In addition to the physical symptoms, I also discussed the difficult cycle of tiredness and emotional issues, and how after time, the lines are blurred between the physical and emotional symptoms. So here is my list of common causes of female tiredness:

• Thyroid dysfunction – this is a common finding in female episodes of tiredness, especially in cases where there is family history or during menopause. This can be diagnosed with a simple blood test.
• Epstein Barr Virus / glandular fever / “mono” – this hits with ‘flu-like symptoms but can knock you out for months. It also tends to reactivate when your immunity is low or when you are going through a stressful time. I believe that in the region of 70% of the patients I see with fatigue/tiredness have been found to be positive for a current or reactivated EBV infection. Much of the research into ME and chronic fatigue is centred around the role of viruses.
• Anaemia and iron intake – a drop in iron level is common when women menstruate and also after menopause when women cut down on red meat intake to manage their cholesterol levels. If you’re experiencing tiredness, a general blood count and iron profile check is advisable. Lentils, kale, spinach and many other low-cholesterol foods contain iron and supplements are available at most pharmacies.
• Vitamin D deficiency – we are only beginning to understand the importance of vitamin D. Not only has a low level been found to have links to tiredness but also to aches and pains, hair follicle strength and a host of more serious illnesses including MS. High concentration supplements are available on prescription if you are found to be significantly deficient. Unfortunately, we are trapped between making sure we are safe from the effects of sun exposure and ensuring we are not vitamin D deficient. Supplementation and brief, protected periods in the sun are the best way forward.
• Lifestyle – if you are not eating plenty of fresh vegetables, not drinking plenty of water, eating too much salt, drinking too much alcohol, smoking, not exercising regularly or not sleeping well and long enough (7 – 8 hours), then make these changes as a first step in boosting your energy levels. Some things start at home!
• Food intolerances – if you are gluten, lactose or fructose intolerant or suffer from other food allergies and intolerances, these may be part of the cause of your tiredness and probably a number of other symptoms including bloating and sluggishness.
• Candida overgrowth – the US has caught on to this issue with must more gusto than the UK. This is essentially an overgrowth of yeast in the gut causing a high level of alcohol in the blood, leaving you with what is essentially a constant minor hangover! Nasty! But easily diagnosed and treated. Most NHS GPs do not test for this and will not test for this. You will have to go to a private clinic. This can also contribute to weight gain, bloating, irregular bowels as well as tiredness.

Emotional connection to tiredness

There is a vicious cycle between the physical symptom or tiredness and the emotional response of depression. As you start thinking about your tiredness, they soon become blurred and merge into each other and it’s important to try to take the following steps to prevent this happening:

• Stop thinking about being tired and break your day into smaller parts – don’t write off entire days because you woke up late or feel tired in the morning.
• Be aware of the link between your body and your emotions. Exclude physical causes of tiredness before thinking about depression.
• Emotional wellbeing is connected to diet, exercise, sunshine, dehydration and sleep. Are you looking after yourself physically?
• When feeling low, try to exercise, even if going for a walk. Avoid caffeine and sugar. Drink plenty of water.
• Therapy is an important part of maintaining emotional wellbeing and can help you leave negative feelings aside