July 7, 2025 • 24 mins
Feeling tired but wired? Snapping at your partner for breathing too loud? Your hormonal rollercoaster might not be just perimenopause—it could be adrenal dysfunction hijacking your entire endocrine system.
Cortisol isn't just a stress hormone; it's the orchestra conductor of your hormonal symphony. When chronic stress throws this crucial hormone out of balance, it creates a cascade of symptoms easily confused with perimenopause. The key lies in understanding the Hypothalamic-Pituitary-Adrenal (HPA) axis—your body's communication network that governs stress response, energy levels, and yes, your reproductive hormones.
The most fascinating aspect? Cortisol literally steals from progesterone through the "pregnenolone steal." When your body prioritizes stress management, it diverts resources away from making sex hormones, leading to estrogen dominance, irregular periods, mood swings, and the constellation of symptoms many women attribute solely to perimenopause. Research confirms this connection, with a 2015 study showing that chronic stress significantly worsens perimenopausal symptoms like hot flashes and insomnia.
Recognizing the red flags of adrenal dysfunction—exhaustion despite adequate sleep, 3 AM wakings, afternoon energy crashes, salt/sugar cravings, and feeling worse after intense workouts—can transform your approach to midlife symptoms. Through functional testing like the Simply Test Cortisol Panel or Hair Tissue Mineral Analysis, we can pinpoint your unique cortisol pattern and create targeted protocols that restore balance to your entire hormonal system.
By implementing circadian rhythm resets, appropriate adaptogenic herbs, stress management techniques, and targeted nutritional support, women report more predictable cycles, better sleep, improved mood stability, and renewed energy. What looked like inevitable hormonal decline may actually be adrenal fatigue in disguise—and addressing this root cause can help you finally feel like yourself again. Ready to discover your hormone blueprint? Book a consultation at Harmony Hub Health and reclaim your vitality.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Harmony Hub Health, where my mission is
to provide comprehensive,affordable, integrative care
that addresses the root cause ofhealth issues.
At the Hub, the focus is onindividual patient journeys.
I strive to optimize health,vitality and longevity,
fostering a community where eachperson can thrive in body, mind
and spirit.
(00:21):
So is it perimenopause or justburnout?
We're going to do a cortisolreality check and we want to
talk about how adrenaldysfunction can hijack your
(00:42):
hormones and your sanity.
This is when you're feelingtired but wired.
Your period is a mess.
You snap at your partner forjust breathing too loud.
I've done that, and don't evenget started about sleep.
Is this the beginning ofperimenopause or is it just
full-blown burnout?
And there's a spoiler alert itmight be both, and cortisol, the
(01:05):
infamous stress hormone, mightbe calling the shots.
So perimenopause and burnoutcan be confusing to know the
difference.
Perimenopause is the hormonalroller coaster before menopause.
In burnout, this is the chronic, stress-induced dysregulation
of the hypothalamic pituitaryadrenal, or what I call the HPA
(01:25):
axis.
They often look like twins whenit comes to symptoms.
They can both cause fatigue.
They can both cause sleepdisturbances, anxiety,
irritability, brain fog.
Now, usually perimenopause isthe irregular periods and it's
not adrenal dysfunction orburnout, but when stress is what
(01:47):
caused it, that can suppressyour ovulation.
Both of them cause weight gain,low libido, blood sugar
instability, and this overlapmakes it easy for women to
assume that it's justperimenopause.
But they're missing thatadrenal piece.
That can mean treating hormonesymptoms without addressing the
(02:07):
root cause.
This leads to poor results or,even worse, it can make things
worse.
So with functional medicine,you know, cortisol is the middle
manager of hormones.
We look at the HPA axis.
This is a system that governsyour body stress response and as
the orchestra conductor of allhormones, including estrogen,
(02:29):
progesterone and your thyroidhormones.
When you're under chronic stress, whether it's emotional,
physical, environmental orbiochemical, your cortisol
production shifts in stages.
First we have the hypercortisol.
These are the people that feelwired but tired.
They have high cortisol, sleepdisruption, they're anxious and
they have insulin resistance.
(02:50):
Then we have what I callflatline fatigue.
This is hypocortisol, this islow cortisol.
They feel depressed, they havelow blood pressure, they're
burnt out, there's thyroidsuppression and then we have
dysregulated rhythm.
These are those with poormorning energy, and then they
still crash in the afternoon,but then they get that second
(03:11):
wind at night.
And here's where it gets spicyCortisol steals from
progesterone, a phenomenon knownas the pregnenolone steal.
So cortisol is made up frompregnenolone, which is the same
precursor as progesterone.
Chronic stress divertspregnenolone away from making
sex hormones to keep up with thestress response.
(03:33):
So what happens is yourprogesterone goes low, you
become estrogen dominant andsymptoms that look just like
perimenopause.
There was a 2015 studypublished in menopause and they
found that chronic stressexacerbates perimenopausal
symptoms, especially hot flashes, insomnia and mood swings, and
(03:55):
that makes cortisol a coreculprit in hormone chaos.
And I know HPA axis soundsreally fancy and very scientific
, but it is your hormoneheadquarters for stress and
survival.
I want to break down this HPAaxis because once you understand
this, everything about hormonechaos, burnout and perimenopause
makes a little bit more sense.
(04:16):
So HPA stands for hypothalamicpituitary adrenal axis.
It's not a physical organ.
It's a communication systembetween your hypothalamus, your
pituitary and your adrenalglands.
So the hypothalamus, this isthe command center in your brain
.
The pituitary gland, this isthe hormone boss sitting just
(04:37):
below the brain.
Then you have your adrenalglands.
These are littletriangle-shaped glands that sit
on top of your kidneys and theyproduce cortisol and other
hormones.
These three form a feedbackloop that regulates your body's
stress response your energy,your mood, your immune system,
your sleep-wake cycles and, yep,even your sex hormones.
(04:59):
And here's a really easy, simpleversion of how it works.
So first we have stress thathits, whether it's like your job
or it's just perceived stressbecause you're scrolling through
news or skipping meals.
That's a stress.
Your hypothalamus releases CRH,this is corticotropin releasing
hormone.
This hormone signals yourpituitary gland to release ACTH,
(05:24):
also known asadrenocorticotropic hormone.
Acth tells the adrenals to pumpout cortisol.
So cortisol helps your bodydeal with stress, but it also
sends feedback up the chain tosay, okay, we've got enough, and
it calms your system down.
This is all good unless thestress doesn't stop.
This is when your system starts.
(05:45):
This is all good, unless thestress doesn't stop.
This is when your system startsto glitch.
When you have chronic stress, itcauses this HPA dysfunction.
So your HPA access is not builtfor nonstop email pings, blood
sugar crashes, toxicrelationships, overtraining and
poor sleep.
When it gets overused, threedifferent things happen.
(06:07):
First, your hypothalamus stopsresponding properly to stress
cues.
Second, the pituitary getssluggish and it signals it's
tired.
Three, the adrenals either gointo overdrive and make too much
cortisol or they completelyburn out and then you have too
little cortisol.
This dysregulation leads to abroken rhythm of cortisol rather
(06:30):
than the natural pattern ofhigh in the morning and low at
night.
And cortisol is not just thestress hormone, it is the
ultimate multitasker.
When cortisol goes rogue, itstarts pulling the strings on
other hormone systems.
So first there's progesterone.
Cortisol and progesterone sharethe same precursor Remember
that pregnenolone.
(06:51):
So when you have chronic stress, pregnenolone gets shunted to
make more cortisol.
That means there's left to makeyour progesterone.
So the result is yourprogesterone is lower, your
estrogen is higher, you becomeestrogen dominant, you have mood
swings, you get breasttenderness and you have
menstrual cycle issues.
Then we have our estrogen High.
(07:12):
Cortisol increases an enzymecalled aromatase, so more
testosterone gets converted intoestrogen.
This leads to weight gain, foodretention and just bad PMS
symptoms.
Then we have our thyroid.
Cortisol slows down theconversion of T3 to T4, which
are your active thyroid hormones.
You know T4 has to convert toT3 to stimulate your thyroid and
(07:38):
when cortisol slows down thatconversion, this causes low
energy, causes hair loss, coldhands and even when your labs
may look normal, the cortisol isstill slowing down that
conversion.
It also increases reverse T3,which is known as a thyroid
blocker.
This is why when I amevaluating thyroid for people
(08:00):
that are really having thyroidissues, I don't just check the
TSH and the T4 like your PCP.
Might I do like to do a free T4, a free T3, and that reverse T3
.
I do like to do a free T4, afree T3, and that reverse T3.
And cortisol also raises bloodsugar to prep for that fight or
flight.
So when you have long-termcortisol raises, then insulin
(08:22):
resistance happens and abdominalweight gain happens because
you're just constantly raisingblood sugar.
So your HPA axis is kind of likethe thermostat of your hormonal
house.
Think of the HPA axis as yourbody's thermostat.
It tries to keep your internalenvironment just right.
When life turns up the heat orthe stress, it cranks out
(08:45):
cortisol to cool things down.
But if you keep leaving theoven on or keep having more
stress, the system can't keep up.
Eventually your thermostatbreaks and the whole house
becomes unstable.
Does that make sense?
Studies show that women inperimenopause have more cortisol
reactivity.
Their bodies respond moreintensely to stress.
(09:06):
This is due in part toprogesterone's calming effect
decreasing while estrogenbecomes more erratic.
So stress hits you harder inyour 40s than when it did in
your 20s and you probablynoticed that if you were my age
I'm 48, but there are signs thatit's cortisol and not just
estrogen.
So I want to decode some of thered flags that your adrenals
(09:29):
need support, even if you're inthat perimenopause age range.
All right.
So one of them is if you feelexhausted even though you've
slept for eight hours, and thenthere's that three o'clock
afternoon energy crash where youwant to go for that latte that
used to be me.
I have not had an afternoonlatte.
(09:49):
Honestly, I can't even tell youthe last time I had an
afternoon coffee.
If you wake up at two to threeo'clock in the morning regularly
, or if you have high cravingsfor salty or sugary foods.
If you have mood swings oranxiety that worsens when you're
under pressure.
If you feel worse after highintensity workouts.
If your cycle worsens afterperiods of intense stress, or
(10:14):
you've become intolerant tostimulants or alcohol.
Okay, so I like to do somefunctional testing.
I don't like to guess which oneit is.
In functional medicine I don'tchase symptoms.
I test the full hormonallandscape, including cortisol,
not just estrogen or thatfollicle stimulating hormone,
and there are some tests that Ireally love for this.
(10:36):
One of them is the Simply TestCortisol Panel.
It's a four point salivary test.
There's also the Dutch cortisoltest that can show cortisol
rhythm, but the Simply TestCortisol Test is, I'm not going
to say, better, but I will sayit's budget friendly.
It's an at-home saliva-basedcortisol test that's designed to
(10:58):
give you a snapshot of yourdiurnal cortisol rhythm that
reflects how your body isproducing and regulating
cortisol across the day.
So it's a functional,medicine-friendly tool that
offers convenience and ease touse while still capturing
clinically relevant patterns ofadrenal function.
So it measures salivarycortisol at four points
(11:19):
throughout the day.
Now, the Dutch test is great.
The reason why it's more isbecause it does more than just
measure cortisol.
It measures hormone cycles andall of that.
So if I'm looking at justcortisol, then this Simply Test
is amazing.
So it measures your salivarycortisol when you wake up, 30
minutes after you wake, in themid afternoon and then right
(11:41):
before bed.
So it provides a diurnalcortisol curve, a visual of how
cortisol rises and falls in yourbody over 24 hours.
So it's looking at that HPAaccess function.
If your cortisol is too high ortoo low or dysregulated, we can
see that.
We can see if you'reexperiencing cortisol spikes at
(12:02):
night leading to insomnia.
Most people only check acortisol level in the morning.
Well, in the morning it'ssupposed to be high, but you're
not really seeing what'shappening throughout the day.
To find out if that is what'saffecting your sleep cycle, Do
you have a flat curve?
I see this a lot with burnoutand adrenal fatigue.
If your cortisol awakeningresponse, known as a CAR, is it
(12:25):
robust enough, do you have a 30to 45% jump in the first 30
minutes that's why we check itwhen you wake and then 30
minutes after.
Cortisol in saliva does reflectthe free, bioavailable cortisol,
not protein bound like in blood.
So this gives a more functionalpicture of what your tissues
(12:46):
are actually experiencing.
And there's certain patternsthat I can see with a simply
test.
A normal curve would be high inthe morning with a gradual drop
.
This shows me that you'reresilient to stress response.
A flat curve where you're lowall day.
Usually I see this if you havefatigue, brain fog, burnout.
If you have a reverse curve,that's when you're low in the
(13:09):
morning and high at night, thisis where I see people with night
cravings, anxiety, insomnia.
Or if you're elevated all dayand just overstimulated.
These are people that are wired, anxious and they have that
belly weight game.
So in this Simply Test Kit youget four little collection tubes
.
They're labeled.
I have the boxes at Monarchready to go if you want to get
(13:30):
tested.
There's detailed instructions,there's return shipping
materials and then turnaroundtime is usually five to 10
business days.
And I like to use it to evaluateadrenal fatigue, adrenal stress
, to track how your cortisolimpacts your thyroid or your sex
hormones.
I can use it to assess sleepdisorders, burnout or mood
(13:51):
swings, and we can also monitoradaptogen or hormone therapy
responses.
It does go good with the Dutchhormone testing.
Dutch also has their own CARtest if you want that.
The good news is that it isvery easy.
It's not invasive, there's noneedles involved.
It tracks real world cortisolfluctuations and it really is
(14:15):
great for early detection ofthat HPA axis dysfunction and,
like I said, it's veryaffordable.
The only thing I don't likeabout it is it doesn't allow
cortisol metabolites like theDutch test.
It doesn't test DHEA Somepanels can and it doesn't assess
any of the sex hormones.
But that's okay because it'sideal if you think perimenopause
(14:40):
symptoms are worsened by stress.
If you have that tired butwired insomnia, we can see if
you have that flatline fatigueor burnout, if you have anxiety
or panic attacks that's linkedto stress, if you're having
mystery waking and not quitesure why.
I like to use this test and forpeople that have that
post-COVID exhaustion or longhaul symptoms, it really is
(15:03):
powerful and a functionalsnapshot of how your stress
response really is working.
The other test that is myfavorite for this is the HTMA.
It's the hair tissue mineralanalysis.
That's another non-invasive,functional snapshot of mineral
patterns and it can reflectadrenal function over time,
especially chronic stress loadand adrenal reserve.
(15:23):
It doesn't measure cortisoldirectly like the saliva or DASH
testing.
It actually reveals mineralratios and levels that are
influenced by adrenal hormoneactivity, particularly that
aldosterone and the cortisol.
So I look at your sodium andyour potassium in your tissue.
(15:44):
These are the adrenal markers.
These two minerals are the mostdirectly linked to adrenal
function.
So sodium is regulated largelyby aldosterone that's an adrenal
hormone and then potassiumaffects our cellular energy and
sensitivity to aldosterone.
So I get a sodium to potassiumratio.
I call it the stress ratio orvitality ratio.
(16:05):
Normally the range is 2.3 to2.5, but when I see a high ratio
that tells me there's acutestress or there's early adrenal
stimulation, often seen in highcortisol states.
So these people are anxious,they're wired but tired phase
and then there's a low ratio.
This is when you're less than2.3 and I can see adrenal
(16:25):
burnout or exhaustion.
So often this is linked to lowcortisol and low aldosterone
production and it also tells methat people have chronic stress,
long-term fatigue or evenprobably a flatlined HPA axis.
So just a fun fact, potassiumloss relative to sodium can
signal exhaustion phase ofadrenal dysfunction where
(16:48):
cortisol and aldosterone areboth low.
The other ratio I like to lookat on HTMA is the sodium to
magnesium ratio.
This shows me adrenalresilience and cortisol activity
.
Sodium to mag is known as theadrenal ratio and I talk about
it with all of my HTMA results.
If you have a high ratio, thatindicates that you have
(17:09):
sympathetic dominance or thatstress overdrive.
If your ratio is low, then thatshows me adrenal fatigue or
that parasympathetic dominanceand it really reflects how your
body is adapting or not tostress over time.
When I look at the calcium topotassium ratio, this shows your
thyroid and adrenal connectioncauses hyperactivity, stress and
(17:46):
anxiety.
So remember the thyroid andadrenals are tightly linked.
When cortisol is not regulatedit can suppress thyroid function
and impact that ratio.
There's a lot of other clues ofadrenal impact, like low sodium
and low potassium in the tissuesis classic in burnt out
adrenals.
High calcium and low potassiumshows me that someone's a slow
(18:09):
classic oxidizer and they'reprone to fatigue, burnout and
what I call mineral lock.
And then low zinc.
Low zinc impairs your HPA axissignaling and your stress
resilience and immune modulation.
I could do a whole podcast onInosacare, which what I've been
using for people that it reallyis helping that HPA axis.
And even that elevated copper,because I can see copper
(18:32):
imbalance on HTMA.
Elevated copper causes estrogendominance and adrenal stress in
women.
But with the HTMA it does notmeasure real-time cortisol like
the SimpleTest or Dutch.
It doesn't replace salivaryurine or blood hormone panels.
I still like to have blood workwith HTMA.
Instead, though, it doesevaluate chronic patterns over
(18:56):
three to four months that showhow well your body is coping
with stress, regulating mineralsand producing adrenal hormones
like that aldosterone.
So HTMA can show me if you'rerunning too hot by overproducing
stress hormones, if you'rerunning on fumes, if you're
running too hot by overproducingstress hormones, if you're
running on fumes, if you'reburnt out and depleted or if
you're struggling to maintainelectrolyte and energy balance.
(19:17):
So what do I do when I findthis cortisol imbalance?
Functional medicine is great.
We talk about lifestyle first.
We want to do a circadianrhythm reset.
This means we want to wake withnatural sunlight or you can use
a red light panel.
It means you want to dogrounding and breath work in the
morning.
You want to avoid caffeinewithin 60 to 90 minutes of
(19:39):
waking.
I know that's really hard forpeople in the beginning until
they do it.
Blue light blockers after 7pmand then prioritize sleep like
it is your job.
That was a huge change for mewas learning to sleep.
And then how much now I dependon sleep and I love sleep.
The other treatments I do arenutraceuticals and adaptogens.
(20:01):
You know magnesium, glyconateor threonate.
They both support cortisolmetabolism and sleep.
Vitamin C and B complex theseare cofactors for adrenal
function.
Rhodiola, ashwagandha, holybasil you want to choose those
based on your phase ofdysfunction.
I talk to a lot of people andthey're just taking them all and
(20:22):
have no idea why they're takingit or what.
Because you shouldn't take allof it, right?
If you have high cortisol,that's when ashwagandha comes in
.
That's when phosphatidylserinecomes in.
If you have low cortisol,that's the licorice root, the
rhodiola and ginseng.
But I see a lot of people thatfeel like they have really high
cortisol but they're takingginseng because they read
(20:42):
somewhere that you should, butyou may have the opposite effect
.
And then DHEA.
But you may have the oppositeeffect, and then DHEA.
That's if I do testing for youand show that you need some
additional DHEA and I don't meanhigh dose DHEA I do see people
that here you should take it.
So I have a lot of females thatcome to me and they're taking a
men's dose of DHEA and thenwondering why they have acne and
(21:04):
oily skin.
So don't, just don't, don't doit.
All right, um, targeted support,depending on what our
consultation has.
I do like adrenal cortexextracts, um for people with
severe fatigue that are undersupervision.
Uh, mitochondrial support, ofcourse, with my decor um, coq10,
(21:24):
nad or PQQ, and then bloodsugar balance.
That would be with the chromium, the berberine, or like really
good protein forward meals.
And then I like to talk aboutstress detox.
This is where we identifyhidden stressors.
You know, have you been exposedto mold?
Do you have parasites?
Do you have unresolved trauma?
All of these things matter.
(21:45):
Gentle movement is important,whether you're walking or yoga.
I don't want CrossFit duringthese types of people.
That's the worst type ofactivity you can do if you are a
cortisol mess, even therapy orEMDR if you do have that
emotional burnout.
One of my favorite in-officetreatments that I do are, of
course, the IV infusions.
(22:06):
When I add in the B-complex andNAD or magnesium or ascorbic
acid, you know they'refunctional stress hacks.
All of those are.
When you balance cortisol,perimenopause becomes manageable
.
So women who focus on restoringtheir HPA axis these are the
ones that tell me they have morepredictable cycles.
(22:27):
They have fewer mood swings,better sleep, better energy,
less weight gain and then theyhave that improved libido and
resilience.
So sometimes what looks likehormone failure is actually
adrenal fatigue in disguise.
If you are wondering hmm, is myproblem?
Is it perimenopause or am Iburnt out?
(22:49):
Is it both?
Then it's time for a functionalmedicine evaluation or a good
hormone consultation.
At Harmony Hub Health I offeradvanced testing and
personalized care plans thatsupport both hormone balance and
adrenal recovery.
So book a consultation to mapout your hormone blueprint and
finally feel like yourself again.
To map out your hormoneblueprint and finally feel like
(23:11):
yourself again, you can schedulein person at Monarch Beauty and
Spa in Manchester, maryland.
You can see me virtually onlineand go to
wwwharmonyhubhealthcom.
You can send me an email atmichelle that's M-I-C-H-E-L-E at
harmonyhubhealthcom.
Please just don't send me youremail at 3 amam while you're
(23:32):
having your cortisol spike.
I'm just kidding.
You can do that, but just knowI'm going to be asleep.
Okay, so this podcast is foreducational purposes only and
not intended to diagnose, treator cure any condition.
Always consult a qualifiedhealthcare provider for
personalized medical advice.
And yes, raging at your partnermight be justified.
(23:53):
Just don't blame me.
I hope to see you soon.
Welcome to Harmony Hub Health, where my mission is
to provide comprehensive,affordable, integrative care
that addresses the root cause ofhealth issues.
At the Hub, the focus is onindividual patient journeys.
I strive to optimize health,vitality and longevity,
fostering a community where eachperson can thrive in body, mind
and spirit.
(00:21):
So is it perimenopause or justburnout?
We're going to do a cortisolreality check and we want to
talk about how adrenaldysfunction can hijack your
(00:42):
hormones and your sanity.
This is when you're feelingtired but wired.
Your period is a mess.
You snap at your partner forjust breathing too loud.
I've done that, and don't evenget started about sleep.
Is this the beginning ofperimenopause or is it just
full-blown burnout?
And there's a spoiler alert itmight be both, and cortisol, the
(01:05):
infamous stress hormone, mightbe calling the shots.
So perimenopause and burnoutcan be confusing to know the
difference.
Perimenopause is the hormonalroller coaster before menopause.
In burnout, this is the chronic, stress-induced dysregulation
of the hypothalamic pituitaryadrenal, or what I call the HPA
(01:25):
axis.
They often look like twins whenit comes to symptoms.
They can both cause fatigue.
They can both cause sleepdisturbances, anxiety,
irritability, brain fog.
Now, usually perimenopause isthe irregular periods and it's
not adrenal dysfunction orburnout, but when stress is what
(01:47):
caused it, that can suppressyour ovulation.
Both of them cause weight gain,low libido, blood sugar
instability, and this overlapmakes it easy for women to
assume that it's justperimenopause.
But they're missing thatadrenal piece.
That can mean treating hormonesymptoms without addressing the
(02:07):
root cause.
This leads to poor results or,even worse, it can make things
worse.
So with functional medicine,you know, cortisol is the middle
manager of hormones.
We look at the HPA axis.
This is a system that governsyour body stress response and as
the orchestra conductor of allhormones, including estrogen,
(02:29):
progesterone and your thyroidhormones.
When you're under chronic stress, whether it's emotional,
physical, environmental orbiochemical, your cortisol
production shifts in stages.
First we have the hypercortisol.
These are the people that feelwired but tired.
They have high cortisol, sleepdisruption, they're anxious and
they have insulin resistance.
(02:50):
Then we have what I callflatline fatigue.
This is hypocortisol, this islow cortisol.
They feel depressed, they havelow blood pressure, they're
burnt out, there's thyroidsuppression and then we have
dysregulated rhythm.
These are those with poormorning energy, and then they
still crash in the afternoon,but then they get that second
(03:11):
wind at night.
And here's where it gets spicyCortisol steals from
progesterone, a phenomenon knownas the pregnenolone steal.
So cortisol is made up frompregnenolone, which is the same
precursor as progesterone.
Chronic stress divertspregnenolone away from making
sex hormones to keep up with thestress response.
(03:33):
So what happens is yourprogesterone goes low, you
become estrogen dominant andsymptoms that look just like
perimenopause.
There was a 2015 studypublished in menopause and they
found that chronic stressexacerbates perimenopausal
symptoms, especially hot flashes, insomnia and mood swings, and
(03:55):
that makes cortisol a coreculprit in hormone chaos.
And I know HPA axis soundsreally fancy and very scientific
, but it is your hormoneheadquarters for stress and
survival.
I want to break down this HPAaxis because once you understand
this, everything about hormonechaos, burnout and perimenopause
makes a little bit more sense.
(04:16):
So HPA stands for hypothalamicpituitary adrenal axis.
It's not a physical organ.
It's a communication systembetween your hypothalamus, your
pituitary and your adrenalglands.
So the hypothalamus, this isthe command center in your brain
.
The pituitary gland, this isthe hormone boss sitting just
(04:37):
below the brain.
Then you have your adrenalglands.
These are littletriangle-shaped glands that sit
on top of your kidneys and theyproduce cortisol and other
hormones.
These three form a feedbackloop that regulates your body's
stress response your energy,your mood, your immune system,
your sleep-wake cycles and, yep,even your sex hormones.
(04:59):
And here's a really easy, simpleversion of how it works.
So first we have stress thathits, whether it's like your job
or it's just perceived stressbecause you're scrolling through
news or skipping meals.
That's a stress.
Your hypothalamus releases CRH,this is corticotropin releasing
hormone.
This hormone signals yourpituitary gland to release ACTH,
(05:24):
also known asadrenocorticotropic hormone.
Acth tells the adrenals to pumpout cortisol.
So cortisol helps your bodydeal with stress, but it also
sends feedback up the chain tosay, okay, we've got enough, and
it calms your system down.
This is all good unless thestress doesn't stop.
This is when your system starts.
(05:45):
This is all good, unless thestress doesn't stop.
This is when your system startsto glitch.
When you have chronic stress, itcauses this HPA dysfunction.
So your HPA access is not builtfor nonstop email pings, blood
sugar crashes, toxicrelationships, overtraining and
poor sleep.
When it gets overused, threedifferent things happen.
(06:07):
First, your hypothalamus stopsresponding properly to stress
cues.
Second, the pituitary getssluggish and it signals it's
tired.
Three, the adrenals either gointo overdrive and make too much
cortisol or they completelyburn out and then you have too
little cortisol.
This dysregulation leads to abroken rhythm of cortisol rather
(06:30):
than the natural pattern ofhigh in the morning and low at
night.
And cortisol is not just thestress hormone, it is the
ultimate multitasker.
When cortisol goes rogue, itstarts pulling the strings on
other hormone systems.
So first there's progesterone.
Cortisol and progesterone sharethe same precursor Remember
that pregnenolone.
(06:51):
So when you have chronic stress, pregnenolone gets shunted to
make more cortisol.
That means there's left to makeyour progesterone.
So the result is yourprogesterone is lower, your
estrogen is higher, you becomeestrogen dominant, you have mood
swings, you get breasttenderness and you have
menstrual cycle issues.
Then we have our estrogen High.
(07:12):
Cortisol increases an enzymecalled aromatase, so more
testosterone gets converted intoestrogen.
This leads to weight gain, foodretention and just bad PMS
symptoms.
Then we have our thyroid.
Cortisol slows down theconversion of T3 to T4, which
are your active thyroid hormones.
You know T4 has to convert toT3 to stimulate your thyroid and
(07:38):
when cortisol slows down thatconversion, this causes low
energy, causes hair loss, coldhands and even when your labs
may look normal, the cortisol isstill slowing down that
conversion.
It also increases reverse T3,which is known as a thyroid
blocker.
This is why when I amevaluating thyroid for people
(08:00):
that are really having thyroidissues, I don't just check the
TSH and the T4 like your PCP.
Might I do like to do a free T4, a free T3, and that reverse T3
.
I do like to do a free T4, afree T3, and that reverse T3.
And cortisol also raises bloodsugar to prep for that fight or
flight.
So when you have long-termcortisol raises, then insulin
(08:22):
resistance happens and abdominalweight gain happens because
you're just constantly raisingblood sugar.
So your HPA axis is kind of likethe thermostat of your hormonal
house.
Think of the HPA axis as yourbody's thermostat.
It tries to keep your internalenvironment just right.
When life turns up the heat orthe stress, it cranks out
(08:45):
cortisol to cool things down.
But if you keep leaving theoven on or keep having more
stress, the system can't keep up.
Eventually your thermostatbreaks and the whole house
becomes unstable.
Does that make sense?
Studies show that women inperimenopause have more cortisol
reactivity.
Their bodies respond moreintensely to stress.
(09:06):
This is due in part toprogesterone's calming effect
decreasing while estrogenbecomes more erratic.
So stress hits you harder inyour 40s than when it did in
your 20s and you probablynoticed that if you were my age
I'm 48, but there are signs thatit's cortisol and not just
estrogen.
So I want to decode some of thered flags that your adrenals
(09:29):
need support, even if you're inthat perimenopause age range.
All right.
So one of them is if you feelexhausted even though you've
slept for eight hours, and thenthere's that three o'clock
afternoon energy crash where youwant to go for that latte that
used to be me.
I have not had an afternoonlatte.
(09:49):
Honestly, I can't even tell youthe last time I had an
afternoon coffee.
If you wake up at two to threeo'clock in the morning regularly
, or if you have high cravingsfor salty or sugary foods.
If you have mood swings oranxiety that worsens when you're
under pressure.
If you feel worse after highintensity workouts.
If your cycle worsens afterperiods of intense stress, or
(10:14):
you've become intolerant tostimulants or alcohol.
Okay, so I like to do somefunctional testing.
I don't like to guess which oneit is.
In functional medicine I don'tchase symptoms.
I test the full hormonallandscape, including cortisol,
not just estrogen or thatfollicle stimulating hormone,
and there are some tests that Ireally love for this.
(10:36):
One of them is the Simply TestCortisol Panel.
It's a four point salivary test.
There's also the Dutch cortisoltest that can show cortisol
rhythm, but the Simply TestCortisol Test is, I'm not going
to say, better, but I will sayit's budget friendly.
It's an at-home saliva-basedcortisol test that's designed to
(10:58):
give you a snapshot of yourdiurnal cortisol rhythm that
reflects how your body isproducing and regulating
cortisol across the day.
So it's a functional,medicine-friendly tool that
offers convenience and ease touse while still capturing
clinically relevant patterns ofadrenal function.
So it measures salivarycortisol at four points
(11:19):
throughout the day.
Now, the Dutch test is great.
The reason why it's more isbecause it does more than just
measure cortisol.
It measures hormone cycles andall of that.
So if I'm looking at justcortisol, then this Simply Test
is amazing.
So it measures your salivarycortisol when you wake up, 30
minutes after you wake, in themid afternoon and then right
(11:41):
before bed.
So it provides a diurnalcortisol curve, a visual of how
cortisol rises and falls in yourbody over 24 hours.
So it's looking at that HPAaccess function.
If your cortisol is too high ortoo low or dysregulated, we can
see that.
We can see if you'reexperiencing cortisol spikes at
(12:02):
night leading to insomnia.
Most people only check acortisol level in the morning.
Well, in the morning it'ssupposed to be high, but you're
not really seeing what'shappening throughout the day.
To find out if that is what'saffecting your sleep cycle, Do
you have a flat curve?
I see this a lot with burnoutand adrenal fatigue.
If your cortisol awakeningresponse, known as a CAR, is it
(12:25):
robust enough, do you have a 30to 45% jump in the first 30
minutes that's why we check itwhen you wake and then 30
minutes after.
Cortisol in saliva does reflectthe free, bioavailable cortisol,
not protein bound like in blood.
So this gives a more functionalpicture of what your tissues
(12:46):
are actually experiencing.
And there's certain patternsthat I can see with a simply
test.
A normal curve would be high inthe morning with a gradual drop
.
This shows me that you'reresilient to stress response.
A flat curve where you're lowall day.
Usually I see this if you havefatigue, brain fog, burnout.
If you have a reverse curve,that's when you're low in the
(13:09):
morning and high at night, thisis where I see people with night
cravings, anxiety, insomnia.
Or if you're elevated all dayand just overstimulated.
These are people that are wired, anxious and they have that
belly weight game.
So in this Simply Test Kit youget four little collection tubes
.
They're labeled.
I have the boxes at Monarchready to go if you want to get
(13:30):
tested.
There's detailed instructions,there's return shipping
materials and then turnaroundtime is usually five to 10
business days.
And I like to use it to evaluateadrenal fatigue, adrenal stress
, to track how your cortisolimpacts your thyroid or your sex
hormones.
I can use it to assess sleepdisorders, burnout or mood
(13:51):
swings, and we can also monitoradaptogen or hormone therapy
responses.
It does go good with the Dutchhormone testing.
Dutch also has their own CARtest if you want that.
The good news is that it isvery easy.
It's not invasive, there's noneedles involved.
It tracks real world cortisolfluctuations and it really is
(14:15):
great for early detection ofthat HPA axis dysfunction and,
like I said, it's veryaffordable.
The only thing I don't likeabout it is it doesn't allow
cortisol metabolites like theDutch test.
It doesn't test DHEA Somepanels can and it doesn't assess
any of the sex hormones.
But that's okay because it'sideal if you think perimenopause
(14:40):
symptoms are worsened by stress.
If you have that tired butwired insomnia, we can see if
you have that flatline fatigueor burnout, if you have anxiety
or panic attacks that's linkedto stress, if you're having
mystery waking and not quitesure why.
I like to use this test and forpeople that have that
post-COVID exhaustion or longhaul symptoms, it really is
(15:03):
powerful and a functionalsnapshot of how your stress
response really is working.
The other test that is myfavorite for this is the HTMA.
It's the hair tissue mineralanalysis.
That's another non-invasive,functional snapshot of mineral
patterns and it can reflectadrenal function over time,
especially chronic stress loadand adrenal reserve.
(15:23):
It doesn't measure cortisoldirectly like the saliva or DASH
testing.
It actually reveals mineralratios and levels that are
influenced by adrenal hormoneactivity, particularly that
aldosterone and the cortisol.
So I look at your sodium andyour potassium in your tissue.
(15:44):
These are the adrenal markers.
These two minerals are the mostdirectly linked to adrenal
function.
So sodium is regulated largelyby aldosterone that's an adrenal
hormone and then potassiumaffects our cellular energy and
sensitivity to aldosterone.
So I get a sodium to potassiumratio.
I call it the stress ratio orvitality ratio.
(16:05):
Normally the range is 2.3 to2.5, but when I see a high ratio
that tells me there's acutestress or there's early adrenal
stimulation, often seen in highcortisol states.
So these people are anxious,they're wired but tired phase
and then there's a low ratio.
This is when you're less than2.3 and I can see adrenal
(16:25):
burnout or exhaustion.
So often this is linked to lowcortisol and low aldosterone
production and it also tells methat people have chronic stress,
long-term fatigue or evenprobably a flatlined HPA axis.
So just a fun fact, potassiumloss relative to sodium can
signal exhaustion phase ofadrenal dysfunction where
(16:48):
cortisol and aldosterone areboth low.
The other ratio I like to lookat on HTMA is the sodium to
magnesium ratio.
This shows me adrenalresilience and cortisol activity
.
Sodium to mag is known as theadrenal ratio and I talk about
it with all of my HTMA results.
If you have a high ratio, thatindicates that you have
(17:09):
sympathetic dominance or thatstress overdrive.
If your ratio is low, then thatshows me adrenal fatigue or
that parasympathetic dominanceand it really reflects how your
body is adapting or not tostress over time.
When I look at the calcium topotassium ratio, this shows your
thyroid and adrenal connectioncauses hyperactivity, stress and
(17:46):
anxiety.
So remember the thyroid andadrenals are tightly linked.
When cortisol is not regulatedit can suppress thyroid function
and impact that ratio.
There's a lot of other clues ofadrenal impact, like low sodium
and low potassium in the tissuesis classic in burnt out
adrenals.
High calcium and low potassiumshows me that someone's a slow
(18:09):
classic oxidizer and they'reprone to fatigue, burnout and
what I call mineral lock.
And then low zinc.
Low zinc impairs your HPA axissignaling and your stress
resilience and immune modulation.
I could do a whole podcast onInosacare, which what I've been
using for people that it reallyis helping that HPA axis.
And even that elevated copper,because I can see copper
(18:32):
imbalance on HTMA.
Elevated copper causes estrogendominance and adrenal stress in
women.
But with the HTMA it does notmeasure real-time cortisol like
the SimpleTest or Dutch.
It doesn't replace salivaryurine or blood hormone panels.
I still like to have blood workwith HTMA.
Instead, though, it doesevaluate chronic patterns over
(18:56):
three to four months that showhow well your body is coping
with stress, regulating mineralsand producing adrenal hormones
like that aldosterone.
So HTMA can show me if you'rerunning too hot by overproducing
stress hormones, if you'rerunning on fumes, if you're
running too hot by overproducingstress hormones, if you're
running on fumes, if you'reburnt out and depleted or if
you're struggling to maintainelectrolyte and energy balance.
(19:17):
So what do I do when I findthis cortisol imbalance?
Functional medicine is great.
We talk about lifestyle first.
We want to do a circadianrhythm reset.
This means we want to wake withnatural sunlight or you can use
a red light panel.
It means you want to dogrounding and breath work in the
morning.
You want to avoid caffeinewithin 60 to 90 minutes of
(19:39):
waking.
I know that's really hard forpeople in the beginning until
they do it.
Blue light blockers after 7pmand then prioritize sleep like
it is your job.
That was a huge change for mewas learning to sleep.
And then how much now I dependon sleep and I love sleep.
The other treatments I do arenutraceuticals and adaptogens.
(20:01):
You know magnesium, glyconateor threonate.
They both support cortisolmetabolism and sleep.
Vitamin C and B complex theseare cofactors for adrenal
function.
Rhodiola, ashwagandha, holybasil you want to choose those
based on your phase ofdysfunction.
I talk to a lot of people andthey're just taking them all and
(20:22):
have no idea why they're takingit or what.
Because you shouldn't take allof it, right?
If you have high cortisol,that's when ashwagandha comes in
.
That's when phosphatidylserinecomes in.
If you have low cortisol,that's the licorice root, the
rhodiola and ginseng.
But I see a lot of people thatfeel like they have really high
cortisol but they're takingginseng because they read
(20:42):
somewhere that you should, butyou may have the opposite effect
.
And then DHEA.
But you may have the oppositeeffect, and then DHEA.
That's if I do testing for youand show that you need some
additional DHEA and I don't meanhigh dose DHEA I do see people
that here you should take it.
So I have a lot of females thatcome to me and they're taking a
men's dose of DHEA and thenwondering why they have acne and
(21:04):
oily skin.
So don't, just don't, don't doit.
All right, um, targeted support,depending on what our
consultation has.
I do like adrenal cortexextracts, um for people with
severe fatigue that are undersupervision.
Uh, mitochondrial support, ofcourse, with my decor um, coq10,
(21:24):
nad or PQQ, and then bloodsugar balance.
That would be with the chromium, the berberine, or like really
good protein forward meals.
And then I like to talk aboutstress detox.
This is where we identifyhidden stressors.
You know, have you been exposedto mold?
Do you have parasites?
Do you have unresolved trauma?
All of these things matter.
(21:45):
Gentle movement is important,whether you're walking or yoga.
I don't want CrossFit duringthese types of people.
That's the worst type ofactivity you can do if you are a
cortisol mess, even therapy orEMDR if you do have that
emotional burnout.
One of my favorite in-officetreatments that I do are, of
course, the IV infusions.
(22:06):
When I add in the B-complex andNAD or magnesium or ascorbic
acid, you know they'refunctional stress hacks.
All of those are.
When you balance cortisol,perimenopause becomes manageable
.
So women who focus on restoringtheir HPA axis these are the
ones that tell me they have morepredictable cycles.
(22:27):
They have fewer mood swings,better sleep, better energy,
less weight gain and then theyhave that improved libido and
resilience.
So sometimes what looks likehormone failure is actually
adrenal fatigue in disguise.
If you are wondering hmm, is myproblem?
Is it perimenopause or am Iburnt out?
(22:49):
Is it both?
Then it's time for a functionalmedicine evaluation or a good
hormone consultation.
At Harmony Hub Health I offeradvanced testing and
personalized care plans thatsupport both hormone balance and
adrenal recovery.
So book a consultation to mapout your hormone blueprint and
finally feel like yourself again.
To map out your hormoneblueprint and finally feel like
(23:11):
yourself again, you can schedulein person at Monarch Beauty and
Spa in Manchester, maryland.
You can see me virtually onlineand go to
wwwharmonyhubhealthcom.
You can send me an email atmichelle that's M-I-C-H-E-L-E at
harmonyhubhealthcom.
Please just don't send me youremail at 3 amam while you're
(23:32):
having your cortisol spike.
I'm just kidding.
You can do that, but just knowI'm going to be asleep.
Okay, so this podcast is foreducational purposes only and
not intended to diagnose, treator cure any condition.
Always consult a qualifiedhealthcare provider for
personalized medical advice.
And yes, raging at your partnermight be justified.
(23:53):
Just don't blame me.
I hope to see you soon.
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