Endometriosis and Fatigue
Does Endometriosis Make You Tired?
You wake up each morning, and instead of feeling refreshed, you’re greeted by a wave of constant exhaustion that seems to live in your bones. Simple day to day activities—like getting out of bed, preparing breakfast, or remembering what you needed to do next—feel monumental.
This isn’t just being “a little tired.” For many endometriosis patients, fatigue is a burdensome symptom equal to pelvic pain or heavy periods. And yet, for years, fatigue symptoms were overlooked in the medical literature.
Sound familiar?
It certainly did to me! My goodness, chronic endometriosis fatigue used to dominate my daily life — and back then, even Google searches like "why so tired endometriosis" yielded few helpful answers. I was told it was because of endometriosis symptoms I was so tired (like, what?? being tired WAS my symptom). Or it was the pain that was exhausting me (but I no longer had bad pain). None if it made sense.
In another of my articles, I chat about the importance of iron for the endo body. But indeed there are many factors beyond iron that can make you feel totally depleted. Today, I want to walk you through the real roots of endometriosis-related fatigue (one of my worst endometriosis symptoms) and what you can do about it.
Endometriosis Symptom: Fatigue
Most people recognize endometriosis for its hallmark symptoms: severe pain, painful periods, and sometimes heavy menstrual bleeding. But one of the most common symptoms reported—and least talked about—is fatigue.
Endometriosis symptoms don’t always look the same. While one woman may be bed-bound by cramps, another may instead feel a foggy, low-energy heaviness that affects her relationships, work, and overall quality of life.
But endometriosis related fatigue is not like the tiredness that follows a late night or stressful week. It is deeper, heavier, and often described as persistent tiredness or severe fatigue. It can feel like your immune or nervous systems are permanently “on,” draining your reserves, leaving you with constant fatigue and low mood.
For some women’s health researchers, endometriosis related fatigue is now being recognized as a burdensome symptom that needs as much attention as pain.
Chronic Fatigue
The fatigue experienced by those with endometriosis can mimic general fatigue (like, “I’m tired and need to lay down”), but the drivers are unique and seem to be without end. With endometriosis, chronic inflammation, immune system activation, and hormonal imbalance all intersect to create exhaustion that is hard to shake. It's not like we need more sleep or rest.
Unlike occupational stress or being "simply" over tired, this is an inflammatory fatigue that often disrupts sleep, lowers energy levels, and makes even ordinary activities hard to manage.
If you have hit your head against a wall for a long time trying to understand why, let me help you understand!
How Chronic Inflammation Creates Endometriosis Fatigue
Fatigue experienced by endometriosis patients has multiple pathways:
Immune System Overdrive – Your body fights invisible threats as if you had the flu every day, using up energy that should go to healing.
Nervous system overdrive: Have a lot of negative spirals, repetitive thought patterns, or anxious brain issues? This is a sign your nervous system is on high alert often! This can drain you like a car battery with the light left on.
Muscle Breakdown – Chronic inflammation leads to muscle atrophy, lowering your reserves and worsening constant exhaustion.
Nutrient Depletion – Ongoing inflammation consumes vital nutrients, reducing your ability to boost energy levels naturally.
Disrupt Sleep – Inflammatory cytokines interfere with restorative sleep, leading to increased fatigue.
Susceptibility to Illness – Fatigue symptoms worsen when sore glands, gastrointestinal disturbances, or infections pile on.
Other Endometriosis Symptoms That Worsen Fatigue
Alongside chronic fatigue, many endometriosis patients deal with:
Heavy periods and painful periods: Excess bleeding leading to iron loss and pain lending more to the nervous system overdrive.
Bowel movements changes (constipation, bloating, diarrhea): We never know how our bodies will feel or look, and it's exhausting to worry this much.
Anxiety, low mood, and personality shifts: Again, when the nervous system can't relax, it drains your entire battery.
Reliance on pain medication: This can rob you of necessary nutrients.
Hormonal imbalance, which compounds fatigue: If you're not sleeping deeply, moving well, getting sunlight, and relanxing consistently, hormones can be off, which then contributes to the problem.
When these chronic symptoms cluster together, they intensify the sense of constant exhaustion and affect every layer of life.
Manage Fatigue, Address Inflammation
If you’re living with endometriosis fatigue, the first step is to reduce inflammation. Root causes may include the folling (which I have a number of great reads on! Please read more to better understand the complexity of endo-fatigue).
ENDOMETRIOSIS, BACTERIA, AND GUT HEALTH
Dysbiosis and "leaky gut" allow toxins into the bloodstream, triggering systemic inflammation. A healthy gut is crucial for overall well-being, as it plays a significant role in the immune system and inflammation regulation. With endometriosis, we know there is an obvious link with dysbiosis. An imbalance of gut bacteria can disrupt the delicate ecosystem, leading to a condition known as leaky gut. In leaky gut, the intestinal barrier becomes permeable, allowing toxins, undigested food particles, and harmful bacteria to leak into the bloodstream. This triggers an immune response, causing inflammation throughout the body.
Moreover, harmful bacteria in the gut can release toxins known as lipopolysaccharides (LPS). These toxins, also called endotoxins or LPS, can provoke a heightened immune response, resulting in chronic inflammation. Additionally, poor gut health can impair nutrient absorption, leading to deficiencies in essential vitamins and minerals that are crucial for energy production. I talk about all of this in my post on bacteria, dysbiosis and endometriosis.
CHRONIC STRESS
Long-term stress raises cortisol and inflammatory cytokines, compounding fatigue and low blood sugar swings. Chronic stress is a modern-day epidemic that can wreak havoc on the body, including promoting inflammation. Not to mention stress also makes endometriosis worse. When you experience stress, the body releases cortisol, a stress hormone that initiates the "fight or flight" response. While this response is essential for survival in acute situations, prolonged exposure to cortisol can lead to chronic inflammation.
Stress-induced sleep disturbances also play a role in exacerbating inflammation. Lack of quality sleep compromises immune function, leading to an increased susceptibility to inflammation-triggering factors. Moreover, inflammatory cytokines released during periods of stress can impact energy-regulating pathways, contributing to feelings of fatigue and low energy levels.
SEDENTARY LIFESTYLE
Our modern sedentary lifestyle, characterized by prolonged periods of sitting or physical inactivity, has a profound effect on inflammation. Regular physical activity releases anti-inflammatory substances in the body, helping to reduce chronic inflammation. On the other hand, a lack of exercise hinders circulation and impairs the body's ability to regulate inflammation effectively.
Moreover, sedentary behavior is associated with increased levels of pro-inflammatory markers, further promoting inflammation and its related effects, including fatigue. Individuals who lead a sedentary lifestyle may experience higher levels of inflammatory cytokines, contributing to feelings of exhaustion and reduced vitality. This may be why regular movement was shown to reduce endometriosis-related pain more than pain-killers
PRO-INFLAMMATORY DIET
An unhealthy diet, high in processed foods, sugars, and unhealthy fats, is a major contributor to chronic inflammation. Processed foods often contain artificial additives, preservatives, and trans fats, which can trigger an inflammatory response in the body. Additionally, excessive sugar consumption leads to elevated blood glucose levels, promoting the release of inflammatory cytokines.
Furthermore, nutrient deficiencies play a crucial role in inflammation. Antioxidant vitamins like vitamin C, vitamin E, and beta-carotene help neutralize free radicals and reduce oxidative stress, but their absence in the diet can lead to increased inflammation and cellular damage. Similarly, insufficient intake of omega-3 fatty acids, found in fatty fish, flaxseeds, and walnuts, deprives the body of essential anti-inflammatory compounds, exacerbating the inflammatory process. See the best endometriosis diet to follow.
ENVIRONMENTAL TOXINS
In our modern world, we are exposed to a plethora of environmental and inflammatory toxins, , and they can have a significant impact on inflammation. Pollutants in the air, chemicals in household products, pesticides on fruits and vegetables, and heavy metals in water and soil can all trigger inflammation when absorbed by the body.
Exposure to environmental toxins can lead to a phenomenon called systemic inflammation, where inflammatory mediators circulate throughout the body. This process can provoke an immune response and contribute to fatigue, chronic pain, and other health issues. Moreover, certain toxins disrupt cellular function and damage DNA, further contributing to inflammation and compromised energy production.
ENDOMETRIOSIS LESIONS
While many functional medicine experts will help you get to the “root cause” of your endometriosis, remember that endometriosis lesions themselves can be a root cause! Endometriosis lesions produce inflammatory immune factors, like little annoying factories, as well as pain-provoking chemicals (ouch) and mast cells (allergies, anyone). They can infiltrate the bladder (urinary issues), intestines (digestive issues), or, well, anywhere else.
So while, yes, it’s important to seek root causes for this complex issue, remember that endometriosis is more like cancer than a typical autoimmune disorder, and may absolutely need removal by a skilled excision surgeon. I like to recommend icarebetter.com as a place to find a vetted surgeon near you.
By the way, I discuss all these factors and more in my book, Heal Endo, along with key steps to takewhich produces immune factors that trigger inflammation and endometriosis related pain
These aren’t just “other factors”—they are risk factors for chronic inflammation, constant fatigue, and worsening energy levels.
Step 2: Supplements and Treatment Options
Some natural supplement options can help reduce fatigue:
Omega-3 fatty acids (from fish or supplements):These essential fats, commonly found in fatty fish like salmon, mackerel, and sardines, are potent anti-inflammatory agents. They play a crucial role in modulating the body's inflammatory response by reducing the production of pro-inflammatory substances like cytokines and prostaglandins.
Additionally, omega-3 fatty acids promote heart and brain health, further supporting overall well-being. Incorporating omega-3 supplements into your daily routine can help alleviate inflammation and its associated symptoms, including fatigue.
Curcumin (Turmeric): Turmeric is a vibrant yellow spice that contains curcumin, a powerful anti-inflammatory compound. Curcumin inhibits the activity of various inflammatory enzymes and molecules, effectively reducing inflammation throughout the body.
Studies have shown that curcumin's anti-inflammatory properties are comparable to some anti-inflammatory drugs but without the side effects. Including turmeric in your diet or taking curcumin supplements can be beneficial in managing chronic inflammation and supporting overall wellness.
Ginger Extract: Known for its distinctive flavor and numerous health benefits, ginger is another natural anti-inflammatory powerhouse. Ginger contains bioactive compounds like gingerol and shogaol, which have demonstrated strong anti-inflammatory effects.
Consuming ginger or using ginger extract can help reduce inflammation and ease digestive discomfort. By calming inflammation, ginger can contribute to increased energy levels and improved overall vitality.
Iron: Reversing iron deficiency can be a GAME CHANGER for endometriosis patients. Please do me a favor and test first, to make sure you know you’re deficient, and then work with a practitioner to bring you up to sufficiency. Read this detailed blog on iron for endometriosis fatigue here for more details.
Of course, supplements aren’t a cure, but they can support energy and reduce fatigue alongside a healthy diet and lifestyle changes.
Chronic Pain
Lifestyle shifts matter. A healthy diet, adequate rest, and movement can improve energy levels significantly. Stress management practices are equally important.
Still, sometimes medical treatments are necessary. Confirmed endometriosis and lesions can themselves be root drivers of chronic pain which can be another root driver of fatigue. In these cases, a treatment plan may include excision surgery, hormonal therapy, or other medical treatments personalized to your situation.
Endometriosis Symptoms, Fatigue, and Personality
What makes fatigue so hard isn’t just the tiredness—it’s how it changes who you are. Severe fatigue can alter personality, relationships, and self-perception. Patients perspectives show how this burdensome symptom reshapes identity, leading to frustration and isolation.
But remember: fatigue isn’t a character flaw! It’s a symptom, driven by biological processes like inflammation and hormonal imbalance.
In Summary: Managing Endometriosis Fatigue
Endometriosis related fatigue is one of the most challenging aspects of the disease. It’s rooted in inflammation, immune system activation, and hormonal imbalance—not laziness or lack of willpower.
Addressing root causes through dietary and lifestyle shifts, a personalized treatment plan, and sometimes medical treatments can make a significant reduction in fatigue symptoms. With the right tools, it’s possible to reclaim your energy levels, manage fatigue more effectively, and begin to feel like yourself again.
There is hope! If you want more in depth information on endometriosis, fatigue, and healing anew, make sure to read my book, Heal Endo: An Anti-Inflammatory Approach to Healing From Endometriosis