Adrenal fatigue and the HPA-axis explained!

Updated: Feb 26

Symptoms such as unrelenting fatigue, sugar cravings, weight gain, body aches and sleep issues are often attributed to adrenal fatigue but what does that really mean? A more correct name for adrenal fatigue would be HPA-axis Dysregulation. The HPA-axis is the body system used to respond to stressors – it is a communication and feedback network between the hypothalamus, pituitary, and adrenal glands. The glands communicate and modulate hormonal output accordingly.

In response to stressors hormones are released from the hypothalamus and the then pituitary, which triggers the release of cortisol from the adrenal glands several hours after stressor was first encountered (Adrenaline and noradrenaline are the hormones that take effect immediately when stressors are encountered). Repeated frequent exposure to stressors results in constant HPA-axis activation. Given the stressful nature of the modern world this is problematic.

Cortisol acts to "help" the body deal with these stresses in many ways. It increases blood pressure and cardiac output allowing for increased blood flow to your muscles; just in case responding to the current stressor involves physical exertion. Blood glucose levels are also increased by cortisol to provide energy to your body for dealing with the stressor. Finally cortisol inhibits process that are less important during emergencies, so this would be things like digestion and reproductive activity.

Whilst these effects of cortisol would be useful in a run-for-your-life type emergency you may see how constant activation of this system is not helpful for our health long term. Chronically high stress, and thus high cortisol, can lead to cortisol resistance. Similar to insulin resistance this is a protective mechanism. Cortisol resistance leads to "adrenal fatigue" in the sense that whilst cortisol levels may be high receptors are not sensitive to it; we are not getting the effects of the cortisol we have in our system, thereby causing fatigue. This is often when we crave stimulants, such as coffee, to give us a boost and make up for this cortisol resistance. Eventually the brain will attempt to protect us from chronically high cortisol by reducing its signals to produce cortisol and cortisol levels become way too low again causing further fatigue. The image below shows the stages of adrenal fatigue.

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So what contributes to this dysregulation? And what can you do to begin healing your HPA-axis?

1. Stress

As we've discussed stress is the main driver in the process. What we should really say is "perceived stress". Everyone's experience is individual and what one person may find stressful may not be for another. From the outside there be nothing wrong but on the inside perceived stress may be very high. Recent evidence has found early life trauma can lead to an overactive HPA axis. This is why addressing early life experiences and family dynamics is an important part of fixing adrenal fatigue.


  • Lower perceived stress though daily stress management techniques, this could be by using meditation in the typical sense or in your own way with activities such as colouring or dancing.

  • Exercise helps to relive mental stress so do this in whatever way is possible for you whether that is simply a short daily walk or yoga.

  • Develop healthy coping techniques - seeing a counsellor can be helpful in achieving this.

2.Poor quality sleep & disruption to circadian rhythm

It's very common for people experiencing adrenal fatigue to have problems with sleep, whether that is trouble falling asleep, trouble staying in a deep sleep or waking feeling unrefreshed. This can be incredibly frustrating when you already feel exhausted. Often we can be in a "wired but tired" state - we feel exhausted but yet our HPA axis is overactivated and we cannot relax. Resetting your circadian rhythm is vital; when you get back in sync with nature's natural dark/light it is much easier for your body to get into a deep sleep.


  • Avoid blue light and screens in the evening - this disrupts your circadian rhythm contributing to the "tired but wired" feeling.

  • Watch the sunrise as often as possible, this sends signals to your brain to get your hormones back in alignment with the natural circadian rhythm. Waking up at this time and watching the sunset can also be an incredibly calming ritual to begin your day with.

  • Herbs - there are numerous herbs that can be used to nudge your body into a relaxed state and improve your quality of sleep.

  • Cutting out or reducing coffee - this may seem impossible when you feel exhausted but in the long run this is vital to allow your body to develop its own stable energy levels. Swapping out coffee for green tea can be a great way to do this, green tea still contains caffeine but the L-theanine it also contains means you will get a much more stable energy boost in comparison to coffee.

3. Inflammation

Inflammation plays a big role in HPA-axis dysfunction. Both low and high blood sugar can be experienced as part of adrenal fatigue and further trigger inflammation and hormonal disruption. Gut infections and dysbiosis can be a massive trigger for inflammation in the body preventing it from functioning properly. It will be hard to fix your adrenal health with high levels of inflammation therefore, as with almost every health issue, inflammation must be addressed.


  • Diet is huge here, adopting an anti-inflammatory diet is vital to lowering inflammation in the body.

  • Eating smaller frequent meals containing protein can help to maintain blood sugar levels throughout the day.

  • Addressing gut infections and dysbiosis will be vital to healing, this is where a naturopath can be really helpful. They can order proper testing to figure out what is going on and come up with a treatment plan accordingly.

If you want more personalised support in healing your adrenals and HPA-axis dysfunction we recommend booking in for a consultation. Aurora will use her expertise to come up an individualised treatment plan including herbal medicine and acupuncture. You can book online or by calling us on 08 9336 6880.

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