Fatigue in Endometriosis: New Study About a Neglected Problem

Müde Frau

Fatigue, including severe fatigue, is common in endometriosis.

Besides the excruciating pain, endometriosis manifests in other symptoms that significantly disrupt daily life. Among these symptoms, severe and debilitating fatigue afflicts 50-70% of women with endometriosis.

Surprisingly, despite its prevalence, this symptom often receives minimal attention or understanding from healthcare professionals and loved ones. In addition to the pain, this persistent fatigue and chronic lack of energy hinder women with endometriosis from participating in social activities.

A recent study sheds light on the profound impact of fatigue on the lives of those with endometriosis and reveals when it is most prevalent [2].

What Does Fatigue Feel Like?

Fatigue Müdigkeit

Fatigue describes the feeling of having less energy.

“It feels as though all your energy has been drained away, making it challenging to carry out your usual daily activities during that time of the month.” [2]

Fatigue can manifest as a symptom of certain chronic diseases or as a standalone condition, such as chronic fatigue syndrome. Moreover, it is prevalent in many individuals with endometriosis [1]. According to various studies, the reported incidence of increased fatigue ranges from 50% to 100% [1,2,3,4]. This fatigue is described in multiple ways; some characterize it as severe exhaustion, while others express feeling drained, tired, lethargic, or weak. Nevertheless, these descriptions all converge on a common theme: the sensation of having insufficient energy.

The Profound Impact on Daily Life

Müde bei der Arbeit

Fatigue, lack of energy, and tiredness – decrease quality of life.

Simultaneously, this persistent fatigue and exhaustion often serve as a primary reason for work absenteeism and a hindrance to actively participating in social engagements [1-4].
A recent American study discovered that 95% of women with endometriosis who experience fatigue symptoms found it challenging to carry out their daily routines. Among these individuals, 19% described their impairment as extremely limiting, while over 54% considered it severely debilitating [2].

“It is extremely annoying. It limits my work and social life; it prevents me from getting up and doing everyday things. The limitation affects my life on so many levels. The pain I can deal with, but the fatigue does not allow me to do laundry, clean up, get things done, get up on the bed, or shower.” [2]

The study further revealed that over 90% of participants from two states acknowledged a negative impact on their mood, while 95% noted strained relationships with family members or partners. Events, social activities, daily routines, and exercise were also adversely affected [2].

“Just not being able to do anything. I am a go-go-go type, and having my whole world shut down is hard. I think sometimes – maybe it just signals me to sit down and rest, but it bothers me a lot! ” [2]

When Does Fatigue Occur in Endometriosis?

“It is mental fatigue, physical exhaustion, and especially during the first day or two, I need to nap when I get home. I am just utterly drained, and it feels like I cannot get enough sleep.” [2]

Frau mit Schmerzen im Bett

Fatigue often occurs together with the pain of endometriosis

The study revealed that fatigue predominantly occurred before and during menstruation, with a notable escalation in lack of energy when accompanied by severe pain or heavy bleeding. However, fatigue and other symptoms were not solely confined to these phases [2].

Another study reinforced these findings, indicating that fatigue was especially pronounced in women with endometriosis experiencing lower abdominal pain outside their menstrual cycles, period pain, or during sexual intercourse [3].

These observations underscore a strong connection between fatigue and other symptoms of endometriosis.

Furthermore, the research demonstrated that

  • Insomnia
  • Depression
  • Pain
  • Stress

were factors contributing to increased fatigue [1, 3, 4, 5].

What to Do About Chronic Fatigue and Fatigue in Endometriosis?

As numerous studies have highlighted a significant link between endometriosis-related pain and heavy bleeding with fatigue, addressing these symptoms can also help alleviate fatigue [2,3].

To achieve sustainable improvements in energy levels, it is essential to address the underlying causes of insomnia, depression, pain, and stress. Consequently, fatigue can be positively impacted through the following measures:

  1. Treating Endometriosis
  2. Pain Relief
  3. Bleeding Reduction
  4. Stress Management
  5. Improved Sleep Patterns
  6. Depression Treatment

1. Treating Endometriosis


The primary intervention involves the treatment of endometriosis, which includes surgical options, hormonal therapy, and multimodal pain management.

On the one hand, direct therapy involves surgical procedures, ideally complete excision (or “cutting out”) of the endometriosis lesions.

On the other hand, symptomatic therapies, including hormone therapy, can also provide relief. Long-cycle therapy has the potential to alleviate heavy bleeding and pain, subsequently reducing fatigue. It is important to note, however, that fatigue can be one of the possible side effects of hormonal therapy, so close monitoring of its effect is essential.

In managing endometriosis-related pain, a multimodal pain therapy approach is crucial. This approach extends beyond solely relying on painkillers for acute pain but emphasizes the prevention and treatment of chronic pain. Multimodal pain therapy integrates different treatment concepts, hence the term “multimodal.” It has demonstrated positive effects in managing endometriosis, and this therapy has already been proven for endometriosis and various other chronic pain conditions. For more detailed information on multimodal pain management, click here.

2. Pain Relief

This encompasses all the measures mentioned in the initial point, which involves medical interventions for endometriosis. However, it is crucial to recognize that beyond medical treatment, strategies such as dietary adjustments, yoga, physical activity, or meditation can be seamlessly integrated into daily life. Understanding the condition and how pain originates as part of this comprehensive approach is equally vital as part of this comprehensive approach.

3. Bleeding Reduction

Since fatigue in endometriosis often correlates with heavy bleeding, managing bleeding may alleviate fatigue. Long-cycle progestin therapy could offer potential relief in heavy menstrual bleeding and fatigue cases.  [2,3]

4. Stress Management

Es klingt einfach. Es klingt banal. Aber es ist weder das eine, noch das andere. Stress beeinflusst unser Schmerzempfinden, Stress beeinflusst unser Energielevel und Entspannungsübungen und Stressreduktion können einen immensen Einfluss auf die Schmerzen haben, vor allem bei chronischen Schmerzen. Auch wenn es im Alltag oft schwerfällt – eine Reduktion von stressigen Terminen und regelmäßige Entspannungspraktiken haben einen kurz- und vor allem langfristigen positiven Einfluss auf das Allgemeinbefinden und Schmerzen. [3, 6]

5. Improved Sleep Patterns

Schlaf ist wichtig

Particularly crucial when dealing with fatigue – is maintaining a consistent and adequate sleep schedule to prevent exacerbating the issue due to sleep deprivation.

Sleep disruptions can exacerbate fatigue, and seeking medical assistance is advisable when sleep disturbances become severe. For most individuals, however, even minor adjustments can yield improvements. Establishing a consistent sleep routine with fixed bedtimes can enhance sleep quality. Quantity also matters as insufficient sleep has been linked to decreased happiness and reduced performance. Additionally, it amplifies the perception of pain, and it is no surprise that chronic sleep deprivation contributes to increased fatigue. Women experiencing fatigue symptoms, in particular, should prioritize obtaining adequate sleep, aiming for at least 7 hours of sleep every day, even outside their menstrual periods, to prevent further worsening of fatigue [3].

6. Depression Treatment

Fatigue and tiredness are frequently observed symptoms of depression. Moreover, depression can heighten the perception of pain. Consequently, when depression accompanies fatigue in individuals with endometriosis, prompt treatment becomes essential [3].


Fatigue and severe fatigue represent common symptoms of endometriosis. Women experiencing fatigue in the context of endometriosis often grapple with its profound effects on their daily lives, social interactions, relationships, and more. In this context, fatigue and tiredness tend to be most pronounced during painful menstrual periods and in women who experience heavy bleeding or pain unrelated to their menstrual cycles.

Significant relief from fatigue can be achieved by successfully managing endometriosis-related pain and heavy bleeding. As a result, addressing endometriosis through surgical intervention and providing pain relief during both menstruation and non-menstrual phases, along with handling dyspareunia (pain during sexual intercourse), are vital strategies in combating fatigue.

The adoption of multimodal pain management approaches is also essential.

In cases where sleep disorders or depression are present, timely treatment is crucial. Furthermore, reducing stress and ensuring adequate sleep can contribute to overall improvement in fatigue management.


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
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Dr. med. Nadine Rohloff