Chronic Fatigue Syndrome (ME/CFS)
Myalgic encephalomyelitis, also known as chronic fatigue syndrome or ME/CFS, is a long-term, multisystem condition characterised by a substantial reduction in normal activity together with post-exertional malaise, unrefreshing sleep and difficulties with concentration, memory or remaining upright. Symptoms vary considerably between individuals and may fluctuate over time. Although there is currently no single cure or diagnostic test, careful assessment, energy management and personalised support can help reduce symptom instability and improve quality of life.
This information is intended for educational purposes and should not replace professional medical advice. If you have new, severe or worsening symptoms, always seek advice from your GP or specialist healthcare team.
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Living Well with the Condition >
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KEY FACTS
✔ Recognised medical condition
ME/CFS is a recognised long-term medical condition affecting several systems within the body. It is not simply ordinary tiredness, lack of fitness or a psychological disorder.
✔ Post-exertional malaise is central
The defining feature is post-exertional malaise, or PEM: a delayed and disproportionate worsening of symptoms after physical, cognitive, emotional, sensory or social exertion.
✔ No single diagnostic test
There is currently no blood test, scan or other investigation that confirms ME/CFS on its own. Diagnosis is based on the pattern of symptoms, their impact on daily function and the exclusion of other possible causes.
✔ Symptoms can fluctuate
ME/CFS may follow a stable, relapsing or fluctuating course. Symptoms can worsen after exertion, infection, disrupted sleep or other physical and emotional demands.
✔ Management can help
Careful pacing, prevention of post-exertional malaise, treatment of associated symptoms and personalised support can help improve stability, function and quality of life.
The defining role of PEM, the absence of a single diagnostic biomarker and the need for personalised, longitudinal management are central to the Rowan Health clinical pathway.
UNDERSTANDING THE CONDITION
Myalgic encephalomyelitis, commonly referred to as ME/CFS, is a complex long-term condition that affects much more than energy levels.
It can influence:
The body's response to physical and mental activity
Sleep and recovery
Concentration, memory and information processing
Heart rate and blood-pressure regulation
Pain processing
Temperature regulation
Digestion
Sensitivity to light, sound, touch or other sensory input
The term “chronic fatigue syndrome” can sometimes create the impression that the condition is simply a severe form of tiredness. However, ordinary tiredness generally improves after rest or sleep. In ME/CFS, rest may not feel restorative, and relatively minor activity can cause a delayed worsening of several symptoms at once.
This delayed reaction is known as post-exertional malaise, or PEM. It is the feature that most clearly distinguishes ME/CFS from many other causes of persistent fatigue.
PEM may develop after activities that would previously have been manageable, such as:
Walking or completing household tasks
Attending a medical appointment
Reading or using a computer
Holding a long conversation
Experiencing emotional stress or excitement
Remaining upright for too long
Spending time in a noisy or brightly lit environment
Symptoms may not worsen immediately. The effects frequently develop later the same day or during the following 12 to 48 hours and may last for days, weeks or, in severe cases, longer.
ME/CFS can affect people at very different levels of severity. Someone mildly affected may remain able to work or study with considerable adjustments, while someone severely affected may be largely housebound or bedbound and require assistance with everyday activities.
The condition can also change over time. Some people experience a relatively stable but reduced level of function. Others have periods of improvement followed by significant relapses or “crashes”.
ME/CFS is a genuine physical illness. Current research is investigating changes involving immune regulation, the autonomic nervous system, circulation, energy metabolism, muscle responses and the way the brain regulates effort and sensory information. No single mechanism currently explains every person’s symptoms, and no routine biomarker has yet been validated for diagnosis.
It is therefore best understood as a multisystem disorder involving disrupted physiological regulation, rather than as a disease affecting only one organ or body system.
COMMON SYMPTOMS
ME/CFS affects every person differently. The number, severity and combination of symptoms can vary considerably, and symptoms may fluctuate from one day or week to another.
Post-Exertional Malaise
Post-exertional malaise is the defining symptom of ME/CFS.
It is a worsening of symptoms following activity that would not previously have caused difficulty. Unlike ordinary tiredness after exertion, PEM is often delayed, disproportionate to the activity and affects several body systems at once.
A PEM episode may include:
A major increase in exhaustion
Worsening pain
Heavier or weaker-feeling limbs
Increased brain fog
Flu-like feelings
Sore throat or tender glands
Palpitations or dizziness
Poorer sleep
Increased sensitivity to light, sound or touch
Digestive symptoms
A general sense of being acutely unwell
PEM can be triggered by physical activity, but also by cognitive concentration, emotional demand, prolonged standing, social interaction or sensory overload. Recovery may take several days or longer.
Persistent Fatigue
The fatigue associated with ME/CFS is different from normal tiredness.
People may describe:
Profound physical and mental exhaustion
A significant reduction in stamina
Feeling drained after small activities
Heavy or weak-feeling limbs
Difficulty initiating or completing tasks
A need for prolonged recovery after exertion
Energy levels that are not restored by sleep or rest
The severity of fatigue does not always reflect how much activity has been undertaken.
Unrefreshing Sleep
Many people sleep for what appears to be an adequate number of hours but wake feeling as though they have not rested.
Common patterns include:
Difficulty falling asleep
Frequent waking
Light or disrupted sleep
Sleeping for prolonged periods without feeling restored
A delayed or reversed sleep pattern
Feeling most alert late at night
Increased symptoms after poor-quality sleep
Other sleep conditions, including sleep apnoea or restless legs syndrome, may coexist and should be considered during assessment.
Cognitive Difficulties
Cognitive symptoms are often described as “brain fog”.
They may include:
Difficulty concentrating
Slower information processing
Problems finding words
Short-term memory difficulties
Losing the thread of a conversation
Difficulty reading or following complex information
Reduced ability to plan or multitask
Increased symptoms after mental effort
Cognitive exertion can itself trigger post-exertional malaise.
Orthostatic Intolerance
Some people feel significantly worse when standing or remaining upright.
Symptoms may include:
Dizziness
Light-headedness
Palpitations
Feeling faint
Blurred or altered vision
Nausea
Shakiness
Weakness
Worsening brain fog
Relief after sitting or lying down
Some individuals meet the diagnostic criteria for postural orthostatic tachycardia syndrome, or POTS, while others experience different forms of autonomic dysfunction.
Pain
Pain varies between individuals and may include:
Muscle pain
Joint pain without visible inflammation
Headaches or migraine
Neuropathic or burning pain
Abdominal discomfort
Widespread tenderness
Pain that worsens during PEM
Some people also meet the diagnostic criteria for fibromyalgia.
Other Symptoms
ME/CFS may also be associated with:
Flu-like feelings
Sore throat
Tender lymph glands
Temperature sensitivity
Cold hands and feet
Sweating or altered temperature regulation
Nausea
Bloating
Changes in bowel habit
Sensitivity to medication
Sensitivity to light, noise, smell or touch
Menstrual worsening of symptoms
Reduced tolerance of alcohol
Anxiety or low mood associated with the burden of long-term illness
Not everyone experiences all of these symptoms. Their pattern and severity are often more clinically useful than the presence of any single symptom.
Relapses and Crashes
A significant worsening of symptoms is often described as a relapse, flare or crash.
Common triggers include:
Exceeding current physical capacity
Prolonged mental concentration
Emotional stress
Social or sensory overload
Medical appointments or travel
Infection
Poor sleep
Remaining upright for too long
Attempting to resume activity too quickly after a previous relapse
Because symptoms can be delayed, the activity that triggered a crash may not always be immediately obvious. Careful activity and symptom monitoring can help identify these patterns.
CAUSES, MECHANISMS AND DIAGNOSIS
Why Does It Happen?
Why Does It Happen?
No single cause of ME/CFS has been identified.
For many people, symptoms begin following an infection. Recognised triggers include Epstein–Barr virus, SARS-CoV-2 and other viral or bacterial illnesses. Some people develop symptoms after surgery, pregnancy, physical trauma or another major physiological stressor, while others cannot identify a clear initial trigger.
Current research suggests that a triggering event may disturb several connected regulatory systems in someone who is already susceptible.
Areas being investigated include:
Immune-system regulation
Autonomic nervous-system function
Blood-volume and circulation regulation
Cerebral blood flow
Energy production and recovery after exertion
Muscle metabolism
Neuroinflammation and brain signalling
Hormonal and stress-response regulation
Gut microbiome and metabolite changes
These mechanisms are likely to interact rather than operate independently.
For example, altered autonomic regulation may affect heart rate, blood pressure, circulation, digestion and temperature control. Changes in circulation and oxygen delivery may then contribute to cognitive symptoms, weakness and reduced tolerance of exertion. Immune and metabolic changes may further influence pain, sleep and recovery.
Research has also identified measurable changes after exertion in people experiencing PEM, including abnormalities involving muscle structure, metabolism and recovery. These findings support the understanding that PEM is a biological response rather than simply a consequence of inactivity or lack of motivation.
However, research findings are not yet sufficiently consistent or specific to provide a routine diagnostic biomarker. ME/CFS should not therefore be presented as a single proven mitochondrial, autoimmune, neurological or infectious disease.
It is more accurate to describe it as a complex multisystem condition in which the normal regulation of energy, immunity, circulation and nervous-system activity appears to have become disrupted.
How It Is Diagnosed
How It Is Diagnosed
There is currently no single blood test, scan or biopsy that confirms ME/CFS.
Diagnosis is based on:
A detailed medical history
The characteristic symptom pattern
A significant reduction from previous levels of activity
The presence of post-exertional malaise
Sleep disturbance
Cognitive difficulties and/or orthostatic intolerance
The duration of symptoms
Examination findings
Investigations to identify or exclude other explanations
Under current NICE guidance, ME/CFS may be suspected when the characteristic symptom pattern has persisted for at least six weeks in adults or four weeks in children and young people. A diagnosis can generally be confirmed after symptoms have persisted for three months, provided another condition does not better explain them.
A proper assessment should consider whether the person is experiencing:
Fatigue as a symptom of another condition
Persistent or chronic fatigue of uncertain cause
Post-viral fatigue that is gradually improving
ME/CFS
Long COVID with an ME/CFS pattern
An overlapping condition such as fibromyalgia, POTS or a sleep disorder
The presence of another illness does not automatically exclude ME/CFS. Some people have more than one condition, and each may require appropriate assessment and management.
Medical Investigations
Blood tests and other investigations do not directly diagnose ME/CFS, but they remain an essential part of assessment.
Your GP may arrange tests including:
Full blood count
Ferritin and iron studies
Kidney and liver function
Thyroid function
Blood glucose or HbA1c
Inflammatory markers
Creatine kinase
Calcium and phosphate
Coeliac screening
Vitamin B12 and folate
Vitamin D where appropriate
Urinalysis
Additional investigations may be considered depending on your symptoms, examination and medical history.
These may include:
Autoimmune investigations
Infection screening
Morning cortisol or recognised adrenal testing
ECG or cardiac monitoring
Sleep studies
Respiratory assessment
Neurological assessment or imaging
Formal autonomic testing
Endocrine or gynaecological investigation
Nutritional or malabsorption assessment
Normal routine blood results do not mean that symptoms are imaginary or that nothing is wrong. Routine investigations are mainly used to identify treatable alternatives or associated conditions.
Tests That Are Not Currently Validated
Some commercial tests are advertised as diagnosing ME/CFS or identifying its underlying cause.
These may include:
Commercial mitochondrial-function panels
Broad cytokine panels
Natural-killer-cell testing
Unvalidated viral-reactivation panels
“Adrenal fatigue” saliva testing
Organic-acid testing
Commercial microbiome scores
Food-IgG intolerance panels
Live-blood analysis
Experimental toxin or provocation testing
At present, these tests have not been validated as reliable methods of confirming or excluding ME/CFS. Testing should be selected to answer a clear clinical question rather than ordered as part of an undirected “fatigue panel”.
HOW IS IT USUALLY MANAGED?
Management depends on the diagnosis, symptom severity, underlying mechanisms and each person's individual circumstances.
There is currently no single curative treatment for ME/CFS.
Management is individualised and generally focuses on:
Understanding the condition
Avoiding post-exertional malaise
Establishing a sustainable activity pattern
Managing individual symptoms
Identifying and treating associated conditions
Supporting daily function
Making appropriate workplace, educational or home adjustments
Monitoring changes over time
Education
Understanding PEM is one of the most important aspects of management.
Many people have previously been advised to push through fatigue or steadily increase exercise. This can be unhelpful and potentially harmful when genuine PEM is present.
Education helps the person and those around them understand:
Why symptoms may be delayed
Why all forms of exertion need to be considered
How to recognise early warning signs
How to reduce the boom-and-bust pattern
Why periods of rest may need to be planned in advance
Why progress should not be measured only by doing more
Energy Management and Pacing
Pacing means matching activity to the energy that is currently available.
It applies not only to physical activity, but also to:
Mental concentration
Emotional demands
Social interaction
Sensory exposure
Time spent sitting or standing upright
Self-care and domestic activities
Pacing may involve:
Breaking activities into smaller stages
Alternating different types of activity
Planning rest before exhaustion develops
Spreading tasks across several days
Avoiding doing too much on better days
Identifying an individual energy envelope
Monitoring delayed symptoms
Adjusting plans after illness or relapse
Pacing is not simply permanent inactivity. Its purpose is to reduce repeated crashes and establish a more stable baseline from which carefully selected, patient-led changes may eventually become possible.
Physical Activity and Rehabilitation
NICE advises against programmes based on fixed, automatic increases in exercise or physical activity as a treatment for ME/CFS.
Any physical rehabilitation should be:
Individualised
Flexible
Based on present capacity
Responsive to delayed symptoms
Agreed with the patient
Reduced or paused if it causes deterioration
Activity should not be increased according to a predetermined timetable.
For some people, particularly those with milder illness and greater stability, carefully adapted movement may help maintain mobility, circulation and confidence. For others, especially during a relapse or with severe ME/CFS, basic self-care may already represent substantial exertion.
The appropriate level must therefore be determined individually.
Symptom Management
Treatment may be offered for individual symptoms or associated conditions, including:
Pain
Migraine
Sleep disturbance
Nausea or reflux
Bowel symptoms
Allergy-type symptoms
Menstrual aggravation
Anxiety or depression
Nutritional deficiencies
People with ME/CFS may be unusually sensitive to medication. Prescribing clinicians may therefore consider beginning with a low dose and increasing cautiously where appropriate.
Medication decisions should always be discussed with the responsible GP or specialist.
Psychological and Emotional Support
ME/CFS is not a psychological illness. However, living with an unpredictable and disabling condition can understandably affect mood, confidence, relationships and emotional wellbeing.
Psychological support may help someone:
Adjust to changes in health and independence
Communicate their needs
Manage anxiety associated with symptoms
Cope with loss or uncertainty
Adapt work, study and family expectations
Develop practical strategies for living with a long-term condition
Cognitive behavioural therapy may be offered as support for living with ME/CFS, but it should not be presented as a cure or based on the assumption that unhelpful beliefs are causing the illness.
Specialist Care
Referral may be appropriate when:
The diagnosis is uncertain
Symptoms are severe or very severe
Another condition is suspected
Orthostatic symptoms are significant
A sleep disorder may be present
Neurological or cardiac symptoms require investigation
Nutritional status or basic care is becoming compromised
Specialist occupational, educational or social support is needed
Successful care often combines medical assessment, symptom-specific treatment, energy management, practical adaptation and ongoing review.
LIVING WELL WITH THE CONDITION
Impact on Daily Life
Impact on Daily Life
ME/CFS can affect work, education, relationships, family responsibilities, social activities and the ability to complete basic everyday tasks.
Because the condition is often invisible, other people may not understand why someone who appears well during a short interaction needs prolonged recovery afterwards.
Living well with ME/CFS does not mean ignoring the illness or constantly attempting to return to a previous level of activity. It means learning how to protect health, preserve meaningful activities and reduce avoidable symptom deterioration.
Understanding Your Energy Envelope
An energy envelope is the approximate level of physical, cognitive, emotional, social and sensory activity that can currently be tolerated without provoking PEM.
It may help to consider separately:
How long you can walk or stand
How long you can concentrate
How much conversation you can tolerate
Whether screens, light or noise increase symptoms
How long you can remain upright
How medical appointments or travel affect you
How much recovery is needed after different activities
The envelope may change after infection, a relapse or a period of greater stability. It should therefore be reviewed rather than treated as a fixed limit.
Avoiding the Boom-and-Bust Cycle
On a better day, it can be tempting to catch up on everything that has been postponed. This may lead to a delayed crash and several days of reduced function.
A more sustainable approach may involve:
Stopping before symptoms become severe
Dividing larger jobs into smaller stages
Leaving space between appointments
Planning recovery time after unavoidable exertion
Prioritising essential or meaningful activities
Accepting help with less important tasks
Keeping activity more consistent across better and worse days
Monitoring Progress
Improvement is not simply doing more.
Early signs of improvement may include:
Fewer PEM episodes
Shorter recovery after exertion
More predictable energy
Better activity stability
Improved sleep
Greater upright tolerance
Clearer thinking
Reduced pain
Greater confidence in recognising personal limits
These changes may occur before any meaningful increase in total activity.
Tracking should remain proportionate. A diary that is too detailed or demanding can itself create cognitive exertion. Brief written notes, simple rating scales or voice recordings may be more appropriate for some people.
Sleep and Routine
A consistent routine may help reduce additional disruption, although rigid schedules are not appropriate for everyone.
Helpful measures may include:
Keeping sleep and waking times reasonably consistent
Creating a calm sleep environment
Reducing unnecessary light and noise
Reviewing pain or autonomic symptoms that interrupt sleep
Screening for sleep apnoea or restless legs where relevant
Avoiding attempts to force sleep through excessive daytime activity
Improving sleep may reduce symptom burden, even though it does not cure ME/CFS itself.
Work, Education and Family Life
Practical adjustments may include:
Flexible or reduced working hours
Working from home
Rest breaks
Reduced travel
Gradual, symptom-contingent returns rather than fixed timetables
Flexible attendance at school or university
Written rather than verbal instructions
Reduced sensory exposure
Extensions for assignments or administrative tasks
Assistance with household activities
Early communication with employers, educational institutions and family members can help prevent a crisis caused by repeatedly exceeding current capacity.
Managing a Relapse
During a relapse, it may be necessary to reduce activity below the usual baseline.
A relapse plan may include:
Reducing non-essential commitments
Increasing planned rest
Simplifying meals and self-care
Minimising sensory stimulation
Maintaining hydration and nutrition
Asking for help early
Reviewing possible triggers
Seeking medical advice if the deterioration is unusual, severe or prolonged
Returning to the previous activity level too quickly may trigger another crash. Recovery should be gradual and guided by symptoms rather than by a predetermined deadline.
HOW ROWAN HEALTH SUPPORTS YOU
Every person experiences ME/CFS differently. Although the diagnosis may be the same, the balance between post-exertional malaise, fatigue, sleep disturbance, cognitive symptoms, autonomic difficulties, pain and the impact on daily life varies considerably from one individual to another.
At Rowan Health, we begin with a comprehensive assessment designed to understand not only your diagnosis, but also how the condition affects your overall health, lifestyle and quality of life. Together, we explore your symptom history, pattern of post-exertional malaise, present functional capacity, sleep, cognition, pain, digestive and autonomic symptoms, existing medical conditions, current treatments and personal priorities.
We also consider whether your presentation is most consistent with ME/CFS or whether another cause of chronic fatigue, an associated condition or a combination of factors requires further investigation. Where appropriate, we review available medical results and may recommend that specific investigations are discussed with your GP.
Rather than offering a standard chronic-fatigue treatment package, we use this information to develop a personalised supportive care protocol tailored to your clinical presentation, present energy limits and treatment goals.
Your protocol may combine:
Education about ME/CFS and post-exertional malaise
Individualised pacing and energy-management strategies
Symptom and activity monitoring
Sleep and lifestyle guidance
Support for pain, cognition, digestion or autonomic symptoms
Identification and correction of demonstrated nutritional deficiencies
Practical strategies for work, family life and flare management
Carefully selected supportive interventions
Where clinically appropriate, supportive interventions may include medical acupuncture, manual or craniosacral approaches, herbal medicine, medical homeopathy, adapted breathing, medical Qicong and neuro-coaching. These are integrated within a coordinated care programme rather than delivered as isolated treatments, and their suitability is assessed individually against your symptoms, medical history, current medication, sensitivity and risk of provoking PEM.
Ongoing monitoring is central to our approach. Progress is not measured only by whether you are doing more, but also by whether you are experiencing fewer crashes, recovering more quickly, sleeping better and achieving a more stable and predictable level of function. Your protocol is reviewed and adjusted as your symptoms, tolerance and priorities change.
Where appropriate, we also communicate with your GP or specialist to help ensure your care remains coordinated within your wider healthcare pathway.
Our aim is not to encourage you to push beyond your limits, but to help you understand your condition, reduce avoidable deterioration, improve physiological stability and support the best possible level of function and quality of life.
When to Seek Medical Advice
New or worsening symptoms should not automatically be attributed to ME/CFS.
You should seek prompt medical assessment if you develop:
New focal weakness, facial drooping or speech difficulties
Rapidly progressive muscle weakness
Difficulty swallowing or breathing
Severe or persistent chest pain
Significant breathlessness at rest
Recurrent fainting
New seizures
Unexplained weight loss
Persistent fever or drenching night sweats
Enlarged or persistently painful lymph glands
New bladder or bowel dysfunction
Severe dehydration
Difficulty maintaining adequate nutrition
A sudden, severe or unusual headache
A significant or unexplained change in mental state
Thoughts of harming yourself
Symptoms that are markedly different from your usual pattern
People with severe or very severe ME/CFS may also require urgent medical or community support if there are signs of malnutrition, dehydration, pressure injury or inability to meet essential personal-care needs.
If you experience severe symptoms such as chest pain, difficulty breathing, sudden weakness, signs of stroke or loss of consciousness, call 999 immediately or attend your nearest Emergency Department.
If symptoms are severe, rapidly worsening or causing immediate concern, contact NHS 24 on 111. In a medical emergency, call 999.
If your symptoms are severe, rapidly worsening or causing immediate concern, contact NHS 24 on 111. In a medical emergency, call 999 or attend your nearest Accident & Emergency department.
FAQs
Is ME/CFS a recognised medical condition?
Yes. ME/CFS is recognised by the NHS, NICE and major international health organisations. It is a complex, long-term physical illness and is not simply ordinary tiredness, lack of fitness or a psychological disorder.
Is ME/CFS the same as being chronically tired?
No. Persistent fatigue can have many causes, including anaemia, thyroid disease, sleep disorders, medication effects and other medical conditions. ME/CFS is characterised by a specific symptom pattern, particularly post-exertional malaise and a substantial reduction in previous activity.
What is post-exertional malaise?
Post-exertional malaise is a delayed and disproportionate worsening of symptoms following physical, cognitive, emotional, social, sensory or upright activity. Symptoms often become worse 12 to 48 hours after the trigger and may persist for days or longer.
Is there a blood test for ME/CFS?
No single blood test currently confirms ME/CFS. Blood tests and other investigations are used to identify alternative explanations and treatable associated conditions.
Can normal blood results rule out ME/CFS?
No. Routine blood tests are often normal in people with ME/CFS. Normal results help exclude certain other conditions but do not mean that the symptoms are imaginary or insignificant.
Is ME/CFS caused by depression or anxiety?
No. ME/CFS is not caused by depression or anxiety. However, any long-term and disabling illness can affect emotional wellbeing, and mental-health conditions may coexist and deserve appropriate support.
Should people with ME/CFS exercise?
Fixed, automatically increasing exercise programmes should not be used as a treatment for ME/CFS. Activity must remain within the person’s present energy limits and be adjusted if it causes delayed deterioration. Some stable individuals may tolerate carefully adapted movement, while others may find that basic daily activity already reaches their limit.
What is the difference between ME/CFS and fibromyalgia?
The conditions share symptoms, including fatigue, sleep disturbance, pain and cognitive difficulties. Fibromyalgia is primarily characterised by widespread pain and altered pain processing. ME/CFS is defined particularly by post-exertional malaise and reduced tolerance of physical and cognitive exertion. Some people meet the criteria for both.
Is ME/CFS the same as Long COVID?
No, but the conditions may overlap. Some people with Long COVID meet the diagnostic criteria for ME/CFS, particularly when post-exertional malaise is present. Others have a different pattern of post-COVID symptoms.
Can ME/CFS be cured?
There is currently no single established cure. Some people improve significantly, while others remain affected at varying levels. Appropriate pacing, symptom management, treatment of associated conditions and personalised support may improve stability and quality of life.
Can people recover from ME/CFS?
The course varies considerably. Some people experience meaningful improvement or remission, while others have persistent or fluctuating symptoms. It is not possible to predict an individual outcome with certainty. Reducing repeated PEM and addressing treatable associated factors may help create better conditions for improvement.
How does Rowan Health assess ME/CFS?
Assessment considers your symptom history, post-exertional malaise, functional capacity, sleep, cognition, autonomic symptoms, pain, associated conditions, medical investigations and personal goals. Support is then built around your individual pattern rather than a universal chronic-fatigue protocol.
Sources & references
National Institute for Health and Care Excellence. Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management. NICE Guideline NG206. Published 2021; last reviewed 2025.
Institute of Medicine. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. National Academies Press. 2015.
Carruthers BM, Jain AK, De Meirleir KL, et al. Myalgic encephalomyelitis/chronic fatigue syndrome: clinical working case definition, diagnostic and treatment protocols. Journal of Chronic Fatigue Syndrome. 2003.
Carruthers BM, van de Sande MI, De Meirleir KL, et al. Myalgic encephalomyelitis: International Consensus Criteria. Journal of Internal Medicine. 2011.
Walitt B, Singh K, LaMunion SR, et al. Deep phenotyping of post-infectious myalgic encephalomyelitis/chronic fatigue syndrome. Nature Communications. 2024;15:907.
Appelman B, Charlton BT, Goulding RP, et al. Muscle abnormalities worsen after post-exertional malaise in long COVID. Nature Communications. 2024;15:17.
Haunhorst S, Dudziak D, Scheibenbogen C, et al. Towards an understanding of physical activity-induced post-exertional malaise: insights into microvascular alterations and immunometabolic interactions in post-COVID condition and ME/CFS. Infection. 2024.
Vøllestad NK, Mengshoel AM. Post-exertional malaise in daily life and experimental exercise models in patients with ME/CFS. Frontiers in Physiology. 2023;14:1257557.
Jason LA, Sunnquist M. The development of the DePaul Symptom Questionnaire: original, expanded, brief and paediatric versions. Frontiers in Pediatrics. 2018;6:330.
Cotler J, Holtzman C, Dudun C, Jason LA. A brief questionnaire to assess post-exertional malaise. Diagnostics. 2018;8(3):66.
Komaroff AL, Lipkin WI. ME/CFS and Long COVID share similar symptoms and biological abnormalities: road map to the literature. Frontiers in Medicine. 2023;10:1187163.
Clinical Review
Clinical content reviewed by
Rowan Health
Last reviewed:
22 July 2026
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Every person’s experience of ME/CFS or persistent fatigue is different. A comprehensive assessment helps us understand your symptom pattern, post-exertional response, overall health, present functional capacity, daily challenges and personal priorities.
This allows us to distinguish ME/CFS from other possible causes of chronic fatigue and develop a personalised supportive care programme adapted to your individual needs and energy limits.