Conquer Fatigue: Hormonal Balance in Times of Change

by Tori Hudson, ND

We have all experienced fatigue in our lives at one time or another. On the other hand, chronic, persistent fatigue can be both debilitating and a sign of serious illness. In between short-term bouts with fleeting issues and the lingering fatigue of something more serious, there lies a recurring fatigue that can happen according to the different cycles and phases of a woman’s life — premenstrual, pregnancy, and perimenopause.

Pregnancy is demanding in its own unique way: hormonal changes, increased nutritional demands, and changes in sleeping and eating patterns can take an exhausting toll on a mother-to-be. Regular exercise, healthy eating habits, a prenatal supplement, regular sleep, and moderating one’s work load are usually enough to maintain energy throughout the pregnancy. Some women may become anemic during pregnancy or develop shortages of some vital nutrients. Simple tests can detect these deficiencies that can be corrected with nutritional supplementation. At times, other
health problems emerge during the pregnancy that can cause fatigue, such as hypothyroidism and diabetes. With good prenatal care, these issues can be detected and treated appropriately.

The cycles and phases of hormonal change, such as the monthly premenstrual time and the perimenopause transition, can challenge what is called our stress adaptation mechanism. There are three phases to this stress response, which are generally regulated by our adrenal glands. The initial phase is the alarm reaction, commonly known as our fight-or-flight response. This alarm phase is usually very short lived. The next phase is the resistance reaction, which allows us to continue to deal with stress after the fight-or-flight response has worn off. Lastly, in the exhaustion phase, our adrenal glands have become depleted of the hormones called glucocorticoids, our bodies lack potassium, and cells and tissues do not receive enough glucose or other nutrients to function properly. We become fatigued.

Premenstrual syndrome and perimenopause are their own kind of stress on the system. During these times, many women find that their stress tolerance threshold decreases. The complicated interaction between hormones and brain chemistry challenges our stress adaptation mechanisms, resulting in fatigue. The fluctuating levels of hormones such as estrogen, progesterone, cortisol, and thyroid interact with brain neurotransmitters such as serotonin, dopamine, GABA, and others that affect our emotional and physical responses to life, environmental stressors, to insults, and even infections.

Different circumstances call for different approaches, and if persistent fatigue is something that plagues you, it is important to consult with a licensed health care practitioner to determine the cause. A good medical history, physical exam, and selected laboratory tests can determine if the cause is low thyroid, anemia, an infectious agent, low or high blood sugar, or a serious illness. Licensed alternative practitioners will also have tools and perspectives to consider food sensitivities or intolerances, toxicities, neurotransmitter imbalances, and hormonal status.

Nutritional and herbal support can play a critical role in supporting the adrenal glands when a person displays symptoms of intense prolonged stress or a “burned-out” stress adaption mechanism. Insufficient or excessive adrenal hormone release can usually be addressed with key nutrients such as pantothene, B6, zinc, magnesium, and vitamin C. As these nutrients are critical for optimal adrenal function and the manufacture of adrenal hormones, their levels can be diminished during times of stress. For example, a deficiency of pantothenic acid results in fatigue, headaches, insomnia, and more.

Eleutherococcus and panax ginseng are notable botanicals for their ability to support adrenal function and enhance resistance to stress. They belong to a category of general tonic herbs known as adaptogens. Adaptogens have been shown to act as tonics and anti-stress agents, enhancing the ability to cope with both physical and emotional stressors.1,2,3

Rhodiola is well known in Eastern Europe for its ability to enhance energy, stamina, and endurance. Rhodiola appears to increase the chemicals that provide energy to the muscle of the heart and to prevent the depletion of adrenal hormones induced by acute stress.4

Ashwagandha is another adrenal and immune supporting adaptogen. Its active constituents are called “withanolides” and have been shown to support pain relief, have antioxidant effects, reduce inflammation, as well as stimulate thyroid, respiratory, and immune function. It appears that it may also support optimal dopamine levels in the brain.5

Astragalus has historically been used as a tonic for strengthening and regulating the immune system. Astragalus extracts seem to be able to restore or improve immune function in immune deficient cases.6

Holy Basil, also known as “Tulsi” or “The Uncomparable One,” is one of India’s most sacred plants and has been used in ancient systems of healing including Ayurveda, Greek, Roman and Siddha for thousands of years.

Holy basil, another adaptogen, is also a rich source of vitamin C, calcium, magnesium, potassium, and iron. Experimental studies with humans display promising blood glucose effects. Moderating glucose levels, including after meals, is another positive effect of the basil.7 Many individuals with adrenal dysfunction have increased glucose levels due to stress-induced elevated cortisol.

Schisandra is a Traditional Chinese Medicine solution for many common problems including physical fatigue, immune function, recovery after surgery, increasing physical performance and endurance, and for increasing resistance to disease and stress.8

Maca may be one of the most important plants for the female reproductive system. It has diverse effects on the female reproductive system including enhancing stamina and overall energy. The peoples of Peru and elsewhere have traditionally used it to enhance fertility, regulate the menstrual cycle, treat common menopause symptoms, and to increase libido.

Symptoms such as fatigue, low vitality, low libido, depression, anxiety, poor memory, low stamina, and difficulty handling the premenstrual phase and perimenopausal transition are key indications of adrenal fatigue. Some women who have premenstrual or perimenopausal fatigue, due to no other cause that has been ruled out with testing, may need additional hormonal support, as well.

The best approach to overcoming fatigue is discovering the root cause. Don’t just ignore your fatigue while you tough it out, and
don’t make assumptions about the cause. Instead, seek out a naturopathic physician, a medical doctor, or other qualified healthcare practitioners. A good healthcare team will respect your insights and choices and will assure that you understand the cause of your issue and present the best solutions.

1. Farnsworth N, et al. Siberian Ginseng: Current status as an adaptogen. Economic Medicinal Plant Research,1985;1: 156-215.
2. Hikino H. Traditional remedies and modern assessment: The age of Ginseng. In R.O.B. Wijeskera, ed. The Medicinal Plant Industry (Boca Raton, FL: CRC Press, 1991), 149-166.
3. Shibata S, et al. Chemistry and Pharmacology of Panax. Econ Med Plant Research 1985;1:217-284.
4. Maslova L, Kondrat’ev B, Maslov L, Lishmanov I. The cardioprotective and antiadrenergic activity of an extract of Rhodiola rosea in stress. Eksp Klin Farmakol 1994;57:61-63. (Article in Russian).
5. Upton R, ed. Ashwagandha root (Withania somnifera): Analytical, quality control, and therapeutic monograph. American Herbal Pharmacopoeia 2000;April: 1-25 .
6. Sun Y, Hersh E, Talpaz M, et al. Immune restoration and/or augmentation of local graft versus host reaction by traditional Chinese medicinal herbs. Cancer 1983;52(1): 70-3.
7. Agrawal P, Rai V, Singh R. Randomized placebo-controlled,
single blind trial of holy basil leaves in patients with non-insulin-dependent diabetes mellitus. Int J Clin Pharmacol Ther. 1996;34(9): 406-409.
8. Upton R, ed. Schisandra Berry: Analytical, Quality and Control, and Therapeutic Monograph. Santa Cruz, CA: American Herbal Pharmacopoeia 1999; 1-25.

Tori Hudson is the Director of Research and Development at Vitanica and has been a naturopathic physician specializing in women’s health since 1984. She is the Clinical Professor at the National University of Natural Medicine and Bastyr University, as well as the Medical Director at A Woman’s Time health clinic in Portland, OR. Dr. Hudson is the author of Women’s Encyclopedia of Natural Medicine and several scientific journals. To learn more visit