Fatigue in endometriosis – a neglected problem

Müde Frau

Fatigue / severe fatigue are common in endometriosis.

In addition to the most severe pain, endometriosis brings other symptoms that complicate everyday life. 50-70% of women with endometriosis suffer from fatigue – severe and limiting fatigue.

Even though there are many sufferers, this symptom is given little attention or understanding by doctors or relatives. In addition to the pain, this fatigue and lack of energy means that women with endometriosis are less able to participate in social life.


What does fatigue feel like?

Fatigue Müdigkeit

Fatigue describes the feeling of having less energy.

“Like somebody completely drained your energy out of you. And it’s really hard to like function and complete your daily tasks as you normally would if it wasn’t that time of the month.” [2]

Fatigue occurs as a symptom of some chronic diseases or as a disease in its own right – in the context of chronic fatigue syndrome. However, it is also a part of many endometriosis patients’ lives. [1] Depending on the study, between 50% and 100% of respondents with endometriosis report suffering from increased fatigue and tiredness. [1,2,3,4] Some describe it as severe exhaustion, others say they feel drained, tired, lethargic or weak. They all mean the same thing – the feeling of having too little energy.

Great influence on everyday life

Müde bei der Arbeit

Fatigue, lack of energy, tiredness – decreases quality of life.

At the same time, this fatigue and exhaustion is also often cited as a reason for missing work or not participating in social activities. [1-4]
In a new American study, 95% of women with endometriosis and fatigue symptoms reported that fatigue made it difficult to go about their daily lives. Of these, 19% felt extremely impaired and over 54% felt severely impaired. [2]

 “Extremely bothersome. It’s curtailed my work, my social life, me wanting to get up and just do everyday things. It’s impacted my life in so many ways. The pain I can deal with, but the fatigue is what really doesn’t allow me to do the laundry, clean up, go run these errands, get out of bed, take a shower.” [2]

Over 90% of respondents from two states said they would perceive a negative impact on their mood. 95% of respondents indicated that their relationships with family or partners would suffer. Further negatively impacted were events and social activities, daily routines, and exercise. [2]

 “Just not being able to do anything. I’m a go, go, go type person, and me having to shut my whole world down, it’s hard for me. And I’m thinking maybe it’s a way of saying I need to sit down and rest, but it bothers me a lot.” [2]

When does fatigue occur in endometriosis?

“It’s mental fatigue, it’s physical exhaustion, and especially the first day or two I come home, I need to take a nap. I’m just spent. And so it seems like I can’t get enough sleep.” [2]

Frau mit Schmerzen im Bett

Fatigue often occurs together with the pain of endometriosis

The study was able to show that fatigue occurred primarily before and during the period. The lack of energy was particularly strong when there was severe pain or heavy bleeding. Nevertheless, symptoms of fatigue also occurred independently.[2]

Another study also showed that fatigue was particularly severe in women with endometriosis who had lower abdominal pain outside of their periods, period pain, or pain during sexual intercourse. [3]

Fatigue thus appears to be strongly related to the other endometriosis symptoms.

In addition, it was shown that

  • Insomnia
  • Depression
  • Pain
  • Stress

increase Fatigue. [1, 3, 4, 5]

What to do about chronic fatigue and fatigue in endometriosis?

Since a strong association with the pain and heavy bleeding of endometriosis has been found in several studies, treating these symptoms is a good way to combat fatigue as well.[2,3]

All causes of insomnia, depression, pain and stress should be treated to sustainably increase energy levels. Overall, fatigue can therefore be positively influenced by the following measures.

  1. Endometriosis treat
  2. Relieve pain
  3. Reduce bleeding
  4. Less stress
  5. Better sleep
  6. Depression treatment

1. Treat endometriosis


The most important measure is the therapy of endometriosis – by surgery, hormonal therapy and multimodal pain therapy.

On the one hand, this means direct therapy through surgery with, optimally, complete excision (“cutting out”) of the endometriosis lesions.

On the other hand, symptomatic therapies such as hormone therapy can also bring relief. Long-cycle therapy can reduce heavy bleeding and pain. This can greatly reduce fatigue. It should be noted, however, that fatigue is also one of the possible side effects of hormonal therapy. So here the effect should be well observed.

In connection with any type of endometriosis pain, multimodal pain therapy is particularly important. This means not (only) taking painkillers for acute pain, but above all the prevention and/or treatment of chronic pain. Different therapy concepts are combined – hence multimodal. A positive effect of this therapy has already been proven for endometriosis and other chronic pain diseases.

For more information on multimodal pain management, click here..

2. Relieve pain

This includes all the measures mentioned in the first point. Medical treatment of endometriosis is important, but also strategies such as diet, yoga, sports or meditation, which can be integrated into everyday life. An understanding of the disease and how pain is created is also important here.

3. Reduce bleeding

Since fatigue in endometriosis is also associated with heavy bleeding, a reduction in bleeding may play a role. If heavy menstrual bleeding and fatigue occur together, progestogen therapy in the long cycle may provide relief. [2,3]

4. Stress reduction

It sounds simple. It sounds banal. But it’s neither. Stress affects our perception of pain, stress affects our energy levels, and relaxation practices and stress reduction can have an immense impact on pain, especially chronic pain. Even if it is often difficult in everyday life – a reduction of stressful appointments and regular relaxation practices have a short and especially long-term positive impact on the general well-being and pain.[3, 6]

5. Better sleep

Schlaf ist wichtig

Especially important with fatigue – regular and sufficient sleep, so that lack of sleep does not aggravate the problem.

Sleep disturbances aggravate fatigue. If sleep disturbances are severe, medical help should be sought. For most, however, even small measures can bring improvement. A sleep routine and fixed bedtimes improve sleep quality. But quantity is also crucial. Lack of sleep has been shown to make us unhappy and make us perform worse. In addition, pain is perceived more intensely. And that a regular lack of sleep leads to more tiredness is not surprising. So women with fatigue symptoms should make sure they get enough sleep (at least 7 hours) every day, even outside of their periods, so as not to exacerbate fatigue. [3]

6. Treatment of depression

Fatigue and tiredness are also common symptoms of depression. In addition, depression leads to an increased perception of pain. Therefore, if depression occurs in addition to fatigue in endometriosis, it should of course be treated immediately. [3]


Fatigue and severe fatigue are common symptoms in endometriosis. Women with fatigue in endometriosis are affected by the severe fatigue and lack of energy in their daily life, social activities, relationships and much more.
In this regard, fatigue and tiredness occur especially during painful periods and in women with heavy bleeding or pain unrelated to periods.

Relief of pain and heavy bleeding in the context of endometriosis therapy also leads to significant relief of fatigue. Therefore, causal treatment of endometriosis by surgery and, in addition, pain relief during and outside the period and relief of dyspareunia (pain during sexual intercourse) are the most important strategies against fatigue.

Multimodal pain therapy should also play a role.

If present, sleep disorders and depression should be treated. Stress reduction and sufficient sleep can also lead to improvement.


Boneva RS, Lin J-MS, Wieser F, Nater UM, Ditzen B, Taylor RN, et al. Endometriosis as a Comorbid Condition in Chronic Fatigue Syndrome (CFS): Secondary Analysis of Data From a CFS Case-Control Study. Front Pediatr [Internet]. 2019 May 21 [cited 2020 May 26];7:195. Available from: https://www.frontiersin.org/article/10.3389/fped.2019.00195/full
DiBenedetti D, Soliman AM, Gupta C, Surrey ES. Patients’ perspectives of endometriosis-related fatigue: qualitative interviews. J Patient Rep Outcomes [Internet]. 2020 [cited 2020 May 26];4(1):33. Available from: https://jpro.springeropen.com/articles/10.1186/s41687-020-00200-1
Ramin-Wright A, Schwartz ASK, Geraedts K, Rauchfuss M, Wölfler MM, Haeberlin F, et al. Fatigue – a symptom in endometriosis. Human Reproduction [Internet]. 2018 Aug 1 [cited 2020 May 27];33(8):1459–65. Available from: https://academic.oup.com/humrep/article/33/8/1459/5040620
Schoep ME, Nieboer TE, van der Zanden M, Braat DDM, Nap AW. The impact of menstrual symptoms on everyday life: a survey among 42,879 women. American Journal of Obstetrics and Gynecology [Internet]. 2019 [cited 2020 May 26];220(6):569.e1-569.e7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002937819304272
Schwartz ASK, Gross E, Geraedts K, Rauchfuss M, Wölfler MM, Häberlin F, et al. The use of home remedies and complementary health approaches in endometriosis. Reproductive BioMedicine Online [Internet]. 2019 [cited 2020 May 26];38(2):260–71. Available from: https://linkinghub.elsevier.com/retrieve/pii/S147264831830600X
Surrey ES, Soliman AM, Agarwal SK, Snabes MC, Diamond MP. Impact of elagolix treatment on fatigue experienced by women with moderate to severe pain associated with endometriosis. Fertility and Sterility [Internet]. 2019 [cited 2020 May 26];112(2):298-304.e3. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0015028219301463

Learn more about Fatigue in endometriosis in our Symptom Explorer.

Benachrichtige mich bei
Inline Feedbacks
Zeige alle
Dr. med. Nadine Rohloff