood sugar drops, this pathway gets affected and your liver is not able to release stored glycogen and provide the sugar your cells need and this is one reason we often get these extremely strong cravings and feel shaky, and very fatigued.  Given that up to the majority of women with PCOS have some degree of insulin resistance, this is very likely.

Inositol is a supplement I recommend to all my PCOS clients. This amazing supplement helps get glucose into cells where they need it, this can do wonders for your energy levels. Inositol is also found naturally in some foods such as legumes, bananas and citrus fruits – incorporating them in your diet can be very helpful.

You’re deficient in certain essential vitamins and minerals

Gut health is one of the biggest drivers of PCOS and the one I find most fascinating. We know for a fact that women with PCOS have a completely different microbiome from women who do not have PCOS. This affects how we metabolize food and what nutrients we absorb from the food we consume.  So many women with PCOS find themselves deficient in iron, Vitamin B’s, Vitamin D, and many more. Iron is responsible for transporting oxygen around our body, having low iron levels means that you are not transporting oxygen to all your cells which can make us feel very tired. So I do recommend getting your ferritin levels checked out next time you are at your doctor.

Vitamin B is essential for your body to actually make energy.  If your vitamin B levels are low that means that your energy will be low. Furthermore, Metformin and the birth control pill depletes the body of vitamin Bs, in fact, 30% of people who take Metformin are vitamin B12 deficient.  So if you take, or have taken Metformin or the pill you need to be taking a Vitamin B supplement.

In my PCOS blueprint program I go into detail on how to eat to improve levels of all these nutrients.

What are some common symptoms of Adrenal fatigue?

  • Feeling excessively tired after 20 minutes of exercise
  • Difficulty staying asleep – and waking up several times a night
  • Wake up tired after a full night of sleep
  • Early afternoon fatigue
  • Afternoon headaches
  • Tension headaches
  • Unable to fall asleep
  • Sweating when not exercising
  • cold hands and feet
  • Crave salt

How to improve energy with PCOS

Manage your stress levels

Completely eliminating stress is impossible but learning how to actively manage and control stress is essential.  Sit down and see what items on your regular task lists you can delegate or get help with. Perhaps getting someone to help with housework, using school transport for kids instead of driving them yourself

For stress that is out of your control, think about how you could reframe that situation so that your body actually doesn’t perceive it as a stressor. Find time to be in nature every weekend. Practice deep breathing and meditation and do something just for yourself at least once a week.

Get more sleep

When you get less than six hours of sleep a night you not only feel drained, but you also produce more stress hormones. 7-8 hours should be your minimum, however, whilst you’re trying to repair your stress response,  and improve your PCOS root causes you should aim for 9- 9.5 hours.  So go to bed early enough to give yourself enough time to wake up naturally and then you’ll figure out how much sleep you actually need right now. So focus on improving your sleep hygiene. Focus on relaxing before bed, remove unwanted lights from the bedroom and give yourself the gift of time.

Take a break from the hardcore HIIT or endurance exercise for a while

While I am a huge advocate of moving your body, if your stress hormones are out of balance you will need to focus on restorative movement rather than high intensity. Even a jog might be too much for your adrenals to handle. Exercise that increases your heart rate too much will have your body pumping out cortisol for up to 48 hours after

I would recommend leisurely walks, yoga, and pilates for between 4 – 6 months until your body starts feeling safe enough.

Cut the caffeine

I know many cysters survive with caffeine and drink several cups a day to keep them going. Unfortunately, caffeine is a stimulant, it stimulates the adrenals to produce more cortisol and DHEA.  Having said that I do not recommend going off coffee cold turkey. This is likely going to result in some really bad headaches. So I recommend starting your day with green tea or water and reduce 1 cup every 4 days. So if you take 8 cups a day – tomorrow avoid your morning cup and have 7 cups and after 4 days replace your last cup of coffee with herbal tea and keep doing that every 4 days until you wean yourself off.

If you would like to learn more about improving your PCOS symptoms dont forget about my blueprint program