The endo fatigue spiral
Are you feeling tired? Not as in tired after one night of bad sleep, but as in ‘did I really sleep tonight?’-tired? Like a normal chore is too energy consuming, like feeling like procrastinating just about everything, like counting down to when you can get back to bed, on a daily basis?
It’s one of the most common consequences of endometriosis. As I argued in this post, I believe it’s even the worst one, or at least the first to be addressed.
Feel like cawling up into a ball and staying in bed? You're not alone
But how come we are so tired?
Let’s unravel how endo works:
Lesions: Hormone imbalance (probably) causes lesions on and between organs, leading to discomfort and pain.
Inflammation: Our body tries to clean up these lesions via inflammation, which is painful and energy-draining.
Immune System Overdrive: Constant inflammation overstimulates our immune system, making us prone to food intolerances and chronic diseases. It’s also *exhausting*.
Hormonal Influence: During periods, lesions and inflammations hurt more, deepening the pain and fatigue cycle.
Increased Pain Sensitivity: Frequent pain signals make our brain’s pain center more sensitive, worsening even minor discomforts.
Mental health - pain flywheel: Suffering pain, fatigue, misunderstanding, as frequently as we do, makes us prone to mental health issues like depression, insomnia and burn-out. This in turn leads to… Inflammation!
You saw that right, most of the parts of the “endo mechanisms” cause fatigue.
Physical triggers
On the one hand, there are physical triggers, like constant inflammation and hormone imbalance. Our body is in a constant fight/flight state, which is exhausting. All of our energy is being consumed by trying to get better (inflammation is a normal response of our body, it’s trying to do good).
This in turn leads to digestive tract issues, in a number of ways:
constant inflammation sends our immune system in overdrive, leading to more food intolerances. These are foods that our body disagrees with and has a hard time digesting. Or in other words: requires a lot of energy to handle these AND because of bad digestion we absorb less energy and experience cramps and bloating, which in turn are exhausting because it’s just plain painful.
many of us have endo lesions infiltrating into our bowel. These lesions react to hormones, meaning they bleed and become less flexible around our period, leading to more cramping and in general more sensitivity. The same thing can happen with our bladder and other organs, interfering with normal movement and function. All the discomfort this causes, leads to fatigue and reduced functionality, often leading to either more toxins or less nutrients being released into our blood stream.
The increased pain and immune system overdrive lead to us being very prone to Inflammatory Bowel Syndrom (IBS). This means we react badly to a few foods, just like the intolerances in the first bullet.
In addition to digestive tract issues, our suffering immune system means we catch a virus more easily. Have you ever noticed you seem to catch every cold and every bug that’s going around? That’s just another gift, brought to us by endo.
Research also found a correlation between endo and long covid, endo and lupus, endo and lots of other auto-immune and inflammatory diseases. All of these make. us. tired!
Powering through
And then there is the powering through the pain. It has a physical and mental aspect, so allow me to put it in the middle here.
Being in pain is exhausting.
Trying to act like you’re not in pain? Even more so.
Trying to do physcal activities while acting normal? What’s more than ‘even more so’?
Have you ever noticed that when you try to power through the pain and act normal, you’re more tired the next days? Since I decided to not to that anymore, and just lean into it and rest, I noticed I feel better the next day. I strongly recommend.
Mental triggers
And as if that isn’t enough, let’s add the mental aspect of endo to the mix.
As explained in this post, endo is strongly correlated to mental health issues. These include depression, burn-out, anxiety. Do you know what these tend to have in common?
You guessed it! It makes you feel tired.
And there is a negative spiral here, too: the more tired you feel, the less likely you are to take action to feel better.
It’s kind of the theme of this website, right?
Break! The! Cycle!
How do you break that cyle?
Another theme: with strategies that don’t require more energy than you have available right now. The Endo To Energy framework was developed just for this.