PCOS and Exhaustion: Understanding the Connection and Finding Solutions

Feeling tired and exhausted seems to be the norm these days. We’re all juggling work, stress, and sleep deprivation. However, for women with Polycystic Ovary Syndrome (PCOS), fatigue can be especially debilitating. It can lead to memory issues, poor work performance, and difficulty fulfilling social and emotional responsibilities. In this article, we will delve into why PCOS and tiredness often go hand in hand and explore potential strategies to combat it.

Causes of Fatigue: Unraveling the Mystery

Fatigue is a common complaint among women with PCOS. While normal tiredness can be alleviated with rest and sleep, excessive tiredness, or fatigue, can be overwhelming, affecting one’s overall quality of life[^1^].

It’s important to note that fatigue can also be a symptom of other disorders. Your doctor will need to rule out any underlying medical conditions that may be contributing to your fatigue and low energy levels. If it is indeed related to PCOS, your PCOS care team will work with you to develop a treatment plan to manage your symptoms.

Chronic Fatigue Syndrome (CFS)

Chronic Fatigue Syndrome, also known as Myalgic Encephalomyelitis (ME), is a long-term illness that affects various systems in the body. It is characterized by severe fatigue, sleep problems, memory loss, headaches, and muscle pain[^2^]. Individuals with CFS often experience overwhelming fatigue that is not relieved by rest. Many find themselves unable to perform their usual activities and may be bedridden or house-bound for extended periods[^3^].

Underactive Thyroid

The underproduction of thyroid hormones can lead to low energy levels. Conditions such as Hashimoto’s disease and hypothyroidism can cause a lack of thyroid hormone production[^4^]. Since these hormones regulate how the body uses energy, insufficient levels can result in feelings of sluggishness, weakness, and tiredness.


Anemia is another condition associated with fatigue. It can manifest as weakness, shortness of breath, and disturbed sleep. Iron deficiency or medical conditions like hemophilia and menorrhagia (heavy menstrual bleeding) can contribute to the development of anemia.

Nutrient Deficiencies

Deficiencies in vitamins or minerals can also contribute to persistent tiredness. B vitamins, for example, play a crucial role in converting food into energy. Vitamin B12, in particular, is often lauded as a remedy for fatigue, as it is essential for maintaining healthy blood cells, brain function, and the digestive and nervous systems[^5^]. Additionally, low levels of Vitamin D have been associated with fatigue, weakness, headaches, and musculoskeletal pain[^6^].

Mental Health Issues

Burnout, characterized by physical, emotional, and mental exhaustion, is considered an occupational syndrome resulting from prolonged exposure to excessive workplace stress[^7^]. While not a disorder or a mental condition, burnout can be considered a mental health issue. Mood disorders such as anxiety and depression are also common causes of fatigue. Furthermore, there is evidence suggesting that depression can trigger chronic fatigue syndrome[^8^]. Even after responding to antidepressant treatment, about one-third of patients with major depressive disorder (MDD) may still experience symptoms of fatigue[^9^].

Polycystic Ovary Syndrome (PCOS)

While PCOS itself is not a direct cause of fatigue, it is not surprising that there is a link between the two. PCOS affects various systems in the body beyond the reproductive organs, and it is associated with a range of conditions that can contribute to fatigue.

What Causes Fatigue in PCOS?

Although the exact cause of fatigue in PCOS is not yet clear, several likely factors contribute to its onset.

  1. Sleep Disturbances: PCOS is often accompanied by chronic insomnia and obstructive sleep apnea, which can negatively impact sleep quality[^10^]. If your sleep quality remains poor despite trying various remedies, it’s advisable to consult your doctor for further evaluation.
  2. Iron Deficiency Anemia: Women with PCOS, particularly those with heavy periods, may develop iron deficiency anemia. In such cases, seeking guidance from your doctor regarding dietary adjustments or iron supplements may be appropriate.
  3. Insulin Resistance: Up to 70% of women with PCOS experience some degree of insulin resistance[^11^]. When your cells do not effectively absorb glucose, they lack sufficient fuel. This insulin resistance can lead to uncontrolled glucose levels, contributing to overall feelings of tiredness. Embracing a healthy, balanced diet and engaging in regular exercise can help prevent insulin resistance and diabetes.
  4. Clinical Depression: Women with PCOS have higher rates of anxiety and depression compared to the general population[^12^]. These conditions can result in poor sleep quality and fatigue. Treating PCOS alone may help alleviate depressive symptoms.
  5. PCOS Medications: Some medications used to manage PCOS, such as Metformin, which improves insulin resistance in women with PCOS, have been found to be associated with Vitamin B12 deficiency[^13^]. Inadequate levels of B12 can cause constant tiredness. It is crucial not to stop your medication without consulting your doctor. Discuss your symptoms with your PCOS care team, and together, you can find an appropriate solution.


Fatigue is a prevalent issue among women with PCOS. Although the exact cause is still uncertain, ongoing research is shedding light on the connection between PCOS and tiredness. If fatigue affects your daily life, make sure to discuss it with your doctor or PCOS care team, as they can provide the best support and guidance.

[^1^]: NHS Choices. Sleep and Tiredness. NHS. Published 2019. source
[^2^]: Jackson A. Understanding Chronic Fatigue Syndrome. Allen & Unwin; 2000.
[^3^]: CDC. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Centers for Disease Control and Prevention. Published 2019. source
[^4^]: NIDDK. Hashimoto’s Disease | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Published September 2017. source.
[^5^]: NIH. Office of Dietary Supplements – Vitamin B12. Nih.gov. Published 2017. source
[^6^]: Nowak A, Boesch L, Andres E, et al. Effect of vitamin D3 on self-perceived fatigue. Medicine. 2016;95(52):e5353. doi:10.1097/md.0000000000005353
[^7^]: WHO. Burn-out an “occupational phenomenon”: International Classification of Diseases. www.who.int. Published May 2019. source
[^8^]: Harvey SB, Wadsworth M, Wessely S, Hotopf M. The relationship between prior psychiatric disorder and chronic fatigue: evidence from a national birth cohort study. Psychological Medicine. 2007;38(07). doi:10.1017/s0033291707001900
[^9^]: Fava M. Symptoms of fatigue and cognitive/executive dysfunction in major depressive disorder before and after antidepressant treatment. J Clin Psychiatry. 2003;64(suppl 14):30-34.
[^10^]: Fernandez RC, Moore VM, Van Ryswyk EM, et al. Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nat Sci Sleep. 2018;10:45-64. Published 2018 Feb 1. doi:10.2147/NSS.S127475
[^11^]: Marshall JC, Dunaif A. Should all women with PCOS be treated for insulin resistance?. Fertil Steril. 2012;97(1):18-22. doi:10.1016/j.fertnstert.2011.11.036
[^12^]: Månsson M, Holte J, Landin-Wilhelmsen K, Dahlgren E, Johansson A, Landén M. Women with polycystic ovary syndrome are often depressed or anxious—A case-control study. Psychoneuroendocrinology. 2008;33(8):1132-1138. doi:10.1016/j.psyneuen.2008.06.003
[^13^]: Aroda VR, Edelstein SL, Goldberg RB, et al. Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab. 2016;101(4):1754-1761. doi:10.1210/jc.2015-3754