Endometriosis is Tiring... Literally

A new study on endometriosis finds that doctors may be overlooking a critical symptom.

When discussing the physical effects of endometriosis, pain is generally the main symptom doctors focus on, as they should. It’s the one thing that all women with this disease have in common in some form. But coming in a close second is a very important symptom of endometriosis: fatigue.

A new study on endometriosis — uterine tissue that grows outside the uterus and can cause pain and bleeding in women — finds that doctors may be overlooking this critical symptom.

The symptoms of endometriosis can have major effects on a woman's quality of life, mental health and physical health, and ability to function in daily life. Keep reading to find out in what ways this kind of fatigue is different from common tiredness, what exactly causes endometriosis fatigue, and what doctors think about it.

There is a difference

A Swiss study has found that more than half of women with endometriosis experience frequent fatigue at more than twice the rate of women without endometriosis.

Until this study was published, little was known about how common fatigue is in women with endometriosis and how it affects their mental and physical health.

Despite chronic fatigue being one of the most debilitating symptoms of endometriosis, it is not widely discussed and only a handful of large investigational studies have addressed it.

It is important to note that endometriosis fatigue is not a typical tired feeling due to a lack of sleep or a full day of work. Rather, endometriosis patients report feeling constant exhaustion.

A person with fatigue feels extremely tired and weak. Their energy levels will be low. Patients have described this fatigue as being “tranquilized” or having “their eyes go heavy and swollen to the point where they just felt like they cannot do anything.”

Fatigue may have other symptoms, including muscle or joint aches and pains, headaches, sore glands that are not swollen, difficulty concentrating and confusion, insomnia, flu-like symptoms, dizziness, nausea, and heart palpitations.

When fatigue is severe, a person will often take long naps and feel faint when rising or moving too quickly.

Unfortunately, there are many women suffering from the debilitating symptoms of endometriosis who have been misdiagnosed. The condition is frequently mistaken for many others causing fatigue, and patients often suffer in silence.

Why it happens

Symptoms of endometriosis vary depending on where the endometrial tissue has grown. The condition has several stages. Each stage describes how much endometrial tissue is present and whether it has embedded into an organ or is growing on the surface.

People with endometriosis may feel especially fatigued around the time of their menstrual cycle.

This fatigue can also serve as a warning sign that a flare-up of pain is approaching.

Research suggests that the pain associated with endometriosis may have significant effects on sleep. One study in a European publication found that women with endometriosis not only have a lower pain threshold but also poorer sleep quality than their peers.

With other research showing that fatigue is a common symptom among people who suffer from other inflammatory conditions, the researchers believed the widespread fatigue in women with endometriosis may be due to the inflammation triggered by the endometriosis activating the immune system, and that this caused the fatigue.

Inflammation may well contribute to feeling exhausted. The release of cytokines and the body's attempts to heal can lead to an immune response — and therefore chronic inflammation — that can leave women with endometriosis feeling drained.

Also, a common symptom of endometriosis, as you may already know, is heavy menstrual bleeding. Menstrual blood contains high levels of iron, and a person who regularly loses a lot of blood has a high risk of developing anemia, which also includes fatigue as one of its symptoms. This condition causes a person to feel tired all the time.

Another possible explanation for fatigue is that chronic exposure to high stress can lead to adrenal fatigue.

More attention needed

Frequent fatigue affects a full half of women diagnosed with endometriosis, according to the Swiss study. Therefore, it needs to be addressed during discussions between physicians and patients on how to manage and treat the disease.

The take-home message from this research is that, because so many women with endometriosis experience frequent fatigue, health care professionals need to be aware of this and ask women about it when they discuss management and treatment of their condition.

Health professionals also need to bear in mind the link between frequent fatigue and insomnia, depression, pain and workplace-related stress, and work with women to reduce these symptoms, as this might help reduce fatigue and improve women's quality of life and productivity.

For example, by treating pain and inflammation, the doctors may be able to improve the quality of their patients‘ sleep.

Treating anemia and addressing insomnia may also help to lessen fatigue.
Women with endometriosis who feel fatigued should consult a doctor to determine the underlying cause.

Usually, changes to the lifestyle and diet can help to relieve symptoms of fatigue, experts report.

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