Investigating
Fatigue in Women
A Pathological Perspective
By Associate Professor Chris Barnes
Published September 2024
Fatigue has been recognised in medical practice for centuries. Initially regarded as a vague symptom often attributed to “neurasthenia”,1 it was historically considered a minor complaint influenced by societal norms. Consequently, fatigue was frequently dismissed and underestimated. Unexplained fatigue is the most common unexplained complaint presenting in general practice and is acknowledged as a symptom indicative of various psychological and physical conditions, from depression to chronic fatigue syndrome and thyroid disorders.2
Despite its prevalence, reported more commonly in women due to factors like menstrual cycles, pregnancy, and iron deficiency anaemia, fatigue often suffers from a lack of serious consideration in both the community and healthcare settings. This is compounded by a gender bias that sometimes leads to women’s symptoms being taken less seriously, potentially delaying crucial diagnosis and treatment.
This introduction sets the stage for a discussion on the modern investigation of fatigue in women, highlighting the need for greater recognition and a systematic approach in medical diagnostics to improve outcomes for those affected.
Diagnostic approach to fatigue in women:
Thyroid function tests
Thyroid dysfunction, particularly hypothyroidism and less commonly hyperthyroidism, can significantly impact energy levels. These conditions can lead to fatigue when the thyroid gland either produces too little or too much thyroid hormone. Testing TSH and free T4 helps to diagnose these conditions, which are manageable through hormonal therapies.
Glucose levels
Fatigue can be a symptom of both diabetes and pre-diabetes, where the body struggles with insulin regulation leading to abnormal glucose levels. Early detection through fasting glucose tests or HbA1c measurements can guide interventions that may alleviate fatigue and manage the underlying metabolic dysfunction.
Full Blood Examination (FBE)
This test can detect a variety of conditions that may cause fatigue. Iron-deficiency anaemia is a common finding, particularly where there is chronic blood loss such as in heavy menstrual periods or gastrointestinal bleeding. FBE can also identify other forms of anaemia caused by vitamin deficiencies or chronic diseases, and less commonly, haematologic malignancies.
Iron studies
Besides iron-deficiency anaemia, iron overload disorders like haemochromatosis can also cause fatigue. This test measures ferritin and transferrin saturation, which can guide appropriate treatment strategies, such as dietary adjustments, iron supplementation, or investigation forcauses of increased iron stores.
Vitamin B12 and folate levels
Deficiency in either of these vitamins can lead to megaloblastic anaemia, characterised by the production of abnormally large red blood cells that are inefficient at oxygen transport, resulting in fatigue. Causes include poor dietary intake, malabsorption conditions like coeliac disease, or intrinsic factor deficiency leading to pernicious anaemia.
Vitamin D levels
Deficiency in vitamin D is linked not only to musculoskeletal pain and weakness but also to chronic fatigue. This nutrient is pivotal for bone health and immune function, and deficiency can be due to inadequate sunlight exposure, poor dietary intake, or malabsorption disorders.
If you enjoyed this article, subscribe to our electronic Pathology Focus newsletter.
How to Order the 'Fatigue in Women' Test Profile with Clinical Labs
For clinicians using eOrders in Best Practice, MedicalDirector Clinical, or Clinical Labs eResults, we have developed a ‘Fatigue in Women’ test profile that follows the clinical recommendations provided by A/Prof Barnes in this article.
Ensure you have eOrders with Clinical Labs activated in your practice management software.
Navigate to ‘Clinical Recommendations’ (MD) or ‘Clinical Details’ (BP).
Choose our pre-configured ‘Fatigue in Women’ test profile that can be ordered with the click of a button.
B12
Folate - Serum
Full Blood Examination
Glucose - Serum (BSL)
Iron Studies
Thyroid Functions Tests
Vitamin D (25 Hydroxy)
For vitamin D testing, note the reason the patient meets the eligibility criteria for bulk-billing in the ‘Clinical Notes’ section when ordering.
Bulk-billed, subject to Medicare eligibility criteria.
Fatigue in Women Doctor Brochure
Fatigue in Women Patient Brochure
References
-
Beard, G., Neurasthenia, or nervous exhaustion. The Boston Medical and Surgical Journal, 1869. 80(13): p. 217-221.
-
Koch, H., et al., Demographic characteristics and quality of life of patients with unexplained complaints: a descriptive study in general practice. Quality of Life Research, 2007. 16: p. 1483-1489.
About the Author
Associate Professor Chris Barnes
MBBS FRACP FRCPAAssociate Professor Chris Barnes
MBBS FRACP FRCPA- non–malignant haematological conditions including…
- paediatric haematology
Associate Professor Chris Barnes joined Clinical Labs in 2016 and is the National Director of Clinical Pathology. Prior to this, he worked as a consultant haematopathologist with Healthscope Pathology from 2009. Chris is a dual-trained clinical and laboratory haematologist, having trained at the Royal Children’s Hospital and the Royal Melbourne Hospital. He also undertook training at The Hospital for Sick Children in Toronto, Canada. He holds a part-time public hospital appointment at the Royal Children’s Hospital, where he serves as the Director of the Henry Ekert Haemophilia Treatment Centre. Chris has extensive clinical research interests and is the principal investigator on eight separate clinical trials based at the Murdoch Children’s Research Institute. He has held numerous leadership positions, including Chair of the Medical Staff Association at the Royal Children’s Hospital and Chair of the Australian Haemophilia Directors Association. He is currently the Chair of the Australian Bleeding Disorders Registry with the National Blood Authority and a Director of Melbourne Haematology and Melbourne Paediatric Specialists. Chris’ focus within Clinical Labs is the national supervision and management of clinical pathology disciplines, including haematology, biochemistry, microbiology and immunopathology.
Related Pages
Iron Deficiency in Women
Associate Professor Chris Barnes discusses the prevalence of iron deficiency in women, its symptoms, diagnostic strategies and effective treatment options.
Thyroid Function Test Interpretation
Dr Phoebe Stanford explains how to interpret thyroid function tests accurately, addressing common pitfalls and interferences to improve diagnostic confidence.
eRequests
eRequests streamlines pathology request workflows by enabling Clinical Labs referrers to easily send patients an electronic copy of their referral via SMS.