Fatigue

Fatigue is tiredness that does not lift with rest, in the body, the mind or both. The NHS website says it is normal to feel tired sometimes, but being tired all the time without knowing why can be a sign of a problem.

The Pakistan Menopause Society lists fatigue among the early symptoms of perimenopause, which can start while your periods are still coming. Its recommendations ask doctors to look at how symptoms affect your daily life, and they name prayer alongside sleep, work and relationships.

Legs like lead on the stairs to the roof. Sitting down halfway through the chores and not getting back up. Cancelling a visit you were looking forward to because you cannot face the drive.

The NHS website says memory and mood problems may feel worse when you are very tired, so fatigue often comes with brain fog and a shorter temper.

In Urdu, thakawat. On the worst days, nidhaal.

The NHS website lists hormonal changes such as the menopause among the common causes of fatigue, along with poor sleep, stress, depression, an unhealthy diet and too little exercise.

Sleep is often the link. Night sweats and broken nights add up, and the British Menopause Society lists daytime fatigue among the effects of sleep problems around the menopause. Sleep disruption has more.

Fatigue is worth checking, because so much else can cause it. The NHS website lists sleep apnoea, iron deficiency anaemia, diabetes, an overactive thyroid and chronic fatigue syndrome. Its anaemia page names heavy periods as a very common cause, and its menopause pages say bleeding can get heavier in perimenopause, so heavy periods and fatigue may be connected. And the British Menopause Society notes that South Asian women have a higher rate of heart risk factors during the menopause transition, insulin resistance and diabetes among them. Diabetes risk has more.

• The NHS website suggests a healthy diet and regular exercise, keeping to the same sleep times, winding down before bed, and a sleeping area that is not too bright, noisy or warm. It suggests not smoking, not drinking too much alcohol, and avoiding food, caffeine, exercise and screens close to bedtime.
• On chai, the NHS iron deficiency anaemia page says large amounts of tea and coffee can make it harder for your body to absorb iron. Chai and caffeine has more.
• The Pakistan Menopause Society says regular physical activity has evidence behind it for mood, sleep and stress (section 4.2.2).

The NHS website says treatment for fatigue depends on the cause. It lists talking therapies such as CBT, advice on sleep, and advice on relaxing or changing your lifestyle, and says a GP may arrange blood tests to check for anaemia, diabetes or an overactive thyroid, or refer you to a specialist.

When fatigue comes with hot flushes and broken sleep, the PMS recommendations say MHT, their word for HRT, may improve mood, sleep and quality of life (section 7.2). Whether that applies to you is your doctor's call, once other causes have been looked at.

The NHS website says to see a GP if you have been tired for a few weeks and are not sure why, if tiredness is affecting your daily life, or if it comes with other symptoms such as weight loss or mood changes. It adds being told you make gasping, snorting or choking noises in your sleep to that list.

Mention it too if your periods have become heavier, if you are very thirsty and passing urine more often than usual, or if you get short of breath or notice your heartbeat. The NHS links those to anaemia and diabetes.

Fatigue on a fasting day hits hard, and a broken night before suhoor makes it worse. Questions about the fast belong with a qualified scholar. Questions about medicine timing in Ramadan belong with whoever prescribes it. Ramadan and fasting has more.

At home, tiredness is easy to wave away as laziness, by others and by you. It is a symptom, and asking for help with the load is not giving up.