age is really just a number

Part One

Why am I so fatigued? I sleep enough, I eat enough, I exercise, and yet I always seem to be exhausted. Is this you? If so, you’re not unusual. Many women experience severe fatigue in the late 40s and early 50s. Some experience it even earlier.

Motherhood ain’t for sissies and our mothers never told us that we would be exhausted all the time. Of course, when you first have children you expect to be exhausted. It’s that whole co-sleeping or no sleeping thing. My children are in high school, why do I feel more tired now, then when they were young? Sadly, this is not an unusual complaint and the answer is because of a laundry list of reasons. 

So, if you still feel overwhelmingly fatigued after getting 8 to 10 hours of quality sleep, keep reading. 

There’re three main reasons that I’ve identified that cause this fatigue. In this first article, we will discuss the truly medical reasons that you may be fatigued. Call it the rule out anything other than crazy and hormones chapter. We will discuss further psychological and hormonal reasons in parts two and three. Sorry to keep you hanging, but the topic was way too broad for just one post.

Fatigue does start subtly. It’s a nagging lack of energy. It’s pervasive and hard to shake. You just don’t feel like yourself. Yup, that was me and later we’ll discuss how I got out of it. I love my children and I’m sure that you love yours. I love my medical practice and I’m sure that you feel the same about your profession. Somehow the combination of the two tends to be an energy suck. Forget about keeping your husband happy as well. I’m tired just thinking about all the ball in the air that we juggle daily. The reality, life causes you to be tired, but not the overwhelming fatigue that we are discussing.

I recommend that if you are feeling profusely fatigued, visit your doctor. I did and she gave me a lot of answers. 

There are some real medical reasons for fatigue outside of hormones, depression, and a just plain crazy life.

1. Anemia: This is a very common cause of fatigue in women. You may be having heavy periods or longer than normal, which may be causing anemia. First, you need to identify whether you are anemic. A simple CBC (complete blood count) can screen for anemia. I also recommend that you look for iron deficiency, decreased folic acid and decreased vitamin B12; which can also cause anemia. You can also have anemia from other reasons such as blood in your stool or urine; and other sources of blood loss. A urinalysis and guaiac test (detects blood in stool) can also be helpful in identifying causes of anemia. If you are 50 or older, you should already have has a colonoscopy; if not, get one!
2. Thyroid disease: An overactive or underactive thyroid can cause fatigue. Hypothyroidism causes weight gain, cold intolerance, hair loss, joint pain, and constipation as well as menstrual irregularity and fatigue. Hyperthyroidism can cause agitation, a racing pulse, heat intolerance, and weight loss at first; but as your thyroid “burns out” you complain of fatigue and weight gain. The best test your doctor can run to evaluate your thyroid is a TSH level. This measures how much thyroid the brain is receiving unbound and it is more reliable than just a T4 level.
3. Menopause: Most of us are very aware of the ravages of menopause. Another topic our mothers forgot to tell us about. Symptoms of irregular to absent periods, hot flashes, night sweats, insomnia or restlessness, moodiness, inability to concentrate and yes, fatigued. A simple FSH can tell you if you are in menopause, but it can’t tell you if you are in that lovely perimenopausal time of life that we will discuss later.
4. Autoimmune diseases and arthritis: Unfortunately, there are a lot of autoimmune diseases that show up in your 40s and 50s. Things like lupus, rheumatoid arthritis, ankylosing spondylitis, fibromyalgia and way too many to name them all. These unwanted guests make us fatigued with muscle and joint pain as well as so many other symptoms including skin rashes and emotional lability. If you are experiencing muscle and joint pain that seems to travel around your body in no apparent pattern, you may have an autoimmune disease.  Your doctor can do a basic rheumatoid panel including an ANA and sed rate which will help in diagnosing your issues. If these are positive, seek the help of a rheumatologist who specializes in these types of diseases.
5. Infections: Most infections cause fatigue as one of their symptoms. Most of us recognize acute infections, either bacterial or viral, because their symptoms are readily apparent. This may include chills, fever, nausea and vomiting. It is the more chronic infections that can be insidious in nature and many viral infections have a post viral syndrome that persists for weeks to months after the acute infection is gone. Talk to your doctor about screening for mononucleosis, hepatitis, HIV and cytomegalovirus just to name a few. Again, persistent fatigue after an acute infection may just be the normal course of the infections; but don’t ignore your symptoms.
6. Other illnesses that cause fatigue: This list is endless, but just to name a few: high blood pressure, diabetes, heart disease, kidney disease, multiple sclerosis, adrenal gland insufficiency and cancer have fatigue as a pervasive symptom. Let’s face it, you need a physical and probably you haven’t had one in years. We tend to take care of everyone else, and not ourselves! Stop that!

So, as you can plainly see there are some real medical reasons that may be causing your fatigue. Please, please, please stop ignoring your symptoms. I have lost friends to colon cancer, melanoma and heart attacks that just ignored their symptoms thinking it was normal to feel like you got run over by a truck every day. Regretfully, I have to let you know that these truly medical reasons only cause about 10% of the cases of pervasive fatigue in 40-60-year-old women. Thes are very important, though, to rule-out prior to moving on with this discussion of the causes of fatigue.

Next post: depression can be causing your fatigue.