Does PMOS (PCOS) Cause Fatigue?

Polycystic ovary syndrome (PCOS), now being renamed PMOS (polyendocrine metabolic ovarian syndrome), affects women in a variety of ways. Those who suffer with PMOS can experience ovarian cysts, weight gain, irregular periods, infertility, and a whole lot more. But, one of the most debilitating symptoms isn’t one often regarded as serious or severe: chronic fatigue. 

Experiencing chronic low energy levels is anything but an insignificant symptom. When you’re overly tired, you lack motivation, you miss out on important events, and you’re robbed of joy. When you experience fatigue daily, it’s hard to ever enjoy anything that’s happening in your life. 

You suddenly dread the job you once loved. Quality family time after school feels impossible. And, no one should even think of inviting you to anything. You’re. Too. Tired. PMOS directly affects your energy, but how?

As a Registered Dietitian, one of the most common things I hear from women with PMOS is that they feel completely wiped out, even after a full night of sleep. If that sounds like you, there’s usually a reason, and it’s often something you can work on. Today, we’re discussing all things fatigue. You’ll learn where the low energy comes from and how to relieve the symptoms. Let’s get into it:

Does PMOS (PCOS) Cause Fatigue?

Yes, PMOS can make you tired, but usually not directly. Fatigue with PMOS is most often driven by the things that come with it, like insulin resistance, poor sleep, low iron, thyroid issues and stress. Left alone, some of these (like insulin resistance) also raise your risk of type 2 diabetes, which is one more reason fatigue is worth taking seriously.

No one PMOS diagnosis is the same. Each woman experiences a different array of issues and symptoms; there’s no single cause or treatment. So, before we jump into how to rid yourself of this burdening, yet common symptom, let’s get into some reasons PMOS causes extreme fatigue. 

Irregular Sleeping Patterns

This one’s easy. If you don’t sleep well, you’ll be tired in the morning! If you suffer from sleep problems, you probably already know this is a contributing factor to your daytime fatigue. This is because sleep disorders are more common in women with PMOS.

Women with PMOS are more likely to have obstructive sleep apnea, excessive daytime sleepiness, and other sleep disturbances. When you don’t have a regular sleep schedule, you’ll feel more tired. As sleeping issues worsen, your fatigue will increase too. 

Underactive Thyroid 

Women with PMOS are more likely to also have an underactive thyroid, including subclinical hypothyroidism, where your levels are only slightly off but can still leave you exhausted. When your thyroid is underperforming, it doesn’t produce the hormones your body needs to thrive. Hypothyroidism symptoms include dry skin and hair, body aches, weight gain, depression, hot and cold sensitivity, and, you guessed it, excessive tiredness! 

Your iron stores can drop before full anemia shows up, so a regular blood count doesn’t always catch it. Ask your doctor for a ferritin test, which measures how much iron your body has in storage.

Iron Deficiency Anemia 

Irregular, heavy periods aren’t just annoying, but they’re also bad for your health. The excessive blood loss can lead to an iron deficiency. And, when your iron levels are low, chronic fatigue follows. 

Low Vitamin B12 or Vitamin D

Vitamin B12 is a vital nutrient that produces energy in your body. Your cells use vitamin B12 to function. So, without the proper intake, oxygen delivery and red blood cell production are both hindered. Since your tissues aren’t receiving the proper oxygen, you’ll feel weak and tired. Additionally, vitamin D deficiencies have also been linked to chronic fatigue!

Insulin Resistance 

Many women with PMOS struggle to manage their blood sugar levels due to increased insulin resistance. When your body is insulin resistant, your cells don’t respond well to insulin, so sugar has a harder time getting into your cells for energy. Your body makes extra insulin to compensate, which leads to blood sugar spikes and crashes and more fat storage. This leads to weight gain and tiredness. Then, you’ll feel especially fatigued after meals! Extra insulin also pushes your ovaries to make more male hormones (androgens), which is behind symptoms like acne and unwanted hair growth.

Chronic Inflammation

Inflammation is all too common for women with PMOS. Many women with PMOS have chronic low-grade inflammation, which means the immune system stays slightly switched on all the time. That constant activation uses up energy and can leave you feeling exhausted.

Stress

In the body, stress triggers cortisol release, which is the “stress hormone.” This is the hormone that’s meant to keep us alert and focused, but too much can have us feeling wired and anxious, plus it can disrupt sleep. Poor sleep, as I’ve mentioned, is not good for fatigue! Beyond that, stress can also worsen insulin resistance leading to more energy crashes.

PMOS (PCOS) Medications

A drug known as “metformin” is often prescribed to women with PMOS to increase their insulin sensitivity and reduce androgens. Unfortunately, long-term use of this drug has also been linked to vitamin B12 deficiency, so ask your doctor to check your B12 levels and consider a supplement with B12.

Depression

The psychological stress of PMOS is abundant. There are a lot of reasons to feel overwhelmed, unhappy, and anxious. Acne,  extra hair growth on the face and body, weight gain, hair loss, infertility, and other physical changes can lead to enough mental turmoil that women with PMOS develop depression.

If you’re dealing with depression and anxiety, please bring it up with your doctor or a therapist. It’s just as important to treat as the physical symptoms. Depression fuels fatigue. And, unfortunately, fatigue fuels depression. 

What Does PMOS Fatigue Feel Like?

PMOS fatigue is different from feeling a little tired after a late night. A lot of women describe it like this:

• Waking up tired, even after a full night of sleep
• An afternoon crash that hits like clockwork
• Brain fog, where it’s hard to focus or find the right word
• Arms and legs that feel heavy
• Needing caffeine just to function throughout the day

If that list sounds familiar, the causes above are a good place to start looking.

When To Talk to Your Doctor About Fatigue

Fatigue has a lot of possible causes, and some of them only show up in your blood work. Ask your doctor about these labs:

• TSH, to check your thyroid
• Ferritin, to check your iron stores
• Vitamin B12, especially if you take metformin
• Vitamin D
• A1C or fasting insulin, to check your blood sugar and insulin resistance

Call your doctor sooner if you faint, feel short of breath, have very heavy periods, or your fatigue doesn’t get better after a few weeks of changes. I go deeper on reading your results in my guide to PMOS hormone levels.

How to Treat PMOS Fatigue

Knowing there are a lot of reasons why you may feel fatigued can be both relieving and overwhelming. Where do you start? How do you begin to relieve this symptom if there are so many reasons PMOS is dragging you down? Hang tight, I’m here for you. (For even more detail, check out my full guide to treating PMOS fatigue.)

Maintain a balanced PCOS diet. 

Food is powerful. If you eat a balanced diet to maintain proper nutritional health AND keep insulin resistance in mind, you can work wonders on your PCOS fatigue. Eating nutrient-rich foods and going gluten-free, dairy-free, and discovering your carb tolerance can increase insulin sensitivity, provide your needed vitamins and minerals, relieve inflammation, and balance hormones. For more support in this realm, we’ve created The Cysterhood, a hub where cysters can find meal and workout plans as well as our 5 Steps to PCOS Weight Loss video series to help you learn along the way.

What does all this mean? It means you’ll see a ton of relief by just changing your diet! Not only will you see an improvement in your fatigue, but you’ll see improvements in other symptoms too. (Ehm. No more weight gain!) Check out this article for PCOS pantry essentials and this post for the top PCOS fighting foods! 

Maintain a good sleep schedule. 

This one is tough if you have a sleeping disorder connected to PMOS. These tips can help you sleep better with PMOS. But, if you can change your sleeping patterns over time, you’ll experience a ton of long term gain. Try setting a bedtime alarm as well as a morning alarm. Keeping yourself on a consistent schedule will help develop those circadian rhythms! 

Before you go to bed, you should also practice some relaxation techniques. Try mediating, breathing techniques, or even a warm bath. Additionally, avoid late caffeine, blue light and long afternoon naps (and talk to your doctor before stopping any sleep medication). If this is intimidating, try a complete bedroom makeover. Make your room a fresh and positive place to sleep in again! (Trust me, it helps!)

Stay hydrated. 

Bodies function using fluid balance. Even mild dehydration lowers your blood volume, so your heart has to work harder to get nutrients and oxygen to your muscles. Your body working this hard will leave you feeling constantly fatigued. Drink lots of water. Don’t let yourself get dehydrated! 

Reduce your caffeine intake. 

Did you know that caffeine can actually make you more tired? This is true when stress is in the mix. When you drink caffeine, it stimulates your nervous system and makes you more alert and awake. Additionally, when you’re stressed, your nervous system is stimulated as well. This is to prepare your body for flight or fight mode to deal with whatever the stressor is. 

Your body must release cortisol when you’re stressed to help your body regulate.  Caffeine also raises cortisol, so if you’re already stressed, it piles more stress hormones on top. That can throw off your sleep and leave you more tired the next day. So, if you add caffeine on top of that, you further overwork your body. This leads to a hormonal imbalance and adrenal fatigue. 

Get outside. 

The sun’s rays help us with so many vital body functions! It helps calibrate our body’s internal clock (those circadian rhythms we discussed earlier), which leads to improved sleep and, thus, less fatigue! Plus, sunlight helps your body make vitamin D, and low vitamin D has been linked to fatigue and low mood.

Reduce stress.

We’ve already discussed how stress can lead to hormonal imbalances as your body releases more and more cortisol. This stress hormone wreaks havoc on the body, leading to fatigue, high blood pressure, sleep problems, anxiety, weight gain, and more! So, evaluate your life and see where you can minimize stress. 

This may look like better self-care practices. It may also look like cutting things out of your schedule. Or, maybe it’s ending a toxic relationship. Delete what you can to give yourself a more peaceful, stress-free life. 

Exercise regularly. 

I know what you’re thinking: Exercise is going to make me less tired? It’s true!  One University of Georgia study found that regular low-intensity workouts increased energy levels by 20% and reduced fatigue by 65% in sedentary adults with persistent fatigue. WOW! This is because exercise doesn’t just workout your body, but it works out your central nervous system too. If you’re looking for a place to start, here are some great exercises for PMOS

My husband Sirak, a PMOS-focused personal trainer, built our workouts around slow, weighted movements, since they generally don’t spike cortisol the way intense exercise can. You can find them all when you download The Cysterhood App.

Take supplements.

Taking the right supplements will replenish the nutrients your body is lacking to stay energized and focused. You can try to get all your essential vitamins through your diet, but it’s really tough.  I recommend curcumin, coenzyme Q10, omega-3 and my Metabolism Plus Daily Multi (which includes 100 mg of CoQ10) from my supplement line, OvaFit.*

You can read more about these collections of vitamins here.

PMOS Fatigue FAQs

Why Is PMOS So Exhausting?

PMOS rarely causes fatigue on just one front. Insulin resistance can cause blood sugar crashes, sleep problems like sleep apnea are more common, and low iron, low B12 or an underactive thyroid can all show up alongside it. Stack a few of those together, add stress, and it’s easy to see why you feel drained.

Can PMOS Cause Chronic Fatigue Syndrome?

No, they’re two different things. Chronic fatigue syndrome (also called ME/CFS) is its own condition that a doctor diagnoses after ruling out other causes. PMOS fatigue usually has a cause you can find and work on, like your blood sugar, sleep, iron or thyroid. If your exhaustion is severe and doesn’t get better, talk to your doctor.

Can Lean PMOS Make You Tired?

Yes. Women with lean PMOS can still have insulin resistance, poor sleep, low iron and thyroid issues, so the same causes of fatigue apply no matter your size. The steps in this post help with lean PMOS too.

Fatigue is a common, debilitating symptom of PCOS, but with the right lifestyle changes, you can experience relief! 

Living your life with low energy makes everything difficult. Then, when you pile on other PMOS symptoms, life can feel impossible. Luckily, there are a lot of things you can do to help manage your PMOS symptoms and get your energy back. Start with your labs and one or two changes from this post, and build from there. Check out my blog and podcast to learn all about living and thriving with PMOS, and download The Cysterhood App for meal plans and workouts.

You’ve got this,

Tallene, RD

Medical disclaimer: This content is for general informational purposes only and is not medical advice. Only a physician can diagnose a medical condition or prescribe treatment. Always consult your physician before making changes to your diet, exercise, medications, or health routine.

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.