After months of tests I have finally been diagnosed with chronic fatigue syndrome. Why did it take so long to be told this was the problem?

Unfortunately, it can take a while before people can be diagnosed with chronic fatigue syndrome (CFS). This is because there is no specific test available for this condition. Doctors have to rule out other treatable illnesses that are hard to distinguish from it.

CFS is diagnosed by incapacitating fatigue that is not relieved by rest, and at least four of the following symptoms for at least six months; sore throat, tender lymph nodes in the neck or underarms, muscle pain, pain in joints with no swelling or redness, impaired short-term memory or concentration, unrefreshing sleep, and extreme exhaustion lasting more than 24 hours after physical or mental exercise.

These symptoms can also be found in many other illnesses, such as infections or psychological disorders.

What causes chronic fatigue syndrome? I was fit and healthy before. I was told a virus can be a reason for it.

Chronic fatigue syndrome is mysterious and frustrating for sufferers. It can be difficult to get exact answers. Several possible causes may be involved -- a viral infection such as Epstein-Barr (which causes glandular fever), herpes virus 6, or a form of retrovirus called XMRV.

A viral infection can trigger a dysfunctional immune response which can lead to the symptoms of CFS. Other possible triggers include hormone imbalances -- studies have shown that people with CFS have lower levels of the hormone cortisol, which is secreted by the adrenal glands, as well as changes in the levels of hormones produced in the hypothalamus or pituitary glands.

Are there any natural remedies that can reduce my exhaustion?

As there is no known cure for CFS, your doctor may need to use a combination of treatments to relieve your symptoms. Lifestyle changes include preventing overexertion, reducing stress, gentle stretching and carefully supervised physical therapy.

A very moderate approach to exercise and activity management is important to avoid over-activity and to prevent a worsening of your symptoms. Cognitive behavioural therapy, in combination with graduated exercise, has been found to help.

There are many natural products that can be taken for CFS, but their effectiveness and long-term safety in most cases isn't known.

Supplements such as L-Carnitine, NADH, DHEA, a combination of fish oil and evening primrose oil, have shown encouraging results. D-ribose, an essential energy source for cells, has been found to improve energy as well as reduce pain associated with CFS.

Acupuncture can also help decrease fatigue, pain, anxiety and other symptoms.

- Niamh Houston