struggling plant

PCOS and Fatigue

Fatigue, or low energy, is one of the most common symptoms reported by women with Polycystic Ovary Syndrome (PCOS) in our membership program. 
In this article, we’ll discuss the relationship between PCOS and fatigue, explain possible root causes, and provide actionable tips to treat your PCOS and improve energy levels.

PCOS and Fatigue: Root Causes

Before treating your PCOS and improving your energy levels, we must identify the underlying causes of your fatigue. 

Insulin Resistance

Insulin is a hormone responsible for controlling blood sugar levels. When your cells become resistant to insulin, your body releases even more insulin and blood sugar levels remain abnormally elevated. About 70 percent of individuals with PCOS have some degree of insulin resistance, which can cause fatigue, difficulty losing weight, sugar cravings, and more.


Hashimoto’s is an autoimmune thyroid disease involving chronic inflammation of the thyroid gland. It is also the most common cause of hypothyroidism in the United States. Women with PCOS are three times more likely to suffer from Hashimoto’s thyroid disease than women without PCOS (1). These two conditions share many symptoms, like fatigue, thinning hair, and difficulty losing weight. In fact, before diagnosing PCOS, it’s crucial to rule out Hashimoto’s hypothyroidism with a blood test. We order a full thyroid panel for all individuals in our membership program. Read more about the relationship between PCOS and thyroid disease.

At Root, we actually wrote the first book in the U.S. on the connection between PCOS and thyroid conditions. The PCOS Thyroid Connection, by Dr. Erica Armstrong, is available on Amazon, Barnes and Noble online and more. 

Vitamin D Deficiency

Women with PCOS are more likely to have low levels of vitamin D (2). In fact, some studies estimate up to 85 percent of women with PCOS have deficient or insufficient levels of this vitamin. Vitamin D is crucial for numerous functions in the body related to hormone balance and energy levels. Fortunately, supplementation in these scenarios can not only correct a vitamin D deficiency and improve energy levels, but may help treat other root causes of PCOS like insulin resistance and high androgen (i.e. testosterone) levels. 


PCOS patients are about three times more likely to suffer from anxiety than the general population (3). Fatigue is a very common symptom of anxiety. Anxiety in PCOS may be related to low progesterone, high cortisol levels, or imbalances in gut bacteria. 

How to Improve Energy Levels in PCOS

While the treatment plan for our members is always individualized based on an extensive clinical history and test results, here are a few common interventions we may suggest for an individual with PCOS and fatigue. 

The Root Plate™ (PFC Balance)

An anti-inflammatory diet containing wholesome sources of protein, fat, and fiber-rich carbohydrates (PFC) improves your body’s sensitivity to insulin and balances your blood sugar levels. Our PFC method ensures you have all three macronutrients for sustainable meal planning to support healthy hormone and energy levels. Our Root Plate™ is a way to visualize the PFC method and encourage adequate intake of each macronutrient. To make your own Root Plate™ fill ½ of your plate with non-starchy vegetables, ¼ of your plate with fiber-rich carbohydrates, and ¼ of your plate with high-quality protein. Lastly, top off your plate with 1-2 tablespoons of healthy fat, like olive oil, avocados, nuts, and seeds.


Ovasitol is a supplement designed for women with PCOS containing two vitamin-like compounds called myo and d-chiro-inositol. We recommend Ovasitol for PCOS quite frequently in our practice because it treats one of the main root causes of PCOS symptoms: insulin resistance. Research suggests the main ingredient in Ovasitol can reduce insulin levels, promote regular periods in PCOS, and even improve your mood (4, 5, 6). Treating insulin resistance can boost energy levels by reducing sugar cravings and preventing blood sugar fluctuations.


There’s a reason we call it magic period dust…

Correct Nutrient Deficiencies

In our membership program, we evaluate levels of crucial vitamins and minerals required for optimal energy like vitamin D, vitamin B12, magnesium, and iron, and replete as needed with food and supplements. As mentioned above, vitamin D is a fairly common nutrient deficiency in women with PCOS. Vitamin D supplementation is very individualized, which is why we like to order this test for our members. However, we find that most people require vitamin D supplementation throughout the year, especially during the winter months. You can find vitamin D in our Root Shop with added vitamin K2 to optimize absorption and utilization by the body. 

Additionally, many women are prescribed a drug called metformin to treat their insulin resistance and PCOS. Unfortunately, taking metformin for longer periods of time may cause a vitamin B12 deficiency (7). This vitamin has many important jobs in the body like forming red blood cells to prevent anemia and optimizing energy levels. If you take Metformin, or have taken it in the past, you may have lower vitamin B12 levels and benefit from a B12 supplement. Root B-complex includes the most common B vitamin deficiencies (including B12) at effective doses and they are activated so the body can use them easier for energy.
Vitamin D3 K2

Vitamin D3 K2

You won’t be feeling very sunshiny if you are low in this critical vitamin.
A bottle of B Complex supplements

B Complex

You won't B tired when you take this one

Sleep Hygiene

Poor sleep has significant health consequences for individuals with PCOS and is largely responsible for daytime fatigue. There are many possible causes of insomnia in PCOS. For example, if you suffer from horrible insomnia before your period, you may have low progesterone levels. Women with PCOS are also more likely to suffer from a serious sleep disorder, called sleep apnea, which largely impacts daytime fatigue. If you suspect you have sleep apnea, we encourage you to speak with your doctor to see if they recommend a sleep study.

Implementing habits for sleep hygiene sets your body up for better quality sleep each night. Reduce sleep disruptors, like alcohol, close to bedtime and avoid drinking caffeine after 1pm. Establish a regular nighttime routine and avoid electronic screens too close to bedtime. Many of our members also use our Sleep Support supplement to achieve more restful sleep.
sleep support

Sleep Support

A calming blend of minerals and herbs that promote muscle relaxation and more restful sleep.

Key Takeaways

Many women suffer from both PCOS and fatigue due to insulin resistance, nutrient deficiencies, or other underlying conditions, like hypothyroidism. After identifying the root causes of fatigue, our Root doctors and dietitians help women implement individualized treatment plans which often include meal plans to balance blood sugar levels, specific food and supplement recommendations, and lifestyle modifications to optimize sleep quality.
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