Tired All The Time

Menstuff® has information on the possible causes of being tired all the time.

Tired All the Time?

These tests can help you determine why you're dragging.

Courtesy of Prevention

A lot of the patients Sandra Adamson Fryhofer, MD, sees in her Atlanta internal medicine practice are just plain tired. In fact, her women patients, especially those over the age of 40, are most likely to schedule appointments for persistent fatigue or bring it up at their annual exams.

Both men and women tend to blame fatigue on a too-busy lifestyle. And much of the time they're right. But Dr. Fryhofer takes all "I'm tired all the time" complaints very seriously. "It's very easy for someone to say, 'I'm just feeling tired because I'm run-down and have too much going on,'" she says. "But the bottom line is that fatigue could be a sign of a medical condition that can be treated."

Her advice: Give yourself about 2 to 3 weeks to make some lifestyle changes. Get more sleep, trim your social calendar, eat more wholesome foods, drink more fluids, take a multivitamin, and cut back on caffeine and alcohol. "If you have made the changes that make sense, and you're still feeling the symptoms of fatigue, then you need professional help," says Dr. Fryhofer.

While many things can cause fatigue -- from the ridiculous (your dog is snoring at the foot of your bed, and you can't sleep) to the obvious (you're staying up to watch David Letterman) -- here are some of the more common causes of fatigue that can be diagnosed at the doctor's office with a combination of tests and a thorough exam.

The fatigue caused by anemia is the result of a lack of red blood cells, which contain hemoglobin, a protein that brings oxygen from your lungs to your tissues and cells. In addition to feeling tired, you may feel weak and short of breath.


Anemia may be caused by an iron or vitamin deficiency, blood loss, internal bleeding, or a chronic disease such as rheumatoid arthritis, cancer, or kidney failure. In some cases, anemia may be a side effect of a medication that you're taking, such as chemotherapy for cancer patients. Women of childbearing age are especially susceptible to iron-deficiency anemia because of blood loss during menstruation and the body's need for extra iron during pregnancy and breastfeeding, explains Laurence Corash, MD, adjunct professor of laboratory medicine at the University of California, San Francisco.

Symptoms: Anemia may be the first sign of a serious illness, so it's important to recognize the symptoms and seek treatment as soon as possible. Fatigue is a major symptom. Others include extreme weakness, difficulty sleeping, lack of concentration, rapid heartbeat, chest pains, and headache. Simple exercise, such as climbing the stairs or walking short distances, can cause fatigue.

The Tests: A thorough evaluation for anemia includes a complete physical exam and blood tests, including a complete blood count (CBC), to check the levels of your red blood cells and hemoglobin. It's also standard to check the stool for blood loss. Sugar, also called glucose, is the fuel that keeps your body going. And that means trouble for people with diabetes who can't use glucose properly, causing it to build up in the blood. Without enough fuel to keep the body running smoothly, people with diabetes often notice fatigue as one of the first warning signs.

In people with type 1 diabetes, usually occurring first in childhood or the young-adult years, the body doesn't produce insulin, a hormone that converts sugar, starches, and other food into energy. They must take daily insulin injections to survive.


In type 2 diabetes, which accounts for 90 to 95 percent of diabetes in the US, the body either doesn't make enough insulin or doesn't use insulin effectively. Type 2 usually develops gradually, most often in people over age 45, but it's occurring earlier in life as Americans become more overweight.

Symptoms: Extreme fatigue is one of the early warning signs that your blood sugar level is out of control, says Christopher D. Saudek, MD, professor of endocrinology and metabolism at Johns Hopkins University School of Medicine in Baltimore and president of the American Diabetes Association. Other symptoms of diabetes include excessive thirst, frequent urination, extreme hunger, weight loss, irritability, vaginal yeast infections, and blurred vision.

The Tests: There are two major tests for diabetes: the fasting plasma glucose test and the oral glucose tolerance test. The more common is the fasting plasma glucose test, also known as fasting blood sugar test. With a simple blood draw, usually first thing in the morning, it measures your blood glucose level after fasting for 8 hours.

For the glucose tolerance test, blood is drawn twice: just before drinking a glucose syrup, then 2 hours later.

Thyroid Disease

The thyroid gland, about the size of the knot on a man's tie, is found in the front of the neck. Thyroid-stimulating hormone (TSH) produced by the pituitary gland causes the thyroid gland to secrete two hormones, thyroxine (T4) and triiodothyronine (T3), that control metabolism. Too much thyroid hormone (hyperthyroidism), and metabolism speeds up. Too little thyroid hormone (hypothyroidism), and metabolism slows down.

Symptoms: Hyperthyroidism causes muscle fatigue and weakness, which you may notice first in the thigh muscles. Exercises such as riding a bike or climbing stairs become more difficult. Other symptoms include unexplained weight loss, feeling warm all the time, increased heart rate, shorter and less frequent menstrual flows, and increased thirst.

Hyperthyroidism is most commonly diagnosed in women in their 20s and 30s, but it can occur in older women and men too, says Robert J. McConnell, MD, co-director of the New York Thyroid Center at Columbia Presbyterian Medical Center in New York City. In postmenopausal women, hyperthyroidism may lead to osteoporosis.

Hypothyroidism causes fatigue, an inability to concentrate, and muscle soreness, even with minor activity. Other symptoms include weight gain due to water retention, feeling cold all the time (even in warmer weather), heavier and more frequent menstrual flows, and constipation.

Hyppthyroidism is most commonly diagnosed in women past the age of 50. In fact, as many as 10 percent of women past 50 will have at least mild hypothyroidism, says Dr. McConnell.

The Test: Thyroid disease can be detected with a blood test for TSH. Too much thyroid hormone, and TSH goes down; too little thyroid hormone, and TSH goes up. "Thyroid disorders are so treatable that a thyroid test should be done in all people who complain of fatigue and/or muscle weakness," says Dr. McConnell.


More than "the blues," depression is a major illness that affects the way we sleep, eat, and feel about ourselves and others, explains Kathy HoganBruen, PhD, former senior director of prevention for the National Mental Health Association in Alexandria, VA.

Without treatment, the symptoms of depression may last for weeks, months, or even years. So it's important to recognize the warning signs and get help.

Symptoms: We don't all experience depression in the same way. But commonly, depression can cause decreased energy, changes in sleeping and eating patterns, problems with memory and concentration, and feelings of hopelessness, worthlessness, and negativity.

The Test: While there is no blood test for depression, your physician may be able to identify it by asking you a series of questions related to your mental health. If you experience five or more of the symptoms at right for more than 2 weeks, or the symptoms interfere with your life, see your doctor or mental health professional. Your doctor may also recommend a thorough physical exam to rule out other issues.

Source: National Mental Health Association

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic disease that involves inflammation in the lining of the joints. It happens when the body's immune system turns against itself and attacks healthy joint tissue, sometimes resulting in irreversible damage to bone and cartilage.

Symptoms: RA is not always easy to diagnose early, because many symptoms (such as fatigue, low energy, loss of appetite, and joint pain) are shared by other health conditions, including other forms of arthritis such as fibromyalgia and lupus. Also, anemia and thyroid disorders, which also cause fatigue, are even more common in people with RA, according to John Klippel, MD, president and CEO of the Atlanta-based Arthritis Foundation.

Rheumatologists look for at least four of the following criteria in diagnosing RA: morning stiffness in and around the joints lasting at least 1 hour before maximum improvement; at least three joint areas with simultaneous soft tissue swelling or fluid; at least one joint area swollen in a wrist, knuckle, or the middle joint of a finger; simultaneous involvement of the same joint areas on both sides of the body; lumps of tissue under the skin; and bone erosion in the wrist or hand joints, detected by x-ray.

The Tests: A thorough physical exam by a rheumatologist can provide some of the most valuable evidence of the disease, but there is also a test for the presence of rheumatoid factor, an antibody found in the blood. About 80 percent of people with RA test positive for this antibody, but the test is not conclusive since you can test positive and not have RA, and test negative when you do have RA.
Source: body.aol.com/condition-center/chronic-fatigue/tired-tests?icid=1615984945x1203662062x1200309847

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