Adrenal Fatigue and Disruptions of Reproductive System Function

By: Michael Lam, MD, MPH

We first start our discussion on Adrenal Fatigue Syndrome (AFS) and reproductive system function by going through some of the basic sciences involved by looking at the fertility process and reproductive system function first. It is first controlled by the hypothalamus through a series of hormones including LH and FSH, and the body’s response through the pituitary system and through the ovarian systems follows accordingly. The basic hormones responsible for reproduction and the reproductive system function and for making women feel good are estrogen and progesterone. Now estrogen we use as a term to indicate a family of hormones which includes E1, E2, and E3, which we will go into later, but we will lump them all together and call them estrogen for now.

Ovarian hormones and reproductive system function

Now, as you can see above, the key diagrams here are number 3 and number 4, and they show the normal reproductive menses. Now, Day 1 is when menstruation begins, and then going through a cycle of 28 days. The uterine lining sloughs off from Day 1 to Day 5, which is what we call the menses, and then after that, it regenerates itself until ovulation occurs on Day 14, and if fertilization does not occur, the endometrial lining will be sloughed off again resulting in the menses.

The key things to look at in the reproductive system function here is that ovulation occurs on Day 14, the pre-ovulation phase is from Day 1 to Day 14, and the post-ovulation phase is from Day 14. The responsible hormones for this reproductive system function include estrogen and progesterone. As you can see here, the estrogen level usually starts to rise from menstruation (day 1) and hits a peak around Day 14. If fertilization occurs during the ovulation period, then the graph will reflect this accordingly, but if there is no fertilization, then the estrogen level will gradually go down until the menses starts on Day 28. In the meantime, the progesterone level tends to rise around Day 14 and goes up in the 20-30 day cycles and without the reproductive system function of fertilization there’s no need for the progesterone to be there because there’s no fetus to support, and therefore the progesterone level goes down as the resulting menses comes on.

What is important to understand in this basic diagram is that estrogen and progesterone need to be maintained at a very fine balance throughout the menstrual cycle for proper reproductive system function. In other words, if your estrogen level and progesterone level are off, then problems in the reproductive system function can arise. Additionally, if the absolute levels are within the range, but they’re off balance relative to one another (a relative increase or relative deficiency of either estrogen or progesterone), then the hormonal cycle can be disrupted; we will talk about that more later.

Absolute vs. Relative Hormone Level

Hormones and age and reproductive system function

Taking a step back now and looking at this diagram above, you can see that women during reproductive ages from 25-50, and then postmenopausal onwards, have a very fine estrogen/progesterone balance that we mentioned before. However, if you look at the overall picture, there’s this reduction of estrogen over time as one approaches menopause. Progesterone also has a reduction. The problem with most women’s reproductive system function is that in most cases the decline in progesterone is far greater than the decline in estrogen. As a result, as a person goes through teens, young adulthood, and even adulthood into menopause, the tendency is for a condition called estrogen dominance to arise, whereby the drop in estrogen is relatively small compared to the drop in progesterone. As a result, you have a relative increase in estrogen. In other words, the estrogen drops, as well as the progesterone drops, while they are within normal ranges on an absolute basis, the end results is a relative increase of estrogen in the body. Now, this is very disruptive and leads to many conditions in the reproductive system function, which we will discuss later, but suffice to say that the estrogen/progesterone ratio is very important to be maintained. If this ratio is not maintained, then problems will occur in the reproductive system function and other areas.

Estrogen Dominance

The major reproductive system function disruption exhibited in modern society is this condition called estrogen dominance we just referred to. Now, this is very serious because it actually starts quite early on, even in the teens, but it is rarely noticed. Remember, we said earlier that estrogen dominance is when you have excessive amounts of estrogen relative to progesterone, not on an absolute basis but on a ratio basis. So the question is, “What are things that disrupt this ratio and lead to an increase of estrogen on a relative basis?” There are many things we need to consider with reproductive system function. In addition to exogenous estrogen such as the intake of estrogenic compounds in the form of hormones, we are all exposed to environmental estrogen, or what we call xenoestrogens. These are chemical compounds that are structurally similar to estrogen, so when they enter the body, they behave with estrogenic effect on the reproductive system function. Examples are certain plastics, chemicals that are petroleum related because their chemical molecular structures are quite similar. Remember that cholesterol is the mother of estrogenic hormones, and petroleum oil rings are very similar in structure.

It is important to back up and understand that estrogen is a pro-growth hormone. It causes the endometrium to proliferate, it causes breast stimulation that leads to menarche, it increases body fat, it increases endometrial cancer risk, and it restrains the osteoclasts. Progesterone is the balancer of estrogen in terms of the reproductive system function, and it does many things on the opposite side. In other words, it maintains the secretory endometrium, it protects against fibrocystic breast, it helps to prevent breast cancer, it helps to use fat for energy, and it helps to prevent endometrial cancer. So in the body, the estrogen and progesterone are always in a perfect balance for the reproductive system function, but when you off set this balance problems begin.

Swollen fingers and disruptions of reproductive system functionSymptoms of estrogen dominance can include the following:

  • Swollen breasts
  • Rings no longer fit on fingers
  • Impatience
  • Bossiness
  • Irregular or missed periods
  • Clots during period
  • PMS
  • Endometriosis
  • Fibrocystic breast disease
  • PCOS
  • Fibroids
  • Breast cancer

These are all part of the continuum of estrogen dominance that are exhibited in the body and the reproductive system function, usually over a long period of time, starting in the teens with PMS, advancing to fibrocystic breast disease and PCOS during college days and young adulthood, and eventually, fibroids, severe endometriosis, and breast cancer.

In addition to what we learned earlier about environmental estrogen, it is very important to know that the estrogen level in our body is also regulated by two other organ systems. One system is the adrenal glands and the adipose tissue. In other words, the estrogen level increases in the body when the adrenal glands are stressed because that is how estrogen is made. At the same time, those who are overweight have a tendency to have more adipose tissue, which leads to more estrogen secretion for reproductive system function. Coffee and other dietary factors can also increase estrogenic production in the body. So, multiple things contribute to a higher level of estrogen including the environment, lifestyle, our intrinsic ability to handle stress, the adrenal glands, and adipose tissue.

Steroidal Hormones and Adrenal Glands

Reproductive system function and steroids and sex hormones
Now that you understand how the estrogen and progesterone levels are balanced in the body for the reproductive system function, both in the ovaries as well as being made in the adipose tissues, we now have to focus on the adrenal system. The adrenal glands are the hormonal system glands that are responsible for synthesizing many of the hormones used in the body. Starting from cholesterol as a building block, it makes a prohormone called pregnenolone (the mother of all hormones), from which many other hormones are made. Pregnenolone as you can see is made into progesterone, which then is made into cortisol.

Additionally, pregnenolone is also made into DHEA as well as other male hormones, some of which are turned into estrogen. In other words, with this simplified diagram, the lesson to take home is this: if your adrenal glands are working properly, your progesterone level will be well balanced with the estrogen family (E1, E2, and E3), which are estrone, estradiol, and estriol.

When your body is stressed, the adrenal glands are put into overdrive to deal with the stress, and then the body tends to put out more cortisol in order deal with said stress, because the cortisol is the ultimate anti-stress hormone. In this process, pregnenolone is used up to make more cortisol in a concept known as “pregnenolone steal.” In other words, the body uses more cholesterol to make pregnenolone, but that extra pregnenolone, instead of sticking around, is being used to make more progesterone with the ultimate goal of making more cortisol. The problem is that, in the process, the precursor hormones such as pregnenolone and progesterone can be depleted. In the case of progesterone, if it is depleted in this process as the adrenal glands are put on overdrive to make cortisol, then you have less opposing progesterone in the body to offset estrogen. This results in the estrogen dominance that we referred to earlier.

Therefore, anything that stresses the adrenal glands has a potential to reduce progesterone output, leading to an increase in estrogen output. This is why we often see that in people with Adrenal Fatigue Syndrome (AFS), the tendency is for them to have estrogen dominance symptoms such as PMS, endometriosis, the irregular menses, fibrocystic breast disease, as well as fibroids. The severity of the symptoms will go up in advanced cases, as the adrenal glands approach a near-failure stage. A separate mechanism will then kick in where the body shuts down, resulting in amenorrhea. That’s why many people, even young people, if they try to exercise too much and start training for excessive exercise programs such as a marathon or ultramarathon, will have their body’s menstrual cycle shut down for a period of time during said training. This reflects the body’s way of survival, because it feels fatigue and pregnancy is low priority in a time that it perceives as being stressful.

Ovarian Adrenal Thyroid Axis

Now, let’s take a look at what happens when estrogen dominance becomes very severe. In the body, when you have an adrenal system that’s out of balance because of stress as we talked about earlier, whether it is because a person is involved in excess exercise, very stressful schoolwork, a stressful career advancement, or even relationship difficulty, the adrenal glands will kick into overdrive, resulting in an increased level of estrogen circulating in the body. Now, advanced Adrenal Fatigue Syndrome causes another set of problems in the sense that estrogen dominance is also related to the ovarian system as well as the thyroid system through the Ovarian Adrenal Thyroid (OAT) axis as you can see here.
Reproductive system function and the OAT Axis
In other words, the hormonal systems in the body and the reproductive system function are not singly independent. Instead, they are all tied together with networks, and one of the key networks is the Ovarian Adrenal Thyroid axis. What happens to the adrenal system will affect the ovarian system and reproductive system function, and what happens to the ovarian system and reproductive system function will affect the thyroid system. It’s like three legs of a stool. When one is disrupted, whether it is a thyroid problem, a low adrenal function problem, or an ovarian problem, then the other two systems are invariably affected. The key to balancing hormones properly in women is to look at all three at the same time and see what we can do to simultaneously nurture the systems back and rebalance all three at the same time. If the emphasis is just to balance one of the three, for example the estrogen level, without looking at the thyroid or the adrenal glands, then this will usually fail.

Typical Case Presentation of OAT Axis Imbalance

Now let’s take a step back and look at what we see clinically. A typical patient will come in, in their mid-teens, late teens, or early young adulthood complaining of problems with irregular menses, periods that are somewhat disruptive in nature (longer or shorter than normal), stress related acne that can be worsened by a lot of sugar intake, and severe PMS. Usually, the doctors do a complete workup and find that things are okay at the pituitary and the hypothalamic levels, and so these people are put on either hormones or birth control pills in various forms. If the diagnosis is mild endometriosis or a mild type of PCOS and if the PCOS is severe, then the common recommendation is to put them on insulin regulating drugs like metformin. If it was found that the thyroid is the problem then usually the patient is started on thyroid medication and thyroid support of one kind or another. So, the conventional medicine approach is to look at each one of these symptoms. If it’s a thyroid problem, then they will fix it with thyroid medication. If it’s an ovarian system problem, then they will fix it with bioidentical or regular hormone replacement.

Very little attention is actually paid to the adrenal system. However, we know that this is not the most comprehensive way because until you fix the adrenal glands, you are not going to be able to really balance the system of female hormones. As a result, many people go into long trials of birth control, thyroid stimulations, and bioidentical hormonal replacement, but they never really can get a good balance. they sometimes feel slightly improved, but the PCOS continues, the irregular menses continue, and fertility becomes a big issue.

Adrenal Fatigue

Reproductive system function and Adrenal FatigueWhy is it a big issue? It’s because the body is decompensating over time, and this can take anywhere from a few years to a decade. This is because when the hormones are not well balanced, the body is under stress, and it draws on its reserves. When the reserves start to run out, then the body becomes fatigued. The body’s way of preserving itself when it’s faced with fatigue and reduced energy output is to slow down the body even more in order to conserve what it has. As a result, fatigue, tiredness, and lethargy become more prominent, and this can then in turn lead to a compensatory activation of the neuroendocrine system to release adrenaline and norepinephrine in order to stimulate the body to increase energy supply as a last resort. When that happens, the body enters into what we call a wired and tired state where centrally at the nervous system, it is excitatory, however, the peripheral nervous system is being slowed down; For example, the person cannot sleep because they are wired, but at the same time, they are tired throughout the day’s activities.

Now, usually by this time the patients will have seen multiple doctors. They are probably on thyroid medication to stimulate their energy supply, because the emphasis is on energy by the time this disruptive process progresses to this stage. They can be on birth control pills as well. Those who see a naturopathic professional might be put on natural stimulants, which are not far away from thyroid type medicine in principle, in terms of metabolic stimulation. However, all of these actually increase estrogen dominance because they tend to stimulate the adrenal glands more than what they are capable of delivering. As you can see, when you try to stress the adrenal glands, the progesterone levels tend to go down, resulting in worsened estrogen dominance. As the estrogen dominance worsens, which was the initial trigger for problems such as PMS, fibrocystic breast disease, endometriosis, irregular menses, and fibroids, the symptoms actually get worse. A person just seems to have a tough time managing these symptoms, and the more they try to patch up the symptoms, the worse they get. The reason is because they are not factoring in all three components of the OAT axis (the adrenal glands, thyroid, and the ovarian system), but are only focusing on one or two.

Adrenal Fatigue and Reproductive System Function Disruptions

As this goes on, what happens is that when it comes time for reproduction, the first problem a person faces is infertility. If the estrogen dominance, OAT axis imbalance, and adrenal fatigue are severe, then the body will shut down and the person will have amenorrhea (lack of menstrual cycles). However, not many people are in that stage, especially when they are still young in their mid-20s to mid-30s. So, the first sign of a problem, in addition to PCOS, endometriosis, and PMS, is infertility.

reproductive system function, pregnancy, and AFSThe person has a hard time getting pregnant because ovulation is difficult, and implantation is difficult. Many people end up doing in vitro fertilization (IVF), as well as multiple attempts to get pregnant, but each time they are met with failure. Usually, many tries are necessary in order to have success. In other words, the body is not quite ready and is sending a signal that it does not want to get pregnant, which is why fertility becomes a challenge. This is a subtle sign that most people just disregard. They think that this is just something that can be overcome with IVF, and they start planning for IVF.

Sometimes they may get lucky and ovulation occurs, then implantation occurs and they become pregnant; these are the lucky few and usually have a relatively strong constitution or are still relatively young, and their body is able, with the last resort, to still go through pregnancy and fertilization of the egg despite a dysfunctional and imbalanced OAT axis.

Bear in mind that not everybody is on thyroid medication or antidepressants, which conventional doctors often give when they run out of options. Not everybody is on a lot of medication, but a lot of them cannot figure out what is going on. The pregnancy becomes a problem, because they keep trying and trying, thinking that after an extensive workup – in which they were told that everything is fine at the hypothalamus as well as the pituitary gland – that they are just unlucky, so to say.. Even so, after years of trying, some people eventually get pregnant. Of course, they are overcome with joy, and they start to think they have overcome the problem.

First Trimester Miscarriage

As you remember, earlier we talked about the progesterone level being reduced when you have severe adrenal fatigue. In the first trimester of pregnancy, progesterone is an absolutely necessary hormone in order to maintain the fetus. If you don’t have enough progesterone in the body, then the tendency is for miscarriages to occur. This usually happens anywhere from week 6 or 7, all the way up to the late first trimester. So, despite the initial happiness, those people who have OAT axis imbalance as well as adrenal fatigue and pregnancy will invariably find themselves having some miscarriages, usually during the late first trimester. This can happen one time, and then two times, and three times; and some people will come to us with 5, 6, or even 7 serial miscarriages usually happening in the late first trimester. But the question is, why?

Miscarriages and reproductive system functionThe answer is quite obvious if you understand the physiology. It’s that the body simply will not allow the fetus to carry into the second and third trimesters because it is unable to come up with an adequate amount of progesterone. Now, an astute obstetrician can sometimes pick this up, and then give a natural progesterone supplement during the first trimester. This is good, but by and large, this is usually missed until after many miscarriages because people don’t think about this, because physicians don’t think of the general picture of stress, of the thyroid involvement or the adrenal dysfunction when a young, otherwise healthy woman comes into the office after just having a miscarriage.

The tendency is to treat it as an isolated event, and ask the patient to try again. Then if that fails, the natural progression is to proceed to very expensive IVF, when in fact we should be looking at adrenal dysfunction as a possible cause of the miscarriages. So the alarm is this; if a person has repeated miscarriages in the first trimester, especially the late first trimester, you have to think of adrenal fatigue. If you don’t, it will happen again and again. The good news, on the other hand, is that if you do support the adrenal glands, then this usually results in a happy ending for everybody.

Pregnancy Maintenance

We have now covered two aspects: infertility that is due to estrogen dominance and OAT axis imbalance, and that when you are able to get pregnant, serial miscarriages are a warning sign of underlying worsening estrogen dominance and OAT axis imbalance in the setting of stress and the adrenal fatigue. Now, some are fortunate enough to be able to get pregnant as well as go through the first trimester, and they are relatively home free in terms of keeping baby after that.

So, this is good news, but then the question becomes, “Well, how does the person go through the rest of the pregnancy?” and there are two general pictures that can emerge. Now, if a person has adrenal fatigue, then the body is trying to put out more progesterone during the pregnancy. Sometimes the body is successful in doing that, especially if the person is young and constitutionally strong. So during pregnancy, the woman will feel very good, and in fact most of them will report looking back at this as the best time of their life. They love to get pregnant and they want to get pregnant again just to experience that moment of bliss, because the body is able to put out sufficient progesterone not only to overcome the progesterone deficiency that is common in OAT axis imbalance and estrogen dominance, but the extra progesterone also causes a calming effect for them, and overcomes their fatigue. Now, unfortunately, this does not happen too often.

Fatigue during pregnancy and reproductive system functionHowever, there’s another group of people who, even though they make it through the first trimester, have a terrible time in the second and the third trimesters. This is actually more common than we think. They seem to struggle along, they are tired all the time, they have to rest a lot, and their life is devastated, but they don’t think about the adrenal glands as the reason; they think that this is just part of the normal pregnancy process.

A person who gets pregnant who is healthy, who has a good estrogen-progesterone balance, who does not have OAT axis imbalance, who does not have estrogen dominance, will go through fertilization and pregnancy rather uneventfully, even through delivery and postpartum. So, a difficult pregnancy is usually a sign of an underlying problem in the body that is unresolved. So while rest is good to maintain the pregnancy, more attention must be paid.

Some of the pregnant mothers who go to see their doctors may even have a thyroid workup, and may even be started on thyroid medication if it was found that their thyroid level is low, either clinically by symptoms or by laboratory work. While medication can be useful and the problem needs to be corrected if indeed it is primary hypothyroidism, because we know that a thyroid problem in the mother, if untreated, can affect the fetus in terms of having a lower birthrate. However, if the thyroid gland is overly stimulated because of the aggressive approach to treat fatigue during pregnancy, then this can have an undesirable effect because the over stimulated thyroid increases the metabolism and the demand on the adrenal system, which actually makes the progesterone level even worse. Even though they are able to pass through the first trimester of pregnancy safely, they have a difficult time, and they just never feel good during the rest of the pregnancy period, and they don’t enjoy going back to get pregnant again.

So the challenge for those who are able to get pregnant but have symptoms of Adrenal Fatigue, ovarian disruptive imbalances, and thyroid imbalances is how to maintain the body in a steady state that is well nurtured throughout the pregnancy, both for the fetus’ benefit and the mother’s benefit, and to ensure a smooth delivery. Unfortunately, very little attention is paid to this and often the mothers are just told to go home, rest, and to take it easy. Now, for the fortunate ones that are able to go through the pregnancy and the delivery, that’s wonderful. But, many will find that as they go through the second and the third trimesters, they become more tired, more fatigued, almost to the point of dragging themselves around every day. Fortunately for most of these people, they are able to go through that because they are still young; they are able to have a normal delivery. The baby comes out and everybody’s very happy.

Post Partum Fatigue and Crashes

Post Partum Fatigue and reproductive system functionMany are surprised to find that after the baby is delivered, on a postpartum basis, many of them start crashing. They have continued and unresolved fatigue, they’re tired, their energy never quite returns, and those who are breast-feeding are particularly vulnerable because their body is drained all the time. And so whether it is three months, six months, or nine months, depression sets in, insomnia sets in, and the fatigue just keeps getting worse and worse; and as time goes on, they can get anxiety, they can get depressed, they can have panic attacks, and they are just unable to deal with stress.

Now despite adequate rest by that time, they can have crashes that come on, what we call adrenal crashes that come on very frequently, sometimes rolling in nature: they crash one time, they rest and they get better, and then they crash again. So, postpartum adrenal crashes and fatigue are very common, and that’s another warning sign of a body that is been not well managed and not well nurtured during the pregnancy period, allowing the body to deplete itself of progesterone reserves and so going into acute adrenal fatigue stages in advanced phases after the baby is born. So with that clinical picture, the mother becomes very tired and unable to take care of the baby, and just things just keep progressively getting worse.

They will have seen their doctors, and because laboratory tests usually continue to be normal at this time, no focus is placed on the adrenal glands, no focus is placed on the stress, and more stimulants are added in terms of hormone replacement; thyroid medication, testosterone, and the like are prescribed. If all this fails, then the conventional doctors will basically give up, provide antidepressants, and send the patients to see a psychiatrist.

The body’s cry for help and its slowing down resulting in the fatigue are normal physiological and neuroendocrine responses, and it is not that the body is dysfunctional. It is only dysfunctional in that we are unable and have not paid enough attention to recognize these and look for the underlying root cause. From time to time you do have real pathology so it’s important to always have these mechanisms checked on by a conventional doctor. But the important lesson to learn is that when you have these abnormal symptoms that come up, whether it is the postpartum fatigue, infertility, a difficult first trimester, or dragging throughout the day before and after pregnancy, these are all alert signs that something is wrong underneath, and are not to be brushed over as insignificant.

Lessons Learned

Let’s look at the lessons learned:

  1. For a female to feel good and have good reproductive function, her hormones must be balanced. There’s no question about that.
  2. Our body has self-regulating internal balancing systems between all the hormones if it is functioning properly.
  3. If the system of hormonal balances becomes upset and deregulated, then the estrogen level tends to rise beyond what the progesterone can overcome, leading to a state of estrogen dominance, and this can happen very young, even in the teens.
  4. Estrogen dominance in turn disrupts ovulation and the menstrual cycle making pregnancy even harder; it’s also associated with PCOS, endometriosis, fibroids, and fibrocystic breast disease. Estrogen dominance as a condition cannot be overlooked and must be very closely attended to in order to maximize the chance of fertility in young women. Those who are not having regular cycles or have PMS must be on alert. Do not simply have it regulated without looking at the root cause.

Serial miscarriages and reproductive system function

  1. Those who have Adrenal Fatigue and pregnancy are at risk of having a miscarriage in their first trimester. This is a very important alert for those who have miscarriages and cannot figure out why, especially those who have serial miscarriages in the first trimester.
  2. During the pregnancy period, whether a person is normal, slightly abnormal, or borderline, many women have a borderline OAT axis imbalance and a borderline estrogen dominance, and so it’s very important to pay some attention to supporting the body’s adrenal function and to normalizing the estrogen level during the pregnancy period in order to have a smooth second and third trimester and a smooth delivery. In particular, it is very important during the late pregnancy period to build the body’s reserves of progesterone so that the body has enough to go through the delivery with relative ease and more importantly, to avoid having any postpartum fatigue. So after the pregnancy is finished, the body must continue to be supported from the adrenal perspective to ensure that after the delivery there’s no crash. Once the body crashes after postpartum, because it already has low reserves from the months of pregnancy, its ability to recover is compromised.

How to Prevent Disruptions of Reproductive System Function

We must understand that a proper reproductive system function program must incorporate plans to ensure that first, hormones are balanced from a natural perspective to allow the body to have all the tools it needs to achieve maximum chance for fertility to begin with ovulation and fertilization. Next is to go through the first trimester with ease by making sure there’s enough progesterone internally. Then, make sure that you have a smooth second and third trimester until delivery. And finally, to make sure that after the delivery, the body still has enough reserves to fall back on so it does not have unrelenting crashes leading to adrenal exhaustion. A complete program, therefore, has to think more comprehensively, not just to patch up the symptoms, but to look at the entire reproductive cycle and the entire process with a comprehensive approach, so that starting very early on, even before pregnancy begins, we can address the PMS endometriosis, and fibrocystic breast, so that a person is well protected throughout.

If you have any of these following symptoms, you have to think of adrenal fatigue syndrome. They include endometriosis, PMS, fibrocystic breast disease, fibroids, irregular menses, PCOS, serial miscarriages during the first trimester, feeling fatigue that is unresolved with thyroid medication, feeling great during pregnancy with all the fatigue reduced, feeling extremely weak and barely making it through in previous pregnancies, excessive fatigue, depression, and postpartum anxiety. There all have underlying adrenal dysfunction, and you would be wise to take care of those things, which is easy enough to do if you have a comprehensive plan to make sure that not only you go through, and the woman go through the pregnancy with great, great results, but also a healthy baby; because we know that an unhealthy mother will lead to an unhealthy baby.

Doctors and reproductive system functionFor the health and benefit of the baby, the mother must be taken care of. The earlier you try to overcome these things to prepare the mother, the better the chance of a healthy baby. For people that you may see that have a lot of this reproductive issue, the strategy is to take a step back, nurture their system back into wholeness for optimal hormonal function, and such a retreat will yield great results for not only pregnancy, but much for a better and healthier family in the future.

The four step approach, therefore, requires optimization of the adrenal function to normalize the OAT axis imbalance and neutralize estrogen dominance, making sure that the body is hormonally optimized without stimulants during the first trimester, building the adrenal reserve throughout pregnancy in preparation for a smooth delivery, and making sure, that the postpartum adrenal support is there so that there’s no postpartum fatigue and adrenal crashes. Throughout these natural support programs, a qualified conventional OB/GYN doctor’s understanding and cooperativeness are beneficial as well.


Disruption of reproductive system function is a very important topic that affects many women who are having difficulty with pregnancy. If they are in careers that are very demanding or if they have a Type A personality that’s on the go all the time, the price that they pay for a disruptive body hormonally is  very long term and is very severe, and most people, unfortunately, take it for granted until it’s too late. I hope that the alert signs are there; watch out for them, and try to support the body and allow the body to heal itself, and because most of these reproductive problems actually happen in relatively younger women, in their mid-20s or in their mid-30s, the chances for recovery are actually very good, if the proper steps are taken. Furthermore, another alert is to make sure that you do not overstimulate the body, because during these times, even though it may have some temporary benefit, overstimulation is usually a failure in the long term.

If you think that you are in, or have symptoms of Adrenal Fatigue and pregnancy disruptions, recovery needs to be personalized. An improper approach to recovery can complicate, deter, or even exacerbate your current state.

© Copyright 2014 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Question

This diet is based on a certain protein found in all foods call lectin, and how this lectin reacts to the blood that is specific for each blood type. While you are young, you may not feel anything. But as your body start aging, chronic diseases may start. Blood Type O recommends that a person eats more meat or high protein, if you have been vegetarian all your life, your digestive system may not be able to handle the amount of meat the diet recommends. So you may want to slowly ease into the diet.

Reproductive System Function
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  • Tina says:

    what is the best way to try and start conceiving when having adrenal fatigue?

  • Wayne says:

    Can adrenal fatigue cause productive harm in men?

    • Dr.Lam says:

      Reproduction is not a high priority item as far as the body is concerned for both sex when energy is at risk.

      Dr. Lam

  • Garfield says:

    Interesting. So is AF more prominent in aging women or does the risk get higher as women age?

  • Kelsie says:

    If you have AFS and become pregnant, is it ok to continue using just progesterone cream? Or would you want something like capsules to take internally?

    • Dr.Lam says:

      Depending on the degree of weakness, progesterone level after you become pregnant needs to be adjusted, in most cases, upward until the first trimester to support the pregnancy. Your OB doctor would be able to make that assessment as needed. Self-navigation is not recommended.

      Dr. Lam

  • Freddy says:

    Can Adrenal Fatigue cause infertility?

  • Taylor says:

    Wow, I’m a little blown away with the intricacies of creating a life. This is a great article to read though, I’m going to share this on my Facebook. Thanks

  • Jonah says:

    Could a child born to a parent with adrenal fatigue find they have hormonal issues even pre-puberty?

  • Emily says:

    is there any connection to an ectopic pregnancy and adrenal fatigue?

  • A.W. says:

    This article was great, but it didn’t outline what steps need to be taken! Here’s my story:
    I’m 34 years old and pregnant with #7. For the last 4 pregnancies (and now this one), I stop sleeping. Almost completely. It’s not because I’m uncomfortable, or because I have to get up to go to the bathroom, or any of the other normal pregnancy complaints. I just can’t sleep. (wired but tired?) That’s usually how I find out I’m pregnant. It’s like my body just won’t shut down. I’ll go for 4-5 nights without any sleep (and during the day I’ll feel like death), and then the next night I might sleep a few hours. Then it starts all over. I’ve taken all the herbs I feel comfortable taking (valerian, ashwaghanda, hops, passionflower), melatonin, magnesium/calcium, and even Unisom on occasion. But all they do is relax me. Sleep still won’t come. Because I don’t sleep, I feel depressed and anxious all the time, and it makes it really difficult to take care of my other children every day. I eat a pretty clean diet, trying to stay away from sugar and wheat 90-95% of the time, and basically following a LCHF diet. I also have high fasting glucose levels during pregnancy, despite being LCHF and sugar-free. After years of researching, I really think i must go into adrenal exhaustion when I’m pregnant. This was an unplanned pregnancy, and I was trying so hard to get my health back BEFORE I ever had another pregnancy. I can’t go on like this for another 32 plus weeks. Any advice for me? I feel like I’m going to go crazy if this continues much longer.

    • Dr.Lam says:

      Being pregnant is a very traumatic event as far as the body is concern. When you are pregnant, you dont want to use glandular or herbs as they may affect the baby. You also need to plan ahead of time for post-partum to avoid risk for crashes.
      Click Adrenal Fatigue Glandular & Herbal Therapy for more information.

      Dr Lam

  • Beatrice says:

    How does a hysterectomy affect Adrenal Fatigue?

    • Dr.Lam says:

      A hysterectomy in theory will reduce estrogen load. That may be helpful in people with advanced AFS. But because estrogen is made in multiple places in the body, reducing one source does not necessarily solve the problem, and that is why many people continue to feel bad after hysterectomy, contrary to their expectation. The root problem is not about estrogen, but about balancing the body in a way that is suited for you, and everyone is different. With that, AFS will get better.

      Dr Lam

  • Mary says:

    Can having an ectopic pregnancy be related to Adrenal fatigue?

  • Diane Jacobson says:

    Wow, I wasn’t aware of the intricacies of pregnancy and adrenal fatigue but, I do like that you think it is wise not to rush into things. Great read.

  • Deena says:

    I know I have estrogen dominance i was diagnosed with PCOS about 2 years ago. Over time using birth control my periods have become more regular but my weight has been consistently high (about 40lbs over where i should be). Is this normal for people who are estrogen dominant? and if so what to you recommend bring my estrogen levels back into a normal range?

    • Dr.Lam says:

      Estrogen is hormone that can lead to increase in weight. There are many ways to offset it, including using natural progesterone at the right time and reducing estrogen load by keeping healthy weight and de-stress.

      Dr Lam

  • RebeccaM says:

    I was diagnosed with stage 3 adrenal fatigue 4 years ago and have been treated consistently since then. I have had tests throughout that time, which show no change in my condition (adrenal and ovarian hormone problems), other than my most recent tests now showing thyroid involvement. My naturopaths are baffled, and my integrative GP just says I need to reduce my stress with meditation and mindfulness. I no longer have a lot of stress! I’m 36 and I want to have babies, but with this lack of progress, I don’t think I’ll get there. Any advice you can give is much appreciated.

  • Mandy says:

    I just found out that I am pregnant and I have adrenal fatigue how do I know what supplements I should stop taking?

    • Dr.Lam says:

      You should see your doctor. Not all supplements need to be stop but because the baby is at stake, the less you take the better.

      Dr Lam

  • Sarah says:

    I have mild AF and my holistic endocrinologist Dr Peatfield has put me on a supplement of Nutri Adrenal Extra one a day tablets to help heal them. I’m also under active thyroid and will be taking WD Thyroid (NDT) after 9 days of being on the Nutri Adrenal tablets.
    We are trying to concieve for last 5 years and think this may be the answer (to balance OAT) is it safe to continue with adrenal supplements during pregnancy?

  • Tara says:

    Amazing information – very easy to understand, I’ve just started Adrenal Support today and will have all 3 monitored – OAT.
    Thank you!

  • Violet says:

    from reading your website i know that taking Vitamin C is good for adrenal recovery, but I’m pregnant so im hesitant to start it. Is that something that is safe for me? if not what are some general supplements i can try out to strengthen my body during my pregnancy?

    • Dr.Lam says:

      Vitamin C can be helpful but also can be problematic for AF. It depends on the body and the stage. The use of vitamin C during pregnancy is a seperate issue your OB doc will have to make that decision for you. In general, it can be taken during pregnancy for normal people. In fact, it is in most if not all pre-natal vitamins.

      Dr Lam.

  • Abdullah says:

    I am 39 years old and my wife has ectopic pregnancy. I wish we have read your article before as I believe this will be helpful. Thank you for your very informative website

  • RH says:

    I have been diagnosed with adrenal fatigue in the past. I received helped and got better and was able to conceived. What is the correlation to breastfeeding? I am not producing as much milk as I thought I would.

    • Dr.Lam says:

      You should see a lactation specialist to make sure there is no structural issues. Advanced AFS sufferers tend to have more problem with lactation because the body is weak.

      Dr Lam

      • roxanne says:

        I have also noticed trouble nursing with my last 2-3 children. I am nursing my 6mo and my milk is not doing well. she is constantly fussy and I am not producing like I was the first 4 mos.

  • Marilu Adorno says:

    how do you fix it? im almost 100% sure I have this. I started going to an accupuncturist and she believes I have this issue… She says she can normalize the hormones and it will kick my brain to do the right thing… im only 35

  • Jane says:

    Hi Dr Lam,

    I have had advanced adrenal exhaustion (cortisol testing showed flat all day, exhaustion and weight gain etc etc) and have been working with diet/supplements etc to try and recover for the last year and a half with small gains in energy but zero shift in weight. Life must go on and I am now 16 weeks pregnant and after a few stressful events have totally crashed. I just feel like I can’t get on top of it to even try and heal again. My doctor has prescribed low dose hydro-cortisone for a 2-6 week period. Would this be something you recommend in this instance? I feel like I need a kick start and I am worried about going through to the birth in this totally exhausted state. I also have hashimoto’s but all tests so far are indicating remission since being pregnant so I know it is my adrenals as root cause of the exhaustion. Look forward to your response.

    • Dr.Lam says:

      hydrocortisone is a drug of last resort in AFS. It has its place but also can have its down side , as with all meds. short term use can be considered to stabilize the body, but it is often easier said than done, so do talk to your doctor carefully about an exit strategy and what are the alternatives if you have difficulty getting off.

      Dr Lam

      • Jane says:

        Thanks for the response. I have been on a short course before and tapered off over a week or so and added adrenal cortex once I had ceased taking it. I am hoping to do the same again and I am really only looking for a kick start and have no intention of long term use. My doctor is monitoring closely and as soon as I feel any better she wants me off so I don’t think there is any chance of overdoing it! This adrenal fatigue is a killer, I know slow and steady is the way to health but it is fraught with difficulties! 🙂 Great site btw, makes for interesting reading.

  • Stephanie says:

    Thanks for the information Dr Lam! i will continue to do my research, but this did help me get a better understanding of what my body could be going through.

  • Stephanie says:

    If late miscarriages in the first trimester can mean i have low progesterone levels, then would you suggest taking progesterone before trying again in order to maintain a fetus the next time? if so, how much progesterone is recommended to take?

    • Dr.Lam says:

      There is a lot of factors involved when AFS is in the picture because progesterone, even good , has some down side so it is not straight forward and everyone is different. you should consult someone who knows and this is not something you want to self navigate. The normal physioloigical dose for progesterone is 20 mg but some need much more while others may not be able to tolerate.

      Dr Lam.

  • Anna says:

    Are Estrogen Dominance and PCOS the same thing, or can one cause the other?

    • Dr.Lam says:

      Estrogen dominance simply describe a hormonal status where estrogen is higher than progesterone on a relative basis. PCOS is a clinical diagnosis with specific criteria to be met on examination and history by your doctor. Much of PCOS is associated with estrogen, but htere are other reasons as well.

      Dr Lam.

  • Joselyn Sanchez says:

    If I start using, either progesterone or an estrogen cream , correctly of course, will my cycle start to regulate itself? Meaning, that I will only have to use these products short term. Should only use them short term if my cycle does not regulate ?

    • Dr.Lam says:

      Everyone is different. There are many factors to consider. In the best case senerio, your body’s hormone, once balanced, will be where you want to be. If you have AFS as underlying issue and you are either weak or sensitive, then you need to be very careful before proceeding with hormone replacment as most people who dont know how to do it will make you worse.

      Dr Lam

  • Susanna says:

    Dear dr. Lam.
    Thank you so much for all these vital informations. I have advanced AF. i have not been working for about 18 months. I had sewer panic attacks and many crashes, but have been doing better the last 6 months with no crashes, but i am very tired and always looking out for my self. I found out 4 months a go, that i am pregnant and it has been okay, but i am so afraid of giving birth because i have not gotten any help with hormone balance or adrenal support. please, is it to late to take a hormonal imbalance test and get natural hormones ? i also have low iodine levels and i have gotten hypothyroid in my pregnancy. i have tried to take some iodine but my adrenals go crazy and i get palpations. i am on no medication. is there something i can do to support my future delivery and postpartum panic attacks and crashes ?? i am 18 weeks pregnant. thank you for all your help.

    • Dr.Lam says:

      There are many natural things you can do the support healthy pregnancy, before delivery ,and post partum. Since you are already 4 months pregnant, the risk of first trimester miscarriage is reduced, so that is good news. Going forward, you need to keep your body stable and protected and supported. Everyone is different and a comprehensive strategy is required to be mapped out as each body is unique. Iodoine is stimulatory and can trigger palpitations. Post partum issues is a high consideration especially as you get closer. You have to be very careful on what you do now and seek the advice of your OB doc to make sure. We can help you after your delivery if you call us.

  • Jan says:

    Our 34 yr old son has had chronic fatigue syndrome for 2.5 years. He has tested low in testosterone and high in prolactin. He has also suffered from POTS, which was just confirmed by tilt table test etc. Do you have any thoughts on this?

  • TIM C says:


    • Dr.Lam says:

      Its very unusual for a male to have this combination. something is going on. you need to seek an endocrinologist help.

      Dr Lam

  • Innus says:

    Hello, are the adrenal yoga exercises safe to do while pregnant? I really like how relaxed they get my body.

  • Mawyarn says:

    Thank you very much for the explanation of everything.Am 32 And had 3 miscarriages in my late first trimester,which was so devastating.My Obygn were not so keen on finding out what was going on,all I knew was I have hypothyroidism.I changed doctors and did several test and found our I have Adrenal Fatigue and low vitamins D.Looking forward to be a mother soon.
    Thank you once again.

  • Joe says:

    Hi Dr Lam, Thank you for your reply.

    I’ve definitely noticed a decrease in sex drive and libido and I avoid all sexual activity now.

    Is that due to low levels of androgens or is it more to do with neurotransmitters, or both?



  • Joe says:

    Hi Dr Lam,

    I’m just wondering, how does adrenal fatigue affect the male reproductive system?



    • Dr.Lam says:

      For male, it usually comes out as low libido and lacking sex drive. Many people crashes after sexual excitation.

      Dr Lam

  • Kelley says:

    Do you think I would have a higher chance of going through postpartum depression if I was to be able to conceive and have a somewhat normal pregnancy?

    • Dr. Lam says:

      The more advance the AFS, the higher the chance of postpartum fatigue and crash. There is no question. We put the body onto a strong non stimulatory support program starting well before conception and also specially in the last trimester to reduce this risk. A healthy mother will give rise to healthy baby.

      Dr Lam

  • Cadie says:

    Thank you so much for this article! I have had 4 miscarriages and I am only 29 years old. My fertility specialist cannot find anything physically wrong and they do not know why I keep miscarrying. I plan on getting your book but do you think that there is hope for me to ever become a mother?