I wanted to write a post for Thanksgiving about something I’m most thankful to have healed out of nearly all of my endo symptoms: chronic fatigue.

This is no normal tiredness. You as an endo-warrrior understand the fatigue we experience with endo can be debilitating. Totally and utterly debilitating. And often it takes a hold slowly so that, years later, you have forgotten what normal energy and stamina feels like. My new normal  - a few years after diagnosis with endo - was exhaustion when I woke up after 9 hours of sleep, a constant “pushing” myself to do pretty much everything, a vitally important IV drip of caffeine to get me through each day and then early wine to get me through the evening. It was a battle to go out and socialize, a battle to do regular chores or walk the dog. Life was a battle.

Looking back, I would have classified myself as a "spoonie", a term coined by Christine Miserandino (called The Spoon Theory). To explain: a healthy person wakes up with endless amounts of possibilities and energy—call these spoons. They have LOTS of them. As for us? Us chronically ill, or endo girls, or spoonies? We wake up with a limited amount of spoons, and each day is different. Maybe some days we have 12 spoons, maybe some day it’s 22, or maybe just 1. But never unlimited amounts. That’s why we have to choose our activities, almost pay for them (with these imaginary spoons), and then go back to hibernation. We literally have Nothing. Left. To. Give.

This is when taking a shower is pretty much out of the picture. So is making decent food, playing with kids/friends/boyfriend/girlfriend, do any sort of exercise, and ummm, yah, do just about anything.

I remember googling this a lot. Dear Google, why am I so fatigued with endometriosis??? Google responded with: maybe it’s because you’re in pain, or feel isolated? Maybe it’s because you feel misunderstood, depressed, or miserable. I read that I should “rest” — not helping since ALL I seemed to do was rest. The truth is my pain was much less than when I was first diagnosed (when it was chronic all the time), and although yes, sometimes I felt misunderstood or isolated, it was mostly because I felt so freaking exhausted all the time. I wanted it gone. I had a burning desire to do anything to make it go away, to be normal again, but I never found a concrete reason I could actually tackle. Nope, all I could find was recommendations to “rest”.

OK, enough with that dark road, it turns out there are real reasons for chronic fatigue. Even better? They’re reasons you can actually fix!! That’s right, you can literally start collecting “spoons” so that one day you too will be able to wake up with endless amounts of possibilities and energy. I know, seems crazy if you’re stuck in your spoonie couch nest reading this right now, but it’s true. My old self from 2 years ago wouldn’t even recognize the new me… she’d probably even be cynically annoyed by my energy ;)

4 Reasons for Endometriosis-Related Chronic Fatigue

1. Under-nutrition and Chronic Fatigue

Imagine the spoons right now—you only have so many right? Now, instead of spoons, imagine micronutrients (like zinc, magnesium, phytonutrients, L-glycine, vitamin A). Like you want “spoons”, your cells (and fallopian tubes, and uterus, and brain)  want micronutrients. It’s how they make energy, energy to be used by your body, energy that turns directly into SPOONS.

The most common deficiency we associate with energy levels is iron. Anemia is severe iron deficiency, and can cause not just fatigue but also bruising, headaches, shortness of breath, rapid heartbeat and more. In the case of anemia, you're lucky because it's easy to get tested for. Other micronutrients, however, are hard or even impossible to test for in a standard blood test. That's why you may also be deficient in calcium, magnesium, B vitamins, glycine, or everything else, and not know it. This too causes fatigue. Deep, death-like fatigue. Oh, and most of us with endo are anemic.

But you don't have to be anemic to have chronic fatigue, you can be undernourished in other ways as well. Yes, even if you’re overweight.

Unfortunately, nutrient deficiencies are widespread in today’s world—yes even in wealthy industrialized countries such as the United States. A recent US National Survey found that nearly all Americans aren’t getting adequate levels of many nutrients; for example, 94 percent are deficient in vitamin D, 88 percent in vitamin E, 100 percent in potassium, and 52 percent in magnesium.

Thanks to the ubiquitous rise in highly refined and processed foods, we’re quickly becoming a nation that is both stuffed with calories yet starved for nutrients.

And, unfortunately, if you analyze published literature linking those with endometriosis and their nutrient intake, something will quickly become very clear to you: those with endometriosis appear to be more undernourished than their non-endo counterparts. It’s one part of the multifactorial problem of endo, and it is important because undernutrition may be partly to blame for your endo pain, progression, severity, infertility, hormone imbalance, brain fog, immune system dysfunction, and chronic fatigue.

2) Chronic inflammation is exhausting

Endometriosis is a chronic inflammatory disease. While inflammation is a necessary component of an immune response, chronic inflammation is not. Chronic infection means your body is not getting problems under control, anything from infections to stress, food allergies to nutrient deficiencies. If these inflammatory “problems” aren’t solved, your immune system's inflammatory response can actually become chronic.

Chronic inflammation can be draining. It’s like when you’re exhausted with a cold, because your immune system is busy kicking butt (and sucking up all your energy in the process. Yah, same thing here, you’re utterly drained, but in this case it’s because your body is fighting 10,000 battles all day long.

To free up the energy you need to approach each inflammatory trigger one by one because, yes, even though you have endometriosis lesions I guarantee they are 1 problem out of 99 others adding to inflammation in your body right now.

3) Your HPA Axis is Off-Kilter, Causing Exhaustion

While our bodies are made to deal with stressors in short bouts, they are not hardwired to deal with stress that never ends. And in today’s fast-paced, tech-heavy, and sugar- and caffeine-laden worlds, our stress can become chronic.

Chronic stress isn’t just a “feeling”, it’s measurable through the levels of stress hormones coursing through your body. Indeed, high levels of both cortisol and adrenaline are associated with endometriosis establishment and progression.

Over time, a chronic stress response will affect your master regulator of stress hormones (called the Hypothalamic-Pituitary-Adrenal Axis, or HPA), creating dysfunction. Dysfunction can look different depending on how long your body has been dealing with stress. Initially, you may be stuck in an alarm phase, where your body is no longer picking up cues that your “threat” is gone and instead keeps you in a fight-or-flight response. You may now constantly feel anxious, worried, agitated, or “wired but tired,” yet are unable to relax.

When the alarm stage goes on for too long, cortisol levels will eventually start to drop. While this may not sound problematic at first, know that cortisol isn’t just used for stress but also for proper wakefulness, rest, and moods. If your cortisol level is blunted, you may find yourself in a state of deep exhaustion—chronic fatigue if you will—something many of us with endo are known to have. You may not be able to wake up easily, nor perform your daily tasks without crumbling. You may have brain fog, be irritable, and be unable to focus. I was there too, with chronic fatigue being one of my worst symptoms, something so different from being just “tired” that many days it would feel like a Herculean effort to simply get up and take a shower.

To get your HPA axis back on board look at the image again to Reduce Inflammation! Sleeping better, quality friendships, hobbies, being in nature, they not only lower inflammation but they bring balance into the hormonal equation.

4) Thyroid Issues and Endometriosis Fatigue

Last but not least the thyroid, the grand maestro of your energy production. Women in the North are getting diagnosed with thyroid issues at an unprecedented rate of 1 in 8. Not only that, women with endometriosis have a much higher likelihood because the two are somewhat sister diseases, meaning women with endo are more likely to develop hypothyroid issues than a woman without endo. Aren't we lucky?? (kidding)

The symptoms of an under-active thyroid include fatigue, being cold, constipation, dry skin, painful or heavy periods, and fertility trouble. Sound familiar? Also, it’s estimated about 60% of people with hypothyroidism don’t realize they have it. Instead, they assume they’re in a slump of sorts, feeling low and tired, perhaps with mood swings partnered with an inability to lose weight. I know for many endo girls, we attribute a lot of these symptoms to endometriosis when in fact, there are often deeper issues like this at play that, if addressed, could help turn these devastating “endo” symptoms around.

Being diagnosed with hypothyroidism is easy IF and only IF you’re already extremely hypothyroid. So please test in case you are! But if your results come back “normal”" and you’re confused, check in with this little bio-hack to see if your “normal” thyroid is still drastically underperforming: check your basil body temperature (bbt) every morning.

Your bbt is your temperature, taken at the 10th of a degree first thing in the morning before you do anything else. You need to purchase a sensitive bbt thermometer for this - don’t worry, not expensive. Your bbt will be different pre-ovulation (follicular phase) and post-ovulation (luteal phase), with the luteal phase temps being higher. However, in general, follicular temps that stay below 97.2 F, or luteal temps that don’t go above 98 F, are strong indicators your thyroid is underperforming. Below is an example of a bbt chart exhibiting signs of hypothyroidism. [If you're post menopausal temps will stay in the follicular phase range]

Why is your thyroid going kaput? Stress is a huge contributor (duh), but perhaps just as important is back at #1-3, malnourishment, gut/immune issues, and HPA axis dysfunction. Women who are malnourished have a higher likelihood of gut issues or intestinal permeability. Both of these issues combined with stress lead us to #3, weak adrenals. All of this is coupled with now chronic stress leads to a sinking thyroid. 

Can I make a Titanic reference real quick, since I heard the movie is being re-released and I’m totally a dork? It’s like when the Titanic was sinking and the bilges filled up one by one, over flowing and bringing down the ship until - finally - the generator went out. Yah, that generator is your thyroid. 

Fixing a thyroid isn't necessarily an easy task, nor would it be fair of me to try to tackle it in this simple blog post. Some of you may need medication to help get you back on track! So again, talk to your doc and get tested.

In the meantime, I will say that if your thyroid is indeed exhausted, then you have to “pump the bilges” before you can actually really address the thyroid. Because the thyroid is the last in line to go, it can’t function without a proper foundation, so first, you must address underlying micronutrient deficiencies and gut issues, then your adrenals, then your thyroid. That's why starting with your diet alone will have enormous benefits to this delicate gland, all without addressing it directly.

Chronic Fatigue and Endometriosis: Some Clues

I hope these 4 real reasons have helped you better understand the nuances of this mysterious yet completely debilitating symptom: chronic fatigue. Maybe Google is right sometimes - that pain and misery wipe us out - but it’s plainly not the answer as to the extent which we experience crippling exhaustion. It shouldn’t be such a battle to get out of bed and take care of ourselves , and it’s not okay to make us think we have to live with this for the rest of our lives. Not okay at all.

If you're ready to start conquering your fatigue once and for all, start in the kitchen. It's the easiest way to begin refueling your body properly. Of course, I also highly recommend working with a holistic health professional who can help you see your opportunities as well as your triggers, especially helpful when you don't really have the energy to be doing all the research yourself :)

Happy Thanksgiving!!!

Love, Katie