Why You Are So Tired All the Time: The Real Reasons Women Struggle With Fatigue
- Dr. Jessica
- Nov 26
- 6 min read
If you wake up tired, move through the day tired, crash in the afternoon, then lie awake at night wired but exhausted, you are not alone. And you are not imagining it.
Fatigue is one of the most common symptoms women bring to my practice. And most of them have already been told their blood work is “normal” even though they still feel awful.
The truth is simple.
Fatigue is not random.
It is a message.
Your body is asking for help long before it breaks.
And real answers come from looking in the right places.
Below, you’ll learn the most common reasons women feel chronically tired, the lab tests that finally reveal what is going on, and what steps help you get your energy back.
1. Fatigue Is Not a Willpower Problem
Most women blame themselves for feeling tired.
You push through.
You drink more coffee.
You try to eat “better.”
You force yourself to be motivated.
But you still feel wiped out.
Fatigue is not a character flaw. It is physiology. When your thyroid, iron stores, blood sugar, or nutrients are off, no amount of discipline fixes that.
This is why testing matters. The standard screening panel misses the deeper reasons women lose their energy.
Let’s break down the most overlooked causes.
2. Iron and B12: Common Missing Puzzle Pieces
If you’re exhausted, cold, losing hair, short of breath, or dealing with heavy periods, iron deficiency is one of the first things to investigate.
Ferritin: Your Iron Storage Tank: below 50 is strongly linked to fatigue, and ferritin below 30 is full-blown deficiency. Optimal energy often lives at 80 or higher.
Many women are told their ferritin is “normal” when it’s in the 10–30 range. Technically normal but can cause symptoms in real life.
Inflammation can also make ferritin look falsely normal. This is why a full iron panel is recommended: ferritin, iron, and transferrin saturation and inflammatory markers: ESR, hsCRP.
Vitamin B12: Your Brain’s Energy Vitamin: low B12 is another common cause of fatigue and brain fog. Women often feel best with B12 above 600 pmol/L, even though the “normal” range dips much lower.
Symptoms of low B12 often include:
Tingling in hands or feet
Anxiety
Low mood
Memory issues
Ringing in ears
If you’re plant-based, have digestive issues, or take heartburn medication, you’re at higher risk.
3. Low Vitamin D: The Fatigue Pattern Almost Every Woman Has
Vitamin D affects immune function, muscle strength, hormones, mood, and energy. In northern climates, it is almost always too low.
Women need levels between 125 and 150 nmol/L for optimal energy.
If you’re sick often, feel low in the winter, or have muscle weakness or bone pain, testing Vitamin D is essential.
4. Thyroid Problems Even When TSH Is “Normal”
This is one of the biggest reasons women feel dismissed.
You feel tired.
Your weight won’t budge.
You’re cold all the time.
Your cycles are changing.
Your hair is thinning.
But your doctor runs TSH alone, and it comes back “fine.”
TSH on its own is not enough. You need:
TSH
Free T4
Free T3
Thyroid antibodies (TPO and TG)
Why this matters
Free T3 is your active thyroid hormone. Women with normal TSH and T4 can still be low in T3 and this pattern causes real symptoms.
Hashimoto’s, the most common cause of hypothyroidism, is also often missed. Many women walk around for years with elevated antibodies (TPO or TG) without knowing their immune system is attacking their thyroid.
If you have:
Fatigue
Weight loss resistance
Brain fog
Hair loss
Feeling cold
Mood changes
A full thyroid panel is essential.
5. Blood Sugar Imbalances: The Hidden Fatigue Loop
Even if you eat “pretty healthy,” blood sugar swings can drain your energy.
The early signs of insulin resistance include:
Crashing after meals
Sugar cravings
Belly weight gain
Evening energy surges
Irritability
Brain fog
Fasting Glucose: optimal: 3.6–5.5 mmol/L
Fasting Insulin: optimal: below 40 pmol/L
HbA1c: optimal: Below 5.5 percent
Women can have normal glucose and still have insulin resistance. This is why fasting insulin is essential and often missing from standard labs.
When insulin is high, your body feels like it is in storage mode, not energy-burning mode. You feel sluggish and hungry, especially late in the day.
6. Inflammation and Liver Markers That Steal Your Energy
Low-grade inflammation is a huge, overlooked cause of fatigue. You may not notice pain or swelling.
You just feel tired, heavy, and foggy.
hs-CRP: Optimal: Below 1.0 mg/L
Levels above 3.0 indicate systemic inflammation.
ALT (Liver Enzyme): Optimal: Below 25 U/L
when ALT is elevated, it can signal early metabolic stress, fatty liver, or toxin overload — all of which affect energy.
The liver plays a major role in hormone detoxification and blood sugar regulation. When it is stressed, you feel it in your energy.
7. Why Women in Their 30s, 40s, and 50s Feel This More Intensely
Women experience several layers of stress on the body:
Changing hormones
Busy lifestyles
Sleep disruptions
Nutrient depletion from pregnancies
More responsibility
Overloaded schedules
Chronic stress chemistry
Add in iron loss from heavy periods or perimenopause, and you have a perfect storm.
This is why many women feel like they “hit a wall” between 35 and 50.
Your body has been compensating for years. Fatigue is the point when compensation stops working.
8. The Lab Tests That Actually Give You Answers
Top fatigue-revealing labs:
Nutrient deficiencies
Ferritin + Full iron panel
Vitamin B12
Vitamin D
Thyroid function
TSH
Free T4
Free T3
TPO antibodies
TG antibodies
Blood sugar and metabolism
Fasting glucose
Fasting insulin
HbA1c
ALT
hs-CRP
When you test these, you get a clear picture of:
How you make energy
How you use energy
Whether you’re inflamed
Whether your thyroid is under stress
Whether your nutrient stores are low
Whether your metabolism is slowing
This is the roadmap women rarely receive.
Cortisol and Burnout: The Stress Pattern Behind Hidden Fatigue
Cortisol is your built-in energy and stress hormone. It should rise in the morning, taper through the day, and drop at night. When life gets busy or stressful for too long, that rhythm shifts. And when it shifts, your energy does too.
Women with cortisol imbalance often feel:
Tired in the morning
Wired at night
Afternoon crashes
Trouble staying asleep
Anxiety that comes out of nowhere
Cravings for sugar or salt
This is the early burnout pattern. Your body is working hard to keep you going, not energized.
Over time, cortisol can become too high, too low, or flipped. All three impact thyroid function, blood sugar, inflammation, and hormones. That is why women with chronic fatigue often say they feel “tired but wired” or exhausted no matter how much they rest.
We can test your morning cortisol levels and are looking to see that your levels are on the top end of the range. When the stress response is supported, through blood sugar balance, morning light, protein at breakfast, and slowing your evenings, energy improves faster and more predictably.
10. What You Can Do Today to Start Feeling Better
1. Get the right labs done
Bring this list to your appointment. Many are not included in routine screening.
2. Aim for optimal, not just normal
Normal ranges represent the average population, not the healthiest population.
3. Support your blood sugar
Eat protein at breakfast. Build meals with protein, fibre, and colour.
4. Prioritize iron-rich foods
Include lentils, red meat, spinach, pumpkin seeds.
5. Replenish Vitamin D
Especially from October to April.
6. Slow your mornings
A rushed cortisol spike worsens fatigue patterns.
7. Get support
You do not need to decode your labs alone. Fatigue improves faster with personalized guidance.
The Bottom Line
You are not tired because you are doing life wrong. You are tired because your body is asking for help. Fatigue has causes. And once you understand those causes, you can finally treat them.
Most women feel better when they:
Restore nutrients
Balance blood sugar
Support thyroid conversion
Lower inflammation
Calm their stress chemistry
Your energy is not gone. It is waiting for the right conditions to return.
If this speaks to you, you deserve a deeper look at your health. Your symptoms matter. Your story matters. And you can feel like yourself again.
My Invitation To You
If this feels familiar and you’re ready for support, I offer personalized naturopathic care for women who want answers, not guessing.
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