My client, Tricia, is well versed in the issues adrenal imbalances can create. She began experiencing signs of adrenal fatigue many years ago, and I worked with her to help her support her adrenals and feel good again. Because we caught it early, healing came easily with some lifestyle and dietary changes. And because she knew what symptoms to look for, she was able to stay healthy for many years. But a few weeks ago, she was back in my office. She said she was feeling exhausted again, and the things she’d done before just weren’t helping as much.

Because she’s in her mid-50s, I asked if anything had been different in her menstrual cycles recently, and she shared that her periods weren’t as regular as they used to be. I dug deeper, she revealed that although she’d sustained some lifestyle changes long term, the stress in her life continued to build. And of course, the pandemic and concern over the general state of the world didn’t help.

After hearing these things, her symptoms made sense to me. Although we’d worked together before, she’d been younger and was able to handle stress differently. Now, she’d moved beyond the early phases of adrenal dysfunction and was headed towards the most severe stage. Luckily, once I realized what was happening, I could help.

As women move through various hormonal stages in their life, keeping the adrenals healthy can be complicated and frustrating unless women understand how the body’s ability to handle stress changes as we age, particularly when we enter new hormonal phases such as perimenopause or menopause.

There are several stages of adrenal fatigue. I most often refer to three: Tired, Wired, or Tired and Wired. Each has distinct symptoms, and where we are in our lives can be a major factor in which stage we reach when dealing with adrenal dysfunction. That’s because our ability to handle stress shifts as we get older, and the hormonal changes that come with perimenopause and menopause have an impact on the essential hormones that the adrenals produce (and I’m not just talking about cortisol).

Let’s look at the different stages of life and the connection with adrenal function and then I’ll give you some natural ways to support your adrenals throughout all these stages.

Adrenal dysfunction in the early stages

With the onset of a menstrual cycle, even young girls can be vulnerable to hormonal changes that put stress on the adrenals. Adrenal dysfunction in teenagers and women in their early twenties are far less common, however, because their bodies usually haven’t experienced the type of constant stress that is behind adrenal problems. And even if they are faced with major stressors, the rest of their body systems are still functioning as they should, if levels of the hormones produced by the adrenals become slightly imbalanced, the body can correct itself more easily.

Our bodies are equipped to handle stressful situations with a normal stress response. When faced with real or perceived danger your adrenals release hormones like cortisol, adrenaline and norepinephrine. Unfortunately, there’s no difference in response whether the stressor is severe (like you’re being chased by a wild animal), mild (like someone cut you off in traffic) or even enjoyable (like a roller coaster ride).

Most younger women haven’t reached a dysfunctional stage, though they may notice energy fluctuations, feeling a little jittery, digestive trouble, or sleep difficulties. These are all early warning signs. If you can get a handle on the stress in your life quickly, adrenal dysfunction is far less likely to become an issue.

Adrenal issues before menopause

Women who haven’t yet reached perimenopause are prone to hyperactive adrenals, and thus find themselves in the “Wired” stage of adrenal dysfunction. These women are building careers, navigating relationships, have young children, and so many other things that can prompt that stress response.

When these high levels of stress linger, these women end up with a consistently high supply of cortisol and adrenaline in their systems – and that leaves them feeling worn out but also unable to stop. This is often the “superwoman” phase of life and being able to get so many things done might even feel satisfying…until the crash.

The big problem here is that your body is overproducing cortisol, but other important hormones are being put on hold for the adrenals to keep up. That means levels of other essential hormones, like DHEA, are starting to fall. And that can set off a chain reaction in your body.

In addition to feeling always “keyed up,” in this phase women may experience trouble sleeping, anxiety, increased restlessness, and may catch colds or develop infection more frequently.

If you catch the problem in this phase and use some of the tips below to help get your hormone levels back where they belong, you can usually avoid the more severe dysfunction – like Tricia did for years.

Adrenal dysfunction in perimenopause and menopause

When women begin to experience major hormonal changes, underactive adrenals are more often the problem. This is partly due to the naturally changing levels of estrogen and progesterone, and the role of the adrenals in producing these hormones when it’s time for the ovaries to stop. The problem, of course, is if the adrenals are so busy pumping out cortisol still, they can’t take over. That means levels of other important hormones drop – and that’s a stressor to your body. Remember what I said about stressors? They make your body release more cortisol. It can quickly become a nasty cycle.

That is why women in perimenopause and menopause often find themselves in the later phases – either Tired and Wired, or just plain Tired. Each phase is more serious than the last. Your body has become used to the chronic stress; it’s just the way life is. And that leads to problems in multiple body systems. When stress is priority number one, other things – including reproduction, digestion, and immune function – are put on hold.

When overproduction of cortisol becomes the norm, eventually your body just can’t keep up. The adrenals, in essence, start to under produce cortisol.

Symptoms include extreme fatigue, fuzzy thinking, moodiness or irritability, low sex drive, hormonal imbalances and sleep problems. As you move into the Tired phase, the most serious stage of adrenal dysfunction, your body just can’t produce much cortisol at all. When this happens, daily life becomes a major struggle.

This is more apt to happen in perimenopause or menopause because you’ve been dealing with the stress for years – and it’s still coming at you. Women may be at the peak of their careers, juggling the needs of children and aging parents, worried about the state of the world, thinking about the financial strain of sending their children to college, experiencing shifts in their relationship, and so much more. And they just don’t have the same hormonal reserves as their younger counterparts.

Sometimes women dismiss symptoms as “normal” signs of menopause– and miss the adrenal issues altogether! This is when the simple changes made when they were younger don’t have the same impact. Like Tricia, they may find themselves frustrated that the way they learned to manage symptoms isn’t working anymore.

Supporting the Adrenals Through Every Hormonal Stage

Though severe dysfunction will take more time and commitment, adrenal health can be restored at any stage and any age! Let’s take a look at some steps that can make a big difference:

Eating for adrenal health

Because sugar and caffeine are false energy boosts, one of the first things I recommend is to cut back (and eliminate if possible) on both. The problem with the quick pick-me-up they offer is that it doesn’t last long…and the crash can be worse than the fatigue you felt in the first place. Eating whole, unprocessed foods is the best way to support your adrenal health.

Give yourself a boost

Supplements can help ensure you get all the nutrients and minerals you need every day. At the very least, I recommend that women take a high-grade multivitamin complex, as well as fish oil. Depending on the stage of dysfunction you are in, some more targeted support for the adrenals through supplementation may be required. If you’ve reached the point where just getting out of bed feels impossible, I often suggest trying Phosphatidylserine, adaptogenic herbs, sometimes low-dose compounded DHEA, and occasionally deglycyrrhizinated licorice (if the person does not have high blood pressure). Because every woman is so unique, I do NOT recommend taking these without talking with your health care practitioner; they can have some adverse health effects, so it’s important to have accurate test results and the guidance of a professional.

Take time for yourself

So often, women are so busy doing for others that they neglect themselves altogether. Don’t let this happen! Finding time to do the things you want to do is just as important (even more so) than for the things you have to do. I also recommend examining those “have-to” list items. Is it truly something you can’t avoid, or do you just need to learn to say no? Gentle exercise is helpful to supporting the adrenals – as long as it’s something you enjoy. Making a list of stressors can help you focus in on what you may need to change in order to give yourself the attention you deserve.

Protect your sleep

This can be frustrating to hear when part of the problem is that you are having sleep difficulty. But it’s extremely important to adrenal health that you allow your body the time to rest and rejuvenate itself. Often there are simple changes that can reduce the difficulties you are having going to (or staying) asleep.

Heal emotional trauma

Emotional stress is just as damaging as physical stress. If you haven’t released old hurts you may end up in self-destructive patterns that are hard to break the longer you use them to cope. Learning techniques for truly processing the emotional trauma in your past is crucial for true healing of the adrenals.

After reviewing my suggestions for managing adrenal dysfunction, Tricia realized she’d been missing a huge piece of the puzzle. She had long ago adopted healthy eating habits and an exercise routine. But she never took a look at the emotional side of things. As she entered perimenopause, she had been struggling with relationships more than ever. When she stopped to examine why, she noticed some startling negative patterns around how she handled her emotions. That was her first step toward healing, and she’s doing so much better now!

The hormonal journey of women lasts a lifetime. Knowing how to keep hormones balanced through the natural shifts is essential. Supporting adrenal health is a great place to start!

Reviewed by Dr. Mark Menolascino, MD