Why Does Your Period Make You Tired and What You Can Do About It

Women's experiences about the days leading to menstruation and during the periods are different. Fatigue or loss of energy is one of the symptoms one may experience during this time. Is it normal? Should you worry if you are unusually tired during the days close to your periods? This article covers the reasons for such symptoms and how you can handle them.

Why am I so tired during my period?

It is common to see online information addressing fatigue or loss of energy appearing in the days before menstruation and improving within a few days after menstruation as 'period fatigue' or 'menstrual fatigue.' However, it is important to know that these terms are not clinically specified disease names. Instead, fatigue associated with menstruation is considered a part of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD).

In PMS, women experience a range of symptoms in the days or weeks before menstruation, which get better with the onset of menses for most of the months over the past year. On average, 47.8% of women are diagnosed with PMS. In about 1.6% of cases, symptoms are more severe, affecting one's daily life, ability to perform daily tasks, and personal relationships. This condition is known as premenstrual dysphoric disorder (PMDD), and women diagnosed with PMDD have a history of having at least five of these symptoms for most of the cycles during the past year.

Symptoms observed in PMS and PMDD, in addition to easy fatigability or significant lack of energy, are:

  • Depressed mood and hopelessness
  • Anger, irritability or anxiety, tension
  • Sudden feelings of crying or sensitivity to being rejected by others
  • Difficulties in concentration or reduced interest in daily activities
  • Appetite changes and food cravings
  • Increased or decreased sleep
  • Headaches, joint or muscle aches
  • Feeling bloated
  • Weight gain

As a part of these syndromes, it is possible to feel tired and exhausted to the extent that may affect your daily routine. Studies show that 71% to 73% of women feel tired during menstruation.

Reasons for feeling tired with an upcoming period

Sometimes, it might concern you if you can't explain these 'on and off' fatigued days. If these symptoms follow a cyclic appearance and worsen right before the menstruation and disappear with the start of periods, it might be comforting to know that cyclic monthly changes might be the reason behind them.

Hormones and neurotransmitters

As PMS symptoms, including feeling overwhelmingly tired, occur in very close association with menstrual cycle changes, it is logical to think that reproductive hormones might be the reason for experiencing fatigue. For a long time, it was believed that changes in estrogen and progesterone levels toward the end of the menstrual cycle cause these symptoms. However, research shows that the levels of these hormones are not different in women experiencing PMS symptoms. Instead, the body's sensitivity to respond to hormone changes is increased.

Serotonin, also known as a 'happiness hormone,' although it is not a hormone per se, has mood, sleep, and appetite-improving effects. The levels of serotonin and the response to the neurotransmitter are altered in women with PMS symptoms. Given the role of serotonin, healthcare providers consider antidepressants that increase the available amount of serotonin in the management of severe PMS cases.

Sleep disturbances

An uninterrupted night's sleep is important for maintaining healthy bodily functions. Sleep disturbances are also associated with the menstrual cycle. A meta-analysis shows that difficulty in falling asleep, poor sleep quality, short sleep duration, and daytime sleepiness are associated with PMS symptoms, including feeling tired and easily exhausted. It was also shown that a night's sleep of less than 5 hours poorly affects premenstrual symptoms.

Health issues

Anemia is a condition with low red blood cells, which carry oxygen to organs. Various conditions, including iron and vitamin B12 deficiency, may lead to reduced red blood cell production. Additional blood loss during menstruation aggravates the symptoms of anemia. Eventually, organs, including muscles, will get tired easily, even with minimal effort, if a woman has low blood hemoglobin levels.

The effect of low magnesium levels in the blood was widely researched in women with PMS symptoms, including fatigue and tiredness. A meta-analysis concluded that magnesium level does not have a significant role in the development of symptoms.

Heavy bleeding

Heavy menstrual bleeding is a condition in which the flow of menstrual bleeding requires hourly tampon or pad change for consecutive hours, requires a change of the pad/tampon during the night, and lasts for more than seven days. If you need to wear multiple pads at once or if you notice blood clots the size of a quarter, that's also considered a symptom of heavy menstrual bleeding.

Normally, the body compensates for the lost blood during the period, and generally, no additional symptoms are felt. However, women experiencing heavy menstrual cycles for a prolonged time, especially if they have untreated anemia, will develop symptoms of exhaustion and lack of energy, even with minimal physical activity.

Emotional stress

The menstrual cycle is very sensitive to various emotional stress factors. It is possible that women may miss their periods, experience irregularities during the exam session, or travel to a different climate. Studies also show a significant impact of stress on the development of PMS symptoms.

For example, a Spanish study shows that women who report experiencing medium to high levels of stress develop PMS and PMDD 2.5 times more. Additionally, cyclic hormonal changes also affect the sensitivity to stress, further complicating the association between emotional stress and PMS symptoms. An electroencephalogram analysis shows that regardless of the menstrual cycle phases, women with PMS display abnormal emotional stress and stress reactivity.

How to deal with fatigue before and during periods

Given that there is no one specific reason for the loss of energy and feeling overwhelmingly tired in the days leading to menstruation, you may consider adjusting different lifestyle aspects.

Rest and sleep

The severity of symptoms may vary from woman to woman. Studies show that women adapt one of the coping mechanisms to alleviate their symptoms. Taking rest or sleeping are among the most commonly used strategies. As sleep disturbances are linked to PMS symptoms, it is important to allow yourself to get 7–8 hours of night sleep. Also, other relaxing methods, such as hot showers, warm beverages, and slowed-down daily routines, should be considered if you are experiencing fatigue on the days when you are expecting your menstruation.

Supplements

Zinc is known for its anti-inflammatory and anti-depressant effects. A study testing 30 mg zinc supplementation for three months found improvement in some PMS symptoms. However, fatigue was not among the analyzed symptoms, making it difficult to conclude its beneficial effect on fatigue symptoms associated with menstruation. Another study showed the beneficial effects of 50 mg zinc-containing capsules in the second half of the menstrual cycle on fatigue symptoms.

Several studies also evaluated calcium and vitamin D supplementation. Although there is no definitive consensus that they may prevent PMS development, several studies reported a reduction in symptoms. For example, twice a day, 500 mg of calcium carbonate supplementation for three months significantly reduced tiredness symptoms.

Although magnesium alone or in combination with vitamin B6 is investigated in PMS-related symptoms, the information on its beneficial effect on tiredness symptoms is scarce.

Diagnosis of iron deficiency anemia is also helpful in managing fatigue symptoms in women, especially those experiencing heavy menstrual bleeding.

Exercise

Exercise is well-known for elevating beta-endorphin levels. Due to their activity on opioid receptors, endorphins are commonly called 'endogenous opioids,' meaning 'morphine-like substance made in the body.' Endorphins are helpful in reducing pain and stress and improving mood and memory. Because of these effects, moderate exercise is recommended in a daily routine.

Swimming was shown to be an effective method of reducing PMS-related fatigue symptoms by 65%. Another study shows that aerobic exercise and yoga movements performed three times per week for one month significantly improve PMS-related symptoms. Also, the same study finds that with yoga movements, women get better results compared to aerobic exercise. Another study presents the beneficial effects of yoga and progressive muscle relaxation on PMS-associated stress and depression.

Balanced diet

The content of daily food consumed may also impact the occurrence of symptoms. Therefore, a well-balanced diet, rich in healthy fats and fibers, is recommended as part of a routine lifestyle.

Foods that can worsen PMS symptoms

  • Fast food
  • Fried foods
  • Carbonated drinks
  • Excess sugar
  • Coffee
  • Alcohol
  • Processed meat

Foods that can help relieve PMS symptoms

  • Eggs
  • Red meat
  • Vegetables
  • Fresh and dried fruits
  • Spices
  • Nuts

Treatment options and alternative therapies

Cognitive behavioral therapy (CBT) could be recommended for the management of premenstrual symptoms that impact mood and behavior. In some more severe cases, antidepressants or combined oral contraceptives may be prescribed.

Laughter yoga combines laughter exercises with breathing techniques. A small Turkish study found that a 30-minute laughter yoga session twice a week may potentially improve fatigue and other PMS-related symptoms. In another study, the emotional freedom technique (EFT) or 'tapping' to the acupressure points was applied to women experiencing PMS symptoms. EFT-applied women showed a 28% reduction in fatigue symptoms.

Generally, the symptoms associated with reduced energy and tiredness should be self-limiting, and with general coping methods, you may resume your daily routine. However, if the symptoms are severe, frequent, and long enough to affect your professional and personal life, it is recommended to seek a professional assessment.

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