We’ve talked a lot recently about the hormone fluctuations, and ultimate decline, that can occur as we move through perimenopause to postmenopause. But that may leave you wondering why we’re not talking about hormone-replacement therapy as the only option for treating symptoms with perimenopause?
Well, it may (or may not) surprise you to learn that when it comes to something as complicated as perimenopause, your symptoms are not just due to changes in estrogen or progesterone. You read that correctly. There is more to perimenopause than just female sex hormones.
To have a truly holistic view of perimenopause, we cannot ignore the hormones from your adrenal glands.
You have a total of two adrenal glands, one that sits atop each kidney. They are relatively small, only 1-2 inches in length and width, but they do a lot, as they are responsible for producing several different hormones that have varying effects.
The adrenal glands are involved in blood pressure regulation through salt retention. They also make adrenaline (epinephrine) and noradrenaline (norepinephrine) which are part of our fight or flight response.
However, two important hormones relating to perimenopause are cortisol and dehydroepiandrosterone (DHEA for short). Cortisol has two different functions: it is an important stress hormone and it’s responsible for regulating our circadian rhythm.
When it comes to our sleep/wake cycle, cortisol should be highest in the morning as it helps us wake up so we can start our day. It gradually lowers over the course of the day and should be the lowest in the evening so we can rest.
The other function of cortisol, which is probably why you’ve even heard of cortisol, relates to stress. During a stressful event, adrenaline is initially released. If the stressful situation is still imminent, the second hormone that’s released is cortisol.
In the short-term, cortisol promotes the formation of energy so we can fight or run away. But since infection or injury is viewed as a stress to the body, cortisol also has an anti-inflammatory effect. Essentially, cortisol is focused on repairing any damage to the body.
The issue is when that acute stress turns chronic. Long-term elevation of cortisol and adrenaline reduces your immune systems activity, which is why chronic stress can cause or worsen infections, cancer, and autoimmune conditions.
Since hormones impact other hormones, such as estrogen, more cortisol can lead to higher levels of estrogen which causes estrogen dominance. As we’ve discussed previously, estrogen dominance has been implicated in endometriosis, fibroids, and even breast and ovarian cancer.
What’s fascinating is that newer research has linked cortisol to hot flashes. One study found that women who had higher levels of cortisol had an increased frequency of hot flashes. And I can confirm that clinically, I have seen women who have had little to no hot flashes, experience an increase in stress, and their hot flashes will worsen.
Now we can’t forget about that other adrenal hormone, DHEA. DHEA-sulfate, one type of DHEA, is made almost exclusively from our adrenal glands and is the precursor to testosterone and estrogen (yes, women have testosterone too and it serve many important functions for us).
If you thought your ovaries were the only place estrogen is being made, think again. We are able to convert DHEA ultimately to estrogen in several other areas of the body regardless of ovarian function. That being said, your ovaries do make a lot of estrogen relatively, but we can’t ignore the estrogen being made in our bones, brain, liver, muscle, and fat cells.
Problems arise if your adrenals have been working hard for too long (think chronic stress). They, like you, become fatigued and aren’t able to keep up with the same level of hormone production. Over time, this can lead to a decline in DHEA production and irregular cortisol patterns. If we don’t have enough DHEA, we’re unable to make testosterone and estrogen and can’t buffer the naturally declining levels due to perimenopause.
The impact stress has on your health is not a new concept but sometimes, understanding the deeper why, helps motivate us to take action and make positive changes to influence our health. We’ll talk more in depth in the future about all the tools we have to help you not only deal with stress but recover and heal from stress but sometimes just recognizing the role stress plays in your perimenopause journey is the first step.