Special thanks to my friend Dr. Carolle for this contribution ...
Many women who come to my center ask me “Why am I so tired?” One example is “Mary-Ann,” 48 years old, diagnosed with perimenopause because of fatigue, difficulty sleeping, and a low sex drive. She tried many alternative therapies, including natural progesterone cream, to no avail.
During the consult, Mary-Ann revealed a deep and tragic secret -- she had been raped from the age of 6 to 14 by an uncle who helped the family financially from time to time. The abuse stopped when he moved to another city but he had threatened to harm her and her parents if she told anyone about their secret. Mary-Ann thought that her mother knew about the abuse but said nothing for fear of losing his financial support.
She confided that all her life she had been trying to prove that she was a lovable and worthy human being. I was the first person that she confided in. She had always felt ashamed and guilty. The relationship with her mother was very strained.
Mary-Ann had one failed marriage and a difficult relationship with her two adult children. She felt they wanted to be around her only when she gave in to their demands for money. Her second marriage was to an old high school sweetheart who was well-to-do and offered her the choice to stop working as a teacher. They lived in a beautiful estate by the ocean.
Her symptoms of overwhelming fatigue started when she decided to do some remodeling and arguments started with her neighbor about whether his view would be jeopardized. By the time she came to see me, it was difficult for her to get out of bed in the morning. She was very concerned since all the blood tests by her healthcare provider were normal.
I told her that fatigue is one of the most common ailments of modern time and that it’s more common among women than men. Studies have shown that about 500,000 people in the US have seen their healthcare providers complaining of fatigue.
What is Fatigue?
Fatigue is a symptom associated with perimenopause and menopause supposedly because of basic biological changes. But is it because a woman is in midlife that there are biological changes inherent to this stage of life -- or is it that conditions in her life are causing her to be stressed, causing abnormal symptoms? I tend to believe it is most often the latter.
We know that stress is indeed associated with fluctuating hormone activity. And when there is hormonal imbalance, women like Mary-Ann will experience hot flashes and night sweats, causing loss of sleep. It has been shown that even with the loss of one night’s sleep; results are tiredness, irritability, inability to concentrate, and mood swings.
What causes fatigue?
Psychological causes of fatigue include depression, grief, and stress. Physical causes include anemia (especially in women with irregular and heavy bleeding who have iron deficiency), alcohol and illegal drug use, allergies, autoimmune diseases such as lupus, cancer, chronic liver and kidney disease, chronic infections, chronic pain, diabetes, eating disorders and malnutrition, heart disease, HIV/AIDS, mononucleosis, parasitic infections, sleeping disorders, under active thyroid, and tuberculosis.
Those with an under active thyroid wake up feeling rested in the morning, but develop fatigue as the day goes on. If your energy level is low throughout the day, this may be a sign of depression.
A survey from the University of Arkansas revealed that in more than 500 women with heart attacks, only 30% had any chest pain or discomfort. Most complained of unusual fatigue, anxiety, indigestion, insomnia, and/or shortness of breath often weeks before the attack. The most important clue was unexplained fatigue.
Fatigue can be the side effect of certain medications such as antihistamines for allergies, blood pressure medicines, diuretics, sleeping pills, and steroids. Other causes include jet lag, and improper nutrition such as consumption of too much refined sugar. Overdoing will eventually cause fatigue. So many women have too much on their plates, taking care of everyone else and not having enough time for themselves – the sandwich generation, the superwomen.
Chronic Fatigue Syndrome SymptonsAccording to CDC estimates, Chronic Fatigue Syndrome or CFS is a condition that affects over 500,000 people in the United States. The exact cause of CFS is unknown. It has been attributed to be caused by a virus such as the Epstein-Barr virus or human herpes virus-6 (HHV-6). The virus responsible for roseola has also been mentioned. However, no distinct viral cause has been identified.
CFS starts with flu-like symptoms and can last for months. In order to be diagnosed with CFS, the symptoms must be severe enough to decrease the ability to participate in ordinary activity at least by 50 percent. The diagnosis of CFS is made only when there is no obvious causes of fatigue.
Chronic Fatigue Syndrome Symptons are similar to those of most common viral infections such as headache, fatigue, and muscle aches. They usually develop within a few hours or days and lasting for 6 months or more. These symptoms are not relieved by bed rest.
Usually those diagnosed with CFS can become socially isolated by their fatigue and depression cause by the uncertainty of this condition.
According to Carolyn Myss, those susceptible to mononucleosis and Epstein-Barr viruses frequently feel that their emotional need have been repeatedly violated. They will involve themselves in relationship patterns in which their needs are not met. Because of fear of rejection, they chronically feel incapable of challenging the cause of their anxiety. This will cause them to get literally sick and tired of the whole situation.
The long-term outlook for those diagnosed with CFS is variable and difficult to predict. Studies have shown that those involved with an extensive rehabilitation program have a better prognosis.
Tips for reducing fatigue
• Cut out sugar
• Eat slow-acting complex carbohydrates
• Get adequate, regular, and consistent amounts of sleep each night
• Eat a healthy, well-balanced diet
• Exercise regularly
• Take a multivitamin. Talk to your doctor about what you need and what is
best for you.
• Avoid alcohol, nicotine, and drug use
• Avoid stimulants, especially caffeine. Those who are addicted to caffeine
will become even more tired when they stop.
• Avoid sedatives, as they tend to intensify fatigue in the long run
• If you have chronic pain or depression, treating either often helps address
the fatigue. Unfortunately, antidepressants may cause or even
In Mary-Ann’s case, I also recommended the following:
• Deal with the issue of betrayal and abandonment by her mother.
• Use therapy to heal her angry inner child; give little Mary-Ann an
opportunity to voice how angry she felt about the years of abuse.
• Try to forgive her uncle.
• Develop a better connection with her higher power. Only then would it be
possible for her to learn better ways to relax and become more capable of
dealing with stress.
At her follow-up visit, Mary-Ann was feeling more invigorated after following most of the recommendations. Her relationship with her children, and neighbor, had greatly improved. She decided to rethink remodeling her home. She realized her own deep issues about having a safe place for herself had surfaced during the stressful disagreement with her neighbor, triggering her fatigue.
Fatigue can be a normal and important response to physical exertion, lack of sleep, emotional stress. Do you listen to these signals? Most of us don’t.
If you have a clean bill of health yet are tired all the time and have not been able to find the cause, I strongly suggest that you ask yourself the following questions:
• Is my body trying to remind me that I need to slow down my hectic life?
• Is it time to let go of something from the past?
• Isn’t it time to stop running from myself?
Take heed -- unexplained fatigue, like any other symptom, is your inner wisdom telling you something important.
Carolle Jean-Murat, MD is a board-certified gynecologist, menopause specialist and intuitive healer with over three decades of experience as a holistic health practitioner. She is one of the ten worldwide doctors featured in Fabulous Female Physicians in The Women's Hall of Fame Series by Sharon & Florence Kirsh and a valued contributor to TalkWithADocLIVE.com on such topics as adrenal fatigue, insomnia, acid reflux disease and menopause.