Quick Facts about Fatigue
- Up to 2.5 million Americans are currently suffering from chronic fatigue.1
- Sixty-nine percent of employees are fatigued at work.2
- Almost a third of women report feeling fatigued just one month after giving birth.3
Fatigue is an ongoing feeling of tiredness or weariness. It can cause a decrease in attention span or difficulty concentrating, which is sometimes referred to as brain fog or fuzziness. People feeling the exhausting physical and mental effects of fatigue often have difficulty functioning, which leads to a decreased enjoyment of daily life and - possibly - depression.
Fatigue is characterized by lethargy and a lack of energy, rather than sleepiness. It is difficult to measure and accurately assess fatigue because doctors must rely hugely on the patient's description of the case, rather than a comprehensive physical or diagnostic analysis.
Fatigue can be separated into two distinct categories; acute fatigue, which is short-term, and chronic fatigue, which is ongoing.
- Acute fatigue is associated with sudden, short-term sleep loss as the result of heavy mental or physical work. Sleep and relaxation are the best cures for acute fatigue.
- Chronic fatigue is a constant and severe state of tiredness that is unrelenting, even when getting enough sleep. Chronic fatigue can begin feeling like the flu, interferes with physical or mental activity, and lasts longer than six months.
Learning about the causes of fatigue provides the key to understanding how to prevent and treat the symptom. While the exact causes of fatigue can be attributed to a number of factors, many researchers have discovered hormonal changes to be one of the most important, especially during periods of reproductive significance. In addition to this, other factors and medical conditions can also lead to fatigue.
Continue reading to learn more about both the hormonal and additional causes of fatigue.
Hormonal Causes of Fatigue
Fluctuating levels of certain hormones, specifically estrogen and progesterone, can make women more susceptible to frequent, deep fatigue, even after a full night of sleep. This is because these hormones influence the body's levels of melatonin and cortisol, two compounds that strongly influence the quality of sleep and the amount of energy required to conduct any activity. Furthermore, there are also specific factors which can explain the occurrence or severity of fatigue according to the stage of a woman's reproductive life in which the disorder presents itself.
Hormonal Causes during Different Phases in a Woman's Life
Puberty is the stage in which a girl's body begins to produce reproductive hormones. Various lifestyle factors, such as spending too little time sleeping, can contribute to fatigue during puberty. As much as a third of adolescents report substantial fatigue at least four times a week.4
During puberty, girls start to become fertile, which means that their bodies start producing estrogen, progesterone, and other hormones. In addition to hormonal changes, the physiological demands of growth, not sleeping enough, and other social and educational pressures may be contributing to fatigue in pubescent girls.
- Family pressure. Fatigue can occur when there is stress at home to excel at a particular sport or academically. Physical and mental exhaustion can result from the excessive training and unreasonable expectations.
- Influence from friends. Friends can encourage girls to do things that they might not have ordinarily engaged in. Staying up late at night or experimenting with illegal drugs or alcohol can cause fatigue, among other complications.
- Dating pressure. Dating someone who requires a great deal of time and attention can be stressful, especially when juggling the responsibilities of being a full-time student, extracurricular activities, or a part-time job.
- Academic pressure. Many young women may struggle with school work and the expectations of them from teachers and parents. Long hours of homework and the need to do well in order to plan ahead for university or college can negatively affect a young girl's mental and physical state.
- Sleep deprivation. Tired girls will not only find it difficult to stay awake in class, but they may also find themselves suffering from other conditions provoked by sleep deprivation, such as a mood swings and behavioral problems.
Pregnancy leads to extreme changes in the production of reproductive hormones, which along with other factors, like mood swings or bodily changes, can lead to fatigue.
During pregnancy, the embryo starts producing human chorionic gonadotropin (hCG) in order to keep the pregnancy hormones at the appropriate levels. This can cause different side effects, including nausea, vomiting, a frequent urge to urinate, anxiety, and a weakened immune system, which can contribute to fatigue. It is common for women to experience fatigue during the first trimester of pregnancy and again closer to her due date in the third trimester.
Fatigue during pregnancy can also be due to other factors, such as:
- Pregnancy discomfort. Constipation, heartburn, leg cramps, and indigestion are a few of the plethora of uncomfortable symptoms that can wake pregnant women at night, making them feel fatigued and sleepy the next day.
- Nesting instinct. It is not uncommon for pregnant women to experience nesting instinct, which is a manifestation of the need to prepare for the birth of her baby. This instinct can prompt women to keep themselves constantly busy by cleaning, organizing, shopping, or decorating the baby's room. Since pregnancy alone can leave a woman feeling mentally and physically exhausted, women with a strong nesting instinct, who do not take time to rest or nap, can suffer from fatigue.
- Prenatal anxiety. It is completely normal for an expectant mother to have worries and anxieties about the birth of her baby. It is important that she speak with her doctor if these worries ever become excessive or out of control because they can result in prenatal anxiety, or constant worrying that is physically and mentally exhausting.
- Iron deficiency anemia. Pregnant women are at an increased risk of having iron deficiency anemia since their bodies need twice the amount of iron than those of non-pregnant women.5 Fatigue is one of the most common symptoms of iron deficiency anemia.
Postpartum and breastfeeding are other stages where reproductive hormones are imbalanced, leading to symptoms like fatigue. Also, other factors can contribute to fatigue after giving birth, like postpartum depression.
During postpartum, estrogen and progesterone levels in a woman's body drop quite drastically, and this drop can cause moodiness, anxiousness, irritability, and fatigue. When coupled with the emotions and responsibilities that come along with having a baby, women can be exhausted.
- Postnatal discomfort. Delivering a baby is physically tolling on the body and may leave a woman feeling incredibly fatigued for a number of weeks or months postpartum. C-section will require a longer recovery time for the body to heal.
- Change in identity. For new mothers, assuming the role of a parent may take some getting used to. Suddenly, they are responsible for someone who requires a great deal of care and attention, which requires a lot of energy and can be physically and mentally draining.
- Postpartum depression. Occasionally, the abrupt fluctuation in hormones after childbirth can cause women to suffer from postpartum depression. This is the case in up to 15 percent of mothers in North America, who experience a disinterest in the baby or daily activities, sadness, despair, loss of appetite, hopelessness, and fatigue.6 There are treatment options and support available for women who think they may be suffering from postpartum depression.
Menopause is the stage in a woman's life when production of reproductive hormones naturally declines, signaling the end of her fertility. As well as hormonal causes, other factors add to the reasons for fatigue during menopause, including the occurrence of other menopause symptoms.
During menopause, there is a constant fluctuation of reproductive hormone levels, leading to their eventual decrease. This hormonal imbalance can cause fatigue as well as other symptoms, all of which may worsen fatigue:
- Night sweats. These episodes can be thought of as nighttime hot flashes. Night sweats may wake a woman, leaving her drenched in a pool of sweat and unable to fall back asleep, causing daytime fatigue.
- Joint pain. Women who experience joint pain during menopause may be feeling fatigued, especially if the pain causes them to lose sleep at night.
- Incontinence. Waking frequently at night in order to use the bathroom may leave a woman feeling exhausted and as though she hasn't slept.
- Other physical menopausal changes like breast pain, migraines, headaches, and depression can also provoke physical discomfort and increase the risk of suffering from fatigue.
Other Less Common Causes of Fatigue
Though fatigue can occur throughout a woman's life, especially when there is a shift in hormones, occasionally it can be a sign of a more serious underlying condition, like depression, narcolepsy, thyroid dysfunction and insomnia, especially in the case of unrelenting fatigue.
- Depression. People living with depression experience a persistent state of low mood and feelings of sadness, anxiousness, hopelessness, and loss of interest in activities that they once enjoyed. Fatigue and depression may feed off of each other, and either condition can cause the other. Apathy, lack of energy, and irritability experienced by someone who is depressed is also associated with fatigue.
- Narcolepsy. This is a neurological sleep disorder characterized by a sudden uncontrollable urge to sleep. People with narcolepsy often fall asleep or become very drowsy, regardless of where they are or how much they slept the night before.
- Thyroid dysfunction. The thyroid regulates how the body uses energy as well as hormones. When the thyroid is malfunctioning, complications like weight changes, hair loss, muscle/joint pain, irregular periods, heart palpitations, or fatigue can result.
- Insomnia. This condition involves the inability to remain or fall asleep; it includes sleep that is also non-refreshing. People with insomnia are often left feeling tired and lethargic during the day.
- Certain prescription medications. Women who take medication - such as sedatives or antidepressants - may experience fatigue or sleep disorders as a side effect.
- Nutritional deficiency. Several nutritional deficiencies or malabsorption disorders can cause fatigue if they deplete the body's storage of certain vitamins, such as vitamins A, B12, or D. Also, iron deficiency - with or without anemia - can cause fatigue as one of its major symptoms.
Though a likely cause of fatigue in women is hormonal imbalance, some are more at risk of experiencing fatigue than others. Keep reading to learn more about the risk factors for developing fatigue.
Risk Factors and Triggers
Risk Factors for Fatigue
For different behavioral, psychological, and health reasons, some women are more likely to suffer from fatigue than others. These predisposing factors can affect a woman's hormone levels and increase the chances that she will develop fatigue during her life.
- Health risk factors. People who do not eat well and lead sedentary lifestyles are more likely to experience fatigue than those who do not. The following may result in fatigue:
- Obesity. Studies have found that alongside depression, obesity is a main risk factor for new-onset and persistent excessive sleepiness.7
- Prescription drugs or treatments. Antibiotics, sedatives, antidepressants, tranquilizers, blood pressure medications, and antihistamines are a sampling of the vast amount of medications that include drowsiness and fatigue as a common side effect.
- Other medical conditions. Women with anemia, the cold or flu, fibromyalgia, sleep apnea, and cancer are more likely to suffer from fatigue.
- Unhealthy eating habits. People with fatigue should only eat when they're hungry, and stop when they're full. An overstuffed stomach is unhealthy and lead to weight gain, causing fatigue. Eating foods that contain refined sugars can also cause a sharp spike in blood glucose levels and a temporary energy fix that drops quickly, leaving a feeling of exhaustion.
- Addictions. The nicotine in cigarettes stimulates the brain and disrupts the natural resting cycle while doing so. This means that smokers may have difficulties sleeping, which can result in fatigue. Moreover, although alcohol has an initial tranquilizing effect, which in itself can cause fatigue, it also interrupts regular sleeping patterns.
- Sedentary lifestyle. It may sound counterintuitive, but exercising more can actually help to reverse fatigue. If fatigue is not caused by physical exhaustion, it may be due to the fact that the body has not been exerted enough, and therefore, physical exercise will be beneficial.
- Psychological risk factors. Further research suggests that the following psychological conditions are put women at a higher risk of fatigue:
- Depression. Fatigue can be a risk factor and an extremely common symptom of depression.
- Boredom. Beyond physical and mental ailments and exhaustion, fatigue can also be caused by boredom or a lack of physical or mental stimulation.
- Stress. Stress is a normal part of daily life, but accumulated stress can cause fatigue, which is the body's way of saying it's had more than it can handle.
Continue reading to discover more about the most common signs and symptoms of fatigue.
Signs and Symptoms
There are a variety of medical signs and symptoms that help to identify fatigue. Keep reading to learn more about them and what to expect during a doctor's visit.
Common Symptoms of Fatigue
- Feeling extremely weak or exhausted
- Inability to concentrate, mind feeling foggy
- Slower reaction times (mental and/or physical)
- Irritability, low tolerance for stress
- Lack of energy
- Slower reaction times (mental and/or physical)
- Chronic tiredness or sleepiness
- Low motivation
Signs of Fatigue
Beyond symptoms of fatigue, there are also medical indicators that can be assessed by a healthcare professional and may be taken into account when diagnosing the disorder:
- Estrogen levels. Fatigue can be caused by a hormonal imbalance of estrogen, especially during puberty, pregnancy, postpartum, and menopause. Estrogen tests - of blood, urine, or saliva - can help determine if a woman's levels are within range for her age and reproductive stage.
- Time and duration of symptoms. It might be a good idea to record feelings of fatigue in a journal. Include when it occurs (time of day and how frequently), food consumed, stress levels, exercise, and any additional relevant information. This may help to establish a pattern to see if fatigue is caused by a habit or routine, like overeating or stress or work. Keep in mind that fatigue that lasts longer than six months is considered chronic.
Diagnosis of Fatigue
A doctor will also perform three assessments in order to diagnose and identify fatigue. He or she will review medical history, conduct a physical exam, and finish with a psychological evaluation. If necessary, additional tests may be ordered.
- Medical history. This will allow the doctor more insight into the initial cause of fatigue. A patient may be asked about medical conditions, medications being taken, and current lifestyle or major life changes. During this stage, the doctor will also inquire about the frequency and severity of symptoms and if they seem to be related to specific triggers or times (such as mornings or during PMS).
- A physical exam may be required to see if any underlying health conditions could be causing the fatigue. Expect the following to be taken: blood pressure, temperature, weight, and heart rate. Unusual results may warrant additional tests to be conducted.
- A psychological evaluation can help to confirm or eliminate any psychological disorders that may be causing the condition, such as depression. The doctor may inquire about recent stressful events, sleep disturbances, the presence of any feelings of hopelessness or sadness, and suicidal ideation.
- Further tests may be carried out based on previous results, including blood and urine analysis, which can identify changes in hormone levels, anemia, or infections.
Complications of Fatigue
Mild cases of fatigue can occur as a natural part of the hormonal changes associated with a woman's menstrual cycle without taking a toll on her daily activities. However, chronic fatigue caused by hormonal imbalance can interfere with the quality of a woman's life.
In rare cases, when chronic fatigue is left untreated, it can lead to certain complications, which present further risks to a woman's mental health. These possible, but uncommon, complications of fatigue can include depression or a reduced reaction time.
- Depression. Depression is a sneaky condition that can also be considered a risk factor or a notable cause of fatigue. Nevertheless, persistent tiredness that interferes with the ability to carry out daily activities can leave a woman feeling down for an extended period of time.
- Forgetfulness. When feeling weak and tired, it's easy for plans, commitments, or meetings to be forgotten.
- Reduced ability to handle stress on the job. Fatigue can sometimes make even getting out of bed an enormous task, not to mention stresses or anxiety at work.
- Reduced reaction time. Physical and mental alertness can be compromised because of fatigue. This can pose a danger in all aspects of life, from crossing the street and driving to responding to an infant's urgent needs and more.
- Reduced ability to stay awake. People with fatigue may feel so lethargic that daily functioning becomes exhausting or impossible to do without frequent naps. Falling asleep at unusual times - such as during a meeting, while driving, or in the middle of a conversation - may be an indicator of fatigue.
Women who experience frequent symptoms of fatigue that are interfering with their daily lives may wish to treat or learn how to prevent the condition.
Keep reading below to learn useful techniques and habits that will prevent fatigue or make it more manageable.
Prevention and Management
There are many different things that a person suffering from fatigue can do to prevent and manage symptoms. While there is no one single cure for fatigue, there are changes that a woman can make in her life, which will help to decrease the mental and physical effects of fatigue.
Home care is the first and most important line of treatment available to combat fatigue. Focusing on diet, exercise, and healthy habits can have a huge impact on preventing or easing symptoms of fatigue.
Lifestyle Changes for Prevention
- Diet. Plan to have meals at regular intervals - every three to four hours - in the day to ensure that blood sugar doesn't spike, and energy levels don't drop too low.8 Getting enough B complex vitamins - including B12 - can help to prevent fatigue. Moreover, alkaline-forming foods are not only nutrient dense and rich in antioxidants, but they can also balance pH levels, boost energy, and reduce the amount of calcium in the urine, thus benefitting bone health.9 To cover all of your bases and make sure you are consuming the necessary vitamins and minerals to beat fatigue, eat a wholesome mix of fresh fruits and vegetables, including figs, dates, beets, and leafy greens; nuts, like almonds; legumes; and more. Work with certified nutritionist to find the best diet plan for you, especially if suffering from a medical condition, such as thyroid dysfunction.
- Exercise. An imbalance of mood-regulating chemicals, such as serotonin, or a minimally underactive thyroid can trigger chronic or acute fatigue. Yoga, Pilates, tai chi, and any aerobic exercise that circulates the blood and oxygen to tissues will help reverse the effects of fatigue because it will trigger endorphin release and boost serotonin production. On the other hand, regular exercise - especially aerobic - can boost thyroid hormone production and provide a sustainable increase in energy, especially for those suffering from hypothyroidism.10,11
- Habits. Maintain a regular sleep schedule and wake times, and aim to get eight hours of sleep each night. Moreover, if at all possible, take control of stressors. This may mean taking a vacation or weekend getaway, dealing with a problematic relationship, hiring a babysitter for some quality alone time, or practicing stress-relief techniques of yoga, tai chi, etc. Furthermore, control addictions, like nicotine, alcohol, and drugs, as they influence the chemistry and functioning of the brain and are particularly harmful for women suffering from chronic fatigue because they disrupt proper sleep cycles. Also, avoid high sugar intake. Although it provides a momentary increase in energy, this is followed by a crash later.
When a woman happens to be experiencing fatigue, there are things that she can do to manage it effectively. Simple changes like prioritizing tasks and getting support can greatly assist a woman as she is trying to combat fatigue.
General Management Tips
- Prioritize tasks. In a modern world where everyone is constantly on the go, everyone should learn the skill of knowing when to slow down. Taking it easy and spacing out activities can help women manage the burden and give them time to recuperate.
- Get support. When you are feeling as if you have no fuel left in your internal tank, reach out to family, friends, neighbors, or coworkers to lend a helping hand with whatever task is currently or soon to be at hand.
- Deal with the stress. If stress is an underlying factor in why you are feeling extremely tired, partake in stress-relief exercises. Section time out of your day to do deep breathing, imagery, meditation, or even a favorite hobby.
- Get moving. It may seem counterintuitive to exercise, but improved blood circulation and a quick energy boost will occur by just taking 10 minutes to go for a brisk walk or even getting up and stretch at the office.
Alternative Management Tips for Fatigue
Alternative treatments are also a great way to alleviate the symptoms of fatigue in the short term. They include acupuncture and cognitive behavioral therapy.
- Acupuncture. This treatment involves the insertion of tiny needles into various parts of the body for pain relief and prevention as well as to stabilize mood. It has been scientifically found to relieve the symptoms of fatigue and improve sleep quality in those suffering from chronic fatigue syndrome (CFS).12
- Cognitive behavioral therapy. When paired with graded exercise training, this type of alternative treatment has been found effective in relieving fatigue, exhaustion, and other physical ailments of those suffering from CFS.13
While aforementioned measures often help to reduce the symptoms of fatigue, they are unable to treat the root of the problem, which in many is hormonal imbalance. However, there are several natural treatments that can treat the hormonal causes of fatigue. Please continue to the next section to learn more about treating fatigue.
The treatment of fatigue, whether acute or chronic, is important in order to prevent it from getting worse or developing into a complication.
Three Approaches to Treat Fatigue
There are three levels of treatment for fatigue, which are (1) Lifestyle Changes, (2) Alternative Medicine and (3) Pharmaceutical Options.
It is always recommended to start with the non-invasive approach, lifestyle adjustments, which tends to be the least risky and least expensive, although it does require the highest amount of self-dedication. Then, proceed to the next level of care if necessary.
While medical intervention is not usually necessary to treat fatigue, some women who are unable to find relief from lifestyle changes and alternative medicine may wish to consider pharmaceutical options, only after properly evaluating the risks associated with such a treatment.
Lifestyle Changes for Fatigue
The first level of treatment involves the least amount of risk, but it requires women to take their new routine seriously. A good diet alongside wholesome habits can do wonders in increasing one's energy levels.
As aforementioned with preventing fatigue, women should eat smaller meals more frequently - composed of whole fruits and vegetables - throughout the day to avoid an energy crash; partake in regular exercise to release endorphins and boost serotonin levels; and maintain a regular sleep schedule in lieu of stressors, addictions, and an excessive consumption of simple sugars.
It is worth noting that most cases of acute fatigue can be reversed by rest. Aim to have sleep that is refreshing, instead of hitting a specific number of hours each night. Also, it is fine to take naps as long as they are not longer than one hour, which will cause grogginess and likely a subsequent inability to sleep during the night.
While lifestyle changes alone can improve fatigue, they do not directly address the hormonal imbalance behind it. Alternative medicine has proven to be an excellent way of treating fatigue and hormonal imbalances in a safe and natural way.
Alternative Medicine for Fatigue
Alternative medicines and supplements involve minimal risk and can be effective to treat fatigue. There are two different types of herbal supplements available: phytoestrogenic and hormone-regulating herbal supplements.
Phytoestrogenic herbal supplementsPhytoestrogenic herbs like black cohosh and red clover contain estrogenic components that are produced by plants, thus adding estrogen to the body.
These herbs are mainly effective for women suffering from fatigue due to low estrogen levels and are, therefore, not necessarily effective for other types of hormonal imbalance, or for those going through puberty or pregnancy.
Moreover, they are not recommended for long-term use because they may make a woman's body less capable of producing its own estrogen.
Hormone-regulating herbal supplements
Hormone-regulating herbal supplements, including Macafem, stimulate a woman's natural hormone production by directly nourishing the pituitary and endocrine glands.
These supplements can be considered the safest natural way to treat a hormonal imbalance behind fatigue.
Furthermore, they can be taken throughout a woman's life - except during pregnancy - as they support the body's natural hormone production.
In addition, there are other types of nutritional supplements that can make fatigue symptoms easier to manage.
- Nutritional supplements. Research has proven that some minerals and nutrients can help to fight the effects of chronic fatigue, including omega-3 fatty acids, magnesium, and NADH. Omega-3 fatty acids (such as those found in fish oil) can help women combat fatigue. As a matter of fact, they are found in lower levels in those suffering with chronic fatigue.14 On the other hand, magnesium and nicotinamide adenine dinucleotide (NADH) - a compound that helps enzymes - are also acclaimed for treating chronic fatigue.
A combination of approaches is usually the most effective route to take. Lifestyle changes combined with alternative medicine or nutritional supplements will most likely be the best way to alleviate the symptoms of chronic fatigue. However, for some women the symptoms will be so severe that more advanced treatment is necessary.
Pharmaceutical Options for Fatigue
If neither lifestyle habits nor alternative treatments provide relief from fatigue symptoms, it may be necessary to take drugs recommended by a healthcare professional.
However, pharmaceutical interventions involve the highest risk and often the highest costs, and not all treatments are suitable for women at every life stage. Many medications can be risky for women who are pregnant or lactating. It is strongly recommended to speak to a licensed physician before starting any pharmaceutical treatments for fatigue.
There are some main types of pharmaceutical options that can be prescribed to treat fatigue, such as oral contraceptives or mood-regulating medication.
- Hormonal replacement therapy (HRT). Although HRT is a quick and strong way to combat fatigue, it can entail serious side effects, and it is linked with an increased risk of certain reproductive types of cancer - like breast cancer - along with higher odds of blood clots and cardiovascular disease, even for years after discontinuation. This treatment is predominantly reserved for women experiencing hormonal imbalance related to menopause.
- Oral contraceptives. When fatigue is strongly linked to PMS, it may be possible to treat it by using oral contraceptives, also known as birth control pills, as they stabilize hormone levels throughout the menstrual cycle. However, this option is not suitable for women who are breastfeeding or with other contraindications.
- Mood-regulating medication. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can be used to help control fatigue, especially when it appears as part of major depressive disorder. However, as with many pharmaceutical drugs, taking SSRIs may entail side effects.
- Thyroid medications. Women who are suffering from fatigue due to thyroid disease - hyper- or hypothyroidism - would do well in taking thyroid medications to control their hormone levels and, thus, treat its symptoms.
These three approaches are not mutually exclusive. A woman may use different approaches at different times or any combination of them, depending on the duration and severity of symptoms. Today more and more women find that dealing with symptoms of fatigue is best accomplished via a combination of healthy lifestyle and alternative treatments.
- AARP. (2012). 9 Types of Medications That Can Lead to Chronic Fatigue. Retrieved October 3, 2019, from https://www.aarp.org/health/drugs-supplements/info-06-2012/medications-that-cause-chronic-fatigue.html
- American Cancer Society, (2017). How to Handle Fatigue. Retrieved October 4, 2019, from https://www.cancer.org/latest-news/how-to-handle-fatigue.html
- American Pregnancy Association. (2019). Fatigue during Pregnancy | Nesting during Pregnancy. Retrieved October 3, 2019, from https://americanpregnancy.org/your-pregnancy/fatigue-during-pregnancy/ | https://americanpregnancy.org/planning/nesting-during-pregnancy/
- Canadian Centre for Occupational Health & Safety. (2017). Fatigue. Retrieved October 3, 2019, from https://www.ccohs.ca/oshanswers/psychosocial/fatigue.html
- Cleveland Clinic. (2019). Feeling Fatigued? Could It Be Magnesium Deficiency? (And If So, What to Do About It!) Retrieved October 4, 2019, from https://health.clevelandclinic.org/feeling-fatigued-could-it-be-magnesium-deficiency-and-if-so-what-to-do-about-it/
- Findlay, S.M. (2008). The tired teen: A review of the assessment and management of the adolescent with sleepiness and fatigue. Paediatrics & Child Health, 13(1), 37-42. Retrieved October 4, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528817/
- Harvard Health Publishing. (2013). Vitamin B12 deficiency can be sneaky, harmful. Retrieved October 4, 2019, from https://www.health.harvard.edu/blog/vitamin-b12-deficiency-can-be-sneaky-harmful-201301105780
- Jaehne, A. et al. (2009). Effects of nicotine on sleep during consumption, withdrawal and replacement therapy. Sleep Medicine Reviews, 13(5), 363-77. doi: 10.1016/j.smrv.2008.12.003.
- Mayo Clinic. (2017). Tween and teen health: Why is your teen so tired? | Symptoms of pregnancy: What happens first? | Postpartum depression: Symptoms & causes | Fatigue: Causes | Chronic fatigue syndrome: Diagnosis & treatment. Retrieved October 3, 2019, from https://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-depth/teens-health/art-20046157 | https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/symptoms-of-pregnancy/art-20043853 | https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617 | https://www.mayoclinic.org/symptoms/fatigue/basics/causes/sym-20050894 | https://www.mayoclinic.org/diseases-conditions/chronic-fatigue-syndrome/diagnosis-treatment/drc-20360510
- MedlinePlus. (2017). Fatigue. Retrieved October 3, 2019, from https://medlineplus.gov/ency/article/003088.htm
- Mirza, S. (2015). Serotonin, chronic fatigue syndrome and mitochondrial dysfunction. BMJ, 350. doi: 10.1136/bmj.h1771
- National Institute for Health and Care Excellence. (2015). Benefits and risks of HRT. Retrieved October 4, 2019, from https://www.nice.org.uk/guidance/ng23/ifp/chapter/Benefits-and-risks-of-HRT
- National Institutes of Aging. (2019). Fatigue in Older Adults. Retrieved October 3, 2019, from https://www.nia.nih.gov/health/fatigue-older-adults
- National Sleep Foundation. (n.d.). How Alcohol Affects the Quality—And Quantity—Of Sleep. Retrieved October 4, 2019, from https://www.sleepfoundation.org/articles/how-alcohol-affects-quality-and-quantity-sleep
- NHS. (2019). Study suggests HRT carries higher risk of breast cancer than thought. Retrieved October 4, 2019, from https://www.nhs.uk/news/cancer/study-suggests-hrt-carries-higher-risk-breast-cancer-thought/
- Pregnancy, Birth & Baby. (2017). Recovery after a caesarean. Retrieved October 3, 2019, from https://www.pregnancybirthbaby.org.au/recovery-after-a-caesarean
- Targum, S.D. & Fava, M. (2011). Fatigue as a Residual Symptom of Depression. Innovations in Clinical Neuroscience, 8(10), 40-43. Retrieved October 3, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225130/
- Victoria State Government. (2015). Fatigue fighting tips. Retrieved October 4, 2019, from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/fatigue-fighting-tips
- Viner, R. & Christie, D. (2005). Fatigue and somatic symptoms. BMJ, 330(7498), 1012-1015. doi: 10.1136/bmj.330.7498.1012
- Winchester Hospital. (n.d.). Nicotinamide Adenine Dinucleotide. Retrieved October 4, 2019, from https://www.winchesterhospital.org/health-library/article?id=21810
- Centers for Disease Control and Prevention. (2019). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Retrieved October 3, 2019, from https://www.cdc.gov/me-cfs/index.html
- National Safety Council. (2018). 69% of Employees - Many in Safety-critical Jobs - are Tired at Work. Retrieved October 3, 2019, from https://www.nsc.org/in-the-newsroom/69-percent-of-employees-many-in-safety-critical-jobs-are-tired-at-work-says-nsc-report
- Henderson, J. et al. (2019). Factors associated with maternal postpartum fatigue: an observational study. BMJ Open 2019, 9(7). doi: 10.1136/bmjopen-2018-025927
- Viner, R. (2005). Fatigue and somatic symptoms. BMJ, 330(7498), 1012-1015. doi: 10.1136/bmj.330.7498.1012
- Mayo Clinic. (2017). Iron deficiency anemia during pregnancy: Prevention tips. Retrieved October 3, 2019, from https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/anemia-during-pregnancy/art-20114455
- American Psychological Association. (n.d.). Postpartum Depression. Retrieved October 3, 2019, from https://www.apa.org/pi/women/resources/reports/postpartum-depression
- American Academy of Sleep Medicine. (2012). Obesity, depression found to be root causes of daytime sleepiness. Retrieved October 3, 2019, from https://aasm.org/obesity-depression-found-to-be-root-causes-of-daytime-sleepiness/
- NHS. (2018). Self-help tips to fight tiredness. Retrieved October 4, 2019, from https://www.nhs.uk/live-well/sleep-and-tiredness/self-help-tips-to-fight-fatigue/
- Schwalfenberg, G.K. (2012). The alkaline diet: is there evidence that an alkaline pH diet benefits health? Journal of Environmental and Public Health, 2012, 727630. doi: 10.1155/2012/727630
- Bansal, A. et al. (2015). The effect of regular physical exercise on the thyroid function of treated hypothyroid patients: An interventional study at a tertiary care center in Bastar region of India. Archives of Medicine & Health Sciences, 3(2), 244-246. doi: 10.4103/2321-4848.171913
- Ciloglu, F. et al. (2005). Exercise intensity and its effects on thyroid hormones. Neuro Endocrinology Letters, 26(6), 830-834. Retrieved October 4, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/16380698
- Xu, Y.X. et al. (2019). Acupuncture in the treatment of chronic fatigue syndrome based on "interaction of brain and kidney" in TCM: a randomized controlled trial. Chinese Acupuncture & Moxibustion, 39(2), 123-127. doi: 10.13703/j.0255-2930.2019.02.003
- Windthorst, P. et al. (2017). Heart rate variability biofeedback therapy and graded exercise training in management of chronic fatigue syndrome: An exploratory pilot study. Journal of Psychosomatic Research, 93, 6-13. doi: 10.1016/j.jpsychores.2016.11.014
- Castro-Marrero, J. (2018). Low omega-3 index and polyunsaturated fatty acid status in patients with chronic fatigue syndrome/myalgic encephalomyelitis. Prostaglandins, Leukotrienes & Essential Fatty Acids, 139, 20-24. doi: 10.1016/j.plefa.2018.11.006