Fight Fatigue!

By: Holly L. Thacker, MD • Posted on March 07, 2014

Fight Fatigue!

Causes of Fatigue

Major causes of fatigue can be:

  • Heart disease
  • Cancer
  • Infection

Sometimes some of the more common causes of fatigue may to be blame unless you have any of the ‘red flag’ symptoms listed below or if you are a smoker and/or heavy drinker (both risks for occult cancers such as pancreatic cancer which can present as fatigue):

  • Unexplained weight loss
  • Fever
  • Chest pain
  • Exertion

Tests and Screenings for Women

You should obtain the following screenings to rule out any major illnesses:

  • Blood count to rule out anemia
  • Chemistries to check for diabetes, kidney and liver problems, chronic hepatitis
  • TSH to screen for primary hypothyroidism

For women, the goal TSH should be between 0.4-3.0. If you have low thyroid and are on a daily thyroid medicine (T4) have your physician check your free T3 level.

6 Common Causes of Fatigue in Today’s Busy Woman

Assuming these tests and a physical exam are normal, below are 6 common causes of fatigue in busy women:

  1. Vitamin D deficiency. Vitamin D is not a vitamin, it’s a pro-sterol hormone. It is common to be deficient in the winter (less exposure to the right wavelength from the sun) and to be deficient in latitudes away from the equator. Unless like you eat like an Alaskan (cod liver oil, fresh salmon, and reindeer meat), you cannot get enough vitamin D from your diet in most instances. Have your physician check a 25-OH vitamin D level. It should be over 32.
  2. Sleep disorders and sleep deprivation. Many women tell me they ‘get by on 6 hours of sleep.’ This is not enough. Prior to electricity, folks slept 10 hours per day. You need at least 8-9 hours of sleep each night. If you have insomnia, restless legs, loud snoring (which may indicate Obstructive Sleep Apnea Syndrome) you need evaluation and treatment.
  3. Vitamin and mineral deficiencies. B-complex vitamins are water soluble and should be obtained in a healthy diet. Some medications and hormones may accelerate B vitamin metabolism. Certain medications like the PPI antacid stomach medicines may impair the absorption of B12. And taking a B50 balanced B-complex vitamin may help. Magnesium deficiency is not uncommon in women. For those with constipation, restless legs, nocturnal leg cramps, migraines, and/or fatigue try an oral Magnesium 250-400mg supplement as long as kidney function is normal.
  4. Medication side effects. Beta blockers (used for hypertension, heart problems, migraine and other conditions) can cause fatigue. Statins (cholesterol lowering medicines such as Mevacor, Zocor, Lipitor, Pravachol, Crestor) can cause muscle and nerve symptoms and/or depletion of CoEnzyme Q10. Your physician may need to obtain blood tests and/or switch your medicines.
  5. Female hormone deficiencies. Many women are happy to stop their menses and go into menopause, however lack of estrogen, progesterone and sometimes testosterone can cause sleep disturbance and/or fatigue as well as less muscle mass. Even if you do not have hot flashes, if you have fatigue of postmenopausal onset, you should be evaluated by a Menopause Specialist.
  6. Depression and neurotransmitter imbalance. Many women come to see me for ‘hormonal imbalance’ with normal menses and what they have is neurotransmitter imbalance of serotonin, dopamine, and norepinephrine. A common cause of unexplained fatigue is untreated depression and/or untreated anxiety disorders. There may or may not be associated mood symptoms. Sometimes fatigue and lack of interest in activities can be the main symptoms. If you feel ‘blah’ and tired in the winter with shorter daylight hours, you may have SAD-seasonal affective disorder and this can be helped with bright light providing 10,000 lux of light for 30 minutes each day in the early part of the morning from September through April (in the Northern Hemisphere).

Finally, daily exercise (both aerobic and weight lifting with pre- and post-stretching) and eating a nutritious, heart healthy Mediterranean diet will boost your energy and concentration and will help promote restorative sleep.

Be Strong. Be Healthy. Be in Charge!

-Holly L. Thacker, MD

Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Her special interests are menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health. Dr. Thacker is the Executive Director of Speaking of Women’s Health and the author of Women’s Health: Your Body, Your Hormones, Your Choices and Cleveland Clinic Guide to Menopause.

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