Your adrenals are two small glands above your kidneys that make your stress hormones, mainly cortisol and DHEA-S. With short-term stress that system works fine, but with long-term pressure the balance can shift. Two values, cortisol and DHEA-S, together often give the most insight.
This article belongs to our cortisol and stress cluster. I notice that the term "adrenal fatigue" gets passed around a lot online, while the real picture is more nuanced. Below you will read what your adrenals do, how they respond to stress, what cortisol and DHEA-S tell you, and when a check can make sense.
What do your adrenals do?
Your adrenals make a number of hormones that regulate your energy, blood pressure and stress response. The best known are cortisol and DHEA-S. They work under direction from your brain, through a system called the HPA axis.
Cortisol is your main stress hormone and follows a daily rhythm: high in the morning, low in the evening.
DHEA-S is another adrenal hormone and serves, among other things, as a building block for sex hormones. The ratio between cortisol and DHEA-S seems to say something about how your body handles long-term stress, though there is no fixed cut-off for it yet.
How do your adrenals respond to stress?
With stress your brain sends a signal to your adrenals to make more cortisol. That helps you respond sharply and alertly in the short term. Once the trigger is gone, the system should settle down again.
With ongoing stress that signal stays active more often. The HPA axis can then become disrupted, which can flatten your daily cortisol rhythm.
The popular term "adrenal fatigue" suggests that your adrenals "run out", but there is no strong scientific evidence for that. It seems to be more about a disrupted control system than about exhausted glands. That distinction matters, because it determines what you look at.
What is the link between cortisol and your sex hormones?
Cortisol and your sex hormones partly share the same building blocks and control systems. With long-term stress the body can give priority to cortisol, which can put pressure on the production of progesterone and oestrogen. That can make your cycle more irregular.
This explains why stress and cycle complaints often appear together. A busy period can coincide with a later or skipped period.
Complaints that often come back in this context:
- An irregular or absent period during stressful periods
- More trouble with your cycle, such as a tense feeling or worse sleep around your period
- Fatigue and mood swings that you cannot quite place
Because these complaints also fit menopause, it is sometimes hard to tell the cause apart. We wrote a separate article about it: menopause or burnout, how to tell the difference.
Which blood values say something about your adrenals?
Two values come up most often for your adrenals and stress: cortisol and DHEA-S. Together they give more insight than each on its own. The table below shows roughly what they tell you.
| Value | What it measures | What you watch for |
|---|---|---|
| Cortisol | Your main stress hormone, with a strong daily rhythm | Draw time matters; a morning draw is the most useful |
| DHEA-S | An adrenal hormone and building block for sex hormones | The ratio with cortisol can say something about your adrenal balance |
Neither value proves stress on its own, and there is no test that can show "adrenal fatigue". An abnormal value always needs explanation in your context. That is why every result comes with an assessment by a doctor.
Want to have these values measured? The Hormones Women panel measures cortisol and your sex hormones among others in one morning draw. Want the full overview of complaints and causes first? Then read our pillar on high cortisol and the symptoms of chronic stress.
What can you do yourself for your adrenals?
You cannot "reset" your adrenals with a miracle remedy, but you can give your control system rest. According to Thuisarts.nl and the Dutch GP guideline on overstrain and burnout, recovery starts with enough rest and reducing the load. A regular rhythm seems to help most here.
What guidelines suggest can contribute:
- Keeping a fixed sleep and wake rhythm, including at weekends
- Daily moderate exercise, preferably in the daytime and outdoors
- Building in short recovery moments instead of waiting for one long break
- Seeking help or guidance if the complaints persist
Be careful with supplements that promise "adrenal support". The evidence for them is limited, and some products can cause interactions. Discuss any doubts with your GP or pharmacist.
Frequently asked questions
Does adrenal fatigue really exist?
The term is used a lot, but there is no strong scientific evidence that your adrenals "run out" from stress. Complaints of long-term stress are real; they seem to be linked more to a disrupted control system than to exhausted glands. Discuss persistent complaints with your GP.
What does the cortisol-DHEA ratio say?
The ratio between cortisol and DHEA-S is sometimes used to say something about your adrenal balance. There is just no fixed cut-off, so a doctor always assesses the values together with your complaints. A single ratio is not a diagnosis.
Does stress affect my menstrual cycle?
It can. With long-term stress the body can give priority to cortisol, which can put pressure on the production of sex hormones. That can give an irregular or skipped period. If it persists, discuss it with your GP.
References
- Dutch GP guideline on overstrain and burnout (NHG-Standaard Overspanning en burn-out). Dutch College of General Practitioners. Available via richtlijnen.nhg.org.
- Thuisarts.nl. I have overstrain or a burnout. Dutch College of General Practitioners. Available via thuisarts.nl.
- Melmed S, Auchus RJ, Goldfine AB, et al. Williams Textbook of Endocrinology. Elsevier. Chapter on the adrenal cortex and the HPA axis.
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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