If you consistently feel like it’s a drag to get through an entire day or completely exhausted even if you’ve been sleeping well, you know the struggle. Fatigue is common. According to National Sleep Foundation research, Americans report feeling sleepy an average of three days weekly, with many noting it negatively affects day-to-day life. What is even more fascinating is that women are the group that report feeling the sleepiest — 3.4 days on average weekly compared to men, who report feeling sleepy 27 days a week.
Why are women tired more often than men? That’s a loaded question, but we can begin to address it by looking at one of the crucial differences between women and men: hormones — chemical messengers that help one part of the body communicate with another.
Key hormones for regulating energy
Numerous hormones play key roles in preventing fatigue and maintaining energy levels: gonadal, thyroid, and cortisol hormones (testosterone and estrogen). These hormones are crucial to the body’s energy regulation system, and disruptions in their balance can lead to chronic fatigue and additional health issues, explains Caroline Messer, M.D., an endocrinologist at Fifth Avenue Endocrinology and Founder of Well by Messer.
Thyroid hormones
Small but mighty hormones your thyroid gland produces — triiodothyronine (T3) and thyroxine (T4) — act like conductors, regulating how efficiently your body converts food into usable energy. Dr. Messer explains that when your thyroid is optimally functioning, you experience consistent energy throughout the day. However, an imbalance in these hormones can throw the entire system off-kilter, leading to significant energy issues. “For instance, hypothyroidism, characterized by low levels of T3 and T4, often results in fatigue and sluggishness, while hyperthyroidism also causes tiredness because the body is essentially in overdrive, which can eventually lead to exhaustion,” she says.
Cortisol
Cortisol — often called the stress hormone — is produced by adrenal glands and plays a crucial role in the body’s stress response, giving you the extra energy necessary to deal with demanding situations. Here is where things become interesting: cortisol has a sweet spot. “When it’s working optimally, [cortisol] ensures you have enough energy (glucose) in your bloodstream to conquer daily tasks and manage stress effectively,” says Messer. “But, like a sugar rush that crashes later, chronically high cortisol levels can backfire, leaving you feeling drained and fatigued.” Conversely, insufficient cortisol can lead to adrenal insufficiency, which results in constant tiredness.
Insulin
Produced by the pancreas, insulin controls blood glucose levels by facilitating glucose uptake into cells for energy production, explains integrative family physician and Founder of California Center for Functional Medicine, Sunjya Schweig, M.D. “When blood glucose levels rise, insulin is released to help cells absorb glucose, reducing blood sugar levels and providing energy. Insulin dysregulation, such as in diabetes, can lead to significant energy imbalances and fatigue.”
Testosterone
While often associated with men, testosterone is also critical for women, supporting muscle mass, overall vitality, and bone density, notes Dr. Messer. Like in men, testosterone in women can contribute to increased levels of energy by helping regulate the rate of metabolism, which can affect energy production. Messer notes it additionally helps maintain muscle mass, which can contribute to an increased basal metabolic rate and possibly more energy throughout the day.
Estrogen
Dr. Messer complains that estrogen plays a key role in women’s health, maintaining bone density, promoting cardiovascular well-being, and regulating the menstrual cycle.
“During menopause, when estrogen levels drop, many women experience fatigue and a decrease in energy,” says Messer. Estrogen is also a precursor to neurotransmitters like serotonin, which can influence our motivation and mood. In other words, higher levels of serotonin might give us a boost in energy, and lower levels could do the opposite.
Hormonal imbalances that can lead to fatigue
Numerous hormones play a critical role in whether or not we feel fatigued unnecessarily. Here is how level imbalances can leave you feeling unmotivated and drained.
- Imbalances of sex hormones: Imbalances involving one or more of the sex hormones, testosterone, estrogen and progesterone, can play a significant role as will. “Menopause in women, characterized by declining estrogen levels, leads to fatigue, mood swings, and sleep disturbances,” says Messer. “In men, decreased testosterone levels, known as andropause, reduce energy, muscle mass, and overall vitality.”
- Thyroid dysfunction: Hypothyroidism and hyperthyroidism are common causes of fatigue. “Hypothyroidism, marked by low thyroid hormone levels, slows down metabolism, leading to persistent tiredness, weight gain, and depression,” says Dr. Messer. “Conversely, with excess thyroid hormones, hyperthyroidism initially boosts energy but eventually causes fatigue due to the body being constantly overdriven.”
- Adrenal insufficiencies: Adrenal insufficiencies, including adrenal fatigue (HPA axis dysfunction), Addison’s disease, also contribute to fatigue. “Addison’s disease, an autoimmune condition, results in insufficient cortisol and aldosterone production, causing chronic fatigue, muscle weakness, and weight loss,” says Dr. Messer. “Adrenal fatigue suggests prolonged stress depletes cortisol production, leading to fatigue and lethargy.”
How to determine if your fatigue is hormonal — or not
According to Messer, hormonal and endocrine disorders often present with nonspecific symptoms, like fatigue. It’s key to think about your nutrition, sleep, and activity habits, as they can influence your fatigue levels. When fatigue is unexplained or persistent, it’s crucial to consider the possibility of an endocrine disorder. “In patients with known endocrine conditions, the onset of fatigue may signal the development of a related disorder or complication, so it’s important to seek medical advice from an endocrinologist if you find yourself in this position,” says Messer.
Endocrinologists are medical doctors who focus on the network of glands responsible for producing hormones that influence everything from sleep to metabolism to mood — the endocrine system. Through a thorough evaluation, they might order blood tests to measure the levels of your hormones and additional diagnostic tests to get a total picture. This helps pinpoint any underlying hormonal imbalances that could be draining your energy.
What you should do to get your hormones under control
Unfortunately, no quick, easy fix or magic pill can repair hormonal issues you might be having, notes board-certified reproductive endocrinologist and fertility specialist at Fertility Centers Illinois, Allison K. Rodgers, M.D. However, there are some lifestyle interventions that may help.
Eat a diet rich in nutrients
Nutritional interventions and dietary changes are key for reducing fatigue and supporting hormonal balance. “A diet rich in whole, unprocessed, and fresh fruits and vegetables will provide you with essential vitamins and minerals,” explains Dr. Rodgers. “Processed sugar can lead to the release of the hormone insulin and a feeling of ‘crashing,’ so glycemic index foods should be paired with proteins and fats so the insulin levels don’t spike and crash.”
Dr. Schweig notes that adequate selenium and iodine intake, found in dairy products, seaweed and fish, eggs, sunflower seeds, and Brazil nuts, is also needed to support thyroid function.
“A healthy gut microbiome, supported by probiotics from yogurt, kefir, fermented foods, and prebiotics from garlic, onions, and bananas, is also essential for hormone metabolism and reducing inflammation.”
Keep stress levels under control
High levels of cortisol can disrupt the balance of other hormones like sex hormones, insulin, and thyroid hormones, Dr. Schweig warns. “Prolonged elevated cortisol can cause adrenal fatigue, increased blood sugar levels, weight gain, and compromise immune function,” he says. “Effective stress management techniques, such as mindfulness, meditation, yoga, and adequate rest, can help regulate cortisol levels and improve hormonal balance.”
Get regular exercise
Exercise isn’t only about burning calories and building muscle but also maintaining hormonal harmony. Regular physical activity helps regulate insulin levels, reduce stress, improve metabolic function, and stimulate the release of endorphins, enhancing energy levels and mood,” says Schweig. “It also supports maintaining a healthy body weight, which is crucial for hormonal balance — for instance, body fat can produce estrogen, and excess fat can lead to estrogen dominance, particularly in postmenopausal women.”
However, remember, moderation is key, even (and maybe especially) when staying active or exercising. While exercise is great, continuing to push yourself too hard without enough rest and correct nutrition can disrupt other hormones like thyroid hormones and cortisol. Pay attention to your body, find a fitness routine you enjoy, and let it be your partner in achieving vibrant energy levels and optimal hormonal health.
Get enough sleep
Do your best to get the 7 to 9 hours of sleep recommended nightly, per the Centers for Disease Control and Prevention (CDC). “If you’re a woman, you will likely need eight or more hours of sleep most of your cycle, with your luteal phase being a key area where more sleep is often needed,” says functional medicine naturopathic doctor, founder of Rubus Health, and board-certified naturopathic endocrinologist, Jolene Brighten, N.D. “Make sure you create an environment conducive to sleep — one that’s dark, cool, and quiet.”
Stay on top of your medical checkups
Regular blood tests and medical check-ups can detect hormone imbalances early, allowing for intervention and timely treatment, Dr. Schweig explains. “In addition to communicating how you’ve been feeling, including your levels of fatigue, with your healthcare provider, it may be worth it to inquire about certain supplements like vitamin D, magnesium, B vitamins, and adaptogenic herbs like ashwagandha, Rhodiola, and holy basil that may help support hormone balance and adrenal function,” he says. “Alternative therapies, such as acupuncture, balance energy flow, alleviate stress, improve sleep, and promote relaxation, reduce stress, and enhance well-being.”
