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I was on methotrexate for a couple of years and started out with the pills. As the dose increased, I started having quite a bit of trouble dealing with the side effects, nausea specifically and we changed to injections. It definitely helped with the stomach-related symptoms - I was much less nauseated. However, I did have some for a few days after each dose and I'd manage that with light meals of relatively bland food, plus lots of hot water with a small slice of lemon (settles the stomach). Peppermint or ginger tea also helps with an upset stomach.   In terms of the fatigue, I don't remember it changing very much when I moved to injectable methotrexate, but I do remember that over time, as my body got more used to the drug, it had less of an impact on my life. What probably helped as well was that once I got used to the rhythm of it, knowing that I would have a couple of days of lower energy after my shot, I rearranged my life so I could rest more for a day or two after the injection.