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 permeates every fiber of your being.
Simple tasks like getting out of bed or preparing breakfast become monumental challenges.
Your body feels heavy, and even the thought of facing your day-to-day activities feels overwhelming.
As you try to muster strength, a fog settles over your mind, making it difficult to concentrate or remember things clearly.
Beyond physical fatigue symptoms, you experience a rollercoaster of emotions — from frustration to sadness to low mood. Women with endometriosis often feel isolated, struggling to keep up with household chores, work, and relationships.
Loved ones might wonder:
"Can't you just drink coffee and get on with your day?"
(If only it were that simple!)
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.
The Connection Between Endometriosis, Inflammation, and Chronic Fatigue
Fatigue experienced by endometriosis patients isn't your typical tired feeling after a late night — it's deeper, heavier, and more complex.
While other health conditions like thyroid dysfunction or iron deficiency can also contribute, one core driver is often overlooked: Chronic inflammation.
Understanding how chronic inflammation affects energy levels is crucial if you want to reclaim your vitality.
What Is Inflammation?
Inflammation is a vital part of the immune system's defense mechanism. I pick it all apart for you in my Heal Endo: An Anti-Inflammatory Approach to Healing From Endometriosis (truly, there is an entire section on how inflammation drives this disease), but for a basic understanding, remember that your immune system is doing inflammation.
Really? Yup.
When tissues are injured, the body releases immune factors (with names like IL-4, IL-8, and NFkB) to fight off threats — like tiny warriors with knives and baseball bats. These are inflammatory immune factors (i.e. inflammation).
Acute inflammation is protective — think:
A sprained ankle
A bout of Covid
A case of travelers' diarrhea
Inflammation also created symptoms like severe pain, swelling, redness, or gastrointestinal disturbances. These are normal — and importantly, they end once the body heals and the inflammation stops coming.
When Inflammation Turns Chronic (and Dangerous)
Chronic inflammation is a different story. When the body stays in "attack mode" for months or years, it leads to:
Chronic pain conditions
Heavy menstrual bleeding and severe menstrual cramps
Formation of scar tissue and adhesions
Hormonal imbalances and infertility
Autoimmune disorders and cancers
Oh, and endometriosis.
For endometriosis patients, two key areas of chronic inflammation exist:
Localized inflammation (around endometrial-like tissue in the pelvis or elsewhere)
Systemic inflammation (affecting skin, joints, digestion, sleep, and overall vitality)
This double hit doesn't just cause severe pain — it drains a person’s energy reserves, leading to constant fatigue.
How Chronic Inflammation Leads to Severe Endometriosis Fatigue
Endometriosis (inflammation-related) fatigue happens through multiple pathways, but here we can break down a few simple ones.
1. Chronic Immune Activation
Your immune system fights invisible "threats" 24/7, sapping energy — like having the flu every single day. Think of the last time you had a cold or flu, and how darned exhausted you were! The exhaustion of a chronic immune attack (i.e. chronic inflammation) is real, as your body prioritizes using energy to fight rather than mending and healing.
2. Muscle Atrophy
Chronic inflammation causes the body to break down muscle tissue. Without strong muscles, you lose critical energy reserves, worsening constant exhaustion. Believe me, when I was an athlete with a strong muscular frame, I felt so much more energized!
3. Nutrient Depletion
Fighting inflammation depletes vital nutrients like zinc, iron, vitamin C, and omega-3s. Deficiencies reduce your energy levels and cognitive function.
4. Poor Sleep Quality
Inflammation disrupts sleep cycles by overproducing cytokines that interfere with restorative sleep — making it harder to heal and feel rested.
5. Increased Susceptibility to Infections
Chronic inflammation weakens defenses, making you more vulnerable to frequent illnesses, sore glands, and sinus infections — further draining day-to-day energy.
Symptoms That Can Worsen Endometriosis Fatigue
Along with chronic fatigue, women with endometriosis often experience:
Bowel movements disruptions (constipation, diarrhea, terrible bloating)
Heavy periods
Pain medication dependency
Anxiety and low mood
Personality changes from feeling stuck, exhausted, and isolated
The combination of severe fatigue plus other symptoms has a profound negative impact on daily life. The totality of the negative experience then lends to other issues like nervous system dysfunction--something that is draining in its own right as the body begins to "protect" itself from the world with a negative spin on everything.
Step 1: Address Inflammation to Combat Endometriosis Fatigue
If you're living with constant fatigue that won't budge, your goal should be:
STOP CHRONIC INFLAMMATION.
If you’re exhausted by your endometriosis fatigue, make it your goal to STOP CHRONIC INFLAMMATION (sorry to yell, I had to wake you up :).
To effectively address inflammation, understanding its root causes is essential. Here are 5 functional root causes of chronic inflammation associated with endometriosis, each contributing to reduced vitality.
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 take.
Supplements That May Support Energy
Some treatment options that help address underlying causes of fatigue experienced by endometriosis patients include:
Omega-3 fatty acids: 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.
Other Lifestyle Tips to Combat Constant Fatigue
Prioritize Stress Management:
Chronic stress elevates cortisol levels, promoting inflammation and contributing to fatigue. Incorporate stress-reducing practices into your daily routine, such as mindfulness meditation, yoga, or deep breathing exercises. Managing stress effectively can help lower inflammatory markers and restore energy balance. If you want to reduce stress with endometriosis, read this.
Get Quality Sleep
Quality sleep is essential for the body to repair and regenerate, including the modulation of inflammation. Aim for 7-9 hours of restorative sleep each night to support healing and reduce inflammation. Establishing a consistent sleep schedule and creating a relaxing bedtime routine can promote better sleep quality and increased energy levels.
Stay Active
Regular physical activity is vital for increasing energy and combatting endometriosis! Sounds counterintuitive, but you need muscle to help energize you, it’s kind of like your battery pack, and you need regular movement to help your body’s internal working function well. Make sure to engage in activities you enjoy, such as walking, swimming, or yoga, as they can be both physically beneficial and emotionally rewarding. Aim for at least 150 minutes of moderate-intensity exercise per week to promote a healthier inflammatory response and boost energy levels.
Minimize exposure to environmental and inflammatory toxins, which can contribute to fatigue and chronic inflammation. Use natural cleaning products and air purifiers to reduce indoor air pollution. Additionally, consider choosing organic produce to limit exposure to pesticides. Supporting your body's detoxification pathways through a healthy diet and lifestyle can help eliminate toxins and reduce inflammation.
Step 2: Advanced Help for Persistent Fatigue
If you've already improved lifestyle factors but still struggle with frequent fatigue, it's time to go deeper:
Test for confirmed endometriosis if not yet diagnosed.
Screen for autoimmune conditions, thyroid issues, and persistent viral infections like EBV. Truly, there are many root drivers for chronic fatigue, so don't give up.
Partner with a practitioner who specializes in women’s health and understands management challenges unique to endometriosis patients.
Getting a personalized treatment plan can be life-changing.
In Summary: Healing From Endometriosis-Related Fatigue
Endometriosis fatigue is real, profound, and can be rooted in inflammation.
Combating it requires more than just sleeping more — it requires addressing root causes at the cellular level.
With the right tools, lifestyle changes, and treatment plan, you can transform constant exhaustion into renewed energy levels and vitality.
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