In this article you’ll learn all about burnout, its most common symptoms, and what you can do to overcome it.
What is burnout?
Burnout is a set of symptoms commonly experienced after prolonged exposure to high levels of stress. It typically manifests itself as physical, emotional and mental exhaustion.
How the body should respond to stress
Hypothalamic-Pituitary-Adrenal axis is essentially the communication pathway between the brain and the adrenal glands. The adrenal glands are two small glands that sit on top of your kidneys.
When the body experiences stress, the hypothalamus releases corticotropin-releasing hormone (CRH), which prompts the pituitary gland to secrete adrenocorticotropic hormone (ACTH). ACTH then stimulates the adrenal glands to release cortisol. These hormones prepare the body for an immediate response, leading to physiological changes such as increased heart rate, elevated blood pressure, and heightened alertness. High cortisol levels signal the hypothalamus and pituitary to reduce CRH and ACTH production, creating a feedback loop to maintain balance.
Our HPA axis is designed for short, acute periods of stress, after which the body can recover. In the case of modern life, many of us are now exposed to near constant stress, which over time can lead to dysregulation of the HPA axis.
HPA axis dysfunction is a root cause of lots of hormonal imbalances including Hypothalamic Amenorrhea, adrenal PCOS and low progesterone. It can also worsen all symptoms of perimenopause.
What happens when the HPA axis is constantly activated?
Prolonged exposure to stress can lead to a constant activation of the HPA axis. As a consequence, the HPA axis gets overworked and cannot keep up with the required hormone production, leading to dysregulation.
Initially, this dysregulation causes high cortisol levels, but eventually, the communication pathway cannot be sustained due to ongoing stress, which eventually leads to poor brain communication to adrenal glands and low cortisol production.
You may have heard the term “adrenal fatigue” to describe this state. However, we prefer the term “HPA axis dysfunction” as it more accurately describes the complex connection between hypothalamus, pituitary gland and adrenal glands.
Burnout is the final stage of HPA axis dysfunction. Therefore, recognising and addressing HPA axis dysfunction is essential for burnout prevention and management.
Read more about Stress and the HPA axis.
How common is burnout in women?
Burnout is increasingly common in modern society, but particularly amongst women.
Research shows that 9 in 10 adults experienced high or extreme stress at some point in 2023, with as many as 1 in 4 feeling unable to cope. But overall women seem to fare worse than men, particularly when it comes to juggling domestic responsibilities alongside their careers. Women are 23% more likely to struggle with poor work-life balance and 50% of senior womenad at work report constant feelings of burnout, stress and exhaustion.
Why are women more likely to suffer from symptoms of burnout?
There are many different reasons for the increasing prevalence of burnout in women, but perhaps the main one is the lack of domestic support and the pressure of unpaid caregiving responsibilities.
Women are more likely than men to be primary caregivers, looking after children and elderly parents, which add extra emotional and physical load. Last year, 58% of women said they experienced high levels of unpaid work, with 48% regularly working unpaid overtime.
Among our own clients at FUTURE WOMAN around 1 in 2 present with low cortisol levels, with symptoms such as fatigue, low mood, insomnia and even digestive issues. Low cortisol levels have an impact on reproductive hormones – women with low cortisol are at greater risk to have low reproductive hormones.
Common symptoms of burnout
Burnout can be experienced differently by different people; however, there are some common symptoms driven by HPA axis’s inability to support proper body functioning.
What are the physical symptoms of burnout?
Physical symptoms of burnout might look like:
- Tiredness/fatigue
- Low energy
- Muscle weakness/pain
- Headaches
- Digestive issues
- Poor sleep
- Weight gain/loss
- Poor immunity
What are the emotional and behavioural symptoms of burnout?
Emotional and behavioural symptoms of burnout might look like:
- Lack of concentration
- Memory problems
- Depression
- Anxiety
- Low self esteem
- Life and job dissatisfaction
- Irritability
- Difficulty in making decisions
- Social withdrawal
- Decreased commitment
- Reduced performance
- Increased alcohol and other stimulants consumption
Causes of burnout
Burnout is caused by prolonged exposure to various stressors in life. These stressors can be real or perceived: the impact on the body is the same.
There are some situations that are generally accepted to be stressful. According to the Holmes and Rahe stress scale, a list of 43 stressful life events that can contribute to illness, the top listed stressors experienced include bereavement, divorce, incarceration and job loss.
The importance of perception
However, it’s very important to note that stress is in the eye of the beholder: the same event can be perceived differently by different people. This is demonstrated clearly by the Perceived Stress Scale (PSS), a popular tool developed in the 1980s, which measures the degree to which situations in one’s life are deemed to be stressful. It all comes down to your perception.
Physical stressors
Stress can also be physical: lack of sleep, jetlag, too much exercise, blood sugar imbalances, infections and illness can all contribute to our stress load. This is why it’s so important to test your adrenal hormones like cortisol – you may not ‘feel’ stressed, but your body may still be experiencing stress due to diet and exercise, for example.
Stages of stress
As mentioned above, burnout is the final stage of stress, occurring when the HPA axis becomes overworked and can no longer meet the demands for hormone production.
Here are the five stages of stress described:
- Alarm: The first stage of stress, where your body goes into the fight or flight response through sympathetic nervous system activation. The first hormones released are epinephrine and norepinephrine, which increase heart rate, blood pressure, and focus, preparing the body to respond to the threat. Cortisol is then released to support energy production by increasing blood glucose levels.
- Resistance: If the stressor continues, the body enters the second stage to adapt to ongoing stress. Cortisol continues to be released to support energy production and decrease non-essential body functions, like digestion.
- Recovery: When the stressor is successfully managed, the body returns to normal functioning. During this stage, cortisol production decreases.
- Adaptation: If stress continues, the body starts to adapt. Cortisol production continues, and DHEA is produced to counteract the negative effects of stress.
- Burnout: When stress remains constant with no resolution, the HPA axis becomes dysregulated. We see a decrease in the production of cortisol, and the production of neurotransmitters like dopamine also decreases, leading to exhaustion, low mood, and depression.
Understanding which stage of stress you are in can help manage stress and avoid negative consequences.
Treating symptoms of burnout for lasting change
Step 1: Identifying burnout through testing
The FUTURE WOMAN Advanced Hormone Test includes several markers that can indicate the stage of stress you might be in and whether you have burnout. When interpreted together, our practitioners can get a good sense of whether you are experiencing stress or burnout.
Cortisol Awakening Response (CAR)
Cortisol follows a daily pattern which we measure in the Advanced Hormone Test. Cortisol peaks in the first 30-60 minutes after waking up in the morning to get you going for the day and then gradually declines as we get closer to bedtime. This pattern is a good indicator of your circadian rhythms and how your HPA axis is coping with stress. A reduced or blunted CAR is associated with chronic stress and burnout.
Free Cortisol
Free cortisol is an active form of cortisol, which is able to bind to cell receptors and cause an effect. However, it only represents a small portion of total cortisol and metabolised cortisol levels should be looked at in order to see the full picture.
Metabolised Cortisol
Metabolised cortisol is determined by measuring cortisol metabolites and shows the total amount of cortisol processed by your body through the day. When considered together with free cortisol levels, it gives us a clear picture of your cortisol output.
Cortisone
Cortisone is the inactive form of cortisol and can be converted back into cortisol when needed. The level of cortisone shows your preference for deactivating or activating cortisol, and during burnout, this regulation could become imbalanced.
Dehydroepiandrosterone (DHEA)
DHEA is produced by adrenal glands in response to stress. It plays a balancing role to cortisol’s effects: it protects the body against harmful effects of chronic stress. Cortisol levels together with DHEA results can show how your body deals with stress. Typically, low cortisol levels and low DHEA levels can indicate burnout, when low cortisol with increased DHEA shows your body tries to balance the effects of stress.
Dopamine
During burnout dopamine levels are usually low, which contributes to feeling low or depressed.
Sex hormones
Chronic prolonged stress and burnout can often lead to a decrease in the production of women’s sex hormones. Low levels of oestrogen and low progesterone may cause irregular periods, mood swings, sleep issues, difficulty concentrating, and many other symptoms.
What Does Burnout Look Like in Clinic?
Here’s an example of a client with burnout. Both free and metabolised cortisol are below range and she shows a strong preference for cortisone, all of which indicate prolonged exposure to chronic stress. Her daily cortisol pattern is also dysregulated, with a flat cortisol awakening response.
Step 2: Targeted Dietary Support for Symptoms of Burnout
Overcoming symptoms of burnout often requires targeted dietary or supplemental support—and this is where your FUTURE WOMAN hormone expert can really help. Using insights from your Advanced Hormone Test, our practitioners will create a bespoke plan that may include carefully selected supplements, dietary strategies, and lifestyle adjustments.
Every recommendation is tailored to your unique hormone profile, ensuring maximum effectiveness. For example, we might recommend specific nutrients to boost energy and improve mood or adaptogenic herbs to support stress recovery, or perhaps we want to focus on blood sugar management with you or eliminating dietary stressors like caffeine. All our recommendations will be tailored to you and your results, giving you actionable tools to feel better faster.
Step 2: Addressing Lifestyle Factors for Burnout
Your lifestyle plays a crucial role in managing stress and preventing symptoms of burnout. At FUTURE WOMAN, we take the guesswork out of identifying which changes will genuinely benefit you. When you take our Advanced Hormone Test, you’ll receive a personalised plan with tailored recommendations designed to suit your specific needs. This might include guidance around sleeping habits, new breathing exercises or even guidance around techniques such as tapping to release negative emotions. You’ll receive actionable steps that make a lasting difference.
Summary
Burnout is the last stage of stress and is caused by HPA axis dysfunction, which manifests in mental, emotional and physical exhaustion. Women are more likely to experience burnout due to managing caring and house responsibilities alongside the career.
At FUTURE WOMAN, we can help you to Identify burnout through testing and create targeted interventions to overcome it.
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