Adrenals are small but powerful glands that sit on top of your kidneys. They are responsible for making the hormones that regulate stress, blood pressure, and sex drive (hot tip: your sex drive doesn’t only come from where you think it comes from).
There are several hormones made in the adrenals.
Let’s take a dive into seven of these and how they are related to stress and women’s health.
There’s no absolute rank order, but we’ll share with you how our medical team prioritizes them for women’s health:
Progesterone is what we call the “Mama” hormone because it creates most of the steroid hormones (estrogen, testosterone, and cortisol). The cholesterol molecule is the base for all of these, which first turns into progesterone. From progesterone, all the other steroid hormones are formed. Progesterone is made from cholesterol and is both created and depleted based on which other steroid hormones are being made. This key characteristic is what makes her the Mama in our eyes. When one of her downstream hormones is crying for attention, she puts all the resources there at the expense of herself. This is why we place her at the top of our women’s health hormone hierarchy. We want to do everything we can to fill her up again because what fills her fills you.
What’s most important to grasp here is that progesterone is NOT only produced by the ovaries during the menstrual cycle. It is often touted as the nesting hormone, and primarily for the purpose of preparing the uterus for pregnancy, or managing menstrual symptoms.
While this is true, progesterone is also essential for mental health, skin health, sexual health, sleep health, and even collaborative and empathic behavior in all humans. This is not news; it is textbook hormone physiology. However, it simply isn’t raised to the top when learning about progesterone, mainly because society assumes that females are only concerned about reproduction.
The adrenal glands are responsible for how your body provides this powerful progesterone if/when you are not ovulating and particularly through perimenopause or the menopausal transition.
Adrenal health is progesterone health and therefore is women’s health.
Estrogen is a name for a group of three steroid hormones (estrone, estradiol, and estriol) primarily produced by the ovaries in ovulating people but also by the adrenal glands.
Estrogen plays a clear role in female reproductive health. Estrogen triggers the development of breasts and hips, hair growth, and egg growth in the ovary. You may also be familiar with the non-reproductive effects of estrogen, such as bone health and cardiovascular health. The lesser-known effects are for mental health, sexual health, muscle strength and tendon flexibility, immune function, and verbal memory (yes, you did remember that conversation correctly).
We love estrogen. High estrogen is a great sign for the facets listed above. Low estrogen is often discussed when talking about menopause and menopausal symptoms. However…
When it comes to adrenal health unrelated to ovulation, estrogen levels can rise higher than needed due to environment, diet, and stress. Various chemicals that disrupt the endocrine pathways can upregulate estrogen production, certain foods that contain phytoestrogens may mimic the effect of estrogen, and stress can increase the enzymes that turn testosterone into estrogen.
The effect of estrogen rising from these situations means they are often not balanced with the other steroid hormones. The call for increased estrogen production often leads to a drain on the other two hormones, progesterone, and testosterone. This is a situation that some call estrogen dominance. This often shows up most obviously as severe period pain or heavy bleeding symptoms, migraines, and acne, but it can sometimes be more subtle.
Add into this that during the 10 years before menopause (perimenopause), some women have ovarian oscillations that also create exceptionally low estrogen periods so these women experience severe and almost contradictory symptoms from month to month. Hot flashes for a spell, then migraines and acne for the next. Welcome to a symptom set that most cannot decipher or solve.
When this pattern occurs for extended periods, perimenopause and menopausal transitions can be exceptionally difficult, as the adrenal steroid hormones are just not prepared to respond to the ovarian oscillations that are likely happening.
Keeping the adrenals healthy so that the reserve of progesterone, testosterone, and estrogen is equipped to respond to this oscillation becomes so much more important in this forgotten decade leading up to menopause.
Testosterone is made in the ovaries/gonads, though in much smaller amounts in females than in males. But as you know by now, it is also made from progesterone in the adrenals in everyone.
Testosterone deepens the voice, increases libido, influences mood and energy, improves muscle mass and strength, and increases spatial awareness (parallel parking is a proof point for many testosterone-rich people).
Testosterone is a key hormone for everyone’s health, but too often gets pinned as the “male” hormone. Instead, we can look at it as the hormone that drives motivation, vigor, and vitality. It is one of the first hormones produced from progesterone. Testosterone can turn into either estrogen or another form of testosterone called dihydrotestosterone (“DHT”). DHT is responsible for some of women’s typically less desirable effects, such as facial hair growth, scalp hair loss, and acne. How does it choose to turn into DHT instead of estrogen? Read on, friend.
Cortisol is the first adrenal hormone we bring up that is produced ONLY in the adrenal gland.
Cortisol is built for handling the stress that goes beyond an emergency (that’s what adrenaline is for)! But stress management is not cortisol’s only job. It is tightly connected to your circadian rhythm. It determines waking time, energy through the day, and sleepiness. It is also critical for immune health, blood sugar balance, cardiovascular health, and bone health. It rises to protect you and direct the blood flow to the organs and muscles that help you get out of challenging situations. It generally floods the system to help get you back to a safe place again, as a healthy stressor should. But, in unrelenting stress, bodies create more cortisol than what is required for energy needs, which can wreak havoc on physical health. In addition, when cortisol is dominating the daily stress response, it can completely unbalance the cascade of hormone production in the adrenal glands.
When stress hits, cortisol becomes more demanding - and who is devoted to fulfilling those demands? Progesterone. Cholesterol turns into progesterone through a precursor called pregnenolone. Sometimes called the pregnenolone steal, when resources get diverted to the production of cortisol. The “steal” refers to stress draining the progesterone reserve that should be available to regulate the other steroid hormones. In addition, the enzyme that helps progesterone take the step to transform into cortisol is called 5-alpha-reductase. The other hormone that responds to this enzyme? Testosterone. The same enzyme that takes the testosterone into its less desirable form of DHT (triggers rogue hairs on the face and loss of hair on the head), gets upregulated when cortisol calls. It’s a double whammy for hormone imbalances. Testing for cortisol is a side door to understanding the drain on progesterone.
Dehydroepiandrosterone (DHEA) is another hormone produced only in the adrenal glands. In the cascade of hormones, cholesterol goes down a side pathway toward the production of testosterone and estrogen. Cholesterol transforms through a few steps into DHEA which merges with the progesterone pathway, producing androstenedione, testosterone, and estrogen, all of which are responsible for the strength, energy, and fertility that people tend to associate with youth. While DHEA and progesterone both form these hormones, progesterone also makes other adrenal hormones, therefore spreading herself a little thin. DHEA, however, is only directed toward testosterone and estrogen - it is often called the "fountain of youth," reflecting that it is a reserve for these hormones. DHEA is high during puberty, and is also responsible for some of the less appealing memories of puberty, such as acne, body odor, and hair growth.
However, it is also a hormone that depletes when stress has been draining the adrenal reserves. As all humans age and enter into the early afternoon of life, DHEA levels naturally decline. In addition, many women at this life stage are often in the midst of intense or chronic stress due to caregiving, financial responsibilities, trauma, and systemic misogyny - stress that upregulates the metabolism pathways of certain hormones. Women in this stage often experience hot flashes, low libido, vaginal dryness, or mood changes - all before menopause, when it is classically expected. When both progesterone and cortisol are regulated, DHEA has a much better chance of replenishing, and prolonging the youthful glow.