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	Adrenal Fatigue and Menopause. Answers, by Dr. Joseph Collins Question: My adrenals were exhausted going into perimenopause and my adrenals are overtaxed on little work. Progesterone cream helped with headaches and regaining some well being, but I am still lacking in stamina. I feel like I have a lot of cortisol output if I "do too much," which is not a normal level of activity. A saliva test has indicated high levels of cortisol and low DHEA. Besides rest and recreation, nutrition and adrenal glandulars, what type of adrenal hormone supplementation should be considered? Answer: It is important to remember that progesterone is a precursor to cortisol, and may therefore contribute to the elevated cortisol. However, progesterone is also a precursor to DHEA, so ideally, one would be able to make DHEA as easily as making cortisol. However, under stress, the steroid pathway increases the production of corticoids, especially cortisol. (In most cases the mineral corticoids such as aldosterone will also rise - this may lead to increased blood pressure and/or fluid weight gains.) This rise in corticoids is at the expense of androgens such as DHEA and testosterone. Estrogens are also likely to be low when there is enough stress to increase cortisol and decrease DHEA. This "shunting" towards cortisol and away from DHEA, is a classic stress response that can result in low levels of all androgens and all estrogens. A saliva test that reveals high cortisol with a low DHEA is showing this classic stress response of the steroid pathway. What Choices can be made in regard to stress and menopause? When lab tests reveal low DHEA, then supplementing with DHEA is a valid choice. It is a good idea to work with a healthcare professional that is experienced in DHEA replacement therapy. Though I have seen women given 25 to 50 mg of DHEA, I have found that many women do not tolerate this for a long time. Excessive DHEA can result in irritability and may cause acne and other signs of excessive androgens. I usually leave women on 1 to 5 mg a day. A better dosing schedule is 1 to 5 mg every other day, or three times a week. By not giving the supplement every day I am discouraging the body from becoming dependent on replacement. Also consider using one of the adaptogens I mention chapter 12. These include Asian ginseng, Siberian ginseng, ashwagandha, astragalus, bupleurum, rehmannia, schisandra and licorice. Of these herbs I tend to think of Asian ginseng, Siberian ginseng, ashwagandha as more capable of raising androgens. Be careful with licorice. This herb may also raise aldosterone levels - which may already be too high because of stress. As you would expect, nutritional support should include all the B vitamins and extra of vitamin C (review chapter 11). It is also a good idea to include chromium supplementation. As I mention on page 184, chromium can help with the production of DHEA. Since high cortisol can also lead to blood sugar imbalances, chromium is again indicated - chromium helps control blood sugar. Do not underestimate the benefits of relaxation, adequate sleep, and exercise. Relaxation exercises can help lower excessive cortisol. Adequate sleep is required for production of DHEA. DHEA levels are naturally higher in the morning, which tells us two things; 1) get enough sleep to allow normal production; 2) always take DHEA supplements in the morning. Be sure to check out the Steroid Pathway which includes a number of images that show how each hormone is produced. Dr. Joseph J. Collins
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