Fatigue

I'm trying to figure out what is causing this extreme fatigue. I feel completely wiped out even when I get out of bed in the morning. No energy. No desire to do anything that involves leaving the house. The thought of driving anywhere makes me exhausted.

I think it may be caused by:
--the Tamoxifen
--the Effexor X
--the Tamoxifen AND Effexor together
--my lack of estrogen from the ovary removal
--residual fatigue from chemo/radiation
--not being able to sleep at night due to hot flashes

I may need to schedule an appointment with the oncologist to find out what's up. I don't even have the energy for that right now. Ugh! Time for a nap...