Fatigue symptoms: what tiredness can point to and when to call your GP

In this article you will read what fatigue symptoms are, how common they are, what tiredness can point to and which signs mean it is time to call your GP. That matters, because almost everyone is tired now and then, and the useful question is when tiredness is just tiredness and when it is a reason to look more closely. In most cases it passes on its own.⁠³ BioProfile’s energy scan measures how much fatigue bothers you and gives you an indication of where you stand today. The scan is not a diagnosis. It is self-insight, to see where you stand and to help you make better choices in your diet and lifestyle. Finding a cause is work for a doctor.

How common fatigue symptoms are

A large review combined 91 studies covering more than 600,000 people from the general population worldwide. About 20 per cent of adults reported fatigue, and about 10 per cent had fatigue that lasted longer than six months. Among young people under 18 this was about 12 per cent, and in some occupations more than 40 per cent. Fatigue was slightly more common in women than in men, and moderate fatigue was more than twice as common as severe fatigue.⁠¹

In plain words: if you are tired, you are in large company, and most of that tiredness is the moderate kind.

What tiredness can point to

Thuisarts, the public website of the Nederlands Huisartsen Genootschap (the Dutch College of General Practitioners), lists a long range of possible causes. Many of them lie in everyday life: problems at home, stress at work, grief, money worries, anxiety, poor sleep, too little exercise and an unhealthy diet. Others are physical: viral infections, hormonal disorders, diabetes, a thyroid that is not working properly, heart rhythm disorders and heart problems.⁠³

What the GP finds in the end was tracked in 147 Dutch general practices. Of 571 adults who came in with a new episode of tiredness, a clear physical illness was found within a year in 8 per cent, and psychological or social problems were recorded in 17 per cent. In about half, nothing was recorded that explained the tiredness.⁠⁴ A review of 26 studies in general practice points the same way. Among people who saw their GP about tiredness, depression was found in about 19 per cent, anaemia in about 3 per cent, a serious physical illness in about 4 per cent and cancer in less than 1 per cent. A serious illness was about as common in people without tiredness, so according to the researchers that illness may not be what causes the tiredness.⁠²

What this means for you: tiredness on its own rarely points to something serious. A low mood and the pressures of everyday life are more common than a physical illness.

Fatigue symptoms together with other complaints: when to call your GP

Thuisarts advises calling your GP if the tiredness lasts a long time, for example longer than a month, or if other symptoms come with it: sweating a lot at night, a smaller appetite, losing kilos without wanting to, a change in your bowel movements, shortness of breath, being very thirsty, heart palpitations, or feeling very low or anxious.⁠³

Some of these signs belong together. Anaemia comes with tiredness and weakness: people get out of breath on the stairs or during exertion, and may feel dizzy, notice palpitations or headaches, or look pale. Causes include too little iron, for example from heavy periods or slow blood loss from the bowel, too little vitamin B12 or folic acid, and long-term illnesses such as kidney or liver disease and cancer.⁠⁵

In plain words: if you have the symptoms of losing kilos and tiredness together, and you are losing those kilos without wanting to, or if you have tiredness with night sweats or shortness of breath, call your GP instead of waiting to see.

When fatigue persists: chronic fatigue

In a register kept by 54 Dutch GPs, most episodes of fatigue were over within four weeks, and about 4 per cent lasted six months or longer. Chronic fatigue syndrome was estimated at about 1 in 1,000 patients.⁠⁶ Thuisarts describes that syndrome as being tired for longer than six months, with other complaints as well.⁠³

Tiredness is also more common with a long-term illness. In the Dutch Lifelines study of more than 78,000 adults, 23 per cent of people with at least one chronic illness were severely tired, compared with 15 per cent of people without a chronic illness. Tiredness was greatest in multiple sclerosis, followed by Parkinson’s disease and liver disease.⁠⁷

What this means: long-lasting tiredness can have more than one background, and a doctor works out which one applies to you.

What the energy scan measures

The energy scan asks five questions about the past two weeks: your energy through the day, energy dips, how much you lean on caffeine, getting physically tired, and being too worn out to do things. The answers add up to an energy score from 0 to 100, where higher is better. That gives you a starting point. Repeat the scan after two weeks and you have two numbers instead of a feeling.

A questionnaire cannot tell a slow thyroid, low iron, poor sleep or a low mood apart, because on paper they all read the same. The scan is not a diagnosis. If your energy drops mainly after lunch, the article on the afternoon dip and why your energy drops after lunch explains that dip.

In summary

Symptoms of tiredness are common and usually go away on their own.⁠^1,3 Behind them there is usually everyday stress, poor sleep or a low mood. Less often, a physical illness such as anaemia, a thyroid problem or diabetes is the cause.⁠^3,2 Tiredness that lasts longer than about a month, or that comes with night sweats, losing kilos without wanting to, shortness of breath or other new symptoms, is a reason to call your GP.⁠³ The energy scan shows where you stand today, and finding the cause is work for a doctor.