The 3 Stages of Adrenal Fatigue & How to Recognize Them

Adrenal fatigue (more accurately known as HPA-axis dysfunction) doesn’t look the same at every stage. The different stages of adrenal fatigue can make a significant difference in how you experience the condition.

If you suspect you may be developing adrenal fatigue, the earlier you get treatment, the better. Don’t wait for Stage 3.

Juggling work and family life is no small feat. You rush in the mornings to make sure everyone is getting to work or school. It doesn’t slow down when you’re home from work.

You hurry to get dinner on the table and help everyone with their homework. It seems like there is no time for self-care. 

In the midst of it all, sometimes life throws us lemons. You’re already burning the candle at both ends. It seems impossible to find energy to manage any unexpected stress.

 “A species’ ability to survive depends on its capacity to adapt to its changing environment,” says Dr. Ash May, a naturopathic doctor at Vytal Health. “Due to technology, our environment is changing at a pace never before seen in human history. The potential to thrive in an age when information is coming at us at lightning speeds will depend upon our capability to slow down.“

Unfortunately, not slowing down is how adrenal fatigue starts. Here’s what you need to know, how to recognize the different stages of adrenal fatigue, and why it’s time to get help today.

What is HPA-axis dysfunction (AKA “adrenal fatigue”)?

Most people know HPA-axis dysfunction as adrenal fatigue. That being said, most doctors prefer to use the term HPA-axis dysfunction. For now, we will keep using both terms, because in the online world, “adrenal fatigue” is still what people who are struggling search for.

HPA-axis dysfunction results from prolonged stress. We all have had times in our lives when responsibilities pile onto responsibilities, and life crises through wrenches into plans.

Your body will try to adjust by giving you a little extra energy. How does your body do this? Your adrenal glands amp up their work by making more cortisol. The high cortisol production will help you keep up with the fast pace for a little while, but not long-term. 

After a while, your body will not respond to all the extra cortisol your adrenal glands are putting out. Next thing you know, you feel depleted of energy. Getting up in the morning feels more like peeling yourself out of bed. 

This unbearable fatigue is the result of a dysfunction between the hypothalamus, pituitary gland, and adrenal glands, hence the HPA-axis. They work together to regulate your hormones.

How does the HPA-axis work?

Cortisol production starts with the hypothalamus. Your hypothalamus sends a hormone to your pituitary gland called corticotropin-releasing hormone, (CRH.) This causes your pituitary gland to produce adrenocorticotropic hormone, or ACTH. ACTH tells your adrenal glands to produce cortisol. 

This is a normal and natural process. In fact, we need it for our survival. Cortisol gives us that fight-or-flight feeling in dangerous situations. 

But, under prolonged stress, the HPA-axis thinks it needs to work overtime. This means that your adrenal glands keep producing cortisol to manage stress. After a while, your body no longer responds well to it. 

Dr. Alicia McCubbins, a naturopathic doctor at Vytal Health reminds us, “Stress can be physical, mental, emotional, environmental, and even somewhat ‘infectious.’ We become more stressed when we spend time with stressed people. Often, it is a combination of these stressors that are the underlying cause of HPA-axis dysfunction.” 

She also says, “Keep in mind that it isn’t always a negative stress—it can be the increased demands that come with a new promotion at work, graduating from school, moving into a house, or having a baby.”

(A longer explanation of adrenal fatigue here.)

How is HPA-axis dysfunction diagnosed?

To learn whether you have developed HPA-axis dysfunction, you will need to test your saliva four times over a 24-hour period. Functional medicine practices, such as Vytal Health, can provide you these at-home tests. The goal is to get a picture of your unique cortisol curve.

When you hear the words “adrenal fatigue,” it may sound like your tired adrenal glands would not be producing adequate cortisol all day long. That used to be the theory and the origins of the term.

Today we know that is not necessarily the case. That’s why HPA-axis dysfunction is a more accurate term.

In reality, your cortisol levels may be too high or too low at various points.

A healthy cortisol curve

In a healthy cortisol curve, cortisol will peak in the wee hours of the morning. It will be high from 7-9 am, and then steadily decline to its lowest point around 10pm-12am. This helps you feel sleepy and ready for bed.

The stages of adrenal fatigue

Depending which stage of adrenal fatigue you have, your cortisol curve will not spike appropriately or at the appropriate times. Your morning values might be too high, while the rest are normal. Or, your cortisol levels could spike at the wrong time of day, such as evening when you need to wind down for bed. Worse, you may have low levels of cortisol all the time, feeling like you have no energy at all. 

Here’s what to expect at each stage of HPA-axis dysfunction.

Stage 1 of Adrenal Fatigue

At the first stage of HPA-axis dysfunction, one or more cortisol measurements are too high. 

Symptoms of stage 1 adrenal fatigue include:

• Tiredness
• Anxiety
• Distracted, foggy thinking

You may notice that you’ve put on a little weight. If you have any combination of these symptoms, be sure to seek out early intervention. You can do this by connecting with one of our doctors. Intervene now, so you don’t progress to stage 2 or 3.

Stage 2 of Adrenal Fatigue

In Stage 2, there are two or more cortisol measurements out of balance. It might be that your cortisol levels are very high upon waking, and extremely low in the afternoon. 

At this stage, you may notice:

• Increased anxiety
• Fatigue 
• Continued weight gain
• Irritability
• An energy crash during the day
• A need for an afternoon “pick-me-up” like caffeine or sugar to make it through the day

Stage 3 of Adrenal Fatigue

Stage 3 is the most severe. At this stage, all your measurements will be low. Your diurnal curve isn’t a curve anymore. It’s more like a flat line. 

You will be feeling awful by this point. Here are the symptoms of stage 3 adrenal fatigue:

• Depleted energy
• Sleep does not make you feel rested
• Moodiness and irritability
• Depression 
• Heavy brain fog
• Poor concentration
• Feeling like you need to stay in bed all day

How can I heal from adrenal fatigue?

Dr. Briley says, “There is no quick-fix for HPA Axis dysfunction. But, a personalized combination of nutrient and herbal medicine can help support and balance your cortisol levels while we address the underlying stressors with diet and lifestyle changes.”

Your first step to healing is to seek help with a functional medicine doctor. Don’t even try visiting an endocrinologist and suggesting you might have “adrenal fatigue.” They’ll shoo you right out the door!

That’s because conventional medicine treats symptoms rather than root causes. Conventional medicine requires a procedure or a pharmaceutical for treatment. We know that adrenal fatigue can’t be treated through pharmaceuticals or procedures.

That doesn’t mean there’s not a research-based treatment! There is.

It just means most physicians are not trained in it. Despite the severity of your symptoms, you can find healing from adrenal fatigue.

Healing HPA-axis dysfunction comes down to stress management.

Your functional medicine doctor will help you evaluate your stage of adrenal fatigue and make the lifestyle adjustments necessary. Treatment for adrenal fatigue might include:

• Dietary changes
• Exercise 
• Stress management techniques

The path to recovery from HPA-axis dysfunction

On your path to healing, our doctors will help you to analyze your first cortisol test. They may have you repeat the test once or twice per year. You may feel improvement after a few months of consistent lifestyle improvements. Full recovery time ranges from 12-18 months. 

Above all, remember that you are worth the time and attention it takes to get better. You deserve  a personalized approach to healthcare. You should have a compassionate functional medicine doctor who treats the real cause of your symptoms. 

If you don’t have a telemedicine doctor ready to work with you, we’d love to talk to you. Start the healing process today by booking a virtual appointment with one of our doctors!