Stress and the HPA Axis

FUTURE WOMAN hormone testing

In this article you’ll discover how stress affects your HPA axis and adrenal glands and what you can do to support them.

To start with, let’s distinguish between internal stressors and external stressors.


External sources of stress include things like work stress, family commitments, relationships, busy cities, light and noise pollution, loss, societal pressure, bills, social media and more. 

Internal sources of stress include things like parasites, underlying viruses, imbalanced blood sugar, lack of sleep, caffeine intake, alcohol intake, negative thoughts, excessive exercise, environmental toxins and under or over eating. 

While sometimes it can be hard to control our external sources of stress, we can address our internal stressors more easily by testing and working with an experienced practitioner.

It's all about perception

Stress has much more to do with how we perceive stress than the events themselves. The Perceived Stress Scale (PSS) is the most widely used psychological instrument for measuring the perception of stress. It is a measure of the degree to which situations in your life are perceived as stressful. You can determine your perceived stress score here.

Symptoms of high stress

If you’re under a lot of stress, symptoms might include:

  • Low energy
  • Poor or disrupted sleep 
  • Skin issues 
  • Weight loss or gain 
  • Hormone imbalances
  • Depression or low mood 
  • Anxiety 
  • Signs of nutrient deficiencies 
  • Poor memory or concentration 
  • Changing appetite. 

Stress can literally affect every single organ in the body and has very widespread effects. Our stress response is mainly governed by a communication pathway called the hypothalamic-pituitary-adrenal axis, or HPA axis.

What is HPA dysregulation?

The HPA axis stands for the hypothalamic-pituitary-adrenal axis. 

The HPA axis is the communication pathway between the hypothalamus, the pituitary gland and the adrenal glands. Therefore this is our main stress communication pathway. It is a combination of the central nervous system and the endocrine system.

The HPA axis acts as our central stress response system – it is comprised of the following: 

  • 𝑯𝒚𝒑𝒐𝒕𝒉𝒂𝒍𝒂𝒎𝒖𝒔 – This is part of the brain responsible for maintaining balance in the body. One of its main roles is connecting the nervous system and endocrine system. 
  • 𝑷𝒊𝒕𝒖𝒊𝒕𝒂𝒓𝒚 𝒈𝒍𝒂𝒏𝒅 – Influencing all parts of the body, the pituitary gland has a major role in hormone function by telling other glands to release certain amounts of hormones. 
  • 𝑨𝒅𝒓𝒆𝒏𝒂𝒍 𝒈𝒍𝒂𝒏𝒅𝒔 – The adrenal glands that sit on top of our kidneys produce sex hormones and stress hormones. They play a role in metabolism, stress, immunity and more.

When the brain registers stressful stimuli (again this can be real or perceived) the hypothalamus releases something called corticotropin-releasing hormone which then signals to the pituitary gland to release adrenocorticotropic hormone, which signals to the adrenal glands to release cortisol in response. Cortisol is one of our main stress hormones. 

When stress is prolonged over a period of time, the signaling pathway from the brain to the adrenal glands gets exhausted and eventually it cannot keep up the production of these stress hormones, leading to HPA dysregulation. This is important to understand because dysregulation of the HPA axis can affect many processes in your body and leads to symptoms such as low energy, crashes of energy in the day, poor concentration, mood changes, hormone imbalance, thyroid imbalance, irregular periods, poor sleep, weight changes and more.

What happens when our hpa axis goes out of balance?

Some of the most common symptoms and effects of HPA axis imbalance include:

  • Lowered immunity 
  • Exhaustion 
  • Poor sleep 
  • Weight loss or gain 
  • Hormone imbalance 
  • Anxiety 
  • Poor memory 
  • Increased risk of cardiovascular disease (PMID: 31471749)

Therefore at FUTURE WOMAN when we are addressing stress as an underlying root cause of imbalance, we ensure that our first priority is re-establishing a healthy connection from the brain to the adrenal glands in order to signal to the body that it is ‘safe’ and can come back into balance. This is especially important when suffering from a hormone imbalance. 

Early life stress and the HPA axis:

Research has shown that early stressful life events can alter the stress response and the HPA axis, therefore  this can predispose adults who experienced early stressful life events to develop psychopathology or psychiatric disorders (PMID: 32002927).

Perimenopause/ menopause and the HPA axis:

During perimenopause and menopause the HPA axis becomes more destabalised and is linked to an increased risk in expereincing mood changes and depression (PMID: 25585035). This is also worsened by fluctuations in oestrogen during this time too (PMID: 27867758). During this time it is even more important to address underlying stress and support the HPA axis.

Can you test for stress?

Yes we can. In our FUTURE WOMAN Advanced Hormone Test and Advanced+ Hormone Test with Cycle Mapping Hormone Test we can look at cortisol in depth. 

In these tests we look at:

  • DHEA (produced in the adrenal glands)
  • Free cortisol 
  • Free cortisone 
  • Metabolised cortisol 
  • Metablised cortisone 
  • Cortisol awakening response 
  • Daily cortisol pattern
  • Your preference for cortisone or cortisol  

This gives us a detailed understanding of the health of your adrenal glands and can even help us to understand if you are in acute or chronic long term stress. 

3 Easy ways to support the HPA axis:

  • Make time for one thing each day that brings you joy such as playing with a pet, meeting a friend or watching a funny sitcom. 
  • Eat foods high in magnesium such as nuts, seeds and green leafy veggies to support the adrenal glands. 
  • Prioritise rest. Get your 7-9 hours of sleep each night.


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Weiser, M. J., & Handa, R. J. (2009). Estrogen impairs glucocorticoid dependent negative feedback on the hypothalamic-pituitary-adrenal axis via estrogen receptor alpha within the hypothalamus. Neuroscience, 159(2), 883–895.

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