Fullscript Academy

The vast network of hormones in women’s bodies plays a crucial role in their overall health and well-being but can lead to a variety of health conditions when imbalanced. Since the adrenal glands are responsible for producing several major regulating hormones for women, adrenal health is a key factor to consider when supporting women’s hormone balance.

The role of adrenal health in women’s hormones

When adrenal function is imbalanced, adrenal glands can produce too much or too little of various hormones that are essential for women’s health, leading to a variety of health complications.

Cortisol

One of the main hormones produced by the adrenal gland is cortisol. Cortisol is released in response to stress and helps the body manage its reaction to stress. (Kumar 2022) However, dysregulation of adrenal function can result in insufficient cortisol production, leading to symptoms like extreme fatigue, postural hypotension, depression, unintentional weight loss, low blood sodium levels, and poor immune system regulation. (Adam 2017) (Husebye 2021)

Adrenal dysregulation can also lead to excess cortisol production, causing symptoms such as weight gain, easy bruising, mood changes, memory loss, irregular menstrual periods, and excess hair on the face, neck, chest, abdomen, and thighs for women. (NIDDK 2023)

DHEA and DHEA-S

Dehydroepiandrosterone (DHEA) is a hormone produced by the adrenal glands that helps balance cortisol levels. Chronic stress is associated with reduced DHEA and its sulfated metabolite dehydroepiandrosterone sulfate (DHEA-S). (Lennartsson 2013) DHEA also produces testosterone and estrogen—two hormones vital to women’s hormone health—and therefore has a protective and regenerative role in sex hormone balance. When under chronic stress, DHEA and DHEA-S levels can drop, impacting levels of testosterone and estrogen. (National Library of Medicine n.d.)

Estrogen

Estrogen plays a crucial role in women's health, regulating menstrual cycles, supporting reproductive health, maintaining bone density, and influencing mood and cognitive function throughout the lifecycle. Measuring estrogen levels helps assess hormonal balance and guide treatment for a wide variety of conditions, such as polycystic ovary syndrome (PCOS), irregular cycles, and perimenopause/menopause.

Physiological and emotional stress can significantly impact estrogen, leading to imbalances that can exacerbate hormone-related symptoms. Furthermore, fluctuations in estrogen levels also impact stress resilience, mood, and mental health. (Albert 2019) (Krolick 2022) Understanding these dynamics allows for targeted interventions to support overall health and well-being.

Hot flashes and night sweats may be a sign of estrogen deficiency caused by imbalanced adrenal function.

Testosterone

Produced in both the ovaries and the adrenal glands, testosterone plays an important role in ovarian function, bone strength, and sexual behavior for women. Low testosterone levels can lead to low libido, weakened bone strength, lack of concentration, and depression. (Harvard Health 2023) Stress can cause a reduction in testosterone levels, simultaneously leading to a lower tolerance to stressful situations by increasing anxiety and irritability. (Afrisham 2016)

Progesterone

Progesterone is primarily produced in the ovaries, rising during the luteal phase after ovulation. It’s also formed in smaller amounts by the adrenal glands or the placenta during pregnancy. Progesterone plays a crucial role in regulating the menstrual cycle, supporting sleep, and maintaining overall well-being. During pregnancy, progesterone is essential for preparing the uterine lining for implantation and maintaining a healthy pregnancy.

Low levels of progesterone cause symptoms like irregular periods, mood changes and anxiety, insomnia, and infertility. (Cable 2023) (Haufe 2023) (Standeven 2020)

Adrenal health assessment

Integrating lifestyle evaluations and laboratory testing can inform personalized treatment plans for patients to support adrenal health and hormone balance.

Initial assessment

Initial patient assessment evaluates any reported symptoms, menstrual and reproductive history, use of contraceptives and other medications, and medical and family history for a comprehensive understanding of the patient’s unique situation.

Document any of the symptoms listed below, making note of onset and duration. Inquire about menstrual regularity, including any missed periods, changes in flow, or premenstrual symptoms. Make sure to discuss libido levels and fertility if applicable.

Given the number of bodily functions affected by hormones and adrenal glands, several related conditions can develop as a result of imbalances. Note any autoimmune diseases or thyroid disorders, along with any known family history of endocrine or adrenal disorders. Make sure to document any medications or dietary supplements that the patient is using.

Symptoms

There are many common symptoms of both hormonal imbalances and adrenal dysfunction to assess. If a patient displays some of the following symptoms, it may indicate that their hormones are imbalanced due to poor adrenal health:

• Cravings for sweet or salty foods
• Difficulty falling or staying asleep
• Fatigue
• Hair loss
• Low libido
• Memory issues
• Menstrual irregularities
• Mood changes, including depression, anxiety, and irritability
• Muscle weakness
• Postural hypotension
• Skin changes, including increased dryness or acne
• Increased sensitivities or allergic reactions
• Sudden weight loss (Husebye 2021) (NIDDK 2022) (Shah 2012)

Assess blood pressure levels for signs of orthostatic hypotension during physical examinations. 

Lab testing

Adrenal imbalances present themselves through a variety of hormonal symptoms. The following lab tests may be helpful for further assessment of a patient’s adrenal health status.

Cortisol levels

Measure morning cortisol levels to assess adrenal function. Consider an adrenocorticotropic hormone (ACTH) stimulation test if adrenal insufficiency is suspected. (Bornstein 2016) Cortisol levels can be measured through saliva, serum, and urine.

Saliva cortisol

A morning saliva cortisol test involves collecting a single saliva sample immediately upon waking to measure peak cortisol levels. Alternatively, with a diurnal cortisol rhythm test, saliva samples are collected at multiple times throughout the day (usually upon waking, mid-morning, afternoon, and evening) to evaluate the cortisol curve. This may also include cortisol awakening response (CAR) collected 30 minutes after waking. (Kobayashi 2017)

Serum cortisol

Morning serum cortisol measures a single blood sample taken typically between 8–9 a.m. when cortisol levels are at their peak. Additional blood sample(s) can be drawn later in the day to compare with morning levels. This is generally inconvenient and less common. (National Library of Medicine n.d.)

Urine cortisol collection

A spot urine test takes a single urine sample at a specific time (often in the morning) to measure cortisol levels. (Reynolds 2007) A 24-hour urinary free cortisol (UFC) test collects all urine produced over a 24-hour period to measure total free (unbound) cortisol. (HealthLink BC n.d.)

Alternatively, a dried urine spot test collects urine samples on filter paper at different times of the day before they’re dried and sent to a lab for cortisol level assessment. This method is convenient and allows for multiple collections over a period without the need for refrigeration. (Newman 2021)

DHEA and DHEA-S levels

Test DHEA and DHEA-S to evaluate their levels, extent of sulfation, and overall adrenal androgen production. (Kassem 2012) Assessment methods include serum, saliva, urine, and dried-spot urine testing.

Dried urine test

A dried urine test measures DHEA and DHEA-S using dried urine samples. This method relies on collection of urine on filter paper. The test is non-invasive and can be done at home, making it convenient and allowing for urine samples over the course of the day to provide a comprehensive view of DHEA and DHEA-S. (Newman 2021)

Salivary DHEA and DHEA-S

Salivary testing measures the free, bioavailable form of DHEA and its metabolite DHEA-S in saliva. The main advantage is that this is reliable, sensitive, and non-invasive and reflects bioactive hormone levels. (Meshari 2022)

Serum DHEA-S

Serum DHEA-S testing involves a blood draw, typically done in the morning. This provides a direct measurement of DHEA-S, which has a longer half-life and more stable levels than DHEA. Serum levels are a reflection of the immediate levels of DHEA. (National Library of Medicine n.d.)

Sex hormone levels

Assessing levels of estrogen, progesterone, testosterone, and other relevant hormones can help clinicians identify the impact of stress on sex hormone balance. (National Library of Medicine n.d.) (Sharma 2021)

Estrogen

Serum, saliva, and dried urine estrogen tests measure estradiol (E2), estrone (E1), and estriol (E3). Estradiol is most commonly measured as it’s the predominant form of estrogen in premenopausal women. This test is crucial for evaluating estrogen levels in various phases of the menstrual cycle or in postmenopausal women. (National Library of Medicine n.d.)

Urine testing can also evaluate estrogen metabolites, providing a picture of how well estrogen is metabolized, which is particularly important in assessing estrogen dominance. (Coburn 2018)

Progesterone

Testing for progesterone is typically conducted during the luteal phase of the menstrual cycle to assess ovulation and luteal phase adequacy. It provides a clear picture of progesterone production by the ovaries. Testing progesterone levels can be done by measuring serum, saliva, and dried urine. (Konishi 2012) (Mesen 2015) (Newman 2019)

Testosterone

Serum testosterone tests measure both total and free testosterone levels. Total testosterone includes both bound and unbound testosterone, while free testosterone reflects the bioavailable fraction. This test is vital for assessing androgen levels, which can impact libido, mood, and metabolic function. (Krakowsky 2015) (National Library of Medicine n.d.)

Saliva testing for testosterone measures the bioavailable fraction and is particularly useful for evaluating diurnal fluctuations. It’s often used in conjunction with cortisol testing to assess adrenal and androgen function. (Crewther 2017)

Urine testing allows the opportunity to measure testosterone metabolites, such as androsterone and etiocholanolone, providing a detailed view of androgen production and metabolism. (Scott 2024)

Thyroid function tests

Include thyroid-stimulating hormone (TSH), free triiodothyronine (T3), and free thyroxine (T4) to rule out thyroid dysfunctions that can mimic or exacerbate adrenal issues. (Garber 2012)

TSH

This test measures the pituitary gland’s signal to the thyroid to produce hormones. Elevated TSH typically indicates hypothyroidism, while low levels may suggest hyperthyroidism. TSH is the first-line screening test for both hypothyroidism and hyperthyroidism. (American Thyroid Association 2020)

Total and free T4

T4 is the dominant form of thyroid hormone produced by the thyroid gland. Total T4 measures all T4, bound and unbound to transport proteins. Free T4 specifically measures the unbound portion of thyroxine available to tissues. Both are a useful addition to TSH in assessing thyroid function, and low levels often indicate hypothyroidism. (American Thyroid Association 2020)

Total T3

T4 has to be converted to T3, the biologically active form of thyroid hormones. This test measures the total amount of T3, including both bound and free T3. It helps evaluate the overall level of active thyroid hormone in the body and can be useful in assessing hyperthyroidism or the severity of hypothyroidism. (American Thyroid Association 2020)

Free T3

Free T3 is the measure of the most biologically active form of thyroid hormone, free and unbound to carrier proteins. Low free T3 levels can suggest impaired conversion, often seen in chronic stress or illness. Often this is accompanied with elevated reverse T3 (rT3) levels. (DeGroot 2015) (Yamazaki 2021)

rT3

Under conditions of elevated physiological, psychological, or environmental stress, the production of rT3 instead of active T3 helps the body adapt and preserve energy by slowing down metabolism. Evaluating levels of rT3 with other thyroid function tests can help clinicians connect the impacts of stress on thyroid dysfunction. (Fröhlich 2021)

Preventative assessment

To prevent potential adrenal and hormonal imbalances in the future, it’s essential to identify risk factors and implement early interventions as needed. Assess the patient's lifestyle and occupational stressors that could contribute to adrenal dysfunction. Take a detailed family history to identify genetic predispositions to adrenal or hormonal disorders.

Educate patients on a balanced diet rich in essential nutrients that support adrenal health, such as magnesium and vitamins B and C. (Moritz 2020) (Noah 2021) Encourage regular exercise tailored to the patient's fitness level, emphasizing stress-reducing activities like yoga and walking. (Stubbs 2017)

If stress management is needed, introduce techniques like mindfulness, meditation, and deep-breathing exercises to help mitigate the impact of chronic stress on adrenal function. (Pascoe 2020) Consider referring patients experiencing significant stress, anxiety, or depression to mental health professionals.

If any risk factors are identified, schedule regular physical examinations to assess and monitor health status and detect any early symptoms.

Supporting women’s hormone balance and adrenal health

Overall, women’s hormones play a vital role in their health and well-being, and maintaining adrenal health is part of a whole person care strategy for ensuring healthy hormone balance. If adrenal imbalance is suspected due to presenting symptoms, risk factors, or genetic predisposition, following this whole person approach to assessment and treatment can help optimize patient outcomes.