I started hearing about “adrenal fatigue” in the last year or so, mostly via Instagram. I knew the word “adrenal”—as in the gland that produces cortisol and a few other hormones—and I am also well acquainted with the word “fatigue,” having had both chronic fatigue syndrome (CFS) and fibromyalgia for 20 years (and a small child for the past one-and-a-half). But “adrenal fatigue?” I had no clue what this now-ubiquitous buzzphrase could mean.
Turns out, I probably hadn’t heard of “adrenal fatigue” before because it’s not an accepted medical diagnosis. But as someone with both fibromyalgia and CFS—two mysterious chronic illnesses—I also know that just because something isn’t “accepted” doesn’t mean that there isn’t real suffering going on behind it. (Fibromyalgia and CFS are now accepted medical diagnoses, but that hasn’t always been the case, and even today, symptoms like chronic pain and chronic fatigue are often dismissed.)
So, is adrenal fatigue real? Or is it social media hokum? And how might HPA axis dysregulation play a role in adrenal fatigue symptoms? Let’s dig deeper:
What is adrenal fatigue?
According to the Endocrine Society, “adrenal fatigue” is a term used to describe “a group of symptoms that are said to occur in people who are under long-term mental, emotional, or physical stress.” It is said to be caused when the adrenal glands can’t keep up with the body’s demand for cortisol, which is the hormone that responds to stress. This condition results in symptoms such as fatigue, difficulty falling asleep or waking up, craving salt or sugar, and needing caffeine or other stimulants to get through the day.
The Mayo Clinic points out that adrenal insufficiency is an accepted medical diagnosis referring to inadequate production of one or more of the hormones produced by the adrenal glands. Symptoms include fatigue, body aches, unexplained weight loss, low blood pressure, lightheadedness, loss of hair on the body, and hyperpigmentation. It is diagnosable through blood- and other diagnostic tests. According to the Mayo Clinic, advocates of the adrenal fatigue diagnosis believe that it is a milder form of adrenal insufficiency, undetectable by a blood test.
Adrenal fatigue or HPA axis dysregulation?
According to this article in Frontiers in Behavioral Neuroscience, the HPA (hypothalamic-pituitary-adrenal) axis is the “neuroendocrine mechanism that mediates the effects of stressors by regulating numerous physiological processes, such as metabolism, immune responses, and the autonomic nervous system” [1]. Some people use the phrase “HPA axis dysregulation” or “HPA axis dysfunction” as a synonym for adrenal fatigue. Others believe that it is actually a more accurate term than adrenal fatigue.
For example, well-known naturopath Dr. Jolene Brighten writes that “while your adrenal symptoms and anxiety are very real, adrenal fatigue is not. Your adrenals (unlike your ovaries) should never give out. Instead, this is more accurately HPA dysregulation, that is your brain and adrenal communication is breaking down.”
Chronic stress can cause dysfunction in the HPA axis [2]. This dysfunction can play a role in cardiovascular disease, metabolic disease (such as type 2 diabetes), and inflammatory and autoimmune disease, as well as some mental illnesses, chronic fatigue syndrome, fibromyalgia, asthma, and eczema [3].
How hormonal birth control dysregulates the HPA axis
Several decades of research, summarized in evolutionary psychologist Sarah E. Hill’s book This Is Your Brain on Birth Control, suggests that women who take hormonal birth control experience two key stress response changes. Firstly, these women appear to have a blunted response to stressors, even happy stressors like an unexpected job promotion, or surprise flowers from a loved one. While a blunted response to stressors might sound like a good thing, as Natural Womanhood’s Grace Emily Stark pointed out previously:
“The stress response is our body’s way of letting us know that something significant is happening and helping us react accordingly. Some stress is normal (in fact, needed) to help us live meaningful, interesting, lives—and to make a quick getaway in dicey situations.” Normally, “a healthy person will exhibit increased cortisol in dangerous or exciting situations, but will also experience a drop in cortisol once the precipitating event has passed.”
In addition to having a muted response to both positive and negative stressors, women on the Pill tend to show signs of chronic stress as evidenced by “higher than average levels of total cortisol, high levels of corticosteroid binding globulins (CBGs), and dysregulated responses to exogenously administered cortisol,” according to Hill’s website. Hill summarizes in her book:
“The Pill-taking women’s pattern of HPA-axis function looks suspiciously similar to that of someone who has experienced chronic stress, suggesting that the Pill might actually cause the HPA axis to go into overdrive, requiring it to take coordinated action to blunt itself.”
Concerningly, Hill writes on the website, “[this stress response pattern] is often observed in children who have been abused or abandoned and those with a joint diagnosis of PTSD and major depressive disorder.” She concludes,
“We should all be alarmed by the fact that the stress hormone profiles of women who are on the birth control pill look more like those belonging to trauma victims than they do like those belonging to otherwise healthy young women.”
Coping with stress
Both the Endocrine Society and the Mayo Clinic express concern that having a “diagnosis” of adrenal fatigue can keep a patient from getting a “real” diagnosis, such as depression or fibromyalgia, which can have similar symptoms. Without a proper diagnosis of the underlying issue(s), they say, a patient can’t receive effective treatment.
In an article for Harvard Health Publishing, Dr. Marcelo Campos writes that if a thorough medical examination of someone complaining of adrenal fatigue turns up no answers, it’s important to examine one’s lifestyle. “Why would your adrenals be drained?” he writes. “Take a better look at what types of stress might be affecting you.” He also notes that while some medical professionals prescribe cortisol analogs to treat adrenal fatigue, “cortisol replacement can be dangerous even in small doses. Unintended consequences can include osteoporosis, diabetes, weight gain, and heart disease.”
Stress reduction is key to restoring the HPA axis to healthy functioning. She also says that exercise, an anti-inflammatory diet, improving sleep, and reducing caffeine can help. Oh, and if you’re on hormonal birth control, getting off of it might help, too.
Finally, be sure to chart your symptoms in whatever app or paper chart you use to chart your menstrual cycle. Including symptoms of HPA axis dysregulation in your chart will help provide a fuller picture of your health, helping you, your fertility awareness method (FAM) instructor, and your medical provider to take steps toward wellness.
References:
[1] Sheng, Julietta et al. “The Hypothalamic-Pituitary-Adrenal Axis: Development, Programming Actions of Hormones, and Maternal-Fetal Interactions.” Front. Behav. Neurosci, vol. 14 (2020): https://doi.org/10.3389/fnbeh.2020.601939 [2] Dunlavey CJ. “Introduction to the Hypothalamic-Pituitary-Adrenal Axis: Healthy and Dysregulated Stress Responses, Developmental Stress and Neurodegeneration.” J Undergrad Neurosci Educ. vol 16, no. 2 (2018):R59-R60. PMID: 30057514; PMCID: PMC6057754. [3] Jones, Carol and Gwenin, Christopher. “Cortisol level dysregulation and its prevalence—Is it nature’s alarm clock?” Physiological Reports, vol. 8, iss. 24 (2021): e14644. https://doi.org/10.14814/phy2.14644Additional Reading:
The Pill and Stress: How Hormonal Contraception Might Make it Harder for You to Cope
New Book Explores how Hormonal Birth Control Affects Women’s Brains
How an Anti-Inflammatory Diet Can Help You Balance Hormones
14 Health Concerns that Fertility Awareness Charting Can Reveal: Part 2
