Why Your PCOS Fatigue is Getting Worse + How to Fight It

Feeling tired all the time is surprisingly common if you have PCOS.

Research shows PCOS is linked with trouble falling and staying asleep. Add hormonal imbalances into the mix, and you’re likely low on energy most of the time.  Completing daily tasks suddenly requires a huge effort. Even worse, when you finally head to bed you struggle to quiet the thoughts running on a loop.

But PCOS fatigue is about more than just lacking the energy to get through the day - though that on its own is pretty debilitating. 

PCOS-related fatigue is bad for your overall health and well-being. Women who report fatigue may find it harder to make the lifestyle changes needed to manage PCOS long-term. What’s more, a 2022 study published in Nature and Science of Sleep suggests PCOS and sleep problems can put you at a higher risk of heart disease and type 2 diabetes.

Ahead, we get into why you’re feeling fatigued and how to treat it. 

Does PCOS cause fatigue?

Although not one of the most well-known symptoms, fatigue frequently accompanies PCOS.  

According to the 2021 BMC Endocrine Disorders journal, women with PCOS are more likely to report that they’re experiencing fatigue than those without. In a study of 150 TikTok videos using the hashtag PCOS, 35% spoke about symptoms like fatigue, period cramps, and thyroid problems.

I know living with PCOS fatigue and sleep problems is terrible. I’ve had many sleepless nights. Too many to count. I've lived through the pain of waking up in a daze after another night of broken sleep, waiting for the caffeine to kick in before I was able to function fully. It wasn't a fun time. 

Eventually, I turned to prescription pills to cure my insomnia. That decision led to an addiction that lasted years. 

Several factors contribute to PCOS fatigue, and below we get into most of them. 

Hormonal imbalances

Fundamentally, untreated PCOS is a state of hormonal imbalance. Namely, the ovaries produce too many male hormones leading to hyperandrogenism. Or, the body doesn’t respond properly to insulin, causing insulin resistance. These imbalances can contribute to fatigue.

Research has also established a link between PCOS and an imbalance of thyroid hormones. A 2018 study explains the effect of thyroid hormones on energy levels:

“Thyroid hormones are known to regulate basal metabolic rate of the body. Any decrease (hypothyroidism) or increase (hyperthyroidism) in the levels of their secretion may cause many physiological changes. Hypothyroidism cause weight gain, depression, hair loss, low energy, constipation, dry skin and cold intolerance.”

Similarly, insulin resistance can be another reason you're feeling fatigued. Insulin resistance is frequently associated with PCOS: in one study of 448 women with PCOS, 56.3% had insulin resistance. The fallout of insulin resistance if that your body can’t use insulin effectively to regulate blood sugar levels. In turn, this can lead to fatigue and low energy levels.

Crucially, some research suggests that PCOS is associated with abnormalities in melatonin. Called the sleep hormone, melatonin regulates your body’s natural sleep-wake cycle. An article published in Clinical Medicine Insights: Reproductive Health reports:

“In one small study, melatonin levels were increased at nights in women with PCOS who also had significantly reduced sleep quality than control women. A more recent study has demonstrated later melatonin offset after wake time, later melatonin offset relative to sleep timing and longer duration of melatonin secretion in obese adolescent girls with PCOS compared to obese control adolescent girls.

These imbalances may be linked with hyperandrogenism and insulin resistance, note researchers.

Bad sleep quality 

One reason you're feeling more fatigue is that you're just not getting a good night’s sleep. Compared to women without PCOS, women with PCOS report higher rates of poor sleep quality and sleep disorders, researchers note in this review. 

One survey looked at sleep disturbances among women with and without PCOS. Women with PCOS were more likely to have difficulty sleeping often, and they had more sleep problems in the past year. 

According to some studies, PCOS is also linked with lower amounts of rapid eye movement (REM) sleep. REM sleep is associated with memory consolidation and emotional regulation.

Nutritional deficiencies

Women with PCOS may be at a higher risk of nutritional deficiencies which can cause fatigue.

Research published in the 2023 World Journal of Advanced Engineering Technology and Sciences said an iron deficiency is linked with PCOS, especially in the case of heavy periods. 

“Iron deficiency in turn can make symptoms of PCOS worse like fatigue and mood disorder.”

Additionally, PCOS may be linked to a magnesium deficiency. One meta-analysis of 32 studies found women with PCOS had lower levels of magnesium.

Birth control pills

Doctors routinely prescribe birth control pills to manage PCOS symptoms like irregular periods and acne. Evidence shows birth control can make you tired.

Not only can hormonal birth control cause hormonal imbalances, research shows it can also cause changes to the part of the brain responsible for sleep.  

Adrenal fatigue

While it’s not a widely accepted medical diagnosis, adrenal fatigue is a term some health professionals used to describe feelings of constant tiredness.

Some practitioners believe adrenal fatigue stems from chronic stress. In other words, there’s too much pressure on the adrenal gland to produce hormones such as cortisol and adrenaline.

Adrenal fatigue symptoms may include fatigue, difficulty sleeping, and weight gain.

As mentioned, adrenal fatigue isn’t actually recognised as a medical condition. But my integrative doctor diagnosed me with adrenal fatigue a few years back. Part of my treatment included a supplement containing ashwagandha. 

Negative body image

A negative body image can cause sleep issues and problems functioning during the day.

In a study published in the 2020 Sleeping and Breathing journal, body image played a major role in poor sleep and sleeping pill use among women with PCOS. PCOS often causes distressing physical symptoms like acne, weight gain, and excess body hair, all of which contribute to body image problems. 

“Studies have suggested that disease such as PCOS is due to loss of body control and leads to create a negative body image. Disease-related changes such as acne, hirsutism, obesity, and fear of infertility affect a woman's identity and cause body dissatisfaction.”

How to treat PCOS fatigue

Several options to treat PCOS fatigue, but some work better than others.

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• Supplements: Supplements like ashwagandha, magnesium, and melatonin can be used to treat sleep disorders, thereby reducing fatigue.
• Cognitive Behavioral Therapy (CBT): Working with a therapist may help if you’re struggling with sleep. Specifically, CBT is a type of therapy that helps people recognise how their thoughts, emotions, and actions are related. Known as talking therapy, CBT aims to help change negative thoughts. One study found that CBT improved fatigue among women with PCOS.
• Sleep hygiene: Establishing a sleep routine can improve sleep. Good sleep hygiene means keeping your room dark, restricting screen time about an hour before bed, and getting to bed around the same time every night. ‍
• Diet: What you eat can worsen or improve fatigue. I know that the worse my diet is, the less energy I have. This is especially true when I eat a carb-heavy meal. And research suggests a diet rich in whole grains and vegetables can improve fatigue.

You’ll note I haven’t included prescription medication above. And honestly, that comes down to my personal experience. I was hooked on sleeping pills for years. It felt as if my body was incapable of falling asleep with the drugs. When I fell pregnant with my son, I was forced to stop taking the pills. During that time my sleep fixed itself on its own. Years later I went through a period of extreme stress and went back on the pills. The cycle ensued. This time I used a combination of natural remedies, specifically ashwagandha and magnesium, and a consistent sleep routine to resolve my sleep issues. 

My sleep routine started in the morning. As soon as my alarm went off, I went onto the balcony of my apartment to get some sunlight. I shut off electronics 30 minutes before bed.

Fix your PCOS fatigue 

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PCOS fatigue is frustrating, but the good news is it's treatable.  Create a sleep routine and try natural remedies like magnesium and ashwagandha.

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