Adrenal Health During Perimenopause: What Actually Matters (and What to Skip)

Your Adrenal Glands Just Got a Bigger Job

Most women know perimenopause involves the ovaries winding down their estrogen production. What fewer know is that the adrenal glands quietly step up to fill some of that gap. That shift is real, measurable, and relevant to how you feel during this transition.

Understanding what your adrenals actually do, and what you can do to support them, is genuinely useful. But it requires separating the solid science from the considerable amount of wellness marketing that has latched onto adrenal health in the last decade.

What Your Adrenal Glands Actually Do in Perimenopause

Your adrenal glands, small triangular structures sitting on top of each kidney, produce a wide range of hormones. These include cortisol (your primary stress hormone), DHEA (dehydroepiandrosterone), and androstenedione.

Androstenedione is an androgen precursor that body fat tissue can convert into estrone, one of the three main forms of estrogen. After ovarian estrogen production declines significantly in menopause, this adrenal pathway becomes the primary source of estrogen in the body. The conversion happens in adipose tissue, which is part of why postmenopausal estrogen levels vary considerably between women.

During perimenopause, as ovarian estrogen output becomes increasingly erratic, the adrenal contribution becomes proportionally more significant. A woman with well-functioning adrenals, good stress management habits, and adequate nutritional status is in a better position to support this pathway than one whose adrenals are already under prolonged strain from chronic stress and poor sleep.

What HPA Axis Support Actually Looks Like

The HPA axis is the hypothalamic-pituitary-adrenal axis. It is the regulatory system that governs cortisol production and your stress response. Supporting its function does not require supplements or special tests. It requires attending to the fundamentals.

Sleep is the most important. Cortisol follows a diurnal rhythm, peaking in the morning and declining through the day. Chronic poor sleep disrupts this pattern, elevating evening cortisol and making it harder to wind down. Protecting sleep quality, and addressing the perimenopausal disruptions to it (night sweats, anxiety, frequent waking), is the single highest-leverage adrenal support intervention.

Stress management is second. This sounds obvious, but the mechanism matters. Chronic psychological stress chronically elevates cortisol, which suppresses DHEA production, disrupts sleep, and creates a cycle that compounds perimenopausal symptoms. Structured practices that activate the parasympathetic nervous system, including breath work, yoga, meditation, and time in nature, have measurable cortisol-lowering effects.

Not overexercising matters more in perimenopause than at other life stages. High-volume, high-intensity training without adequate recovery elevates cortisol chronically. Two to three strength sessions weekly plus moderate movement is a more adrenal-supportive load than daily high-intensity training through exhaustion.

Key Nutrients for Adrenal Function

The adrenal glands have specific nutrient requirements. These are the ones with the strongest evidence base.

Vitamin B5 (pantothenic acid) is essential for cortisol synthesis. The adrenals have very high concentrations of B5. Deficiency is rare on a varied diet, but the demand increases with chronic stress. Good food sources include liver, salmon, eggs, avocado, and legumes. A B-complex supplement covers B5 alongside the other B vitamins needed in the stress response.

Vitamin C is found in extraordinarily high concentrations in adrenal tissue, which has led to a great deal of research into its role in cortisol synthesis and regulation. Studies have examined vitamin C supplementation in relation to cortisol responses to stress with mixed but generally positive findings. Citrus, bell peppers, kiwi, strawberries, and broccoli are the strongest food sources.

Magnesium is involved in cortisol regulation and is depleted by both stress and high cortisol. It is also widely underconsumed. Supplementing with magnesium glycinate, 200-400 mg in the evening, is a low-risk intervention with good evidence for sleep and stress response benefits.

Adaptogens Worth Knowing About

Adaptogens are herbs that research has examined for their ability to help the body respond to stress more effectively. This is not a marketing category invented by wellness brands. The term has a pharmacological definition and a legitimate research history.

Ashwagandha (Withania somnifera) has the most consistent evidence. Multiple randomized controlled trials have found meaningful reductions in perceived stress, cortisol, and anxiety with supplementation. Doses studied typically range from 300-600 mg of root extract daily. It is generally well tolerated, though it should be avoided in pregnancy and discussed with a provider if you have thyroid conditions.

Rhodiola rosea has evidence for reducing fatigue and improving physical and cognitive performance under stress. It appears to act on the HPA axis to moderate the cortisol stress response. Doses studied are typically 200-400 mg daily of a standardized extract. It is considered stimulating, so is generally taken in the morning.

These adaptogens are not magic. They are useful tools within a broader strategy. Taking ashwagandha while continuing to sleep five hours a night and skip meals will not produce meaningful results.

The Adrenal Fatigue Problem

Here is where it gets important to be clear. Adrenal fatigue is not a recognized medical diagnosis. It is a term invented and popularized in wellness circles to describe a cluster of symptoms (fatigue, brain fog, low motivation, salt cravings) attributed to chronically underperforming adrenals.

The problem is that this cluster of symptoms can be caused by many things, including thyroid dysfunction, anemia, vitamin D deficiency, depression, sleep apnea, or actual adrenal insufficiency (a genuinely serious medical condition called Addison's disease, which is diagnosed with specific blood tests).

Expensive functional medicine panels marketed as adrenal fatigue testing, often involving saliva cortisol collections throughout the day, are not standardized, not validated, and not part of conventional endocrine workups. Spending several hundred dollars on these panels rarely leads to actionable clinical information.

If you are profoundly fatigued, ask your primary care provider for thyroid function tests, a complete blood count, ferritin, B12, and vitamin D. These are the evidence-based starting points for fatigue investigation, and they are typically covered by insurance.

Distinguishing Adrenal Support from Adrenal Exploitation

The wellness industry has built a substantial market around adrenal anxiety. Complicated supplement stacks, cortisol tests sold directly to consumers, and expensive protocols from providers who diagnose adrenal fatigue in virtually every patient are a financial ecosystem with limited clinical grounding.

Genuine support for adrenal function during perimenopause looks like this: consistent sleep, structured stress management, moderate exercise with adequate recovery, sufficient protein, B vitamins, vitamin C, and magnesium, and potentially ashwagandha or rhodiola if stress management is a significant issue.

You do not need a $300 supplement package. You need the fundamentals, applied consistently.

Logging What You Notice

If you make changes to your sleep habits, stress management practices, or supplement routine, tracking your symptoms over several weeks reveals whether they are making a difference. PeriPlan lets you log daily symptoms so you can see patterns over time. Fatigue, mood, sleep quality, and stress levels are all trackable, and correlations across weeks tell you more than a single bad day.

Download PeriPlan at https://apps.apple.com/app/periplan/id6740066498.

If symptoms are severe, persistent, or significantly affecting your quality of life, a thorough evaluation with a clinician is the right move. Start with your primary care provider, who can order the relevant tests and refer you to an endocrinologist if needed.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.