Feeling wired and tired? Can’t sleep but feel exhausted? You may be experiencing Adrenal Fatigue so check out my expert guide: What are the 4 Stages of Adrenal Fatigue. 

Our everyday lives are often filled with constant demands, emotional stress, and a pace that rarely slows down. For many women entering perimenopause, the body’s ability to cope with stress is already compromised — and that’s where the adrenal glands come into play.

These small but powerful glands, part of the endocrine system, produce a combination of stress hormones, including cortisol, DHEA, and adrenaline. When the body is exposed to chronic stress over a long time, the adrenal glands can become depleted, leading to a condition often referred to as adrenal fatigue.

Although adrenal fatigue syndrome isn’t widely accepted in conventional medicine, many medical professionals and integrative health practitioners acknowledge a group of symptoms that point to poor adrenal function, especially in women navigating hormonal imbalances during perimenopause.

Please note this article contains affiliate links.  I only recommend products that I use myself or with my patients.  Always discuss any natural health product with your practitioner before starting it as this is not considered medical advice. 

In this article, we’ll explore:

• What is adrenal fatigue?

• The 4 stages of adrenal fatigue

• How it overlaps with perimenopausal symptoms

• What you can do to support adrenal health

What Is Adrenal Fatigue?

Adrenal fatigue refers to a state of adrenal dysfunction in which the adrenal glands can no longer meet the body’s need for enough cortisol and adrenal hormones to handle stress. It’s not the same as Addison’s disease — a rare but serious autoimmune condition resulting in adrenal failure — but it can progress to a phase of total adrenal gland failure if left unchecked.

Adrenal Fatigue is characterized by:

• Low DHEA levels

• Imbalanced cortisol production

• Chronic exhaustion

• Blood sugar instability

• Mood swings

• Digestive issues

• Body aches

• Low energy levels

These issues can resemble similar symptoms seen in perimenopause, making it difficult to distinguish between the two without proper testing and guidance.  Check out this blog to learn more about female hormone testing!

The 4 Stages of Adrenal Fatigue

Let’s walk through the different stages of adrenal fatigue, how they develop, and what signs to look for.

1. The Alarm Phase (First Stage of Adrenal Fatigue)

This is your body’s initial reaction to different stressors — be it emotional, physical, or environmental. The adrenal glands go into overdrive, pumping out adrenal hormones like cortisol and adrenaline in response to the “fight-or-flight response.”  This process can involve making more cortisol and DHEA hormones, and trigger wired but tired feelings.

Common signs:

• Increased heart rate

• Heightened anxiety

• Trouble sleeping

• Sugar cravings

• High blood pressure

• Feeling “tired but wired”

This stage often overlaps with the earlier part of perimenopause when hormonal imbalances begin but are not yet severe. You may feel like you can power through normal life, but your body is already signaling an imbalance.

2. The Resistance Phase

In this stage, the body is still under chronic stress, and the adrenal glands continue to produce cortisol, but now at a cost. The DHEA levels may begin to drop or drop, and the body starts stealing building blocks from other hormones (like estrogen and progesterone) to keep cortisol production going.

Symptoms of adrenal fatigue in this phase:

• Difficulty waking up

• Mid-afternoon crashes

• Brain fog

• Increased belly weight gain

• Reliance on caffeine or sugar

• Disrupted sleep

This is also when many women in perimenopause begin to notice escalating health problems, from digestive issues to menstrual changes. The link between cortisol, insulin, and estrogen becomes more pronounced, and blood sugar levels may swing widely.  The thyroid gland may also suffer and become more sluggish, and one might be more prone to infection and decreased immunity.

3. The Exhaustion Phase

This is often referred to as adrenal exhaustion. At this point, the adrenals are depleted (at least temporarily as they can bounce back- more on this below) and cortisol production becomes erratic or insufficient. The body can no longer maintain its stress response, and symptoms intensify.

Signs of adrenal exhaustion:

• Severe chronic fatigue and insomnia

• Low libido

• Body aches

• Lightheadedness

• Depression or apathy

• Low tolerance to stress and exercise

• Frequent infections

• Brain Fog

Many women are mistakenly diagnosed with depression or even fibromyalgia at this stage, when in fact the real cause of your symptoms could be a combination of adrenal imbalance and the hormonal imbalances of perimenopause.

4. The Burnout Phase (Adrenal Failure)

Burnout phase is the most severe stage is where adrenal function has declined so drastically that symptoms can mimic Addison’s disease. Although rare, some women may develop adrenal insufficiency that needs medical attention.

Symptoms:

• Low blood pressure

• Fainting spells

• Inability to perform normal activities

• Salt cravings

• Irregular heartbeat

• Adrenal crisis (in extreme cases)

• Severe fatigue and/or insomnia

This stage requires immediate intervention and often results from years of neglecting the body’s signals.

How Adrenal Fatigue Relates to Perimenopause

During perimenopause, ovarian hormone production begins to fluctuate and decline. The adrenal glands are meant to “pick up the slack” by converting DHEA into sex hormones like estrogen and testosterone.

But when the adrenals are already taxed due to modern life, poor diet, emotional stress, and chronic stress, they can’t handle the extra workload.

This often leads to:

• Exacerbated hormonal imbalances

• Severe fatigue during the day

• Worsened hot flashes or mood swings

• Trouble managing weight gain

• Insomnia and anxiety

The overlap between perimenopause and adrenal fatigue stages is significant, and without identifying the root cause, women may be offered only temporary relief or misdiagnosed altogether.

How to Test for Adrenal Fatigue

Though not all conventional medicine providers recognize adrenal fatigue, many integrative practitioners use lab tests such as:

• Salivary cortisol testing (4-point daily rhythm)

• DHEA-S levels

• Cortisol awakening response

• ACTH stimulation (to rule out Addison’s)

These tests help determine where you are within the different stages of adrenal fatigue and whether your symptoms stem from adrenal dysfunction or another root cause.

Healing Adrenal Fatigue and Supporting Perimenopause

You can begin to reverse adrenal dysfunction and feel better by addressing both the adrenal imbalance and the underlying hormonal imbalances of perimenopause.

Key Lifestyle Changes:

• Prioritize 7–9 hours of sleep each night

• Reduce caffeine and sugar intake

• Practice daily stress-reducing techniques (yoga, deep breathing, meditation, nature walks, prayer)

• Set boundaries to reduce emotional overload

• Engage in gentle exercise like walking, yoga, pilates, or tai chi

• For a deeper dive into managing imbalanced cortisol during perimenopause, check out this blog!

Nutritional Supplements for Adrenal Support:

Before you start taking any new supplement always discuss it with your healthcare provider as they know you as a unique person and can tell you if it is safe for you. 

• Vitamin C – helps regulate cortisol and supports adrenal repair

• Magnesium – calms the nervous system and reduces cortisol spikes.  I often advise my patients to take magnesium at night as it can help with sleep.  Magnesium glycinate is the type that is least likely to cause loose stools while citrate can help with constipation.

• B-complex vitamins – especially B5 (pantothenic acide), riboflavin, and B6 for adrenal hormone production.  Here’s one of my favorite b complexes:

  

  Integrative Therapeutics Active B-Complex - Energy Metabolism Support* - B-Complex Vitamin Supplement with 8 B-Vitamins, Vitamin B12, Folate, Choline - 60 Capsules

  • Active B-Complex Supplement: Provides all 8 B-vitamins in a high-potency blend containing active forms of vitamins B2, B6, B12, and folate; includes choline to support healthy brain function*
  • Cellular Energy Production: Supports cellular energy production through the metabolism of carbohydrates, proteins, and lipids; converts food into fuel to help you tackle the day*
  • Essential B Vitamins: B vitamins play essential roles in supporting cell function, the nervous system, and cellular energy production; supports the synthesis of serotonin, dopamine, and GABA*
  • Nervous & Immune System Support: Folate plays an essential role in nervous system and immune system functions*; our supplement is formulated with the Quatrefolic brand L-methylfolate
  • Your journey to wellness is easier to navigate with a trusted partner by your side; to find the right products for you, we recommend joining forces with your healthcare provider

  $18.50

  Buy on Amazon

• Adaptogens (like ashwagandha, rhodiola, and holy basil) – balance adrenal hormones.  I love the blend HPA Adapt by Integrative Therapeutics!

  

  Integrative Therapeutics HPA Adapt - Supports a Healthy Stress Response* - Positive Outlook Supplement with Ashwagandha, Maca, Holy Basil & Rhodiola - Gluten-Free & Soy-Free - 120 Vegan Capsules

  • Stress Supplement for Men & Women*: Helps support the body in times of stress*; supports the HPA axis to maintain stress hormonal balance and a healthy stress response*
  • Supplement for Stress Support*: HPA Adapt encourages feelings of calm, supports against stress-related tiredness, supports cognitive function, and supports a positive outlook*
  • Supplement with Maca & Ashwagandha: With a unique adaptogenic herbal blend including rhodiola root extract, Sensoril ashwagandha root and leaf extract, eleuthero root extract, maca root extract, and holy basil leaf extract*
  • HPA Axis & Hormone Support Supplement*: This healthy stress support supplement is gluten-free, soy-free, and vegan; doesn't contain salt, wheat, dairy, or artificial colors or flavors*
  • Your journey to wellness is easier to navigate with a trusted partner by your side; to find the right products for you, we recommend joining forces with your healthcare provider

  $39.50

  Buy on Amazon

• Licorice root (for those with low cortisol) – extends cortisol half-life (only under supervision as this herb can raise blood pressure and sometimes cause water retention)

Final Thoughts

Whether you’re deep in perimenopause or just starting to feel the shift, understanding your adrenal health is important. The adrenal glands are not just responsible for handling stress — they are also instrumental in maintaining hormonal balance, supporting energy, metabolism, and immune resilience.

Recognizing the adrenal fatigue stages early on can prevent more severe health issues and help you reclaim your vitality. If you’re experiencing symptoms of adrenal fatigue alongside typical perimenopausal concerns, you may be dealing with a combination of stress hormones gone awry.

Take the time to assess your stress, support your adrenals, and seek a practitioner who understands the real cause of your symptoms — so you can feel like yourself again!

You may also like:

Taming the Cortisol and Perimenopause Chaos: Lifestyle Hacks to Bust Belly Fat

What No One Tells You About Cortisol and Estrogen Dominance

Perimenopause and Anxiety

DrShelley

Dr. Shelley Meyer is a board-certified family physician and Institute of Functional Medicine-certified functional medicine physician, as well as a Registered Dietitian. She is passionate about helping women navigate the roller coaster of perimenopause and postmenopause.  She has her own Functional Medicine Practice in Denver, Colorado.