The adrenal glands are your body’s primary "shock absorbers." These two little thumb-sized glands sitting on top of your kidneys produce hormones including norepinephrine, cortisol and DHEA that allow you to respond to the conditions of your daily life in healthy and flexible ways.
Norepinephrine (also called adrenaline) is commonly thought of as the ﬁght-or-ﬂight hormone. It’s produced when something is (or you think it is) threatening. This hormone makes your heart pound, your blood rush to your heart and large muscle groups, your pupils widen, your brain sharpen, and your tolerance for pain increase—basically, it prepares you for battle. Modern-day battles are most likely things like pushing your body to keep going when it’s fatigued, dealing with a stressful job, and reacting with quick reﬂexes to avoid a trafﬁc accident. Think of these adrenaline surges as withdrawals from a bank, to help you get through life’s rough spots. If you have gotten into the habit of withdrawing adrenaline from your account too often, you’ll eventually be overdrawn and your adrenal glands will be overwhelmed. Then, you’ll have too little adrenaline when you really need it.
Cortisol increases your appetite and energy level while toning down your immune system’s allergic and inﬂammatory responses. This hormone stimulates the storage and release of energy in the body, helps the body resist the stressful effects of infections, trauma, and temperature extremes, and helps you maintain stable emotions. Synthetic versions of cortisol—prednisone and cortisone, for example—are often prescribed to help people perk up and feel better so they will eat, drink, and move around more and therefore be better able to ﬁght off illness or heal from an injury. Ideally, cortisol is released into the system only on an occasional basis, rather than in response to chronic stress. If cortisol levels become too high for too long, they may have undesirable side effects, including loss of bone density, muscle wasting, thinning of the skin, decreased ability to build protein, kidney damage, ﬂuid retention, spiking blood sugar levels, weight gain, and increased vulnerability to bacteria, viruses, fungi, yeasts, allergies, parasites, and even cancer.
Dehydroepiandrosterone (DHEA) is an androgen that is produced by both the adrenal glands and the ovaries. DHEA helps to neutralize cortisol’s immune-suppressant effect, thereby improving resistance to disease. (Cortisol and DHEA are inversely proportional to each other. When one is up, the other goes down.) DHEA also helps to protect and increase bone density, guards cardiovascular health by keeping "bad" cholesterol (LDL) levels under control, provides vitality and energy, sharpens the mind, and helps maintain normal sleep patterns. Like norepinephrine and cortisol, DHEA also improves your ability to recover from episodes of stress and trauma, overwork, temperature extremes, etc. And if a woman is experiencing a decline in libido due to falling testosterone levels, often it is declining DHEA levels that are at the root of the testosterone deﬁciency, as DHEA is the main ingredient the body uses to manufacture testosterone.
If the intensity and frequency of the stresses in your life—either those internally driven (such as your perceptions about your life) or those externally driven (such as having surgery or working the night shift)—become too great, then over time your adrenal glands will begin to become exhausted. This will mean that you are much more likely to suffer from fatigue and menopausal symptoms. And a woman in a state of adrenal exhaustion is likely to find herself at a distinct disadvantage when entering perimenopause, because perimenopause itself is an additional form of stress.
Adrenal exhaustion usually suggests that there are long-standing life problems in need of resolution. These issues will loom all the larger when seen with the no-nonsense mental clarity of perimenopause, but not only will adrenal exhaustion make the transition needlessly unpleasant, it also can deprive a woman of the resources she needs to address those issues and to take full advantage of the creative promise of the second half of her life.
Abnormal adrenaline and cortisol levels can result in mood disorders, sleep disturbances, reduced resistance to disease, and changes in vital circulation. Because these side effects are not uncomfortable enough to be intolerable, a self-destructive, adrenal-depleting lifestyle often continues. DHEA, which helps the body recover from this sort of chronic abuse, gets revved up full time instead of only episodically. Gradually the adrenal glands become seriously exhausted, with the ﬁrst and most profound effect being their waning ability to produce DHEA. As levels of this restorative hormone fall, cortisol and adrenaline levels begin to ﬂuctuate as well, as the adrenal glands attempt to ﬁll increasingly impossible orders for more support.
The result is often relentless, debilitating fatigue that is the hallmark of adrenal exhaustion. Though this fatigue is often accompanied by depressed mood, irritability, and loss of interest in life, this doesn’t mean that the adrenal problem is necessarily the cause of the mood change, any more than similar problems are always caused by thyroid malfunction. That is why these emotional symptoms do not always go away with treatment—the underlying issues remain unresolved until they are specifically addressed by behavior and lifestyle changes.
Here are some typical signs that your adrenals may need attention: You awaken feeling groggy and have difficulty dragging yourself out of bed. You can’t get going without that first cup or two of caffeinated coffee or tea. You not only rely on sugary snacks and caffeine to get through the day but find you actually crave sweets, particularly in the late morning or afternoon. (Perhaps you’ve even been diagnosed with hypoglycemia.) Your thinking is foggy and you have memory problems. You suffer from recurrent infections, headaches and depression. At night, though exhausted, you have trouble falling asleep as the worries of the day replay in your head and you suffer from insomnia. Ordinary stresses have an impact that is out of proportion to their importance. You wonder what happened to your interest in sex. If this description fits you, your adrenals may be running on empty, even if all your conventional medical tests are normal.
Conventional blood tests, taken at whatever time your doctor has scheduled your appointment, might indicate that your adrenals are normal. However, a better diagnostic approach will test your levels at different times of the day, which is much more likely to reveal an out-of-whack pattern of cortisol or DHEA secretion. Adrenal fatigue is characterized by cortisol levels that are too high at night and not high enough in the morning.
Unabated stress over long periods of time that is not addressed combined with a nutrient-poor diet is what usually leads to adrenal exhaustion.
If an adrenal test shows that you are producing inadequate levels of adrenal hormones, several routes are available for increasing either DHEA, cortisol, or both. First, you can take the hormone directly. If you take DHEA, opt for small doses of pharmaceutical grade DHEA (5–10 mg/day, but possibly up to 25 mg once or twice a day).1 Have your levels retested every three months, and when levels return to the normal range, the dose should be gradually tapered until you’re off the hormone completely.
Some individuals require very small doses of hydrocortisone, which can be used safely and effectively if prescribed by a health care provider knowledgeable about how and when to use it.
Be aware that if you supplement your adrenal hormones in dosages that are too high, or if you take supplements for too long, the result can be permanent depression of adrenal function.
A far better option over the long run is to restore adrenal health and function so your adrenals can eventually produce the hormones you need on their own. That will require making changes in the lifestyle that caused the adrenal depletion. Here are some suggestions: