We’ve all experienced feeling tired from time to time. But fatigue, unlike regular tiredness, is much more than a lack of energy. Fatigue is an overwhelming feeling of tiredness that doesn’t go away, even after rest.

Does endometriosis cause fatigue? People with endometriosis are twice as likely as the general population to feel fatigue. This can have a significant impact on one’s quality of life.

Members of MyEndometriosisTeam often share stories of endometriosis-related fatigue. One member shared, “I am struggling with fatigue. Literally nothing helps … not sleep, not staying hydrated, not caffeine, not exercising. It’s like my body is just falling apart.”

As this member’s experience shows, fatigue can interfere with daily activities. It’s not easily fixed with rest, and it can last for a long time. But why does endometriosis cause fatigue, and how can you manage it? Here’s what you need to know to understand the connection and manage fatigue with endometriosis.

How Is Endometriosis Associated With Fatigue?

Endometriosis is a medical condition in which the tissue that normally lines the uterus, called the endometrium, grows outside of the uterus. This tissue can form cysts or lesions on organs such as the ovaries, the fallopian tubes, and even the intestines. These cysts still respond to hormone signals during the menstrual cycle. The most common symptoms of endometriosis are excessive bleeding and pelvic pain during menstruation, intercourse, and bowel movements.

Fatigue is also reported as a common symptom of endometriosis, and it can be just as disruptive as pain. One member of MyEndometriosisTeam shared, “All month long: pain, fatigue, bloating.” Another member said, “I’m always fatigued and get severe brain fog.”

It’s not fully clear how common it is for people with endometriosis to experience fatigue. However, one study found that more than one-third of women with chronic fatigue syndrome (a medical condition that causes constant exhaustion) also have endometriosis. The study also showed that women with endometriosis were eight times more likely to have chronic fatigue syndrome.

Another study found that 50 percent of women who self-reported endometriosis also reported that they had “stayed in bed all day because of their condition at some time during the past year.”

6 Tips for Increasing Energy Levels in Endometriosis

Treating fatigue effectively often requires a combination of strategies. It’s important to talk to your doctor before trying any new treatments to make sure they’re right for you. Below, we answer the question, “What helps endometriosis fatigue?”

1. Follow Your Endometriosis Treatment Plan

To manage any symptom of endometriosis, it’s best to stick to the treatment plan that you and your doctor have agreed on. Managing the condition properly can help ease your overall symptoms and improve your health. Your treatment plan may include hormonal therapy, like birth control pills, or over-the-counter pain medications. If your symptoms are more advanced, your doctor may also recommend surgery like laparoscopy or a hysterectomy.

2. Take Iron Supplements

If your fatigue is caused by anemia from excessive bleeding, taking an iron supplement or adding more iron-rich foods (like meat and leafy greens) to your diet may help combat feelings of tiredness and weakness. If your anemia is severe, you may need a blood transfusion to help restore iron levels.

3. Try Ginseng

Studies have shown that ginseng, an antioxidant-rich herb, can be helpful for treating fatigue in people with chronic health conditions like endometriosis. The risk of side effects from ginseng supplements is generally low, with only mild reactions like nausea, insomnia, and headache. However, it’s important to remember that dietary supplements are not regulated by the U.S. Food and Drug Administration (FDA), so always talk to your doctor before trying any new supplement.

4. Ask Your Doctor About Elagolix

Elagolix is a medication that can be prescribed to treat endometriosis pain. One study found that Elagolix has also eased fatigue in some people with endometriosis. Participants in one study reported a reduction in menstrual pain, nonmenstrual pain, and pain during intercourse. Elagolix may not be the best treatment for everyone, so it’s important to talk to your doctor about whether it could be a good option for you based on your specific symptoms.

5. Seek Mental Health Support

It’s estimated that over 68 percent of people who have endometriosis experience some form of psychological stress. Since stress and other mental health issues can interfere with sleep and overall health, seeking mental health support may help ease your fatigue and other symptoms.

One study suggested that cognitive behavioral therapy — a psychological treatment that helps people develop coping skills to manage their behavior and stress — may help reduce fatigue. The study wasn’t specific to people with endometriosis, but it did improve fatigue in people with chronic fatigue syndrome.

6. Be Active

There has been some research on the effectiveness of physical activity for reducing endometriosis symptoms — including fatigue and pain. Though an ongoing study is working to further understand these effects, previous research has shown that exercise can reduce overall fatigue and pain. Other research shows that physical activity can slightly improve fatigue for people with chronic health conditions. While more research is needed to know the exact effects of exercise for people with endometriosis, it’s possible that physical activity may help improve energy levels.

How Can Endometriosis Cause Extreme Fatigue?

More research is needed to understand the exact relationship between endometriosis and frequent fatigue, but several endo-related factors are thought to contribute. Here are some reasons why endometriosis can cause fatigue.

Anemia

Endometriosis can cause excessive bleeding, which can sometimes lead to anemia. Anemia is a condition where the body doesn’t have enough healthy red blood cells to carry oxygen throughout the body, causing feelings of weakness and tiredness.

Inflammation

Inflammation is a key factor in endometriosis. Inflammatory chemicals are likely involved in the development of the condition. In addition to this, endometriosis triggers the production of cytokines (inflammatory substances). Inflammation is one of the biggest contributors of pain for those with endo.

Studies have not identified the exact link between inflammation and fatigue, but it’s widely recognized that fatigue is a common symptom for people with inflammatory diseases.

Pain

Any condition that causes pain can lead to sleep problems, which in turn can increase fatigue. One member of MyEndometriosisTeam shared, “I haven’t had a decent night’s sleep in a couple of weeks due to pain-induced insomnia. I’ve almost fallen asleep standing up at work but can’t sleep at night.”

This issue, often called painsomnia, is common for people living with endometriosis. Pain can make it hard to sleep, and poor sleep can trigger the immune system to activate excessive inflammatory responses. The activation of the immune system can lead to more pain. This creates a cycle of pain and fatigue that’s hard to break and can leave you feeling exhausted.

Migraine

Like endometriosis, migraine is common among women of reproductive age. One study found that women with endometriosis are more likely to have migraine. Like general pain, fatigue is a common symptom for those who have migraine.

Anxiety and Depression

Women with endometriosis may also be likely to have mental health issues like anxiety, depression, and reduced quality of life. One member shared, “Feeling deflated, depressed, and fatigued.”

One study found that fatigue was associated with higher anxiety and depression, as well as poor sleep quality. The study, which included 230 women with endometriosis, found that those who experienced moderate to severe fatigue also had higher levels of anxiety and depression than women with milder fatigue symptoms.

Another study of 1,120 women (including 560 with endometriosis) found that fatigue was associated with higher levels of pain, insomnia, depression, and occupational stress. The findings suggest that doctors provide psychological or pharmaceutical treatment for fatigue in addition to medication to treat endometrial pain.

Talk With Others Who Understand

MyEndometriosisTeam is the social network for people with endometriosis. On MyEndometriosisTeam, more than 136,000 members come together to ask questions, give advice, and share their stories with others who understand life with endometriosis.

Do you experience fatigue with your endometriosis? What helps you feel more energized? Share your experience in the comments below, or start a conversation by posting on your Activities page.