Chronic exhaustion (fatigue) during menstruation – why it happens and how to overcome it

Tiredness is a perfectly normal feeling – especially after a long day, following physical exertion or during your period. There is, however, a level of exhaustion that is no longer normal: when you feel utterly drained, both physically and mentally, for extended periods of time.

If you're so exhausted that you're "tired of being tired", with no identifiable illness behind it, you could be dealing with chronic fatigue. In this article, you'll find out why it occurs, how it affects you particularly during your period, and what treatment options are available.

What is chronic fatigue? 

Chronic fatigue, chronic fatigue syndrome (CFS) or chronic exhaustion is a long-term condition that can affect various areas of the body, but most commonly manifests as an extreme feeling of tiredness. Anyone can be affected by it, even children – and the causes have yet to be clearly established.

The difference between chronic fatigue and ordinary tiredness 

It can certainly be difficult to tell chronic fatigue apart from ordinary tiredness. After all, tiredness catches up with all of us from time to time, and it's entirely normal to experience that sense of exhaustion after periods of stress, exertion or lack of sleep.

There are, however, some crucial differences that set ordinary tiredness apart from its severe form and serve as a warning sign that something is wrong with the body. Unlike ordinary tiredness, chronic fatigue syndrome:

• Lasts longer than 6 months;
• Worsens when intense mental or physical activity is continued;
• Does not disappear with rest alone, as is the case with ordinary tiredness.

Chronic fatigue may also be accompanied by symptoms that occur in other conditions too, such as fever, muscle pain or headaches. This is why it's important that the diagnosis is made by a specialist.

Chronic fatigue – causes

The causes of chronic fatigue have not yet been precisely determined. Some people have a genetic predisposition to this condition. In most cases, however, an event or a health problem triggers chronic fatigue, while other factors sustain or further aggravate the condition:

• Infections: viral infections can be one of the causes of chronic fatigue, as some people experience exhaustion precisely after being treated for an infection with viruses such as parvovirus B19, Epstein-Barr virus or human herpesvirus 6.
• Hormonal imbalances: these can trigger or intensify chronic fatigue, particularly after a stressful period.
• Physical or emotional trauma: statistics show that some sufferers noticed their first CFS symptoms immediately after an emotional trauma or a surgical procedure.
• Weakened immune system: this isn't a direct cause of chronic fatigue, but it can encourage the neuroinflammation responsible for excessive cytokine production. Cytokines are proteins that can influence how the brain and body use energy – and thereby cause fatigue.

There are other risk factors too, including age (although any age can be affected, young and middle-aged people are more susceptible), sex (chronic fatigue is diagnosed more frequently in women than in men) and other conditions (patients with serious pre-existing illnesses are at greater risk).

How chronic fatigue syndrome manifests – symptoms

The way chronic fatigue presents varies from person to person. Prolonged tiredness is the predominant symptom, but it may be accompanied by:

• A declining ability to manage everyday activities
• Malaise after exertion
• The inability to get restorative sleep
• Impaired short-term memory
• Difficulty standing for extended periods

In some cases, flu-like signs may even appear:

• Headaches
• Fever
• Joint and muscle pain
• Sore throat
• Tender lymph nodes

Once chronic fatigue syndrome takes hold, some people even develop a hypersensitivity to certain smells, sounds, bright light, foods or medicines.

Chronic fatigue during menstruation

Chronic fatigue can also occur during menstruation, but it fundamentally remains a chronic condition – it is not a menstrual symptom.

For many women, it's quite usual to feel more tired than normal during their period, especially with heavy bleeding. If your flow is heavy, we'd recommend using pads and organic tampons with greater absorbency, so that leaks or other unpleasant side effects don't become an additional source of stress and exhaustion.

In fact, chronic fatigue syndrome can in some cases be linked to hormonal changes. And since hormone levels fluctuate considerably before and during menstruation, it's possible that fatigue symptoms worsen during this time – particularly in the form of bloating, headaches, migraines, anxiety, difficulty concentrating and insomnia.

Causes of chronic fatigue during menstruation

Chronic fatigue syndrome is not considered a separate condition distinct from chronic fatigue. Whether it occurs during your period or at another point in your cycle, chronic fatigue generally has the same triggers listed above.

If, however, the feeling of exhaustion occurs exclusively during menstruation or intensifies markedly, the following causes may be at play:

• Iron deficiency – tiredness is the main symptom of an iron deficiency.
• Cravings – these can lead to bouts of overeating, which further intensify feelings of tiredness.
• Sleep disturbances – if you struggle with insomnia during menstruation and can't get restorative sleep, this can further intensify the symptoms of chronic fatigue.

How chronic fatigue syndrome is diagnosed

There are no specific tests for diagnosing chronic fatigue syndrome. As the symptoms can be identical to those of many other conditions, the diagnosis is made by exclusion.

After reviewing your medical history, carrying out a physical examination and the necessary laboratory analyses (usually blood and urine tests), your doctor can rule out other conditions one by one until a diagnosis of chronic fatigue is reached.

Treating chronic fatigue 

Since the cause cannot be precisely determined, there is currently no specific treatment for chronic fatigue either. Instead, the aim is to ease the symptoms – starting with those that have the greatest impact on quality of life. Recommendations may include:

Lifestyle changes 

In general, it's recommended to avoid a sedentary lifestyle and to stay physically active. Intense training sessions can make chronic fatigue syndrome worse, but exercise of light to moderate intensity is beneficial and can help ease symptoms.

A balanced diet, along with avoiding harmful habits such as excessive alcohol and tobacco use, can also help.

Cognitive behavioural therapy 

People with chronic fatigue syndrome often suffer from anxiety, depression and lower self-esteem at the same time. In such cases, psychological counselling and cognitive behavioural therapy may be recommended to help manage the accompanying emotional strain.

Complementary therapies

Complementary therapies can also help in managing the symptoms of chronic fatigue, as they encourage relaxation and improve sleep quality. These include yoga and meditation, acupuncture, massage and similar approaches.

Medication – on medical advice 

If CFS causes pain or serious sleep problems alongside exhaustion, your doctor may also recommend medication. This consists of painkillers or medicines to treat depression and anxiety – however, these should only be taken on specialist medical advice.

What complications can chronic fatigue lead to?

Chronic fatigue syndrome can affect numerous areas of life. Without suitable treatment to ease the symptoms, complications may therefore arise, such as:

• Depression, anxiety or other psychiatric disorders
• Social isolation
• Absence from work or school
• 

Frequently asked questions about chronic fatigue

In this section we've gathered the most common questions about chronic fatigue syndrome and prepared clear, concise answers for you:

How do you get rid of chronic fatigue?

There is no specific treatment for chronic fatigue, but there are various approaches to easing the symptoms. Light to moderate physical activity, giving up alcohol and tobacco, a balanced diet, cognitive behavioural therapy and complementary therapies can all help reduce feelings of exhaustion and the accompanying emotional difficulties.

Is physical exercise useful in treating chronic fatigue?

Yes, light and moderate physical activity is recommended, as it can ease the symptoms of chronic fatigue. Intense training sessions, on the other hand, are not advisable – they can further intensify states of exhaustion.

Can chronic fatigue occur in children too?

Yes, chronic fatigue syndrome can occur at any age, including in children. Those most commonly affected, however, are young adults and middle-aged people.

How do you cope with chronic fatigue during menstruation? 

The treatment of chronic fatigue doesn't change during menstruation, as it is a chronic syndrome rather than a menstrual symptom. To stop your period making the symptoms worse, however, it's recommended that you:

• Drink plenty of fluids
• Sleep at least 6–8 hours a night
• Take light or moderate physical exercise
• Use pads and tampons made from 100% organic cotton for greater comfort, choosing an absorbency that suits your menstrual flow

Can chronic fatigue affect mental health? 

Yes, people with chronic fatigue syndrome are frequently affected psychologically and emotionally as well. Many suffer from depression and anxiety, have lower self-esteem and reduced ability to concentrate.

Can chronic fatigue be prevented? 

As the precise cause of chronic fatigue is unknown, no preventive measures can be established either. All you can do is pay attention to your body's signals and recognise the symptoms early. The sooner you receive the right diagnosis, the sooner treatment can begin to ease the symptoms, and the better your chances of avoiding complications.