Why Am I So Tired All the Time?

Figuring out – and fixing – common causes of exhaustion in women

At 37, Stephanie was exhausted. The New Jersey mother of three had just started a demanding job with long hours. The day before her final interview she completed a half marathon, but she no longer had time to exercise once she began her new position.

As the stress of her new job intensified, Stephanie felt her lifestyle spiral out of balance. There was no healthy food available at her work cafeteria, so she ate microwave meals for lunch every day. On the weekends she napped, telling herself she was just doing it while her kids were napping. However, she still took a nap, even if her kids didn't. She struggled to get out of bed in the morning and regularly felt completely wiped out.

Stephanie is in good company, according to Shilpi Agarwal, MD, a board-certified family medicine and integrative and holistic medicine physician who specializes in women's health. She says that about half of her female patients in their late 20s through their 40s report some degree of fatigue.

The causes of fatigue range from thyroid imbalances to depression or simply an overscheduled lifestyle, but the important thing to know is you don't have to accept feeling constantly wiped out. Medical treatment and lifestyle changes can help you get your energy back and feel better.

Figuring out why you are tired
It's normal to feel rundown during hectic periods, and your tiredness could be circumstantial – like having a stressful project at work or being the sole caretaker for your children while your spouse is out of town. But if your fatigue persists for more than two weeks, Agarwal recommends going to see your primary care physician to get it checked out.

Here are some common – and treatable – medical conditions that can lead to fatigue:

Agarwal estimates that 7 to 10 percent of her patients are women with anemia, most typically due to a lack of iron in the diet or very heavy periods. "Both of these cause you to have lower than normal circulating blood or blood that's not delivering oxygen efficiently, and when that happens you get a sense of fatigue," she explains.

Fibroids, which are benign tumors in the uterus, could also increase your chances of being anemic, says Agarwal. This is because women who have fibroids can have heavier, longer periods. If you're experiencing ongoing tiredness, let your healthcare provider know if you have a history of heavy periods or fibroids.

A blood test will determine if you're anemic, and the treatment is simple: taking iron supplements and adding iron-rich foods to your diet. These include beans, leafy greens, and red meat.

The thyroid gland is responsible for regulating metabolism and energy levels. If you have an underactive thyroid, you might feel extremely tired or be colder than others around you. You could also notice some hair loss and just have a general sense of lethargy, says Agarwal.

Many people think that an underactive thyroid only develops later in life, but hypothyroidism can impact anyone, even at an early age. Agarwal often sees the condition in young women in their late 20s and early 30s.

And if you already have a slightly overworked thyroid, pregnancy can stress it further. The metabolic demands on your body increase significantly during pregnancy, and the thyroid gland has to produce enough thyroid hormone to sustain both you and your developing fetus, Agarwal explains.

Agarwal suggests asking your doctor to check your thyroid, especially if you have a family history of thyroid problems. Once diagnosed, women with hypothyroidism are given a thyroid replacement hormone and tend to do very well, she says. You may need to adjust the dose to get it right, but in general you should start to see improvements fairly quickly – within two to four weeks.

If your symptoms are primarily physical, you can start out by seeing your primary care doctor. But if your condition includes a mood component, it's a good idea to seek out a mental heath professional (or ask your primary care doctor for a referral), recommends Healy Smith, MD, a New York City-based reproductive and integrative psychiatrist and clinical assistant professor of psychiatry at New York-Presbyterian Hospital, Weill Cornell Medical College.

"If, in addition to tiredness, you have a persistently low or depressed, or even irritable or anxious mood, and find that you're not enjoying yourself much, you might have depression," Smith says.

Other symptoms of depression include insomnia or oversleeping, changes in appetite, loss of interest in activities you used to be interested in, feelings of guilt or low self-worth, difficulty concentrating, low motivation, feeling like it's hard to even move your body, or feelings of helplessness or hopelessness.

“If you are having thoughts of hurting yourself, you should seek help immediately, either through contacting your current provider, calling the National Suicide Prevention Lifeline, calling 911, or going to your nearest hospital emergency room," stresses Smith.

If you've received a diagnosis of depression, the outlook is very hopeful, says Smith. "There are a lot of treatments, whether it be medications or psychotherapy or a more holistic approach, that can be very helpful in treating depression. The vast majority of people can experience substantial improvement or remission," she says.

When the reason isn't medical, it could be your lifestyle
If you've seen your doctor to rule medical causes of exhaustion, and you aren't depressed, your lifestyle could be the cause of your fatigue. Here are some common drains on your energy.

An unhealthy diet
If, like Stephanie did, you find yourself eating a lot of high-sugar, high-carb refined foods, your fatigue may stem from rapid drops in blood sugar, cautions Agarwal. Refined carbohydrates quickly elevate your blood sugar, giving you a temporary energy boost, but they are not good sources of sustained energy. So when your blood sugar inevitably drops, you're likely to reach for more sugary foods to get another boost, perpetuating the cycle of eating poorly and feeling tired.

Caffeine is the other main offender. Agarwal says that people often either overcaffeinate or caffeinate late in the day, which messes up the sleep-wake cycle.

To begin eating healthier, Agarwal suggests eliminating refined sugar as much as possible and replacing it with foods that will keep up your energy. For example, if you're really tired at 3 o'clock, have carrots and hummus or apple slices with nut butter, instead of grabbing a handful of sweets from the office candy bowl or downing a sugary latte.

And while many people wouldn't want to give up caffeine altogether, moderation can help. Agarwal advises not having caffeine after lunch, and limiting your intake of coffee, tea, and soda to one or two servings a day.

Inadequate sleep
This may seem obvious, but sleep is really important, and poor sleep can be an issue for a lot of women. The optimal amount of sleep, according to experts, is seven to eight hours a night, but Agarwal says, "most women are getting between five or six hours on average, and that's not even good quality sleep."

Hormonal shifts during perimenopause or menopause can also lead to sleep disturbances. These fluctuations can cause changes in the body's temperature regulation, resulting in uncomfortable hot flashes that could keep you awake, says Agarwal. In cases where the cause is hormonal, exercising regularly has been shown to improve your ability to fall asleep faster and stay asleep longer.

You might also have some habits that are that are hurting the quality of your sleep, such as using your phone right before bed. The blue light from the screen affects your ability to produce melatonin, a hormone that helps you fall asleep. An inconsistent bedtime may also contribute.

Agarwal suggests not charging your phone by your bed, so you won't be tempted to check it, and trying to get to sleep at the same time every night. Reading a book (an actual paper book, not one on an electronic device) or meditating for five to 10 minutes can help quiet your mind at the end of the day.

Chronic busyness
Agarwal sees a lot of women who don't necessarily have a medical issue and tend to eat fairly well, but are so stressed out that they're running themselves ragged. The best solution for chronic busyness, Agarwal says, is setting aside more time to do things for yourself, like exercise or spend time outside. At home, ask your spouse or a family member for support.

And when you’re at work, try not to eat lunch at your desk, and take a couple of breaks throughout the day to go for a quick walk or sit outside to enjoy a snack or watch a short entertaining video on your phone. Breaking up your workday like this can help you feel more alert and refreshed, says Agarwal.

Although there's a tendency in our society to downplay chronic busyness as something unavoidable that everyone experiences, Joanna Lindenbaum, a life coach who specializes in helping women create balance in their lives, says that it's actually a very serious concern. "I've seen case after case where chronic busyness leads to burnout, making bad decisions out of exhaustion, and perhaps most importantly, disconnection from self and others," she says.

Cutting back on obligations and tasks is a lot easier said than done, especially when it involves saying no to others. As difficult as it may be, Lindenbaum says it's crucial to put your own well-being above all else. "Remind yourself that you're saying no to the opportunity or obligation in order to create some time for yourself," she says. Making your well-being the priority will help you create the resolve you need to really downsize your external commitments.

Once you cut more out of your schedule, Lindenbaum cautions that it can be tempting to fill it up again, even with things that you can justify as being good for you, like yoga and massage appointments. To tap into a slower pace of life, she suggests taking 10 minutes a day to do absolutely nothing. "No yoga, no walking, no technology…simply BE-ing," she says. "Ten minutes of nothing may not seem like a lot, but creating that type of space for yourself each day can have a massive impact in the long run."

If you are taking steps to remedy your fatigue and don't see any improvement after a month, Agarwal advises going back to the doctor. In rare cases, persistent fatigue could be a sign of a more serious condition, so it's important to rule out or diagnose and treat any other potential causes as soon as possible.

Stephanie, now 41, determined that her exhaustion was primarily because of her lifestyle. She eventually found a new job where she can work from home most of the time, only commuting to the office one or two days a week. She'd gained 30 pounds at her previous job, and learning that her cholesterol had skyrocketed prompted her to start eating healthier, incorporating more fruits, vegetables, and protein into her diet and cutting back on sugar and carbs. She also returned to working out on a regular basis, either running on the treadmill or going to a kickboxing class.

All this has led to a significant bump in her energy level and her ability to be present with her family. Stephanie says, "Since I've started taking steps to eliminate the unnecessary stress in my life and take care of me, I feel energized – both physically and mentally."