Fatigue and chronic fatigue
ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), long COVID fatigue
Chronic conditionOngoing exhaustion that limits daily life. It can come from a treatable cause, or it can be ME/CFS, a serious illness in which effort makes symptoms worse.
For education only — this guide can't diagnose you. If these signs sound familiar, talk with a healthcare provider. Book a consult
What happens
Fatigue has many causes, including anemia, thyroid disease, sleep apnea, depression, blood sugar problems, autoimmune disease, and medicines, so a careful workup comes first. ME/CFS is diagnosed when profound fatigue lasts 6 months or more with post-exertional malaise (a crash after physical or mental effort), unrefreshing sleep, and brain fog or dizziness when upright. It often starts after an infection, including COVID-19. Its cause isn't fully understood, but research points to immune, nervous system, and energy metabolism changes.
Who gets it
ME/CFS is two to three times more common in women and often starts after a viral illness. Fatigue is also very common with autoimmune disease, and lasting fatigue after COVID-19 is reported more often in women.
Signs worth getting checked
- Exhaustion that isn't relieved by rest
- A crash in energy a day or two after activity (post-exertional malaise)
- Unrefreshing sleep
- Brain fog and trouble with memory or focus
- Dizziness, a racing heart, or feeling worse when standing
- Muscle or joint aches and headaches
- Sore throat or tender lymph nodes
Labs to ask about
- CBC, ferritin, B12, and folate
- TSH and free T4
- Metabolic panel, A1c, and CRP
- Vitamin D
- A sleep study if you snore or wake unrefreshed
- A 10-minute standing test or tilt-table test for orthostatic intolerance or POTS
Treatments your doctor may discuss
- Treating any underlying cause, such as anemia, thyroid disease, or sleep apnea
- Pacing, which means staying within your energy limits to avoid crashes
- Treating orthostatic intolerance with fluids, compression, and sometimes medicine
- Treating sleep problems, pain, and mood symptoms
Supportive steps to discuss with your provider
- Track activity and symptoms to find your limits. Push-through exercise programs aren't recommended for ME/CFS.
- Break tasks into smaller pieces and schedule rest before you need it.
- Ask whether more fluids and salt are right for you if you feel worse standing.
- Ask about workplace or school accommodations.
- Keep regular sleep and wake times.
See a doctor promptly if you have
- Chest pain or fainting: call 911
- Fatigue with unexplained weight loss, fever, or night sweats
- Severe shortness of breath with activity
- Fatigue with low mood or thoughts of suicide: call or text 988
Related conditions
Ready to find the root cause?
Dr. Lesher is a Naturopathic Doctor who focuses on autoimmune and chronic conditions in women. Since 2020, she's helped hundreds of patients stop managing symptoms and start healing.