Fatigue.(Women's Health Adviser)

Fatigue is a common health complaint; the challenge is in identifying the source. Fatigue comes from a combination of physical and emotional causes.

Fatigue is generally described as a lack of energy. This is not the same as sleepiness, although the desire to sleep may be part of fatigue. In addition, patients may complain of pain, headaches, weakness, feeling faint, heart palpitations, or shortness of breath.

Onset of symptoms may be either gradual or sudden. In most cases, a thorough physical exam and a history, with particular focus on psychosocial elements, combined with a series of routine blood and urine tests, will uncover the source of fatigue. For this approach, it is necessary to be up to date on all recommended preventive screenings.

In a study in a Salt Lake City clinic, which sees only patients complaining of fatigue, this process failed to identify an underlying medical or psychological illness causing fatigue in just 12% of 600 patients. Almost all of the rest had a final diagnosis of fibromyalgia and/or chronic fatigue syndrome (CFS).

Before embarking on a lengthy work-up, however, it's important to consider the possibility of coronary artery disease, even in women without coronary problems or chest pain. A recent study of 500 women who had heart attacks showed that about 70% reported unusual fatigue in the weeks preceding their event. Almost half reported having trouble sleeping in that period, and slightly more than one-third reported being unusually anxious. Chest pain was absent in 43% of these women (Circulation 108[21]:2619-23, 2003).

Once heart disease has been ruled out, a physical exam is necessary, with particular attention paid to the thyroid and lymph nodes. Specific lab tests are indicated: a complete blood count, thyroid stimulating hormone, CHEM-20 panel, urinalysis, erythrocyte sedimentation rate, and a fasting lipid panel (patients with metabolic syndrome or pre-diabetes often experience fatigue). A pregnancy test is indicated for women of childbearing age.

The history should address any abnormal symptoms (such as focal pain), sleep patterns, mood status, family and job stress, and exercise habits. Deconditioning can occur when fatigued women abandon their normal patterns of exercise and physical activity. This can lead to weight gain, which, in turn, can ...