Adrenal Health in Perimenopause

Jun 04, 2024
Anatomical Adrenal Gland Images
Hormonal changes in perimenopause can drive a decline in stress resilience, where you can’t cope with stress like you used to. But, if you’re feeling overly stressed, anxious, and not like yourself, there are strategies to help. Understanding the role of..

Hormonal changes in perimenopause can drive a decline in stress resilience, where you can’t cope with stress like you used to. But, if you’re feeling overly stressed, anxious, and not like yourself, there are strategies to help. Understanding the role of your adrenal glands in perimenopause is an excellent first step, and that’s precisely what you’ll find in today’s article.

We can’t promise a future without stress; stress is part of the human experience. But we can help you identify stress you can let go of and how to nourish your adrenals to better handle what comes your way. Keep reading to learn more about:

  • The adrenal glands and HPA axis
  • The modern epidemic of chronic stress
  • Why coping with stress is harder in perimenopause
  • The critical role of the adrenal glands post-menopause
  • How to support adrenal health with lifestyle and stress management tools

Let’s dive into this critical women’s health topic!

Adrenal Glands and the HPA Axis

The adrenal glands are endocrine glands that sit atop each kidney and produce hormones essential for the circadian rhythm, energy metabolism, blood pressure, and the body’s stress response. They are part of the hypothalamic-pituitary-adrenal axis or HPA axis.

The HPA axis is the communication axis between your brain and adrenals. The brain interprets environmental cues and signals the adrenals to produce stress hormones (epinephrine, norepinephrine, and cortisol) in the fight-or-flight response. This hormone cascade leads to physical changes, like increased blood sugar for energy, that allow you to run and fight danger. After the stress has subsided, the system returns to homeostasis (balance.)

A well-functioning HPA axis is necessary for overall health, and a crucial piece is the ability to fire it up when needed and shut it down when not.

The HPA Axis in Modern Times

But what happens when you are under constant stress as the modern high-productivity, high-input, high-information environment dictates? We all face the emotional and mental stressors that come with work, relationships, finances, loss, trauma, family, and more. Physical stresses like pollution, toxin exposures, poor sleep, dehydration, nutrient deficiencies, etc., also contribute.

Prolonged, chronic stress can lead to HPA axis dysfunction, formerly (and incorrectly) referred to as “adrenal fatigue.” Dysfunction can look like too much cortisol production, too little production, or the wrong amount at the wrong time of day. Essentially, the stress response doesn’t function properly or recover when you need it to, and you may experience many symptoms. Over time, stress and poor stress regulation contribute to depression, cardiometabolic disease, aging, and immune system challenges.

At TārāMD, we offer our patients a 4-point saliva or dried urine test to assess cortisol and other adrenal hormone levels throughout the day to assess HPA axis dysfunction and pinpoint the approaches that will help restore function and balance. 

Stress and Perimenopause

While stress and chronic stress can occur at any point in life, the perimenopausal transition adds another layer. In midlife, ovarian hormones start to decline, and women become more vulnerable to stress and perimenopausal symptoms, including anxiety.

Many perimenopausal patients describe the inability to cope with even minor stressors they could easily handle in the past. Additionally, there may be increased stress during this life phase due to caregiving roles, divorce, career advancement, and more.

Increased stress and poor coping can make perimenopause symptoms worse. One study found that high stress related to the Covid-19 pandemic correlated with increased menstrual cycle disturbances and perimenopausal symptoms.

Further, there is overlap between symptoms of HPA axis dysfunction and perimenopause, such as:

Adrenal Health Post-Menopause

Adrenal health and the HPA axis aren’t only concerns in perimenopause; they actually become more important post-menopause.

After perimenopause and menopause (the one-year mark without a period), you enter the post-menopause phase, but sex hormone levels don’t go to zero. You still get some hormone production coming primarily from the adrenal glands. With the ovaries offline, the adrenals are the primary producers of DHEA-S, testosterone, estrogen, and a tiny bit of progesterone.

If the HPA axis isn’t functioning correctly and the adrenals are sluggish from decades of chronic stress, they may not be able to produce sex hormones optimally, and you could miss their benefits.

How to Support Adrenal Health in Midlife and Beyond

Now is the time to support adrenal health with lifestyle and stress management. This focus will help you feel better through perimenopause and set you up for better health post-menopause. Give your future self the gift of a well-functioning HPA axis!

One of the positives about perimenopause is that many women experience a shift in prioritizing their self-care while caring less about what others think. You can harness this momentum to evaluate what’s important in your life and your relationship to stress. Do you really need to do it all? Perhaps there’s room to carve out more spaciousness by being less busy and saying no more often.

The foundation of adrenal support is decreasing and managing stress. Let’s explore some of the ways to nourish the adrenals and promote a healthy, balanced stress response:

  • Regulate your circadian rhythm – The HPA axis likes a predictable daily pattern. Wake around the same time each day and get sunlight first thing in the morning. Prioritize breakfast and regular mealtimes, dim the lights after dark, and stick to a reasonable bedtime.


  • Optimize protein – Protein helps balance blood sugar, stabilizing the adrenal glands. A high-protein breakfast (within an hour of waking) influences “clock genes” that regulate the circadian rhythm. Try to get at least 30 grams of protein with each meal and eat protein-based snacks when needed.


  • Increase minerals – A symptom of HPA axis dysfunction can be salt cravings, suggesting the body needs more electrolyte minerals, including sodium. Quality sea salt, seaweed, herbal teas (like nettle), and electrolyte supplements may be helpful. Also, ensure you are eating enough mineral-rich vegetables and fruits.


  • Meet micronutrient needs – Along with minerals, the adrenals also love vitamin C and B vitamins. Stress can also deplete vitamins. In addition to food sources, a high-quality multivitamin/mineral supplement helps ensure you’re meeting your daily micronutrient needs.


  • Try adaptogenic herbsAdaptogens are medicinal herbs (and mushrooms) that help the body “adapt” to stress. They nourish the adrenals and have a modulating effect, meaning they can feel energizing or calming depending on your system’s needs. Some examples of adaptogens include ashwagandha, licorice, rhodiola, cordyceps, shatavari, tulsi, and maca. Enjoy these herbs as teas, powders, tinctures, or in capsules.


  • Watch the caffeine – While caffeine can feel energizing, it can promote a stress response and spike adrenal hormones. Ultimately, caffeine is depleting. If you can’t get started in the morning without a cup of coffee, it might mean your adrenals need some love. Taking a break from caffeine (or cutting it back or replacing coffee with matcha) can help restore adrenal health so you have energy in the morning, naturally from the food you eat and a good night’s sleep.


  • Exercise…but not too muchExercise in perimenopause is critical, but overexercising can add even more stress to a stressed system. If you feel exhausted and moody after exercise and it takes a long time to recover, you might be doing too much. Find your sweet spot, and sometimes, when you’re healing your adrenals, less is more. Try more walking and restorative movement, like gentle yoga.


  • Increase parasympathetic activities – The parasympathetic nervous system is your “rest and digest” response. It’s the antidote to the fight or flight, sympathetic response. You can increase the parasympathetic state with breathing exercises, yoga nidra, meditation, laughter, time in nature, and other calming, centering experiences. Make time for these.



If you hear yourself saying, “I can’t handle stress like I used to” or “I just don’t feel like myself,” TārāMD can help. We’ll help you understand where you are in the perimenopause journey and how changing hormones may be affecting stress and vice versa. Since the adrenals need even more care post-menopause to promote health and resiliency, now is the time to manage stress and put supportive strategies in place.


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