person in bed with pillow over their face

Endometriosis and fatigue

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by

Heather Anderson, RD

How common is fatigue in endometriosis?

While there are many symptoms associated with endometriosis, we don’t always think about fatigue being one of them.

In fact, 49-53% of women with self-reported endometriosis in a 2021 Canadian study reported fatigue, versus 37% of women without endometriosis [1].

  • fatigue reports were highest in women aged 35-39 years of age
  • the overall severity of endometriosis was positively associated with fatigue scores (meaning that the worse the symptoms of endometriosis were, the worse the fatigue was as well)

In a 2018 European study, 50.7% of women with endometriosis experienced fatigue versus 22.4% in those without endometriosis [2].

First rule out other causes

Even though fatigue is common in people with endometriosis, there may be other causes. I always advise my patients discuss any symptoms with their doctor and make sure other factors are addressed or ruled out.

Questions to consider:

  • When did the fatigue start?
  • Has it gotten worse over time?
  • Is there anything that seems to make it better, or worse?
  • Have you noticed any other symptoms?
  • Do you think fatigue could be impacted by stress? poor sleep? medications?
  • Do you have any other health conditions that could be contributing?

It’s also a good idea to let your doctor know how much the fatigue is impacting your quality of life. Is it preventing you from work or activities?

Can nutrition help?

It may or may not be possible to resolve fatigue with nutrition alone. Here are some of the areas we can look at.

Fatigue related to iron deficiency

Iron deficiency is more common in people with endometriosis [3]. Symptoms of iron deficiency include [4]:

  • physical fatigue
  • cold hands/feet
  • pale skin
  • brittle nails
  • hair loss
  • reduced concentration and memory
  • headaches
  • shortness of breath

Treatment for iron deficiency can include infusions, supplementation, and nutrition intake. We can work to raise iron levels with an appropriate supplement and a diet that contains the right amount of iron for you.

Other nutrition considerations

Nutrient deficiencies

It’s possible for anyone with or without endometriosis to have underlying nutrient deficiencies that could impact energy levels. While research is definitely lacking in this area, some studies suggest that individuals with endometriosis may have lower dietary intake or serum levels of certain vitamins and minerals, including iron (already discussed above), magnesium, vitamins C, D, and E, some B vitamins, zinc, and selenium [5-7].

Of these, magnesium, zinc, iron, vitamin C, and B vitamins specifically play a role in energy metabolism [8].

Since research isn’t yet great in this area, I always suggest a tailored approach for your overall health and to monitor for improvements. A review of your diet is reasonable, since this would help us to ensure you are meeting dietary reference intakes and may help to rule out deficiencies as a source of your fatigue. If a diet review shows intake of any vitamins or minerals are lacking, we can find foods that you enjoy to fill the gaps or supplement where appropriate. Lab testing can help us to determine if there are any deficiencies that we should target – however, it’s important to know that we can’t easily or reliably test for many nutrients, which is why we often rely on symptoms and dietary review.

Energy intake

Many individuals with chronic conditions find it difficult to eat a consistent and nutritious diet. If your symptoms impact your appetite or ability to cook, getting enough energy from food can be a challenge.

Finding strategies to get regular meals and snacks into your day, with a variety of foods from all of the foods groups can go a long way to ensuring you are not only getting enough energy but also enough protein, vitamins, minerals, and antioxidants to support your health.

Are there any supplements I should try?

This is always a hot topic! There are so many different options available for supplements, including vitamins and minerals, macronutrients (e.g. protein or omega-3 fat), herbal and botanicals, and antioxidant compounds.

Vitamins and minerals

Sometimes vitamin or mineral supplements are helpful when a person is not absorbing a nutrient properly or if they are unable to meet their needs with diet. Some medications can impact your body’s ability to properly use a micronutrient or deplete stores. In all of these cases, it’s important only to supplement when necessary and where recommended by a healthcare provider.

Herbals and other natural health products

Herbal or other supplements typically have mixed evidence to support their use, and even less evidence in endometriosis specifically. Some have better research available than others. Common products that people may try for fatigue include ashwaganda, coenzyme Q10, ginseng and rhodiola rosea [9,10]. Doses vary widely, and often supplements you buy at the store have multiple ingredients or proprietary blends of herbal ingredients so you can’t tell exactly what it contains. Even though these supplements are very accessible, there can be negative side effects and some can also interact with prescription medications. Just like vitamin or mineral supplements, I always recommend discussing with your healthcare provider before starting any herbal supplement. We can look at the possible benefits and risks, and make sure you are choosing a product that is the best choice for you.

Next steps

Connect with me! We can explore what might be driving your fatigue and any other symptoms, and personalize a nutrition plan to fit with your preferences and lifestyle.

Book a free discovery call to chat!

To read more about working with me and services I offer, check out these links: About Heather | Individual Dietitian Services

References

  1. Soliman, Ahmed M., et al. ‘Impact of Endometriosis on Fatigue and Productivity Impairment in a Cross-Sectional Survey of Canadian Women’. Journal of Obstetrics and Gynaecology Canada, vol. 43, no. 1, Jan. 2021, pp. 10–18. DOI.org (Crossref), https://doi.org/10.1016/j.jogc.2020.06.022.
  2. Ramin-Wright, Annika, et al. ‘Fatigue – a Symptom in Endometriosis’. Human Reproduction, vol. 33, no. 8, Aug. 2018, pp. 1459–65. DOI.org (Crossref), https://doi.org/10.1093/humrep/dey115.
  3. Goldberg, Hanna R., et al. ‘High Prevalence of Undiagnosed Iron Deficiency in Endometriosis Patients: A Cross‐sectional Study’. International Journal of Gynecology & Obstetrics, vol. 168, no. 3, Mar. 2025, pp. 1321–27. DOI.org (Crossref), https://doi.org/10.1002/ijgo.15994
  4. Signs & Symptoms | Iron Education.” Hemequity, https://www.hemequity.com/iron-education-signs-symptoms. Accessed 5 June 2026
  5. Qiu, Yichao, et al. ‘Vitamin D Status in Endometriosis: A Systematic Review and Meta-Analysis’. Archives of Gynecology and Obstetrics, vol. 302, no. 1, July 2020, pp. 141–52. DOI.org (Crossref), https://doi.org/10.1007/s00404-020-05576-5.
  6. Roshanzadeh, Ghazal, et al. ‘The Relationship between Dietary Micronutrients and Endometriosis: A Case-Control Study’. International Journal of Reproductive BioMedicine (IJRM), vol. 21, no. 4, May 2023, pp. 333–42. DOI.org (Crossref), https://doi.org/10.18502/ijrm.v21i4.13272.
  7. Mier-Cabrera, Jennifer, et al. ‘Women with Endometriosis Improved Their Peripheral Antioxidant Markers after the Application of a High Antioxidant Diet’. Reproductive Biology and Endocrinology, vol. 7, no. 1, Dec. 2009, p. 54. DOI.org (Crossref), https://doi.org/10.1186/1477-7827-7-54.
  8. Tardy, Anne-Laure, et al. ‘Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence’. Nutrients, vol. 12, no. 1, Jan. 2020, p. 228. DOI.org (Crossref), https://doi.org/10.3390/nu12010228
  9. Kalogerakou, Theodora, and Maria Antoniadou. ‘The Role of Dietary Antioxidants, Food Supplements and Functional Foods for Energy Enhancement in Healthcare Professionals’. Antioxidants, vol. 13, no. 12, Dec. 2024, p. 1508. DOI.org (Crossref), https://doi.org/10.3390/antiox13121508.
  10. Furhad, Shabi, and Abdullah A. Bokhari. ‘Herbal Supplements’. StatPearls, StatPearls Publishing, 2026. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK536964/.