Tiredness Takes More Than Your Energy
Tell me what your tiredness feels like.
That's typically the first thing I ask when a woman tells me she's worn out or "just tired.” Exhausted is where a lot of women start, but on its own it doesn't actually tell me much. There are many different types of tiredness, and they don't all come from the same place.
Tiredness itself is rarely the diagnosis. It's a symptom pointing at something, and how you describe it tells me more than most of the tests I could order. So that's what I want from you first. The second thing is your medication list. Every appointment you have, someone checks it. But reading back through the medications you're on, and asking what each one is still doing for you, is a different job, and sometimes that's where the answer is, not another thing to add, but a closer look, at what's already on your list or at something that's never actually been checked.
What I'm listening for
I want to know whether it's there all the time or comes and goes, whether you wake up already tired, whether you hit a wall in the middle of the afternoon, whether eating makes it better or worse, and when it started.
Before any of that though, most women tell me why they're tired before I've even asked. There's always a reason, and it's usually a fair one. The kids won't go to bed, work got busier and never let up, the dog keeps waking you up in the middle of the night. But what I want to know is, what happened the last time one of those went away? If the kids finally started sleeping through the night and you're still just as tired, then maybe it was never really the kids at the root of it.
Almost everyone gets some version of the afternoon slump, and you've probably already worked out that it has something to do with lunch. That's half right. The dip itself is your body's clock, and it turns up even in people who ate no lunch at all and had no idea what time it was. What you can change is how far down you go, and a lot of that was decided before lunch ever happened. A breakfast that's mostly sugar starts your blood sugar swinging early, and that can catch up with you by the afternoon. A bad night does the same thing.
And that's assuming you even ate breakfast at all. So many of the women I've worked with have spent years being told the answer was always less. But a body that's been underfed for years doesn't usually get calmer. In my experience, it tends to slow down instead. So if you've had nothing but coffee until two, I'm not going to tell you to cut anything. Instead, I'd have you add something with real protein in it earlier on before the coffee ends up doing all the work. And knowing whether eating actually helps or worsens your tiredness tells me quite a bit too.
Being wiped out after a meal is one thing. But when a woman tells me she feels like she's been run over and that sleep doesn't fix it, I'll ask if powering through ends up costing her the next day, because if a normal day out leaves you drained for two days afterward, that's a much different pattern. And these details matter because the usual advice that's given to build your activity back up is going to be what ends up making it worse. What does help more in this case is staying within the bounds of what your body's capacity is able to provide. The more information and how you describe your experience is going to be what helps your practitioner know what's worth trying.
And when it started is the one I find surprises people. A lot of women are able to pinpoint the exact moment, which usually means something changed around then. Maybe it was a new medication, or an illness you never quite bounced back from, where something in your immune system may have stayed switched on long after the infection itself cleared. Sometimes it's even just a year where nothing ever let up at all.
Whatever's behind it, the one I least want to miss in a woman this tired is sleep apnea. What worries me about it is that it's the one most likely to get missed, and usually it comes down to one question. Do you snore? If you sleep alone, you likely have no real way to answer that. And not many women will even admit to snoring in the same way a man would, so when you say "no" or "I'm not sure," it often just gets passed over without anyone looking into it further.
Sleep apnea is when your breathing stops while you're asleep, over and over through the night, without you ever waking up enough to know that it happened. Your oxygen dips while that's happening, though not always by much, and your body has to jolt you awake just enough to get you breathing again. Night after night, that adds up to not getting the repair work sleep is supposed to be doing for you. That's associated with blood sugar that won't steady out and with blood pressure running higher. It's treatable, but only if someone looks into it.
You can't really watch your own night, but your mornings will be able to tell you something. Maybe you wake up with a mouth so dry you're reaching for water before you're actually awake, and you've always figured that was the ceiling fan. Maybe the headache is already going before you even open your eyes and you've put that down to not drinking enough water. You might even be up a few times in the night and have decided that's just your bladder now, or you're just a restless sleeper and have always blamed that on stress, because honestly, when isn't it? Every one of those has its own explanation, which is exactly why they rarely end up in the same conversation. When a few of them turn up together in one visit, that's when I start asking about apnea. So tell your provider you're waking up already tired, walk them through what the mornings are like, and ask whether a sleep study is worth doing.
Some of this has a test, and some of it doesn't
Iron is the one I want to see. Low iron is one of the things I check first when a tiredness won't lift, even when it's never gotten low enough to be identified as anemia. Heavy or long periods, month after month, are one of the most common reasons a woman's iron runs low, and that's worth mentioning to your provider, even if it's just how yours have always been. If your periods have already stopped, low iron means something different, and that needs its own look, because there are other ways the body loses it.
Ferritin is the number that shows whether your iron is running low, and it isn't part of a routine panel. It can also read normal when there's inflammation somewhere, so it gets read next to how you actually feel rather than on its own. And it's a number that matters before you start taking iron, because your body has no easy way to get rid of what it doesn't need.
There's a handful of other things that go with it. You might be cold when everyone else in the room is fine, or your legs won't settle at night once you finally get into bed. There are even some women who just crave ice and chew on it all day long, and never think of it as a symptom. Some of that can look like a thyroid running slow too, so I'd rather have both checked than guess between them.
And if your iron is low, I make sure to explain how long it actually takes to bring it back up, because it's slower than most people expect. Filling the reserve back up takes months of staying on it, well past the point where the count looks normal. What you'll likely notice first is a difference in how you feel, sometimes within a month or two, because iron does a lot more in your body than make red blood cells. But that early relief doesn't mean the job is finished, and a lot of women quit something that was working because they had no idea it would take that long.
Not everything that makes someone tired has a test though, because sometimes it's mood. I see depression turn up in a tiredness evaluation more often than people expect. Usually it's the tiredness that brings a patient in, and that's often the only part they mention, because the low mood underneath it doesn't feel like it's even a medical problem. Treating it does help. It just doesn't always take the tiredness with it. Some of the medications for depression can cause tiredness on their own, so that's worth raising with whoever prescribes them. Not stopping anything, just asking. And if the low mood turns out to be the bigger part of it, that deserves its own appointment with someone who works in that, instead of getting lost in the conversation about being tired, and left to sort itself out.
Mood isn't the only thing without a test either. I use labs to collect as many pieces as I can about what's actually driving the tiredness, and they rule out plenty along the way. But some of the pieces just don't come from blood work. There's nothing on a panel for a nervous system that hasn't had a break in years, or for what months of broken sleep have taken out of you. I don't believe in chasing endless testing either. So when there's nothing obvious left to add, that's the point where it's worth looking at what could come off instead.
The list nobody goes back and reads
Plenty of the women who sit down with me have already been given an answer, and it was always something to add. They got another prescription, or a higher dose of what they were already on, or a supplement someone swore by. Some were told to exercise more and eat differently, because they were carrying extra weight and that seemed like reason enough. When I ask whether anyone's gone back through the list to see what could come off, the answer is almost always no.
Every one of those prescriptions made sense at the time it was started. They got added one at a time, usually by different people looking at different problems, and once something is on the list it tends to stay there. That's why I call myself a deprescriber. The question I'm asking is what's still earning its place.
When I ask a patient what medications they're on, I'll typically get a list of their prescriptions. Over the counter medications are rarely mentioned, because most people don't think of them the same way as something prescribed. So I make sure to ask if they're taking anything over the counter as well, anything with PM on the box, the nighttime cold medicine, or whatever they've been reaching for to get to sleep. Those almost all work the same way, with the kind of antihistamine that makes you sleepy, either the same thing that's in Benadryl or a close cousin of it. A good bit of it is still working when your alarm goes off. So if you're waking up groggy, that can be the medicine doing it. And if it's still there on the mornings you skip it, we're back to why you couldn't sleep in the first place.
I also want to know when you take everything. Many people choose to take them all at once because that's how their routine was built. And in my experience magnesium comes up the most. That's because a lot of women know they're supposed to be taking it, so they just add it to what they're already taking and it goes down with breakfast. But magnesium can help you wind down at night, so moving it to the evening instead makes a real difference for a lot of women. If you're also on a thyroid medication, there's more to it.
Levothyroxine, the pill for a slow thyroid, has to go down on an empty stomach. Most women already know to leave a gap before breakfast. The part I end up explaining most often is that the supplements in that same handful count too. Calcium, iron, and magnesium all grab onto that pill on the way through, and whatever they catch never makes it into you. A lot of multivitamins have some of all three, so that's an easy one to miss. And the gap those minerals need is hours, not a few minutes, because your body has to get the pill in before they turn up.
So if the thyroid pill and the minerals are going down together, you may not be getting the whole dose. You'd be treated for a slow thyroid and still walking around with one, and the tiredness never lifts. Which is exactly why I don't want you rearranging any of it on your own once a thyroid medication is in the mix. Your dose got worked out around whatever your mornings already looked like, minerals and all. So if you separate them yourself, you'd risk over- or under-dosing in either direction, since your dose was never measured that way. Bring the timing up with whoever prescribes your thyroid medication, and tell them what else is in that morning handful so they can work out whether your levels need rechecking.
And there are some medications that will make you tired on their own. Beta blockers are the ones I watch for. Their names usually end in olol. And a lot of women on one have never connected the two. Either they'd forgotten it could do that, or the tiredness came on slowly and just became their new normal. These are prescribed for the heart as often as for blood pressure, and coming off one abruptly can cause real trouble, so it isn't a change to make on your own. If you're on one and you're worn out, let your prescriber know at your next appointment, because there may be other options worth exploring.
Metformin is one I ask about for a different reason. If you've been taking it for years it can slowly pull your B12 levels down, which is why it's meant to be checked periodically. That often doesn't happen, even after years on it. Low B12 can leave you tired, and it can also cause numbness or tingling in your hands and feet. If it's the tiredness, ask at your next appointment whether yours has ever been tested. But if you're experiencing numbness or tingling, I'd call rather than wait.
Some of these are genuinely dangerous to come off without help. So bring the list to whoever prescribes for you, with how long you've been on each thing and when your tiredness started, and ask whether anything on it could come off, or move, or get looked at again.
And if something does come off, it comes off slowly, with somebody watching the whole way. What I always warn about is what comes after. It can feel exactly like the thing coming back when it isn't, and that's how women end up frightened and right back where they started. Other times it genuinely is coming back, and that's just as real. Telling those two apart is the reason somebody's watching in the first place, and it isn't a call to make alone.
Where that leaves you
What women tell me afterward usually isn't that they have more energy. It's that they got themselves back. They only really see how far down they'd gone once they're back up, because it came on slowly enough that they kept adjusting to it.
You don't need to wait until it gets worse to do something about it. I've had many women come to see me because something as ordinary as cleaning a floor or walking to the end of the street became difficult.
So tell me what it actually feels like, when it started, and what you've stopped saying yes to. And bring me the whole list of what you're taking, with how long you've been on each one, even if it's short.
I might not have the whole answer that day. But those two things are what let me start looking in the right place.
Disclaimer & A Note from a Caring Practitioner:
My goal is to translate complex wellness concepts into relatable ideas to support your journey. The explanations I provide are simplified models intended for general education and motivation, based on both clinical patterns and established wellness principles. They are not complete medical explanations, diagnoses, or personal advice.
Every person's body is unique. Your individual health needs, experiences, and underlying conditions must be evaluated by your own healthcare provider. This information is educational only and is never a substitute for professional medical consultation, diagnosis, or treatment. Always partner with your personal healthcare provider before making changes to your health regimen.
