Tiredness has causes. Most are findable with the right blood tests.
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"Tired all the time" is among the most common reasons people see a GP, and among the most frequently dismissed. It is also one of the presentations where a proper twenty-minute consultation does the most work, because the answer almost never comes from a single question.
Fatigue is usually multifactorial. Someone sleeping six hours, drinking most evenings, carrying untreated iron deficiency and low mood does not have one cause — they have four, each individually unremarkable and collectively disabling. Looking for a single explanation is why so many people are told everything is normal.
Two specific points shape this page.
Ask for ferritin, not just a full blood count. Iron stores empty long before haemoglobin falls, so you can be profoundly iron deficient and exhausted with an entirely normal blood count. This is the single commonest missed cause of fatigue, particularly in women.
Post-exertional malaise changes everything. If exertion — physical or mental — makes you significantly worse a day or two later, that is a specific and important finding that points towards ME/CFS or long COVID, and it means some standard advice about exercise would actively harm you.
Beta blockers, sedating antihistamines, opioids, gabapentin and pregabalin, some antidepressants, and antipsychotics all cause fatigue. It is a common and reversible cause that people rarely connect to the tablet they have taken for years.
The history does most of the work. The blood tests exclude the things that are treatable and would otherwise be missed.
Our fatigue panel covers this set in one visit.
Unintentional weight loss; drenching night sweats; persistently enlarged lymph nodes; fevers; bleeding; new breathlessness or chest pain; or a lump anywhere. Fatigue with any of these is investigated urgently rather than worked up gradually.
Fatigue is one of the better uses of a longer remote appointment. Nothing here needs examination that a set of blood tests does not cover, and the work is in the history — which takes time that a ten-minute slot does not have.
If you snore, wake unrefreshed or fall asleep during the day, a sleep study is worth more than any tonic. Treated sleep apnoea transforms fatigue in a way nothing else does, and it is repeatedly missed — particularly in women, where it presents as tiredness and insomnia rather than classic snoring.
Worth an honest look. Alcohol fragments the second half of the night even at modest intake, so sedation is mistaken for sleep and the following day is worse. A two-week trial without it is often more informative than another blood test.
Most people with fatigue have normal results, and that is a useful finding rather than a dead end. It excludes the treatable diseases and moves the work to sleep, mood, alcohol, activity and stress — which are where most fatigue actually lives, and which are addressable.
Where fatigue has lasted months, particularly after an infection, and where exertion reliably makes you worse a day or two afterwards, the approach changes fundamentally.
Current national guidance is explicit that graded exercise therapy should not be offered as a treatment for ME/CFS. Pushing through causes deterioration rather than recovery. The approach is energy management and pacing — working within your limits, deliberately, to avoid the boom-and-bust cycle.
We take this seriously, we will not tell you to exercise your way out of it, and we can refer to specialist services. Being disbelieved is a near-universal experience with these conditions and it will not happen here.
Call 999 for:
Seek prompt assessment — within days — for fatigue with:
Book a consultation for:
Do not push through, and do not follow generic advice to build up exercise. For post-exertional malaise the effective approach is pacing:
Energy supplements, tonics and vitamin drips do not treat fatigue in anyone who is not deficient. Correcting a proven deficiency works; taking something speculatively does not. Save the money for the blood test that identifies whether there is anything to correct.
Fatigue is where the most money is spent on tests that answer nothing, and it is worth saying so plainly.
The useful investigation is short, cheap, and NHS-funded: full blood count, ferritin, thyroid function, HbA1c, kidney and liver function, calcium, coeliac serology and vitamin D. That panel identifies the large majority of medical causes.
What we will not arrange: broad “wellness” panels, food intolerance testing, adrenal fatigue or cortisol saliva profiles — adrenal fatigue is not a recognised diagnosis — chronic Lyme or mould panels from overseas laboratories, and hair mineral analysis. These generate findings rather than answers, and the findings then need explaining away.
The causes most often missed are not exotic. Sleep apnoea, iron deficiency without anaemia, depression, alcohol, and medication account for a great deal of unexplained tiredness, and each is treatable. Ferritin needs asking for specifically, since a normal full blood count does not exclude iron deficiency.
Where a consultation genuinely earns its fee is a proper history — which distinguishes sleepiness from exhaustion from breathlessness on exertion, and those point in entirely different directions.
Fatigue with weight loss, fever, night sweats or a lump warrants prompt assessment rather than a screening panel.
NICE Clinical Knowledge Summary, Tiredness/fatigue in adults, is the principal reference. It sets out the recommended baseline investigations — full blood count, ESR or CRP, U&Es, LFTs, TFTs, glucose or HbA1c, calcium, ferritin and coeliac serology — and advises against extensive undirected testing.
CKS emphasises assessment for depression, anxiety, sleep disorders, alcohol and drug causes, which account for a substantial proportion of presentations.
NICE NG206, Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome, covers diagnosis where fatigue is persistent beyond three months with characteristic features including post-exertional malaise, and is explicit that graded exercise therapy should not be offered as a treatment for ME/CFS.
The Society for Endocrinology does not recognise “adrenal fatigue” as a clinical entity, and salivary cortisol profiling has no validated role in assessing tiredness — the basis for the position above.
NICE NG12 covers fatigue occurring alongside red flag features.
Normal tests exclude the treatable diseases — which is genuinely useful — but they do not measure sleep quality, alcohol, mood, stress or activity, and that is where most fatigue actually comes from. It is also worth checking which tests were done: a full blood count alone misses iron deficiency, and TSH alone gives an incomplete thyroid picture.
Because iron stores empty long before haemoglobin falls. You can be severely iron deficient — exhausted, breathless, losing hair — with a completely normal full blood count. Ferritin is the test that finds it, it is routinely omitted, and it is the commonest correctable cause of fatigue. Ask for the actual number rather than accepting "normal".
Possibly, and it is always checked. But be realistic — thyroid disease is a less frequent cause of fatigue than sleep, mood, alcohol and iron deficiency. It is tested because it is easy and treatable, not because it usually turns out to be the answer.
Only if you are actually deficient. Vitamin drips and injections given without a demonstrated deficiency do not improve fatigue, whatever the marketing implies. The useful sequence is: test first, treat what is low, and do not pay for what you do not need.
For most people with fatigue, yes — inactivity worsens it and gentle regular movement improves it. With one important exception. If exertion reliably makes you worse a day or two later, that is post-exertional malaise, and pushing through causes deterioration. In that situation the approach is pacing, and graded exercise is specifically not recommended.
Both are recognised, both are real, and both have post-exertional malaise as a central feature. They are diagnosed clinically after other causes are excluded, and the management — energy management and pacing rather than pushing — is the same. We will not tell you it is deconditioning.
Very possibly more than you would expect. Alcohol fragments the second half of the night even at modest intake, so people sleep the hours and wake unrefreshed. Two weeks without it is a genuinely informative experiment, and frequently more revealing than another blood test.
Yes — and this catches people out. Coeliac disease commonly presents as fatigue and iron deficiency with no bowel symptoms whatsoever. It is worth screening for routinely. You must still be eating gluten for the test to be accurate, so do not cut it out before being tested.
August 23, 2026
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