Harmony Hub Health
Functional Medicine, Hormone Health and Weight Loss with Michele Postol, CRNP
Harmony Hub Health
Is It Perimenopause or Just Burnout? A Cortisol Reality Check
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.
Welcome to Harmony Hub Health, where my mission is to provide comprehensive, affordable, integrative care that addresses the root cause of health issues. At the Hub, the focus is on individual patient journeys. I strive to optimize health, vitality and longevity, fostering a community where each person can thrive in body, mind and spirit. So is it perimenopause or just burnout? We're going to do a cortisol reality check and we want to talk about how adrenal dysfunction can hijack your hormones and your sanity. This is when you're feeling tired but wired. Your period is a mess. You snap at your partner for just breathing too loud. I've done that, and don't even get started about sleep. Is this the beginning of perimenopause or is it just full-blown burnout? And there's a spoiler alert it might be both, and cortisol, the infamous stress hormone, might be calling the shots. So perimenopause and burnout can be confusing to know the difference. Perimenopause is the hormonal roller coaster before menopause. In burnout, this is the chronic, stress-induced dysregulation of the hypothalamic pituitary adrenal, or what I call the HPA axis. They often look like twins when it comes to symptoms. They can both cause fatigue. They can both cause sleep disturbances, anxiety, irritability, brain fog. Now, usually perimenopause is the irregular periods and it's not adrenal dysfunction or burnout, but when stress is what caused it, that can suppress your ovulation. Both of them cause weight gain, low libido, blood sugar instability, and this overlap makes it easy for women to assume that it's just perimenopause. But they're missing that adrenal piece. That can mean treating hormone symptoms without addressing the 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 governs your body stress response and as the orchestra conductor of all hormones, including estrogen, progesterone and your thyroid hormones.
Speaker 1:When you're under chronic stress, whether it's emotional, physical, environmental or biochemical, your cortisol production shifts in stages. First we have the hypercortisol. These are the people that feel wired but tired. They have high cortisol, sleep disruption, they're anxious and they have insulin resistance. Then we have what I call flatline fatigue. This is hypocortisol, this is low cortisol. They feel depressed, they have low blood pressure, they're burnt out, there's thyroid suppression and then we have dysregulated rhythm. These are those with poor morning energy, and then they still crash in the afternoon, but then they get that second wind at night. And here's where it gets spicy Cortisol steals from progesterone, a phenomenon known as the pregnenolone steal. So cortisol is made up from pregnenolone, which is the same precursor as progesterone. Chronic stress diverts pregnenolone away from making sex hormones to keep up with the stress response. So what happens is your progesterone goes low, you become estrogen dominant and symptoms that look just like perimenopause. There was a 2015 study published in menopause and they found that chronic stress exacerbates perimenopausal symptoms, especially hot flashes, insomnia and mood swings, and that makes cortisol a core culprit in hormone chaos.
Speaker 1:And I know HPA axis sounds really fancy and very scientific, but it is your hormone headquarters for stress and survival. I want to break down this HPA axis because once you understand this, everything about hormone chaos, burnout and perimenopause makes a little bit more sense. So HPA stands for hypothalamic pituitary adrenal axis. It's not a physical organ. It's a communication system between your hypothalamus, your pituitary and your adrenal glands. So the hypothalamus, this is the command center in your brain. The pituitary gland, this is the hormone boss sitting just below the brain. Then you have your adrenal glands. These are little triangle-shaped glands that sit on top of your kidneys and they produce cortisol and other hormones. These three form a feedback loop that regulates your body's stress response your energy, your mood, your immune system, your sleep-wake cycles and, yep, even your sex hormones.
Speaker 1:And here's a really easy, simple version of how it works. So first we have stress that hits, whether it's like your job or it's just perceived stress because you're scrolling through news or skipping meals. That's a stress. Your hypothalamus releases CRH, this is corticotropin releasing hormone. This hormone signals your pituitary gland to release ACTH, also known as adrenocorticotropic hormone. Acth tells the adrenals to pump out cortisol. So cortisol helps your body deal with stress, but it also sends feedback up the chain to say, okay, we've got enough, and it calms your system down. This is all good unless the stress doesn't stop. This is when your system starts. This is all good, unless the stress doesn't stop. This is when your system starts to glitch.
Speaker 1:When you have chronic stress, it causes this HPA dysfunction. So your HPA access is not built for nonstop email pings, blood sugar crashes, toxic relationships, overtraining and poor sleep. When it gets overused, three different things happen. First, your hypothalamus stops responding properly to stress cues. Second, the pituitary gets sluggish and it signals it's tired. Three, the adrenals either go into overdrive and make too much cortisol or they completely burn out and then you have too little cortisol. This dysregulation leads to a broken rhythm of cortisol rather than the natural pattern of high in the morning and low at night. And cortisol is not just the stress hormone, it is the ultimate multitasker.
Speaker 1:When cortisol goes rogue, it starts pulling the strings on other hormone systems. So first there's progesterone. Cortisol and progesterone share the same precursor Remember that pregnenolone. So when you have chronic stress, pregnenolone gets shunted to make more cortisol. That means there's left to make your progesterone. So the result is your progesterone is lower, your estrogen is higher, you become estrogen dominant, you have mood swings, you get breast tenderness and you have menstrual cycle issues. Then we have our estrogen High. Cortisol increases an enzyme called aromatase, so more testosterone gets converted into estrogen. This leads to weight gain, food retention and just bad PMS symptoms. Then we have our thyroid.
Speaker 1:Cortisol slows down the conversion of T3 to T4, which are your active thyroid hormones. You know T4 has to convert to T3 to stimulate your thyroid and when cortisol slows down that conversion, this causes low energy, causes hair loss, cold hands and even when your labs may look normal, the cortisol is still slowing down that conversion. It also increases reverse T3, which is known as a thyroid blocker. This is why when I am evaluating thyroid for people that are really having thyroid issues, 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, a free T3, and that reverse T3. And cortisol also raises blood sugar to prep for that fight or flight. So when you have long-term cortisol raises, then insulin resistance happens and abdominal weight gain happens because you're just constantly raising blood sugar.
Speaker 1:So your HPA axis is kind of like the thermostat of your hormonal house. Think of the HPA axis as your body's thermostat. It tries to keep your internal environment just right. When life turns up the heat or the stress, it cranks out cortisol to cool things down. But if you keep leaving the oven on or keep having more stress, the system can't keep up. Eventually your thermostat breaks and the whole house becomes unstable. Does that make sense? Studies show that women in perimenopause have more cortisol reactivity. Their bodies respond more intensely to stress. This is due in part to progesterone's calming effect decreasing while estrogen becomes more erratic. So stress hits you harder in your 40s than when it did in your 20s and you probably noticed that if you were my age I'm 48, but there are signs that it's cortisol and not just estrogen.
Speaker 1:So I want to decode some of the red flags that your adrenals need support, even if you're in that perimenopause age range. All right. So one of them is if you feel exhausted even though you've slept for eight hours, and then there's that three o'clock afternoon energy crash where you want to go for that latte that used to be me. I have not had an afternoon latte. Honestly, I can't even tell you the last time I had an afternoon coffee. If you wake up at two to three o'clock in the morning regularly, or if you have high cravings for salty or sugary foods. If you have mood swings or anxiety that worsens when you're under pressure. If you feel worse after high intensity workouts. If your cycle worsens after periods of intense stress, or you've become intolerant to stimulants or alcohol.
Speaker 1:Okay, so I like to do some functional testing. I don't like to guess which one it is. In functional medicine I don't chase symptoms. I test the full hormonal landscape, including cortisol, not just estrogen or that follicle stimulating hormone, and there are some tests that I really love for this. One of them is the Simply Test Cortisol Panel. It's a four point salivary test. There's also the Dutch cortisol test that can show cortisol rhythm, but the Simply Test Cortisol Test is, I'm not going to say, better, but I will say it's budget friendly. It's an at-home saliva-based cortisol test that's designed to give you a snapshot of your diurnal cortisol rhythm that reflects how your body is producing and regulating cortisol across the day. So it's a functional, medicine-friendly tool that offers convenience and ease to use while still capturing clinically relevant patterns of adrenal function. So it measures salivary cortisol at four points throughout the day.
Speaker 1:Now, the Dutch test is great. The reason why it's more is because it does more than just measure cortisol. It measures hormone cycles and all of that. So if I'm looking at just cortisol, then this Simply Test is amazing. So it measures your salivary cortisol when you wake up, 30 minutes after you wake, in the mid afternoon and then right before bed. So it provides a diurnal cortisol curve, a visual of how cortisol rises and falls in your body over 24 hours. So it's looking at that HPA access function.
Speaker 1:If your cortisol is too high or too low or dysregulated, we can see that. We can see if you're experiencing cortisol spikes at night leading to insomnia. Most people only check a cortisol level in the morning. Well, in the morning it's supposed to be high, but you're not really seeing what's happening throughout the day. To find out if that is what's affecting your sleep cycle, Do you have a flat curve? I see this a lot with burnout and adrenal fatigue. If your cortisol awakening response, known as a CAR, is it robust enough, do you have a 30 to 45% jump in the first 30 minutes that's why we check it when you wake and then 30 minutes after.
Speaker 1:Cortisol in saliva does reflect the free, bioavailable cortisol, not protein bound like in blood. So this gives a more functional picture of what your tissues are actually experiencing. And there's certain patterns that I can see with a simply test. A normal curve would be high in the morning with a gradual drop. This shows me that you're resilient to stress response. A flat curve where you're low all day. Usually I see this if you have fatigue, brain fog, burnout. If you have a reverse curve, that's when you're low in the morning and high at night, this is where I see people with night cravings, anxiety, insomnia. Or if you're elevated all day and just overstimulated. These are people that are wired, anxious and they have that belly weight game. So in this Simply Test Kit you get four little collection tubes. They're labeled. I have the boxes at Monarch ready to go if you want to get tested. There's detailed instructions, there's return shipping materials and then turnaround time is usually five to 10 business days.
Speaker 1:And I like to use it to evaluate adrenal fatigue, adrenal stress, to track how your cortisol impacts your thyroid or your sex hormones. I can use it to assess sleep disorders, burnout or mood swings, and we can also monitor adaptogen or hormone therapy responses. It does go good with the Dutch hormone testing. Dutch also has their own CAR test if you want that. The good news is that it is very easy. It's not invasive, there's no needles involved. It tracks real world cortisol fluctuations and it really is great for early detection of that HPA axis dysfunction and, like I said, it's very affordable. The only thing I don't like about it is it doesn't allow cortisol metabolites like the Dutch test. It doesn't test DHEA Some panels can and it doesn't assess any of the sex hormones. But that's okay because it's ideal if you think perimenopause symptoms are worsened by stress. If you have that tired but wired insomnia, we can see if you have that flatline fatigue or burnout, if you have anxiety or panic attacks that's linked to stress, if you're having mystery waking and not quite sure why. I like to use this test and for people that have that post-COVID exhaustion or long haul symptoms, it really is powerful and a functional snapshot of how your stress response really is working.
Speaker 1:The other test that is my favorite for this is the HTMA. It's the hair tissue mineral analysis. That's another non-invasive, functional snapshot of mineral patterns and it can reflect adrenal function over time, especially chronic stress load and adrenal reserve. It doesn't measure cortisol directly like the saliva or DASH testing. It actually reveals mineral ratios and levels that are influenced by adrenal hormone activity, particularly that aldosterone and the cortisol. So I look at your sodium and your potassium in your tissue. These are the adrenal markers. These two minerals are the most directly linked to adrenal function. So sodium is regulated largely by aldosterone that's an adrenal hormone and then potassium affects our cellular energy and sensitivity to aldosterone.
Speaker 1:So I get a sodium to potassium ratio. I call it the stress ratio or vitality ratio. Normally the range is 2.3 to 2.5, but when I see a high ratio that tells me there's acute stress or there's early adrenal stimulation, often seen in high cortisol 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 than 2.3 and I can see adrenal burnout or exhaustion. So often this is linked to low cortisol and low aldosterone production and it also tells me that people have chronic stress, long-term fatigue or even probably a flatlined HPA axis. So just a fun fact, potassium loss relative to sodium can signal exhaustion phase of adrenal dysfunction where cortisol and aldosterone are both low.
Speaker 1:The other ratio I like to look at on HTMA is the sodium to magnesium ratio. This shows me adrenal resilience and cortisol activity. Sodium to mag is known as the adrenal ratio and I talk about it with all of my HTMA results. If you have a high ratio, that indicates that you have sympathetic dominance or that stress overdrive. If your ratio is low, then that shows me adrenal fatigue or that parasympathetic dominance and it really reflects how your body is adapting or not to stress over time. When I look at the calcium to potassium ratio, this shows your thyroid and adrenal connection causes hyperactivity, stress and anxiety. So remember the thyroid and adrenals are tightly linked. When cortisol is not regulated it can suppress thyroid function and impact that ratio.
Speaker 1:There's a lot of other clues of adrenal impact, like low sodium and low potassium in the tissues is classic in burnt out adrenals. High calcium and low potassium shows me that someone's a slow classic oxidizer and they're prone to fatigue, burnout and what I call mineral lock. And then low zinc. Low zinc impairs your HPA axis signaling and your stress resilience and immune modulation. I could do a whole podcast on Inosacare, which what I've been using for people that it really is helping that HPA axis. And even that elevated copper, because I can see copper imbalance on HTMA. Elevated copper causes estrogen dominance and adrenal stress in women. But with the HTMA it does not measure real-time cortisol like the SimpleTest or Dutch. It doesn't replace salivary urine or blood hormone panels. I still like to have blood work with HTMA. Instead, though, it does evaluate chronic patterns over three to four months that show how well your body is coping with stress, regulating minerals and producing adrenal hormones like that aldosterone. So HTMA can show me if you're running too hot by overproducing stress hormones, if you're running on fumes, if you're running too hot by overproducing stress hormones, if you're running on fumes, if you're burnt out and depleted or if you're struggling to maintain electrolyte and energy balance. So what do I do when I find this cortisol imbalance?
Speaker 1:Functional medicine is great. We talk about lifestyle first. We want to do a circadian rhythm reset. This means we want to wake with natural sunlight or you can use a red light panel. It means you want to do grounding and breath work in the morning. You want to avoid caffeine within 60 to 90 minutes of waking. I know that's really hard for people in the beginning until they do it. Blue light blockers after 7pm and then prioritize sleep like it is your job. That was a huge change for me was learning to sleep. And then how much now I depend on sleep and I love sleep.
Speaker 1:The other treatments I do are nutraceuticals and adaptogens. You know magnesium, glyconate or threonate. They both support cortisol metabolism and sleep. Vitamin C and B complex these are cofactors for adrenal function. Rhodiola, ashwagandha, holy basil you want to choose those based on your phase of dysfunction.
Speaker 1:I talk to a lot of people and they're just taking them all and have no idea why they're taking it or what. Because you shouldn't take all of it, right? If you have high cortisol, that's when ashwagandha comes in. That's when phosphatidylserine comes in. If you have low cortisol, that's the licorice root, the rhodiola and ginseng. But I see a lot of people that feel like they have really high cortisol but they're taking ginseng because they read somewhere that you should, but you may have the opposite effect. And then DHEA. But you may have the opposite effect, and then DHEA. That's if I do testing for you and show that you need some additional DHEA and I don't mean high dose DHEA I do see people that here you should take it. So I have a lot of females that come to me and they're taking a men's dose of DHEA and then wondering why they have acne and oily skin. So don't, just don't, don't do it.
Speaker 1:All right, um, targeted support, depending on what our consultation has. I do like adrenal cortex extracts, um for people with severe fatigue that are under supervision. Uh, mitochondrial support, of course, with my decor um, coq10, nad or PQQ, and then blood sugar balance. That would be with the chromium, the berberine, or like really good protein forward meals. And then I like to talk about stress detox. This is where we identify hidden stressors. You know, have you been exposed to mold? Do you have parasites? Do you have unresolved trauma? All of these things matter. Gentle movement is important, whether you're walking or yoga. I don't want CrossFit during these types of people. That's the worst type of activity you can do if you are a cortisol mess, even therapy or EMDR if you do have that emotional burnout.
Speaker 1:One of my favorite in-office treatments that I do are, of course, the IV infusions. When I add in the B-complex and NAD or magnesium or ascorbic acid, you know they're functional stress hacks. All of those are. When you balance cortisol, perimenopause becomes manageable. So women who focus on restoring their HPA axis these are the ones that tell me they have more predictable cycles. They have fewer mood swings, better sleep, better energy, less weight gain and then they have that improved libido and resilience.
Speaker 1:So sometimes what looks like hormone failure is actually adrenal fatigue in disguise. If you are wondering hmm, is my problem? Is it perimenopause or am I burnt out? Is it both? Then it's time for a functional medicine evaluation or a good hormone consultation. At Harmony Hub Health I offer advanced testing and personalized care plans that support both hormone balance and adrenal recovery. So book a consultation to map out your hormone blueprint and finally feel like yourself again.
Speaker 1:To map out your hormone blueprint and finally feel like yourself again, you can schedule in person at Monarch Beauty and Spa in Manchester, maryland. You can see me virtually online and go to wwwharmonyhubhealthcom. You can send me an email at michelle that's M-I-C-H-E-L-E at harmonyhubhealthcom. Please just don't send me your email at 3 amam while you're having your cortisol spike. I'm just kidding. You can do that, but just know I'm going to be asleep. Okay, so this podcast is for educational purposes only and not intended to diagnose, treat or cure any condition. Always consult a qualified healthcare provider for personalized medical advice. And yes, raging at your partner might be justified. Just don't blame me. I hope to see you soon.