Why Am I So Tired on My Period?

Turns out, there are plenty of things that can zap your energy levels during menstruation.
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Sometimes I dream about how pleasant life would be if I didn’t get my period every month. I wouldn’t have to deal with brain fog and cramps or worry about whether or not I have any tampons in my house (or scramble when I realize I definitely do not). I also wouldn’t have to force myself to function when all I really want to do, at least for a day or two, is cozy up in bed and nap. When my period hits, my energy crashes, and I transform into a slothier version of myself—and I know I’m not the only person manically (okay, fine, drearily) googling, Why am I so tired on my period?

Between the hormonal fluctuations, bleeding, cramps, and sleepless nights, it’s no wonder fatigue—the type of exhaustion that seems to affect every fiber of your being—ranks as one of the most common period complaints. As Lubna Pal, MBBS, a reproductive endocrinologist and professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine, tells SELF, “There’s a lot going on in your body before and during your period.”

All those changes can be a total energy suck—especially if your symptoms push you to the brink every month. Here’s why your period can be so draining, as well as a few ways to feel like less of a zombie whenever, in the iconic words of Cher Horowitz, you’re “surfing the crimson wave.”

Sinking hormones are a (big) part of the problem.

A few days before your flow starts, the hormones estrogen and progesterone plummet in your body. The decline in estrogen, in particular, causes a dip in serotonin, too—a chemical that affects your mood and energy. As a result, you may feel weak and worn out, Abby Eblen, MD, a board-certified reproductive endocrinologist with the Nashville Fertility Center, tells SELF.

Gabrielle Whitmore, MD, MBS, an ob-gyn at the University of Colorado Anschutz Medical Campus, compares these hormonal (and psychologic) changes to the postpartum “baby blues” many people experience following childbirth. After pregnancy, progesterone levels nosedive, which can drain your energy levels and mental health. A similar effect happens with your period each month, according to Dr. Whitmore. “Fatigue and mood changes—all of that can also absolutely happen with the progesterone drop” that takes place when your period starts, she says.

At the same time, the tissue lining your uterus (a.k.a. the endometrium) starts to break down, says Dr. Pal. Your uterus contracts to shed the lining, causing cramps, menstrual bleeding, and, to put it in scientific terms, the blahs. All of this hard work your body is doing, along with the pain and discomfort associated with it, can tucker you out, Dr. Pal says.

Uncomfortable period symptoms can also mess with your sleep.

That’s not all (and why would it be?!). If your period is on the heavier side or you struggle with horrific cramps, you might find it tough to nod off at night. According to Dr. Eblen, period pain is known to disrupt sleep—good to know I’m not the only one who bolts awake with pain shooting across my lower abdomen at 3 a.m. And who ever felt well-rested and clear-headed after tossing and turning all night long?

Evidence suggests this is an extremely common issue. In fact, some surveys estimate up to 71% of people who menstruate deal with sleep disruptions before and during their periods. Research also shows that PMS is one of the main causes of sleep problems, like insomnia and repeatedly waking up in the middle of the night, in people who get periods. Needless to say, the more disturbed your rest is, the more sluggish you’re going to feel, Dr. Eblen says.

Other health issues can make matters worse.

While being a little more tired than usual is to be expected, it’s not normal to feel super zapped around your period. Excessive sleepiness—i.e. you feel it affecting your ability to work, exercise, do your chores, or even sleep at night—could be connected to another health issue.

Anemia

Bleeding, particularly if it’s *a lot* of red, can worsen (or even trigger) symptoms of anemia, a condition that inherently causes fatigue and weakness, says Dr. Pal. What exactly counts as heavy menstrual bleeding? The American College of Obstetricians and Gynecologists defines it as a period that lasts longer than a week or causes you to soak through a pad or tampon every hour for several hours.

But, as Dr. Whitmore points out, a lot of people don’t use pads and most of us aren’t out here measuring how many milliliters of blood we’re losing every day. Her advice? If you think you’re bleeding more than you used to or are going through multiple Diva Cups, tampons, or period underwear each day, go get evaluated by a health care professional. Even if you aren’t sure, it doesn’t hurt—and, hey, can even help—to ask if the amount of blood you’re losing is normal.

Premenstrual exacerbation

If you have a chronic condition—like anxiety, depression, or fibromyalgia—and feel like it intensifies around the start of your menstrual cycle, you could be dealing with premenstrual exacerbation, or PME. This describes the phenomenon when a chronic illness (either mental or physical) tends to get worse in the second half of the menstrual cycle as you creep closer to your period.

If you struggle with depression, for example, feelings of worthlessness and lethargy may skyrocket during this time, or fear and worry may surge if you have an anxiety disorder. These conditions are often already tiring to deal with—and fluctuating hormones can make that fatigue even worse, Dr. Pal says. PME isn’t a diagnosable condition yet and a lot more research is needed to understand why it happens or how prevalent it is, but some research suggests certain people are more sensitive to hormonal changes for some reason, causing them to feel extra crummy during menstruation.

Premenstrual dysphoric disorder (PMDD)

Feeling drained and lethargic also goes hand in hand with PMDD, a severe form of PMS that affects roughly 5 to 8% of people who menstruate. Most people experience some discomfort during their period, but PMDD—and the exhaustion it can ignite—can upend your quality of life and daily activities. With PMDD, you may tire easily or feel lethargic and perpetually zapped during that time of the month. Or perhaps you suddenly have insomnia, causing you to feel worn out during the day. “There is a spectrum of how much PMDD symptoms can impact people,” Dr. Whitmore says. But increased fatigue, to some extent, is a common one.

Thyroid abnormalities

Your thyroid—a small gland that sits in the front of your neck and controls your digestion, breathing, heart rate, and mood—can impact your menstrual cycle too. For example, if you have hypothyroidism, the thyroid doesn’t produce enough hormones, which can affect how the pituitary gland communicates with the ovaries. As a result, your estrogen and progesterone levels may abnormally ebb and flow, which can certainly cause you to feel drained, especially during your period, Dr. Whitmore says.

Reproductive health conditions

There are also multiple reproductive health conditions that can be incredibly painful and cause higher-than-usual bleeding, which can make you feel spent.

Endometriosis, a condition where tissue similar to the uterine lining grows outside of the uterus, and adenomyosis, which is when this tissue grows deep into the uterine muscle, can both cause heavy, super painful periods. It can be so bad it keeps you up at night, leading to exhaustion the next day. And, just like any other situation where you’re using a ton of blood, it can increase the chances that you become anemic.

The same goes with fibroids, which are noncancerous growths in the uterus. According to Dr. Whitmore, up to 80% of women will get them at some point in their lives. And while many fibroids don’t cause problems, some do prompt heavy bleeding, reducing the amount of blood in your body—“no wonder you can get so fatigued from that,” she says.

Low energy is also frequently reported among folks with polycystic ovary syndrome (PCOS)—a disorder that causes hormonal imbalances, irregular periods, and other symptoms like excessive hair growth and acne. While it’s unclear why PCOS can make you feel sluggish, research suggests the condition can disrupt your sleep, endocrine system, and psychological functioning…. Which could all contribute to diminished energy levels. PCOS may also cause you to skip periods, which can make the uterine lining thicken more than normal, Dr. Whitmore explains. Then, when you finally menstruate, it’ll be like a flood, which can up the fatigue, she says.

How to deal with relentless period fatigue

If you always feel zonked when your period comes around, it’s important to pay attention to the potential factors that could be making you feel so wiped out, Dr. Pal says. Because low energy could be a consequence of other symptoms you may be dealing with—such as pelvic pain, low mood, elevated body temp, or poor sleep—it can help to identify and address these issues first, she notes.

If you have heavy periods, Dr. Pal recommends checking in with your primary care provider who can order a blood test to see if your iron levels are low. If they are, your doctor may advise you to tweak your diet to include more foods that are rich in the essential mineral or start taking a supplement, which can boost iron stores and help improve fatigue in menstruating women.

If you experience brutal cramps or pelvic pain, consider treating them with nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, Dr. Pal suggests. Using a heating pad or taking a hot bath may also help temper period cramps that are keeping you up at night.

While there’s not much you can do about fluctuating hormones and the way they make you feel, you can be extra diligent about good sleep habits to at least improve your chances of getting quality shuteye. For example, Dr. Eblem recommends avoiding caffeine after 2 p.m. and doing your best to keep stress levels low—by trying a mindfulness exercise, perhaps, or another calming activity. It may also help to keep your bedroom on the cool side (experts recommend between 60–70 degrees for max comfort) since your core body temp rises leading up to your period.

A little movement can also go a long way. Exercise, like yoga, walking, swimming, and dancing, increases your heart rate and releases endorphins, which can lift your mood and make you feel more energized when PMS hits, according to Dr. Eblen. Of course, working out may be the last thing you want to do if you’re already feeling like crap—if that’s the case, try to do a different activity that brings you joy, suggests Dr. Whitmore. Maybe that’s pulling out some arts and crafts, listening to an audiobook in bed, or cooking a new recipe.

Finally, if you “feel crappy, just give yourself a break,” Dr. Eblen says—ya know, take it easy, truly rest for a couple of days, and let your body do its thing.

Here’s when to see a doctor about period fatigue

If you’re so tired during your period that it’s impacting your quality of life—maybe you can’t get out of bed or have to keep canceling plans—it’s important to talk to your primary care doctor or ob-gyn. As Dr. Whitmore says, “When in doubt, just go ask.” Clue your physician into when you experience this issue, what it feels like, and how it affects your day-to-day life. If you’re too depleted to function regularly, they may suggest treatment options like hormonal birth control, such as the pill or an IUD, to regulate your progesterone levels and minimize your fatigue (which Dr. Pal says can “really be life-changing” for some people).

Your doctor may also run tests to look for an underlying condition like PCOS, a thyroid abnormality, or endometriosis that may need to be treated or managed with, potentially, medications or surgery. Some folks, including those with bothersome PMS symptoms or PMDD, may feel less drained taking a serotonin reuptake inhibitor (SSRI), even with a short two-week monthly course, Dr. Eblen adds. Talk therapy with a certified mental health counselor can also be incredibly beneficial if you feel down and out when the flow comes, Dr. Whitmore adds.

Bottom line: You’ve likely been told forever that it’s normal to intensely suffer during your period—and I’m here to tell you that no, it is not. While a little bit of weariness for a couple of days isn’t a cause for concern, you shouldn’t feel the need to skip out on a week of life every month because your period has you feeling too gassed to get through the day.

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