A 48-year-old woman came into my office and said, “I’ve been the CEO of this company for years, but now I’m crying at board meetings. I’m tired, I can’t sleep, I feel anxious all the time, and I feel like I’m losing my mind.� She was also raising three children, was recently divorced, and caring for an aging mother. Too much for one person to handle. She was not only in perimenopause; she was also suffering from “adrenal fatigue.� Is Adrenal Fatigue Real or Just My Imagination? Adrenal fatigue is a common term for a condition (called HPA Axis Dysfunction) that refers to the response of the adrenal glands to chronic stress. The Endocrine Society, the world’s largest organization of Endocrinologists, states that adrenal fatigue is not a real disease, that the symptoms—depression, sleep apnea, fibromyalgia, hypothyroidism, and many others—are so general, they could be caused by many conditions or simply stem from everyday life. Yet, naturopaths and holistic practitioners have successfully treated adrenal fatigue for years, in fact, for centuries. What Happens? Initially, when the adrenals respond to stress, the level of the hormone cortisol rises to adapt to the problem at hand but quickly returns to normal when the stressor is gone. However, with prolonged stress, cortisol may remain too high for too long and the adrenal glands lose their capacity to respond to stress. The Four main causes of Adrenal Fatigue: 1. Insufficient sleep (too few hours, irregular sleep patterns, or night shift work) 2. Emotional stressors (chronic pain, overwork, illness, unresolved emotional trauma, PTSD) 3. Inflammation (from food allergies, environmental toxins, infections, and inflammatory conditions such as rheumatoid arthritis) 4. Blood sugar extremes (from eating sweets and junk food, skipping meals) People who may be considered at high risk for adrenal fatigue include busy new parents and working parents, students in college or grad school, caregivers of aging family members, chronic pain sufferers, and those experiencing ongoing emotional trauma such as PTSD or abuse. Menopause and Adrenal Fatigue Women entering menopause, depleted from years of stress, are at especially high risk for adrenal fatigue. The adrenal and sex hormones work together to keep the body in balance. If the body is under an excess of stress, the adrenals need more building blocks to make more cortisol. They do this by “stealing� the sex hormones, estrogen, progesterone, testosterone, as well as pregnenolone and DHEA. In menopause, these levels are already dropping, and the adrenals often cannot keep up production of cortisol. This is when many women experience extreme symptoms and “burn out.� Treatment of Adrenal Fatigue The state of the adrenal system can be determined by a detailed medical history and by measuring cortisol. Cortisol is measured most accurately with saliva testing, where four samples are collected in a day. The results can show how the adrenals respond to daily stressors and may indicate causes of the patient’s fatigue. Normal cortisol is highest in the morning and lowest around midnight so the person can sleep. Many times, we see patients with cortisol that is high all day. These are the ones who are “tired and wired.� Other patients have low cortisol and may have trouble getting out of bed in the morning but can’t sleep because their cortisol is higher at night. The cortisol pattern will influence the recommended treatment. Adrenal fatigue is treated with diet, lifestyle changes, sleep, adaptogenic herbs*, and supplements, as well as bioidentical hormones. Severe cases may require cortisone supplementation. It can take many months to heal from adrenal fatigue. Adrenal fatigue may be mis-understood by the mainstream medical community, but its symptoms are real. Treating it requires a “whole person� approach. By working with an experienced integrative practitioner, you can discover the root causes of your symptoms, adjust your diet and lifestyle and heal your body. You can get your energy back, relieve your symptoms and be back at the top of your game if you give it time. *NOTE: Adaptogenic herbs from non-toxic plants, roots, and mushrooms are marketed as helping the body resist stressors of all kinds. They have been used for centuries in Chinese and Ayurvedic healing traditions and are having a renaissance today. There are many adaptogenic herbs, but the ever-popular turmeric is considered an adaptogenic due to the anti-inflammatory effects of curcumin, the yellow pigment present in its tiny root that helps the body maintain an appropriate level of cortisol. (everydayhealth.com) RESOURCES • https://draxe.com/health/3-steps-to-heal-adrenal-fatigue/ • Adrenal Fatigue: The 21st Century Stress Syndrome by James L. Wilson and Jonathan V. Wright • https://draxe.com/health/3-steps-to-heal-adrenal-fatigue/ •health.harvard.edu/blog/is-adrenal-fatigue-real-2018022813344 • webmd.com/a-to-z-guides/adrenal-fatigue-is-it-real#1 • stress.org/daily-life Jane Hammond specializes in Bio-identical Hormone Replacement Therapy (HRT). She has more than 20 years of experience in internal, integrative, and functional medicine.