The HPA Axis Dysfunction’s Connection to Endometriosis

The HPA Axis Dysfunction’s Connection to Endometriosis

How often have you burned out from stress related to endometriosis?

My training as a women’s health coach has enabled me to unpack some of my symptoms that get lumped under the endometriosis umbrella. While we have some understanding of these more unusual symptoms, we don’t have many concrete answers, and the more extreme cases often leave doctors shrugging their shoulders.

I’ve recently been able to identify the cause of my endo belly: small intestine bacterial overgrowth, commonly associated with endo. But there are other symptoms I don’t think can be fully explained by SIBO and endometriosis alone — symptoms that have left me questioning my sanity and ability to function.

I started suspecting I had hypothalamic-pituitary-adrenal (HPA) axis dysfunction a year or two ago when I first came across it in my studies.

The HPA axis is the system that triggers our stress response. Originally, the HPA axis functioned to save us from threats. The fight-or-flight response was designed to help us either run from danger or fight it, and it worked pretty well back in the day when other tribes or wild animals could endanger our survival. Now, it’s triggered by all sorts of things: late trains, 24/7 news, pandemics, debt, work emails, etc. It’s also triggered by events our body experiences as a stressor, such as imbalanced blood sugar, inflammation, and underlying infections.

The HPA axis also regulates our internal body clock, or circadian rhythm. Cortisol, our body’s stress hormone, peaks in the morning, helping us wake up, feel energized, and prepare for the day ahead.

Cortisol levels rise for about an hour after waking, then begin a slow descent, dropping quite sharply around 3 or 4 p.m. (that mid-afternoon slump) and eventually diminishing to allow melatonin, the sleep hormone, to take over.

If you looked at the graph of a typical circadian rhythm, it would follow the line of a small child’s roller coaster: rising fairly high in the morning, then sloping gently and consistently downward, with a little drop at 4 p.m. (just to keep the element of surprise), before tapering off in the evening as the ride comes to an end.

Now imagine that you’re stressed out in the middle of the day when cortisol is supposed to be declining. All of a sudden, there’s a sharp peak in the roller coaster ride. That’s what the stress response is designed for — acute moments of stress that shouldn’t last too long. If we survive the threat, those cortisol and adrenaline levels will drop back down once we feel safe again and our body can return to normal.

But what happens if we’re experiencing multiple stressors throughout the day? Or we’re chronically stressed?

Essentially, we begin creating too much cortisol and those elevated levels keep our roller coaster way up high. This scenario can last for years. Someone with this type of cortisol dysregulation is likely to feel wired, anxious, stressed, and irritable all the time, with little chance of being able to sleep at night.

In many cases, the body eventually adapts. Unchecked chronic cortisol is damaging in numerous ways, so the body may suppress the production or become resistant to the HPA axis signals.

The roller coasters for these scenarios look like a nearly flat line (hardly any cortisol is produced, resulting in sheer exhaustion), and what we call a “flipped curve” (the roller coaster stays lower to the ground then peaks at night). When someone experiences the latter, they feel exhausted all day and wired at night. Despite yearning for rest, it just doesn’t come.

As someone who has spent most of their life chronically stressed and burned out, I began putting together the pieces of the puzzle a while ago. But juggling studying, a book release, and launching a coaching practice didn’t leave me much time for healing, and I’ve been on and off with my commitment until now. Today I only have the energy to show up for work. By evening, I don’t have the strength to make dinner, and come the weekend, I can hardly gather the energy to phone family.

It’s become painstakingly clear that it’s time to practice what I preach to my clients, and step off this ill-fated roller coaster.


Note: Endometriosis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Endometriosis News or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to endometriosis.