“3 Possible Reasons Why Healthy, Active Women Feel Fatigued”
Chronic fatigue is a rapidly growing health condition that affects women’s lives. An official diagnosis from a healthcare provider determines its underlying cause, however women who are physically active and metabolically healthy may find it more challenging to obtain a diagnosis. Since these healthy, active women tend to not show any obvious signs of underlying health issues and their standard test panel results are usually within normal range, their physician may not be inclined to perform further examination unless persisted upon by their patient. Fortunately, additional testing is available for diagnosing various fatigue-related illnesses that are commonly underdiagnosed such as thyroid conditions, uterine polyps, and POTS.
Thyroid Conditions
The thyroid is one of the endocrine glands that makes hormones and secretes them into the bloodstream. Its hormones, thyroxine(T4) and triodthyronine(T3), control how the body uses energy which affects your weight, metabolism, energy level, heart rate, internal temperature, and hair growth. When this process is interrupted by a decreased amount of hormone production, it causes a condition called hypothyroidism. Fatigue is the main symptom of hypothyroidism, and can be accompanied by extreme weight instability, cold intolerance, depression, thinning hair, irregular menses, and slowed heart rate. Hypothyroidism can sometimes present as an enlarged thyroid that causes swelling and/or pain in the throat region.
The standard blood tests for diagnosing hyperthyroidism are thyroid-stimulating hormone (TSH) and thyroxine (T4) tests. However, they are not always a sure-fire way to detect this condition. Receiving normal test results while your body continues to feel drained could be an indicator that your test results are likely within the normal level, but low in range. Follow up with your health care provider by discussing the specific numerical range of your test results, scheduling a thyroid ultrasound and additional bloodwork such as the thyroid antibody test panel. The thyroid antibody test panel is used to diagnose Hashimoto’s Disease, which is an autoimmune disorder where the immune system detects the thyroid as a foreign body and attacks it. With Hashimoto’s disease, the body initially produces an excessive amount of hormones (hyperthyroidism) to counteract the inflammation, then eventually the inflammation will prevent sufficient hormone production(hypothyroidism).
Uterine Polyps
Several gynecological disorders attribute to chronic fatigue in women, but one condition that often goes underdiagnosed and minimally discussed is called uterine polyps. Sometimes referred to as endometrial polyps, uterine polyps are tissue growths that attach to the inner lining (endometrium) of the uterus. They have the potential to grow very large and cause abdominal tenderness, abnormal bleeding, painful periods, constipation, hormonal imbalance, chronic pelvic inflammation, etc. The abnormal bleeding and larger sized polyps commonly lead to chronic fatigue. However, if fatigue is the only presenting symptom, the menstruation is regulated with birth control, a woman is not attempting to conceive, or the polyps are small, then the gynecologist may not feel lead to consider uterine polyps as a prognosis. Additionally, uterine polyps are widely found in menopausal aged women(40s-60s), therefore the gynecologist may not proceed with utilizing other diagnostic methods for younger women aside from a traditional ultrasound or transvaginal ultrasound. However, these growths can be positioned further into the uterus (i.e., behind the cervix) and can only be viewed with a hysteroscopy or hysterosonogram.
A hysteroscopy is performed by cleansing the vagina and cervix then injecting fluid into the vagina. Once the cervix is dilated, the hysteroscope (a thin, telescope-like device) is inserted using a light and camera which allows your doctor to view your entire uterus. A hysterosonogram is a similar diagnostic procedure except it uses a transvaginal probe. Keep in mind that these diagnostic tests may not be offered at your gynecologist’s office, and they will write an order for you to receive these tests at a radiology facility. If you prefer a gynecologist to perform your screening tests, then ask for a referral to a gynecologist who has this diagnostic equipment in their office or do an independent search.
POTS
Postural orthostatic tachycardia syndrome (POTS) is a dysfunction in the autonomic system where a miscommunication between the brain and the cardiovascular system disrupts the blood circulation, body temperature regulation and heart rate. Due to the disrupted blood flow and the body’s often failed attempt to correct this problem by pumping more blood, exhaustion/fatigue is the top symptom for POTS. Other common symptoms include dizziness, headaches, fainting, brain fog, body temperature dysregulation, and muscle cramps. POTS symptoms become exacerbated in extreme temperatures, with prolonged standing, strenuous activities, other illnesses, and menstruation for women. POTS presents differently in everyone; some people become chronically debilitated while others may experience its symptoms on occasion.
POTS does not have a direct cause and the symptoms often present as other medical conditions, leading to its misdiagnosis. Also, if the physician is not familiar with diagnosing and treating POTS, then there is a great possibility that they will overlook underlying risk factors such as head injuries, autoimmune disorders, low blood volume, and women in their child-bearing years. For a thorough diagnosis and treatment, find a healthcare provider who specializes in POTS such as a cardiologist or a neuromuscular specialist. The tilt table test is the standard exam for diagnosing POTS. It measures the heart rate and blood pressure during position changes. Other diagnostic methods may include echocardiogram, QSART (measures the autonomic nerves that control sweat), blood volume test, and blood and urine tests for underlying causes of POTS and to discover other conditions like POTS.
Being tired all the time is not normal, especially for healthy, active women. Since chronic fatigue is a symptom of other health conditions, it is imperative to find the root cause of this condition for proper diagnosis. If the standard tests repeatedly show normal results, then request additional testing and be open to seek a second opinion if there is pushback or outside of your health care provider’s expertise.