Almost all of the women I work with tell me that their lives are filled with a constant stream of stress, both large and small. They shrug their shoulders when they say this, as if chronic stress were a normal and necessary part of the human experience. And they are often surprised when I tell them that this never ending stress could be behind so many of the reasons that they find themselves coming to see me.

Although there is far more information and discussion on what stress can do to your body and overall health these days, the conversation is often missing when seeing conventional medical practitioners. That’s partly due to the constraints of insurance billing codes and time limits (often, primary care doctors are scheduled so tightly they have less than ten minutes to spend with each patient), and party because conventional physicians are trained to deal with disease. They’re looking for specific diagnoses, but the one that fits most for the myriad symptoms caused by chronic stress, adrenal dysfunction, is only recognized at two extremes.

Adrenal dysfunction is something I’ve talked a lot about. I’ve spent decades gathering information on how the adrenal glands work, how they impact health, and how to help women heal their adrenals naturally. Along the way, it’s become clear how few women have a true understanding of how their stress response works. While adrenal dysfunction is part of the issue, in reality the entire HPA axis is at the heart of the problem. But many women have never even heard of it! This article is meant to remedy that by looking at a brief overview of the parts of the HPA axis and what they do, what happens when this axis becomes dysregulated, and some simple steps you can take to calm the stress response and keep yourself healthy.

What is the HPA axis?

The Hypothalamic-Pituitary-Adrenal (HPA) axis is exactly what it sounds like – the interconnected relationship between several glands in the nervous and endocrine systems that secrete hormones essential to survival.

The HPA axis has the primary function of helping your body respond to stress. Here’s how it works:

The hypothalamus is a small neuroendocrine area in the brain, just above the brainstem. It is responsible for releasing hormones from the pituitary gland, which is just below the hypothalamus. These hormones enter the bloodstream and head to the kidneys where they prompt the adrenal glands, which sit atop the kidneys, to secrete a range of hormones.

In times of stress, the hypothalamus releases corticotropin releasing hormone (CRH) which sends this message to the adrenals: Send in the adrenocorticotropic hormone (ACTH). The ACTH travels through the bloodstream to the adrenals, where it induces the release of cortisol, a primary “stress hormone”.

Cortisol causes your body functioning to change in response to this stress. Blood pressure increases and your muscles receive more blood, in case flight is required. Circulating glucose levels also rise, providing your body with extra energy to deal with the stressor.

Ideally, cortisol levels (and body functioning) return to normal when the stressor has passed. Unfortunately, with the presence of constant stress, cortisol levels in the blood often remain too high. High cortisol levels inhibit some processes, like reproduction, that are less important to survival.

That’s fine in the short term – who is thinking about sex when a wild animal is chasing them? But when it becomes the norm, eventually the high cortisol levels will create a negative feedback loop, shutting down the stress response. This can lead to hormonal imbalances that cause a variety of serious symptoms.

Another important factor is the ratio of DHEA to cortisol. In testing, cortisol levels can appear normal, but the DHEA:Cortisol ratio will indicate a dysregulated HPA axis.

What happens when your HPA axis becomes dysregulated?

Both high cortisol levels and abnormally low levels of cortisol impact the HPA axis. In order to adequately deal with stress, this axis should be functioning properly. But it can become dysregulated in two ways — by being either overstimulated or understimulated. And each come,with a wide range of undesirable health conditions.

An overactive HPA axis can lead to both physical and psychological problems. People with chronically high cortisol levels may have a suppressed immune response which makes them more vulnerable to infection. Research has shown that high cortisol has been linked to obesity, cardiovascular disease, and type 2 diabetes, negative impacts on cognition and memory, and mood disorders. Other conditions related to hyperactivity in the HPA axis include anorexia nervosa, obsessive compulsive disorder, panic disorders, alcoholism, and hyperthyroidism.

On the flip side, low activity in the HPA Axis can lead to conditions like adrenal insufficiency, chronic fatigue syndrome, fibromyalgia, depression, post-traumatic stress disorder in adults, rheumatoid arthritis, asthma and eczema, to name just a few.

As you can see, there are a lot of good reasons to keep your HPA axis functioning optimally. And the good news is, there are some easy ways within your control to do so. It’s all about reducing stressors through lifestyle choices.

Tips for Reducing Stress and Keeping Your HPA Axis Calm

Despite what you may hear from conventional medical professionals, a prescription is not the best way to address the issue of chronic stress. Medication simply masks the symptoms — it’s a bandaid, not a cure. If you don’t pay attention to the source of the problem – the stressors you face daily – it’s unlikely anything will truly change. As soon as you stop taking the medication, symptoms are likely to flare up. And long term use of any prescription comes with the potential for serious side effects. Following are some natural, simple changes you can make to balance out HPA axis activity and feel great.

Keep blood sugar stable with a healthy diet

You may not have ever considered a poor diet a source of stress, but your body does! Long term instability of blood glucose levels certainly contributes to inflammation and cortisol production. Some easy ways to stabilize blood sugar include avoiding added sugars as much as possible; eat plenty of fresh fruits and vegetables, healthy fats, and fiber; eat at regular intervals; avoid processed foods and high carbohydrate choices; and increase phytonutrients with vividly colored vegetables, spices, and herbs.

Skip the caffeine

So many women tell me coffee is a necessity – and it might be just what you need to get you going in the morning. But one cup is plenty. Caffeine mimics the stress response, so your body needs a break!

Learn to say no to stress

You can’t always do something about stressors you’re unaware of, but many of us have filled our days with avoidable stress. You don’t have to say yes to everything others ask of you. Examine your life and start by cutting out just one activity that makes you cringe when you think about it. Keep doing this until the only things left are those that you can get excited about!

Protect your sleep

We all know that sleep is essential – it’s obvious from the way we feel when we miss out on it! When lack of sleep becomes the norm, it’s very likely that your stress response is on overdrive. Create a schedule that works for your life, but still builds in at least 7-8 hours of sleep. For instance, if you can’t get to bed early, don’t set your exercise routine for 5 am. Or if you find yourself awake at 4 each morning, push your bedtime back an hour or two.

Get up and move

It may seem contradictory to move more if your body is already feeling stressed, but physical activity is vital to good health. Extreme sports aren’t a great idea if your HPA axis is already out of balance, but gentle movement like yoga, t’ai chi, or stretching can really help. Finding ways to move that you truly love will make it seem easy. Get up and dance with your children, take a long walk after dinner, or hop on a bike and go for a ride.

Ensure adequate nutrient intake

A healthy diet is a great start, but sometimes it’s just not enough, especially when your HPA axis is overworked. Discuss your individual needs with a functional medicine practitioner and consider finding a supplement regimen designed especially for you.

A proper understanding of the function of your HPA axis, and how stress impacts this function, can be the first step towards a healthier, low-stress life. Doesn’t that sound great?



Chronic Stress and the HPA Axis:
Dunlavey CJ. Introduction to the Hypothalamic-Pituitary-Adrenal Axis: Healthy and Dysregulated Stress Responses, Developmental Stress and Neurodegeneration. J Undergrad Neurosci Educ. 2018;16(2):R59-R60. Published 2018 Jun 15.

Reviewed by Dr. Mark Menolascino, MD