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It's prevalent at this time of life partly due to the decrease in progesterone which occurs up to 12 years before menopause without any other changes to periods. Women report feeling more anxious and irritable, less resilient to stress and experiencing more PMS symptoms. The conversion of progesterone to allopregnanolone interacts with the GABA receptors which have a calming and sedative effect on the body. Allopregnanolone is 10 times more potent than a benzodiazepine e.g., Valium. Hence, with the reduction in progesterone, the brain is less calm and more reactive to stress.
In addition to hormonal changes, women in their 40s often experience more external stressors, with young kids, caring for elderly parents or being at the peak of their careers. This is a perfect storm for increased anxiety and being in 'fight or flight' mode constantly, which leaves no 'fuel in the tank' for any additional stress. In the circumstance where there is additional stress because the individual is already in 'fight or flight' mode, there is nowhere to go, so the body gives up and strategically diverts energy toward its vital functions. Women then feel fatigued, and overwhelmed, and have gut issues and more PMS symptoms, to name a few. It can also make you feel exhausted all day and wired in the evening, making it difficult to wind down to sleep or wake very alert and anxious throughout the night.
So, how can you prevent or treat adrenal fatigue?
Your body relies on many sources of information to assess what the external environment is like, ie. Can we 'rest and digest' or do we need to be on high alert to be ready to fight the lion? One major source of information is the circadian rhythm: little clocks in every cell of the body coordinated by a 'master clock' in the brain. This master clock has direct input from our eyes, to tell our bodies to release melatonin and get sleepy as the sun goes down and to wake up and be ready for food and activity during the day.
Modern-day electricity and technology can confuse our bodies, with overhead lighting, blue light from our devices, and eating dinner late when the sun has already set. Our bodies do not get that 'winding down' cue.
We can better support our rhythm by switching off overhead lights after the sun has gone down and instead using floor and table lamps. Aim to turn off TVs and devices at least 1 hour before bed and turn to a book or a podcast. In the morning, have your cup of tea outside in the sunlight, even on an overcast day. Keeping to regular mealtimes and eating during sunlight hours will also help your digestion.
When we feel fatigued and unproductive, often we'll reach for a coffee to get moving, however, coffee stimulates the body to produce more cortisol. When the body is already depleted from chronic stress it can make things even worse! Caffeine blocks the adenosine receptors, causing you to feel more alert and less sleepy. Adenosine (which should gradually increase during the day to result in sleepiness in the evening) accumulates, so when the caffeine wears off, there is a resultant crash in energy.
Instead of caffeine, swap to 'mushroom coffee', or herbal tea, or put some sugar-free electrolytes in your water to sip throughout the day. Your body may need a few days to adjust, but the benefits will be worth it!
If cutting out coffee is too much to bear, reduce it to one coffee per day, delay it for at least 90 minutes after waking up (but before noon!), and aim to have it alongside food, not on an empty stomach.
Perimenopause and adrenal fatigue can lead to weight gain and difficulty losing weight. Unfortunately in our society, the message is given to women that to lose weight you simply have to eat less and exercise more. Women often cut carbs, turn to intermittent fasting and eat like birds, with no result in weight and a complete decrease in energy.
Women in perimenopause and particularly if they have adrenal fatigue, do not always respond well to ketogenic diets or long periods of fasting. Both can cause stress on the body and compound the issue even further. Eating more regularly and before 9 am, and including wholefood sources of carbohydrates, particularly with the evening meal, helps calm the body, support hormones and stabilise blood sugar throughout the evening. My favourite foods to add to this effect are sweet potato, pumpkin and a small amount of white rice.
As mentioned previously, the aim is to reduce perceived stress by the body. While there are many advantages to 1-2 high-intensity workouts per week, when you are already in a depleted, high-stress state, the addition of HIIT just adds further stress to the body. People often feel exhausted after this kind of exercise, either later in the day or the following day. Instead, opting for more gentle exercise such as walking, yoga or Pilates with 1-2 strength-based workouts can give you the movement you need without over stressing your body. Later when you have recovered, you can add HIIT again, especially post-menopause.
Emerging research about the vagus nerve has linked its dysfunction to conditions such as anxiety/depression, autoimmune disease and Alzheimer's disease. It is especially key in adrenal fatigue as it is the nerve that gets us out of 'fight or flight' and into the 'rest and digest' state. By stimulating this nerve, we can assist our bodies to believe there is no threat in the environment and that we are safe.
Things you can do when feeling stressed or as a daily practice to increase your vagal tone are:
Cold exposure and high-intensity exercise have also been shown to stimulate the vagal nerve, however, it may be more beneficial to do this after recovery when your body is more resilient to stress and not likely to perceive these events as stressful.
As always, these recommendations are generalised tips that I find help most people suffering from symptoms of burnout or adrenal fatigue.
Be kind to yourself, nourish your body and schedule things every day that fill you with joy.It is always recommended that you see someone experienced in this area that can assist you and identify any other factors that may be causing your symptoms and help guide your recovery appropriately.
Dr Lucy Caratti is a highly qualified Integrative Doctor with 15 years of clinical experience and an expert in women's health, particularly issues like menopause, gut health, metabolic diseases, and hormonal imbalances.
