People with PCOS may experience a wide range of symptoms, such as fatigue. Conditions that co-occur with PCOS can also cause fatigue, such as sleep disorders and mental health issues.

Polycystic ovarian syndrome (PCOS) is a common hormonal disorder that affects around 10% of people with female reproductive anatomy. Fatigue typically refers to exhaustion associated with a health condition.

PCOS is not a direct cause of fatigue. However, many symptoms and conditions commonly associated with PCOS have links to fatigue.

This article explores the links between common PCOS symptoms and fatigue, conditions associated with PCOS that can cause fatigue, and possible treatment options.

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The PCOS Awareness Association (PCOSAA) notes that one of the leading symptoms reported by people with PCOS is fatigue.

Similarly, the Royal College of Obstetricians and Gynaecologists notes that PCOS can lead to fatigue, daytime sleepiness, and snoring.

Physical causes

There are various physical causes of fatigue associated with PCOS. These include obesity, hormonal imbalance, and heavy periods.


Many experts believe that weight gain and obesity contribute to the development of PCOS and then exacerbate symptoms of the condition. Some experts estimate that over 70% of people with PCOS also have obesity.

There is a significant relationship between obesity and fatigue. Research indicates that obesity increases fatigue, sleep disturbances, and daytime sleepiness.

People with PCOS are more likely to experience obesity, which may make them more likely to experience obesity-related fatigue.

Hormonal imbalance

PCOS is an endocrine disorder. This means it causes hormonal issues throughout the body. The PCOSAA notes that hormonal imbalances from PCOS can cause lethargy and sluggishness.

Heavy periods

The United Kingdom’s National Health Service (NHS) notes that 75% of people with PCOS will experience period problems, including heavy, abnormal bleeding.

A 2019 study found that heavy menstrual bleeding negatively affects fatigue and overall quality of life.

Additionally, a 2021 study found that people who experience heavy periods are more likely to develop anemia. A common symptom of anemia is fatigue.

Psychological causes

There are significant links between PCOS and depression and anxiety. One of the major symptoms of both depression and anxiety is fatigue.

One 2019 study reported that 61.8% of participants with PCOS also had depression. Researchers suggest that symptoms of PCOS, such as acne, excess hair growth, and infertility, can lead to severe depression.

Additionally, people with PCOS and a body mass index (BMI) over 30 have significantly higher rates of depression than people who have PCOS and a BMI in the recommended range.

A 2018 study found that people with PCOS reported notably higher rates of depression, anxiety, and stress than those without the condition.

These findings suggest that people with PCOS may be more likely to develop depression and anxiety, which may increase the risk that they will also experience fatigue related to these conditions.

There is a close link between sleep and fatigue. For example, long-term sleep deprivation may lead to fatigue. Sleeping too much may also cause fatigue.

People with PCOS may be more likely to experience sleep-related issues, which may increase the likelihood of developing fatigue.

A 2022 meta-analysis of research into PCOS and sleep disturbances suggests that people with the condition may experience more sleep disturbances, lower overall sleep quality, and more general sleepiness than those without PCOS.

A 2018 review of research reported that difficulty falling asleep and maintaining sleep were twice as common in people with PCOS. The review also notes that over a 10-year period, people with PCOS were 50% more likely to develop a sleep disorder.

A 2020 meta-analysis of research into PCOS and obstructive sleep apnea (OSA) found that 35% of people with PCOS had OSA. OSA can significantly affect sleep quality.

Additionally, the data suggests OSA may contribute to insulin resistance, in which the body can create insulin but cannot use it effectively.

Various conditions often co-occur with PCOS. Many of these conditions can also cause fatigue.

Type 2 diabetes

There is a significant link between PCOS and type 2 diabetes. More than 50% of people with PCOS will develop type 2 diabetes by age 40, according to the Centers for Disease Control and Prevention (CDC).

Insulin resistance, a common PCOS symptom, increases the risk of type 2 diabetes. Fatigue is a common symptom of prediabetes and diabetes.

Subclinical hypothyroidism

Subclinical hypothyroidism is an underactive thyroid that does not meet the criteria for a hypothyroidism diagnosis.

A 2021 study found that people with PCOS had a significantly higher rate of subclinical hypothyroidism. Many researchers report that PCOS exacerbates the development of subclinical hypothyroidism.

Thyroid autoimmunity also occurs more in people with PCOS than in the general population. Evidence shows that PCOS may link to an increased risk of thyroid diseases, such as nodular goiter and autoimmune thyroiditis.

Fatigue is one of the most common symptoms of hypothyroidism, goiter, and thyroiditis.

Heart disease

People with PCOS are 19% more likely to develop heart disease. A 2020 meta-analysis of studies on PCOS and heart disease also found that people with PCOS have an increased risk of heart attack and ischemic heart disease.

Fatigue is a common symptom of both heart disease and heart attack.

The most effective way to treat fatigue is to address the underlying cause of it with a healthcare professional.

A number of treatment options are available to help alleviate symptoms of PCOS, which may help ease a person’s fatigue.

Examples of medications a doctor might prescribe include:

  • Metformin: Doctors prescribe this drug to help treat insulin resistance and prevent diabetes. At higher doses, metformin can also help with weight loss, which could help reduce obesity-related fatigue.
  • Inositol: This is an insulin sensitizer, which means it affects the way the body responds to insulin. Research suggests inositol may help regulate hormone levels and reduce menstrual cycle length.
  • Statins: These prevent the production of cholesterol in the body. They can help treat PCOS by decreasing a person’s risk of heart disease.
  • Oral contraceptives: These medications can help treat hormone imbalances associated with PCOS. They can also help reduce the occurrence of heavy, unpredictable periods.

Examples of lifestyle strategies that may help ease PCOS symptoms include:

  • Regular exercise: Research suggests vigorous aerobic exercise for 120 minutes per week can improve insulin resistance and heart health. Examples include running, swimming laps, and fast cycling.
  • Diet: A diet high in protein may help balance hormones, improve insulin resistance, and reduce appetite. Eating fewer carbohydrates may reduce the risk of type 2 diabetes, heart disease, and insulin sensitivity. Some researchers found the DASH diet to be the most effective at reducing insulin resistance.
  • Mental health care: Depression and anxiety commonly occur alongside PCOS. A major symptom of both mental health conditions is fatigue. A person may wish to try mindfulness-based stress reduction, which research suggests may help with glucose levels and stress in people who have overweight or obesity.
  • Weight management: Research indicates that people who have overweight or obesity may experience a significant reduction in PCOS symptoms after losing around 5% of their total body weight.

It is important to talk with a healthcare professional before significantly changing any lifestyle habits.

PCOS does not cause fatigue directly. However, many common symptoms of PCOS can lead to fatigue. Conditions closely associated with PCOS can also cause fatigue.

A person who is experiencing unmanageable fatigue or who thinks they may have PCOS may wish to speak with a healthcare professional.