Your Stress Response

Your adrenal glands are small but mighty! These two almond-shaped glands which sit on top of your kidneys have a big job. They make and release several hormones that help you manage stress, regulate your blood pressure, and balance blood sugars and electrolytes. They even help make sex hormones such as estrogen, progesterone, and testosterone, although to a much lesser degree than the ovaries or testes. During menopause, this balance shifts and the adrenals take over production from the ovaries so it is extremely important to address adrenal health around menopause. 

How the Adrenal Glands Work

The adrenal glands are best known for their role in the fight or flight response. They help you manage stress, be it temporary or long-term, although the system is best suited to short-term stressors

When you encounter a stress, your adrenal glands release epinephrine or adrenaline and the “stress hormone” cortisol. This triggers a fight or flight response throughout the body to help you get out of danger or complete the stressful task at hand. Think: faster heart rate, increased alertness, and blood pumping to your muscles. Once the danger has passed or the task is completed, the body shifts back to rest and digest mode as the adrenaline rush declines. This system is necessary for moments of stress but the fight or flight response is not sustainable long term

Unfortunately, we are under more continuous stress in modern life and your body cannot differentiate between different types of stress. The response is the same whether you are running for your life or facing an everyday stress such as: feeling overwhelmed at work, battling traffic, fighting with your partner, or missing a meal because you’re on-the-go. Even heavy exercise can be perceived by the body as stress, stimulating the release of adrenaline and cortisol which trigger the fight or flight response and promote other changes in the body. 

Hyperactive Adrenals

Initially, the adrenal glands are able to keep up to the increased demand of chronic stress. They become hyperactive, secreting extra cortisol and adrenaline. These hormones are overstimulating and can remain high into the evening when the body is meant to rest. 


Symptoms of Hyperactive Adrenals

Feeling “tired but wired”

Difficulty sleeping 

Waking around 3-4am 

Trouble concentrating / brain-fog 

Cravings for sweets, salty foods, and carbohydrates 

Waking unrested 

Consistent afternoon energy slumps

Anxiety or depression 

Weight gain or difficulty losing weight 



If the stress continues for a long time, or you have a short period of excessive stress, the adrenal glands can no longer keep up. They burnout and cortisol levels drop. Typically this presents primarily as extreme fatigue, but many other symptoms can accompany this stage of adrenal burnout. 

Underactive Adrenals

Symptoms of Underactive Adrenals

Extreme fatigue / exhaustion 

Difficulty sleeping 

Trouble concentrating / brain-fog 

Lack of motivation / burnout 

Cravings for sweets, salty foods, and carbohydrates 

Anxiety or depression 

Weight gain or difficulty losing weight 

Low libido 

Frequent illnesses 


The thyroid gland has an intimate relationship with the adrenal glands and suffers, often adding hypothyroid symptoms to the picture. Since the adrenal glands also produce other hormones, adrenal dysregulation decreases the glands’ ability to produce the other hormones - the ones that help regulate blood pressure, blood sugar, electrolytes, and those related to sex hormones (estrogen, progesterone, testosterone). This makes the combination of adrenal dysregulation and menopause particularly troubling since the already over-worked adrenals are meant to become the hub of sex hormone production in addition to their regular functions. Left untreated, adrenal dysregulation can exaggerate symptoms of menopause such as hot flashes, anxiety, low libido. Adrenal health should be assessed and addressed in all symptomatic perimenopausal or menopausal women. 

It is important to note that adrenal dysfunction occurs on a spectrum. Some doctors do not acknowledge an adrenal problem until your adrenal glands are no longer capable of producing hormones including cortisol, a condition known as Addison Disease. However, I believe the zone between adrenals that function well and adrenals that don’t function at all deserves attention.

Acknowledging that your adrenal glands are struggling allows more timely treatment to help you turn things around before you bottom-out. 

It’s actually quite easy to test your adrenal function. Cortisol is best assessed through a multi-sample saliva or urine test. Using a test with multiple samples shows what your cortisol rhythm is doing over the course of the day.

A healthy cortisol rhythm starts high in the morning then dips lower throughout the day and evening to help you sleep at night. Adrenal hyperactivity will show elevated cortisol levels throughout the day or a reversed pattern with high levels at night and low levels in the morning. Adrenal underactivity will show low levels of cortisol throughout the day and into the evening.

Depending on whether your symptoms and lab results show adrenal hyperactivity or adrenal underactivity, I will tailor your treatment to lower or boost cortisol levels and heal your adrenal glands.

Lab Testing for Your Adrenals


Saliva Lab Sample 1
Saliva Lab Sample 2