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Adrenal Fatigue and Menopause Symptoms: The Cortisol Connection

Evidence-based Reviewed Article

An image of a aged woman holding her templesIt is beyond dispute that the most important hallmark of menopause is hormonal fluctuations. Therefore, it is unsurprising that hormone-producing organs, like the adrenal glands, and their disorders are the subject of multiple studies to determine their role in menopause. Considering adrenal fatigue is one of the most common adrenal conditions, there are often questions about the relationship that exists between adrenal fatigue and menopause. Is there even a relationship at all? Here's the evidence.

The Adrenal Glands and Menopause

The adrenal glands are small, triangular-shaped endocrine glands located on both kidneys. Also known as suprarenal glands, the adrenals help in regulating different bodily functions, especially those relating to stress, immune responses, and blood pressure. While the adrenal glands produce several hormones, the main ones are cortisol, aldosterone, adrenaline, and sex hormones (androgens and estrogen).

Menopause marks the end of a woman’s menstrual cycle and, effectively signals the end of her childbearing years. Technically, it has occurred after a woman goes 12 consecutive months without getting a period. Although the exact age menopause starts varies, it typically occurs around the late 40s to early 50s.

The time leading up to menopause is known as perimenopause, and during this transitional period, the supply of mature eggs by the ovaries becomes irregular. This is also accompanied by a reduction in the production of estrogen. During menopause, the ovaries no longer produce eggs, and there is a drastic reduction in estrogen and progesterone production. Most of the symptoms of menopause arise due to the significant drop in estrogen.

To make up for this reduction in estrogen production, the adrenal glands start producing androstenedione, a hormone that can be converted into estrone and estradiol, both forms of estrogen. This may help mitigate some menopausal symptoms. Also, this helps preserve the function of estrogen in maintaining bone and heart health.

Cortisol and Menopause

Cortisol is referred to as the stress hormone in the body, and it plays a significant role in the “flight-or-fight” response. The adrenal glands produce cortisol when the body is stressed, and studies show that the cortisol levels in the body also increase during menopause.1 The reason for this is the hormonal fluctuations experienced during menopause, as the constantly increasing and decreasing hormonal levels act as stressors on the body.

Also, the body often regulates cortisol levels using progesterone, a precursor of cortisol. When the body is exposed to high stress situations, progesterone levels decrease, as the body utilizes it in cortisol production. However, since progesterone levels naturally decline in menopause, there is reduced control over cortisol levels in the body and they may spiral out of control.

Relationship Between Adrenal Fatigue and Menopause

The body is constantly being exposed to stressors, and even more so in recent times, considering the increase in environmental pollution and diet. Normally, the body efficiently manages stress through the NeuroEndoMetabolic (NEM) Stress Response. This system consists of six circuits comprising several organs in the body working together to keep stress levels low.

However, in the face of chronic stress, one or more of the NEM circuits may dysregulate, causing Adrenal Fatigue Syndrome (AFS). Also known as adrenal fatigue, AFS is the non-Addison's type of adrenal dysfunction in which the body’s stress response cannot keep up with life’s chronic stressors.

An image of a woman holding a magnifying glass with the word estrogen printed on itWhen a woman reaches menopause, her ovaries stop producing eggs and significantly reduce the production of estrogen and progesterone. To fix this, the body directs the adrenal glands to start producing estrogen. However, in adrenal fatigue, there is a reduction in hormone production by the adrenal glands, and this affects estrogen production too.

Therefore, there may be an exacerbation of the menopausal symptoms a woman is experiencing. Also, considering that estrogen has other bodily functions, especially in maintaining bone health, a woman with adrenal fatigue and menopause may be at high risk of osteoporosis.

The relationship between adrenal fatigue and menopause also extends to cortisol levels. In the early stages of adrenal fatigue, there is a high level of cortisol in the body as the adrenal glands are trying to combat chronic stressors. The issue with this is that high cortisol levels in the body can worsen menopause symptoms.

Signs of Adrenal Gland Problems in Women

There are several signs and symptoms of adrenal gland problems in women and they include:

  • Sleep disturbances
  • Irritability
  • Anxiety or depression
  • Reduced sex drive
  • Lightheadedness
  • Brain fog
  • Recurrent infections
  • Increased blood sugar levels
  • Weight gain
  • Cravings for salty and sugary foods
  • Fatigue

Since some of these symptoms are also experienced by women undergoing menopause, adrenal gland problems during menopause can lead to worsening of the symptoms.

Adrenal fatigue and Menopause: Supporting the Adrenal Glands During Menopause

During menopause, the adrenal glands assume the primary responsibility of producing estrogen. This helps to maintain certain bodily functions and reduce the severity of menopausal symptoms. Therefore, it is essential for you to maintain and support the adrenal glands during this period. The following are some of the best ways to do just that.

Avoid Stressors

The primary cause of adrenal fatigue, one of the most serious adrenal gland problems, is chronic stress. Therefore, taking steps to reduce stress levels in the body can help reduce the severity of adrenal fatigue and menopause.

Beyond adrenal fatigue, stress can increase the adrenal production of cortisol. During menopause, the body is already dealing with a significant level of stress due to hormone fluctuations. Adding even more stressors to the mix will only worsen conditions.

Although avoiding stressors is easier said than done, you can take steps to reduce your perceived stress load, rest more often, and support your health. When possible, try to stay away from both physical and emotional issues that will increase your stress levels. Also, you should not hesitate to consider talking to a behavioral therapist or entering support groups to share your thoughts instead of brooding over them. Practices like journaling, yoga, and meditation can also help.

Get Adequate Sleep

Studies show that poor sleep quality is associated with high levels of stress.2 This correlates to an increase in cortisol levels, which puts a lot of strain on the adrenal glands, which should be at rest during the night.

To get quality sleep, consider going to bed at the same time every night, as well as waking at the same time every morning. Also, exercising a few hours before sleeping and limiting exposure to screens and bright lights before bed can help improve sleep duration and quality.

Limit Caffeine, Alcohol, and Smoking

An image of a mug of coffee, cigarette, and alcoholBoth caffeine and alcohol can affect the quality of sleep, which by implication, can increase stress levels. Caffeine is a stimulant and can block the brain’s perception of sleepiness, which then reduces the duration of sleep.

On the other hand, alcohol is considered a depressant, and while it can make you fall asleep faster, it prevents deep, restorative sleep. Aside from caffeine and alcohol, smoking is also implicated in poor sleep quality.

Beyond their effects on sleep quality, drinking and smoking have detrimental effects on cardiovascular health. By destroying blood vessels, blood pressure increases, which serves as a form of stress to the body, eventually requiring the adrenal glands to work more.

Consider Meditation Practices

Meditation and mindfulness practices can help alleviate stress, which is essential for maintaining the adrenal glands. These practices help you focus on the present moment and get your body out of 'fight or flight' mode, lowering cortisol demands. There are several different meditation and mindfulness practices, including mindfulness meditation, visualization, breathing exercises, yoga, tai chi, and pilates. While it may seem counterintuitive, exercise can also help relieve stress through its positive cardiovascular effects.

Reduce Intake of Processed Foods

The quality of food we consume as a society has worsened over the last few years. For one, there has been an increase in junk foods in circulation, and these foods are often high in sugars and processed components. Also, there has been an increase in the use of fertilizers on plants, adding toxins to even otherwise healthy foods.

Instead, aim to consume more whole foods with minimal processing, focusing on fruits, vegetables, whole grains, and lean protein. Try to get organic foods whenever possible.

Making dietary adjustments is necessary when trying to reduce stress and combat adrenal gland problems. You can talk to a dietician or your health professional when trying to devise a new eating plan. Make sure you are getting enough essential vitamins as well, including vitamins C, B5, E, D, and magnesium. As with all supplements, ensure you talk to your healthcare provider before adding these vitamin supplements to your diet.

Adrenal fatigue and Menopause: How to Control Cortisol During Menopause

Cortisol levels increase during menopause and can further lower the sex hormone levels in the body, worsening menopausal symptoms. Additionally, excess cortisol can have other serious effects on health. Therefore, it is essential to keep cortisol levels controlled during menopause.

The most typical way to control cortisol during menopause is bioidentical hormone replacement therapy (BHRT). Although medical practitioners only recommend this when needed because of their side effects, BHRT care options can increase estrogen and progesterone levels in the body, neutralizing the effects of high cortisol levels.

Aside from BHRT, proactively taking steps to reduce stress levels in the body is crucial. This includes regular exercise, limiting alcohol and sugary foods, and relaxation practices. Also, the role of getting good sleep cannot be underestimated.

Adrenal Fatigue and Menopause: Are Supplements Useful?

In the management of adrenal fatigue and menopause, it is worth considering the usefulness of supplements. To alleviate the symptoms of menopause, supplements like EPO Pro, and bioidentical hormone replacement like  Bi-Estrocare, E3-Cream, and P-Balance cream by Dr. Lam can be effective. EPO Pro, with evening primrose and gamma-linolenic acid (GLA), addresses symptoms like hot flashes and supports skin, hair, and nail health. Bi-Est Balance combines bioidentical estriol and estradiol for hormonal harmony and includes skin-soothing ingredients like Aloe Barbadensis gel. E3-Balance, a natural Estriol Cream, balances hormones with ingredients like Aloe Vera Gel and Shea Butter. P-Balance Cream tackles estrogen dominance and menopausal symptoms with micronized bioidentical Progesterone USP, enhancing absorption and offering an all-natural formulation for both women and men. Never start hormones without first asking your provider and be sure to get regular monitoring if you are on BHRT.

Assessing Adrenal Glands Function

Banner image of a color stress testAssessing the function of the adrenal glands can help tell if they are depleted. This is essential in managing the risk of adrenal fatigue and menopause. This adrenal gland assessment can be done via saliva of a four-point cortisol test that will give a good overall picture of your adrenals thorughout the day. Some saliva tests can also test the free and active form of Progesterone, estrogen, DHEA, and Testosterone.

While you may suspect your adrenal glands are depleted due to the presence of symptoms associated with adrenal gland problems, these are not reliable enough to make a definitive assessment. It is also worth noting that some of these symptoms may merely be menopausal symptoms or have other causes.

Adrenal fatigue and Menopause: Conclusion

The relationship between adrenal fatigue and menopause is linked to the role of the adrenal glands in producing estrogen during menopause. Also, cortisol production, which is a function of the adrenal glands, can impact menopause. However, adrenal fatigue does not cause menopause, and neither does menopause cause adrenal fatigue. Adrenal fatigue can only worsen menopausal symptoms.

To support the adrenal glands, it is important to avoid stressors, get adequate sleep, limit caffeine intake and avoid other processed and unhealthy foods.  Supplements are also a great option when trying to manage adrenal fatigue and menopause. However, care is needed when taking supplements. Ensure you only buy from reputable sources and speak to your healthcare provider before adding them to your diet.

For personalized guidance, check out Dr. Lam's Adrenal Fatigue Nutritional Recovery Program, a comprehensive program designed to address the specific nutritional needs of individuals experiencing both adrenal fatigue and menopause simultaneously. In just 30 days, you'll receive expert guidance on how to optimize your diet, incorporate stress-reducing practices, and select the right supplements to support your adrenal health during this transitional phase of life.

To learn more, schedule a free consultation at +1 (626) 571-1234 or utilize our Ask The Doctor system here. Let us help you achieve holistic wellness through informed nutrition and support.

© Copyright 2024 Michael Lam, M.D. All Rights Reserved.

Kapoor, Ekta. "Menopause Symptoms and the Cortisol Response." Menopause, vol. 29, no. 1, Jan. 2022, pp. 6-7. Wolters Kluwer Health, Inc., doi:10.1097/GME.0000000000001907.

Alotaibi, A.D., et al. "The Relationship Between Sleep Quality, Stress, and Academic Performance Among Medical Students." Journal of Family & Community Medicine, vol. 27, no. 1, 2020, pp. 23-28. Medknow Publications, doi:10.4103/jfcm.JFCM_132_19.

Dr. Lam’s Key Question

No, adrenal fatigue does not cause menopause, and menopause does not cause adrenal fatigue. They are independent of each other. However, adrenal fatigue can exacerbate menopausal symptoms due to the reduced production of the necessary sex hormones by the adrenal glands.

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