PCOS Fatigue: What Causes It and How To Beat It

Do you always feel tired despite getting a good night’s sleep? Are you heavily reliant on caffeinated beverages to get you through the day? Do you get the 4 pm energy slumps?

If you answered yes to either question, you may be suffering from fatigue.

I understand it may feel like a daily struggle and a real pain to live with. Your body may feel physically heavy and drained of energy because of your PCOS fatigue.

But you don't have to feel this way.

Fatigue is a common concern for women with PCOS.

So, in this post, we will look at what causes PCOS fatigue and how to beat it. So, if you want to feel energized, I suggest you continue reading this post.

Can PCOS make you tired?

Fatigue is a symptom some women with PCOS experience. I understand that it can be frustrating and difficult to live with. But I want you to know that fatigue from PCOS can be reversed. PCOS women suffer from a hormone imbalance. Which is usually the result of certain possible causes. Including insulin resistance, Hypothalamic Pituitary Adrenal Axis Dysfunction, an underactive thyroid and inflammation. It is these possible causes, not the hormone imbalance alone, that can lead to PCOS fatigue.

So, let’s take a quick look at what fatigue is before we delve further into the causes of PCOS fatigue.

What is Fatigue?

Fatigue is both a physical and mental symptom used to express feelings of tiredness, lethargy and exhaustion. It can be acute, in which the fatigue doesn’t last long. Or chronic, where the fatigue persists and doesn’t go away even after the body is given time to rest.

So, you might be wondering.

Why Do Women With PCOS Experience Fatigue?

PCOS is the result of a hormone imbalance. But both PCOS and its symptoms, like fatigue, occur for various reasons. One of the possible causes is insulin resistance. This is a condition where the cells in the body don't respond to the signal insulin is giving. As a result, blood sugar levels remain high.

A further cause is Hypothalamic Pituitary Adrenal Axis Dysfunction. The constant release of stress hormones can eventually lead to the body becoming desensitized to them.

PCOS fatigue can be the result of an underactive thyroid (hypothyroidism). Hypothyroidism is a hidden cause of PCOS. It is a condition where the thyroid is not producing enough of the hormones.

The final common cause of fatigue in women with PCOS is inflammation. This is an immune system response the body makes to protect us from infections. But unfortunately in women with PCOS, the immune system is constantly activated. As a result, inflammation does not decrease.

To find out what the root cause of your hormone imbalance and PCOS may be, check out my 'Types of PCOS: Ultimate Guide'.

So, you now know the possible causes of PCOS fatigue. Let’s get into them.

Insulin Resistance Can Cause PCOS Fatigue

Insulin resistance is the most common root cause of PCOS, with about 70% of women suffering from this.

Our bodies main source of energy is glucose (sugar) and we get this from the food we eat. The sugar we get from food enters our bloodstream after digestion. Now insulin, a hormone produced by the pancreas, shuttles the sugar out of the bloodstream and to the cells to use as fuel. But when someone is insulin resistant, the cells don't respond to the signal insulin is giving. So, as a result, the cells do not absorb the sugar in the blood and instead it builds-up in the bloodstream.

Because the cells are not getting the sugar they need for fuel they get tired and do not function properly. As a result, this leads to PCOS fatigue.

Manage blood sugar levels

To beat the PCOS fatigue you must balance your blood sugar levels. To do this:

Choose Low Glycemic Index Carbs

I recommend choosing carbs with a low Glycemic Index (GI). Essentially, the index ranks a carbohydrate by how it will affect blood sugar levels after consumption. So a carb with a low GI value will be digested and absorbed into the body more slowly. Causing a slower rise in blood sugar levels, that will be lower overall. The opposite would be true for a carb with a high GI value.

A low GI is 55 or below, medium 56-69 and high is anything over 70. By choosing low GI carbs, you are better able to balance your blood sugar levels.

Combine carbohydrates with protein and/or fat

Avoid eating a high carb meal. Instead prepare balanced meals which contain all three macronutrients, protein, carbs and fat.

By combining carbs with a protein and/or fat blood sugar levels will not spike resulting in a surge in insulin.


Buy a Glucometer

We all have a unique tolerance to carbs. So to find out how a certain amount of carbs affects your blood sugar I recommend buying a glucometer. The normal response after eating a high carb meal is a rise in blood sugar and then a decrease back to a healthy level in a few hours. However, some people will find their blood sugar levels rise way above normal and return back to a healthy range very slowly.

A healthy blood sugar range is between 72-99mg/dL.  If your blood sugar levels rise above 180mg/dL it is an indication you have eaten too many carbs and your body isn’t using the sugar.

Eat Fiber

Studies show fiber can lower blood sugar levels by slowing down digestion and the release of sugar. High fiber foods include vegetables, fruits, oats, beans and legumes.

Avoid Skipping Meals

Going too many hours without eating causes your blood sugar levels to drop. This is because sugar levels have not been replenished. Without enough sugar, in the blood, your body cannot function properly.

Now constantly snacking isn’t the best for blood sugar levels. But eating at regular intervals is important to maintain healthy blood sugar levels. Try to eat every 3-4 hours to keep blood sugar levels stable to avoid the blood sugar rollercoaster.

Now, the next possible cause of PCOS fatigue is hypothalamic pituitary adrenal axis dysfunction.

Hypothlamic Pituitary Adrenal Axis (HPA Axis) Dysfunction Can Cause PCOS Fatigue

Firstly, the HPA axis is a set of interactions between the hypothalamus, pituitary and adrenals. Its role in the body is to regulate stress.

Here’s how it works.

The hypothalamus releases a hormone called corticotrophin-releasing hormone (CRH). This sends a signal to the pituitary gland (a major hormone producing gland) to produce the adrenocorticotropic hormone (ACTH).

ACTH then triggers the adrenal glands to release cortisol. The increase in cortisol allows the body to respond to the stressor through an increase in glucose (our main source of energy).

The increase in cortisol stops the production of both CRH from the hypothalamus and ACTH from the pituitary gland. As a result, ACTH decreases causing a drop in cortisol levels and this then brings balance back to the central nervous system.

Unfortunately, the constant release of cortisol eventually causes the body to become desensitized. As a result, balance to the axis cannot be restored like it used to. So the hypothalamus, pituitary gland and adrenal glands stay chronically stressed.

Restore Balance to your HPA Axis

Balance can be restored when you focus on removing things from your life that stress your adrenals. Look at both psychological and non-psychological stressors. To recover from the fatigue caused by HPA axis dysfunction, it may mean

Stopping high intensity and endurance workouts

High intensity and endurance workouts increase cortisol levels. So, instead, opt for low-intensity exercises like walking, swimming and yoga. Low-intensity exercises do not significantly increase cortisol.

Avoid caffeine

Here’s the thing.

Caffeine is a stimulant because it activates the stress response and causes the adrenal glands to release cortisol. So, to lower cortisol levels you may have to avoid or cut back on your caffeine consumption.

For more information on caffeine for PCOS and which coffee I drink to manage the release of cortisol. Check out my ‘Caffeine and PCOS: Should You Avoid It?’ post.


Many people, unfortunately, do not prioritize sleep. As a result, they do not have a bedtime routine to ensure good quality sleep. Research shows sleep deprivation can increase cortisol levels.

So, aim to go to bed between 9-11 pm and strive for 7-8 hours of sleep. To help you do this, avoid all blue light, that means not looking at your mobile phone or any other screen at least 1 hour before bed. Going for a walk and eating foods that contain tryptophan (a sleep-inducing amino acid) like turkey, spinach and nuts, can help your body relax.

Supplements to Help Cope with Stress

B Vitamins (B6 and B12)

All the B vitamins work together in the body, but each vitamin also has its own specific role. B vitamins support energy production and your adrenals so you don't feel fatigued.

Vitamin B6 has an important role in adrenal functioning. It is involved in the production of our adrenal hormones and in the conversion of food to energy. So, low levels of vitamin B6 can affect the body’s ability to process food into energy. Resulting in symptoms like fatigue and muscle weakness.

B12 creates energy, repairs cells and helps to make red blood cells. The creation of red blood cells helps to deliver oxygen around the blood. This will help with energy levels and PCOS fatigue.

Vitamin C

The adrenal glands contain high levels of vitamin C. When stressed, vitamin C is released into the blood along with stress hormones. This then causes Vitamin C levels to become severely depleted. The more stress your body is under, the more vitamin C your body uses.

Alternatively, when your body is deficient in vitamin C, your adrenals panic and release cortisol.

So including vitamin C in your diet will help replenish low levels and may help with hormonal and blood sugar imbalances.


Adaptogens are plant-based supplements that protect the body from stress by regulating the release of cortisol. As a result, preventing the HPA axis from being constantly activated. This then protects the body from adrenal fatigue and the depletion of nutrients. Popular adaptogenic herbs include Ashwagandha and Rhodiola.

The third possible cause of PCOS fatigue.

Hypothyroidism Can Cause PCOS Fatigue

Researchers have found that up to 25% of women with PCOS have a thyroid condition.

The thyroid is often referred to as the ‘hormone powerhouse’ because it releases various hormones that control the rate organs and cells turn food into energy. As well as how much oxygen the cells use. So, if the thyroid isn’t running optimally, problems arise.

Now, hypothyroidism is the most common hidden cause of PCOS. It is a condition where the thyroid is underactive. Meaning the thyroid is not producing enough of the hormone.

This causes PCOS fatigue because the cells are not getting enough energy or oxygen to thrive.

Support Your Thyroid

As discussed the thyroid gland is a ‘hormone powerhouse’ so you must support and protect it. Dietary and lifestyle tips include

Add Probiotics

Dr. Datis Kharrazian, a functional medicine health care provider, says that 20 percent of thyroid function depends on a healthy gut to help convert T4 to T3.

T4 (the inactive thyroid hormone) must convert to T3 (the active hormone) before the body can use it. So, adding some probiotics to your diet, to improve the health of your gut, may help support your thyroid.

Increase Protein

Protein delivers thyroid hormones to the cells of the body. An adequate daily consumption can help your thyroid work optimally.

But avoid soy protein because it acts like estrogen in the body. High estrogen levels can stop the release of thyroid hormones.

Be Aware of Goitrogens

Goitrogens are plant-based substances that can interfere with thyroid function. They are found in broccoli, kale, Brussels sprouts, cauliflower, cabbage, spinach and strawberries. Experts state they inhibit the intake of iodine by the thyroid gland. The thyroid needs iodine because it helps to make thyroid hormones.

With that said Dr. Izabella Wentz, The Thyroid Pharmacist, says vegetables that contain goitrogens do not have to be avoided entirely. This is because they contain key vitamins and minerals that are important for thyroid health. She recommends cooking, steaming or fermenting the vegetable will help reduce the goitrogens.

Supplements for Hypothyroidism

There are also several supplements that can help the thyroid. But as always, consult a medical professional before taking any of these supplements.

Selenium- Selenium is an antioxidant that supports thyroid function.
Healthy levels of selenium are also necessary for the conversion of T4 to T3. An insufficient amount of T3 causes the body to slow down.

Iodine- Iodine is an essential mineral needed for the production of thyroid hormones. So a deficiency in iodine causes a decrease in thyroid hormone release.

Iodine rich foods include seaweed, fish, eggs, dairy and prunes. Or you can add iodized table salt to your meals.
Consult your doctor because taking too much can have the opposite effect. It can instead cause damage to the thyroid.

The next common cause of PCOS fatigue is inflammation.

PCOS Fatigue Caused by Inflammation

Researchers have found that PCOS women suffer from chronic inflammation.

Inflammation is a response the immune system takes in an attempt to defend itself from outside invaders, such as viruses and bacteria.

While insulin resistance is a root cause of PCOS. Studies have found obesity-induced inflammation can lead to insulin resistance. The inflammation and insulin resistance can then lead to the development of PCOS and its symptoms like fatigue.

When the immune system believes it is under attack from outside invaders, all energy and resources are used to protect the body. As a result, not much energy is left to be used for day to day tasks. This is why inflammation can cause PCOS fatigue.

But, wait there’s more.

The Immune System gets things Wrong

While the role of the immune system is to protect us, things can go wrong. It can instead attack whole organs in the body.

For example

PCOS women have a 3x greater risk of hashimotos thyroiditis. This is an autoimmune disease where the immune system attacks the thyroid. If hashimotos thyroiditis is not treated it can lead to the destruction of the thyroid gland. This can affect the production of thyroid hormones and cause bodily functions like heart rate and metabolism to slow down. Resulting in symptoms like PCOS fatigue.

Lower Inflammation

Here is what you can do to lower levels of inflammation.

Avoid Inflammatory Foods

Inflammatory foods are those that cause inflammation in the body. They include sugar, seed oils, gluten and A1 casein (found in dairy). As well as avoiding these foods, you must eat plenty of anti-inflammatory foods. Like salmon, walnuts, turmeric and ginger.

Increase Fiber

A second nutrition tip to lower inflammation is to increase the amount of fiber you eat. A study found that the risk of high inflammation was 63% lower in the group which followed a high fiber diet. 

Knowing that simply eating more fibre can reduce the risk of inflammation is incredible for PCOS women.

Aim to eat 25g of fibre a day. Fibre-rich foods include fruits, vegetables, seeds, oats, beans.

Avoid Over-Exercising

When we exercise, we experience acute inflammation. This type of inflammation is short term and happens because of the stress put on the body while exercising.

This acute inflammation can become chronic if the body isn’t given time to rest. So, scheduling rest days is so vital for your health and hormones.

What’s Causing Your PCOS Fatigue?

In summary, PCOS fatigue has many root causes. They include blood sugar imbalances, HPA Axis dysfunction, hypothyroidism and inflammation.

But while PCOS fatigue may be a struggle to live with. There are ways to beat the fatigue.

Depending on what is causing your PCOS fatigue, there are certain dietary and lifestyle changes you can make to feel more energized.

Address the Root Cause of Your PCOS Fatigue

If PCOS fatigue is a result of insulin resistance, working on balancing blood sugar levels is key. This can be achieved by choosing low GI carbs, combining your carbs with a protein and/or fat. As well as eating more fiber and every 3-4 hours.

PCOS fatigue caused by HPA Axis Dysfunction requires a focus on balancing the HPA Axis. To restore balance stop high intensity and endurance workouts, avoid caffeine and make sleep a priority. Vitamins b6, b12 and C, as well as an adaptogen can help.

While PCOS women also suffering from hypothyroidism must support their thyroid. To do this add probiotics, eat more protein, be aware of goitrogens and supplement with selenium and iodine.

If your PCOS fatigue is caused as a result of inflammation in the body, these dietary changes may help. Avoid inflammatory foods like sugar and seed oils, eat more fibre and stop over-exercising.

Before changing anything in your diet and lifestyle always consult a medical professional.


Hey there! I am Despina Pavlou, founder of PCOS Oracle, certified personal trainer and corrective exercise specialist.  I want to share with you the diet and lifestyle changes I made to naturally reverse my PCOS and achieve hormonal balance. I believe using my holistic approach you too can take back control from PCOS.


  1. Amber on June 22, 2019 at 11:37 pm

    I didn’t know that, about green tea! I was told to avoid caffeine period, including the tea. I would LOVE to replace my coffee with a hot green tea in the mornings, if you’re saying that’s alright!

    • Despina on June 23, 2019 at 6:37 pm

      Hey Amber,
      Green tea has less caffeine than black tea. It is all about being cautious with the amount of caffeine you consume because it can increase the production of cortisol, the primary stress hormone. Women with PCOS need to manage their stress/cortisol levels in order to balance their hormones and reverse their PCOS. But green tea is great for PCOS because of its antioxidants. It has huge health benefits for women with PCOS, including lowering stress and the L Theanine found in Green Tea helps with anxiety.

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