Could tiredness be affecting your fertility?

Could tiredness be affecting your fertility? Fatigue is an under-recognised symptom of a common womb disorder, reveals study

  • A study of 1,120 women found 50 per cent with endometriosis are fatigued
  • Scientists think the condition activates the immune system, tiring people out 
  • They say doctors should take fatigue more seriously to improve quality of life

Women with endometriosis are more than twice as likely to be overwhelmingly tired, a study has found.

Fatigue is a common symptom of the condition in which womb tissue grows outside of the womb, but experts say it is not discussed enough.

Some 50 per cent of women with endometriosis have the symptom, which can make people so tired even sleeping does not help.

Meanwhile, only around one in five – 22 per cent – of other women get fatigued. 

Researchers from University Hospital Zurich in Switzerland say tiredness is one of the most debilitating symptoms of the condition.

They hope their findings will help doctors to properly address women’s fatigue to improve the quality of life for women with endometriosis.

Women who have endometriosis are more than twice as likely to become fatigued when compared to women who do not have the condition

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Endometriosis is common and is thought to affect up to one in ten women worldwide, but its causes are not well understood.

It occurs when womb lining cells grow where they are not supposed to, such as in the ovaries or fallopian tubes.  

Endometriosis often causes pain and may also lead to heavy periods, infertility or an increased risk of depression because of the impact it has on a woman’s life.

As well as pain, fatigue – a feeling of always being exhausted – is a common effect of the condition.  

Fatigue could be caused by immune system activation 

This might be because endometriosis causes injuries inside the body which activate the immune system, which has been shown to make people more tired, the study claims.  


Endometriosis occurs when cells in the lining of the womb are found elsewhere in the body. 

Each month, these cells react in the same way as those in the womb; building up, breaking down and bleeding. 

Yet, the blood has no way to escape the body.

Endometriosis affects one in 10 women of a reproductive age in the US and UK.

Symptoms include:

  • Pain
  • Heavy periods 
  • Fatigue
  • A higher risk of infertility, and bowel and bladder problem

Endometriosis’ cause is unknown but may be genetic, related to problems with the immune system or exposure to chemicals.

Treatment focuses on pain relief and improving a sufferer’s quality of life, which may include surgery or hormone treatment.

Source: Endometriosis UK

Researchers now say understanding the link between endometriosis and fatigue could help doctors improve their patients’ lives by addressing the tiredness directly.

Professor Brigitte Leeners, who led the research said: ‘Although chronic fatigue is known to be one of the most debilitating symptoms of endometriosis, it is not widely discussed and few large studies have investigated it. 

‘We believe that in order to improve the quality of life for women with this condition, investigating and addressing fatigue should become a routine part of medical care.

‘Doctors should investigate and address this problem when they are discussing with their patients the best ways to manage and treat the disease. 

‘It would also help these women if steps were taken to reduce insomnia, pain, depression and occupational stress.’

Fatigue increases risk of depression 

Pain, insomnia, occupational stress and depression are also known to contribute to fatigue, but the research found endometriosis causes it even when these are taken into account. Body mass and motherhood were also ruled out as the cause.  

Women who have both endometriosis and fatigue are also four times as likely to be depressed or have insomnia, twice as likely to experience pain and have a higher chance of being stressed at work, the study found.

Professor Leeners added: ‘These findings suggest that endometriosis has an effect on fatigue that is independent of other factors and that cannot be attributed to symptoms of the disease.’ 

How the research was carried out  

The Swiss scientists recruited 1,120 women, 560 with endometriosis and 560 without it, from hospitals and private practices in Switzerland, Germany and Austria between 2010 and 2016. 

The women completed a questionnaire about their quality of life and endometriosis, as well as medical and family histories, life style and mental disorders. 

Women were asked to rate how often they had fatigue or insomnia on a five-point scale from never to very often.  

Some 50.7 per cent of the women diagnosed with endometriosis suffered from frequent fatigue, compared to 22.4 per cent of women without the condition. 

Fatigue with endometriosis was also associated with an increased risk of insomnia, depression, pain and occupational stress. 

The women’s ages, time since their first diagnosis and the stage of their disease were not linked to fatigue.

The research was published in the journal Human Reproduction.


Another study done at the same time by Professor Brigitte Leeners’ team at University Hospital Zurich revealed women who suffered abuse or neglect as children are more likely to develop endometriosis.

A total of 421 women with endometriosis were compared with 421 women without the condition.

They completed questionnaires about their childhood and experience of physical, sexual and emotional abuse, emotional and physical neglect, and ‘inconsistency experiences’ – feeling unsafe or scared their family might break up.  

Women with endometriosis were more likely to have experienced all forms of neglect than women without the condition: sexual abuse (20 per cent versus 14 per cent), emotional abuse (44 per cent versus 28 per cent), emotional neglect (50 per cent versus 42 per cent) and inconsistency experiences (53 per cent versus 41 per cent).

Professor Leeners said this could lead to doctors asking women with endometriosis about their childhood so they could be directed to mental health care if they needed it.

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