If You Can Push Through the Fatigue — Should You?
"If I can push through the fatigue, is it really something I need to look into?"
The Fatigue That Gets Explained Away
Most of the professional women I see do not describe themselves as exhausted.
They describe themselves as busy. Stretched. Managing a lot. Running on less sleep than they would like, but functioning.
The word exhaustion feels dramatic. It implies something is wrong. And many high-performing women have spent years being rewarded for their capacity to absorb difficulty without complaint.
So the fatigue gets reframed. It becomes a badge. A reasonable cost of a demanding life.
But biology does not care about your reframe.
Persistent, unexplained fatigue — the kind that does not resolve with a good night's sleep — is one of the most important signals the body can send. And it is also one of the most commonly dismissed.
What Fatigue Can Actually Mean
Fatigue is not a diagnosis. It is a symptom — and it can point in many directions.
Some of the most common underlying causes I see in professional women in their 30s, 40s, and 50s include:
- Iron deficiency anemia. This is far more common than most women realize — particularly in premenopausal women with heavy cycles, or women who have recently had a pregnancy. Low iron does not always show up as extreme pallor or breathlessness. It often presents as a subtle but persistent drain on energy, cognitive clarity, and motivation. A simple blood panel can identify it. Many women go years without one.
- Thyroid dysfunction. The thyroid regulates metabolism, body temperature, heart rate, and energy production. Both hypothyroidism and subclinical thyroid changes can cause fatigue that feels indistinguishable from burnout. Thyroid disorders are significantly more common in women than in men, and they are often underdiagnosed in the early stages when symptoms are mild.
- Vitamin D deficiency. This has become one of the most pervasive nutritional gaps in the United States, particularly in the Northeast, where sun exposure is limited for months at a time. Low vitamin D is associated with fatigue, low mood, muscle weakness, and reduced immune function. It is correctable — but only if it is identified.
- B12 and folate deficiency. These affect red blood cell production, neurological function, and energy metabolism. Women following plant-based diets or taking certain medications — including long-term oral contraceptives — are at particular risk.
- Perimenopause. This is the conversation many women are not having with their doctors. Perimenopause can begin in the late 30s — sometimes earlier — and the hormone fluctuations that accompany it do not always arrive with dramatic symptoms. Many women experience years of disrupted sleep, increased fatigue, mood shifts, and cognitive changes they attribute to stress, aging, or simply their circumstances.
- Chronic low-grade stress response. Sustained activation of the stress axis — the HPA system — can dysregulate cortisol rhythms in ways that produce fatigue, especially in the mornings. The pattern is often described as wired but tired: difficulty winding down at night, difficulty starting in the morning, a constant sense of effort. This does not resolve through willpower. It requires attention to the physiology underneath.
Why 'Pushing Through' Is Not a Strategy
There is a version of resilience that is genuinely valuable. The ability to tolerate discomfort, to stay focused under pressure, to continue working when things are hard — these are real skills.
But pushing through fatigue when it has a physiological cause does not resolve the cause. It delays it.
And the longer these imbalances go unaddressed, the more they compound.
Iron deficiency that is managed early is straightforward to treat. Iron deficiency discovered after years of increasing symptoms — accompanied now by cognitive effects and mood changes — takes longer.
Preventive care is not about finding disease. It is about understanding what is happening in your body before symptoms reach a threshold that is harder to reverse.
What Nutritional Evaluation Actually Involves
At the webinar, another question came up twice, which told me it was genuinely on people's minds: "What can I do to make sure my nutritional levels are where they need to be?"
A comprehensive nutritional evaluation is not the same as a standard annual blood panel. The typical primary care visit does not include ferritin (stored iron), vitamin D, B12, folate, magnesium, or autoimmune markers unless a physician specifically orders them. Many doctors do not include these unless you ask — not because they are not important, but because the current system prioritizes acute problems over proactive insight.
Asking your doctor for a more comprehensive panel is legitimate. A physician who practices preventive medicine will welcome it.
What you are looking for is not just the presence of deficiency, but optimization. A ferritin level that is "within the normal range" may still be low enough to affect energy and cognition. Normal ranges are designed to exclude disease, not to identify what your body needs to function at its best.
How to Talk to Your Doctor About What You Are Feeling
Here is what I tell my patients: describe your experience, not your diagnosis. You do not need to arrive with a theory. You need to describe your day. Tell your doctor what a normal Tuesday looks like. When you are tired. How you are sleeping. Whether your energy in the morning matches your energy at noon. Whether something has shifted in the last year that you cannot fully explain.
A physician who is listening for patterns will hear what matters.
If your current healthcare relationship does not leave room for that kind of conversation — if seven minutes is simply what you are given and it is not enough — that is information too.
The Five Signals Worth Paying Attention To
Bringing together the themes from our webinar, these are the five medical signals I see high-performing women most commonly ignore:
- Fatigue that does not resolve with rest. Not tiredness from a hard week. Fatigue that is baseline, persistent, and present even after adequate sleep. This needs evaluation.
- Sleep disruption. Difficulty falling asleep, waking in the early hours, or waking unrefreshed despite sleeping through the night. Sleep disruption affects every system in the body. It is not a lifestyle issue to manage. It is a clinical signal.
- Cognitive changes. Difficulty concentrating, slower recall, the sense that your thinking is not as sharp as it used to be. In professional women this is often attributed to workload. Frequently, it has a physiological basis that is worth investigating.
- Mood and emotional regulation shifts. Increased irritability, lower tolerance for stress, anxiety that feels new or out of proportion. These are often dismissed as psychological. They are frequently hormonal, thyroid-related, or nutritional in origin.
- Metabolic changes. Weight shifts that do not respond to changes in diet or exercise the way they used to, particularly around the abdomen. This is often one of the early signals of hormonal transition or metabolic change — and it is one of the most commonly normalized.
What Preventive Care Looks Like in Practice
The standard of care at April MD is different from what most people are used to.
Appointments are not compressed. A new patient visit is long enough to take a real history — not just the presenting complaint, but the full picture: work, sleep, stress, family history, symptoms that have been quietly accumulating.
Blood work is ordered comprehensively, not minimally. When fatigue is part of the picture, that means ferritin, thyroid function, vitamin D, B12, folate, autoimmune markers, and metabolic indicators — not just a standard CBC.
For patients in Nassau and Suffolk County, April MD offers this standard of care at a monthly membership rate designed to be accessible to Long Island families. It is Direct Primary Care — not concierge medicine with a five-figure annual fee.
The Answer to the Webinar Question
Back to the question that started this: If I can push through the fatigue, is it really something I need to look into?
The answer is yes — not because pushing through is dangerous, but because pushing through delays the insight that would allow you to feel genuinely better.
Your energy is not an infinite resource. It is a reflection of what is happening in your body. When it signals something, that signal is worth hearing.
You do not have to be falling apart to deserve attention. You do not have to have an obvious diagnosis to justify asking questions.
You just have to care enough about your health to treat it the way you treat everything else you lead: as something worth investing in before the crisis, not after it.
About Dr. Ruth Solomon
Dr. Solomon is a primary care physician and women's health specialist. She is the founder of April MD, a Direct Primary Care practice in Babylon, New York, serving Nassau and Suffolk County, Long Island.
Her clinical focus includes preventive medicine, hormonal and metabolic health, and personalized care for women at all stages of life.
Book a consultation: Dr. Ruth Solomon on Doctoloop
Visit April MD: www.aprilmd.com
