I can't work out if my excessive tiredness is down to a physical or mental issues?

[Rainbowpeppercorn]

I have felt so weak and tired for so many years (decades).

I have suffered from gynae issues and very low iron for years and years. In 2022 I discovered that my ferritin levels had fallen to below 3. I knew I was anaemic as my GP had run blood tests and advised iron supplements, which I struggled with as I also have IBS. However, I had no idea they had allowed me to struggle with iron stores that low for so long. In the end my gynaecologist sent me for iron infusions and I had a uterine ablation to stop the heavy periods. Two years later, at the age of 50 I found that I have endometriosis and adenomyosis. I tried HRT but it made all of my gyane issues worse so have been advised by my endo gynae not to take it. I am on a long waiting list for a hysterectomy so may be able to have oestrogen once I am through that.

At 52 I am still as tired as ever. My GP ran a full panel of blood tests last summer and all (including B12, folate, iron, thyroid, vitamin d etc) came back within normal ranges so no action needed.

I am also under a lot of stress as I care for my mum who suffers from dementia. I am stressed and anxious most days and I know that in itself can be draining but it often feels more than that but I just do not know what exactly.

But I really don't know what else I can do to feel more revitalised and energetic. I walk the dog over fields every day, do weights a few times a week, yoga stretches every day. I only drink water, I follow a healthy diet with lots of iron and b12 rich foods. I don't eat dairy, wheat/gluten, low sugar, no alcohol or caffeine. I am slim and try my best to look after myself but that is so hard when you are permanently exhausted.

I listen to the Calm app and do guided meditation every day, I go to bed around 10pm and get up around 7am. I sleep quite well (although I dream very heavily so always wake feeling knackered).

I came down with the flu 3 weeks ago and my exhaustion is worse than it has ever been. I just want to sleep all day long.

What can I do or take to feel more alive?

Are you tired or are you actively falling asleep? If the latter you should push for a referral to a sleep clinic. Blood tests do not screen for these problems and GPs have very little training on them. Keep a diary of all sleep and naps for 2 weeks first.

I know it sounds odd but have you tried doing less rather than more? Have a few days where you do no exercise and take it easy and see how you feel?

This is sound fatigue management advice.

I had a few sessions of this on the NHS and evidence based recommendation seems to be reduce activity to a level you can manage consistently - stop boom and busting - and then build in multiple "rests" a day, like your mindfulness session but 4+ times a day whether you need them or not.

Might you be burned out with caring for your mum? Do you need to get more support in place for that?

Stress can have a huge impact on the body. It can also lead to chronic fatigue. I would echo the advice to slow down and rest more.

If there is any way to get some more support with your caring role then that would be a good idea.

Can you do a few shorter dog walks or have more rest days? Yoga is fine.

Thank you everyone. I do think that it's a combination of stress and very low mood. I will, somehow, need to find a way to work on that.