An integral part of balanced hormones, a healthy menstrual cycle and optimal fertility, are well-functioning ovaries, thyroid and adrenal glands. Together this triad is known as the ovarian/adrenal/thyroid (OAT) axis.
When part or all of this axis is out of balance, it can cause or contribute to a myriad of health issues or symptoms including:
- menstrual imbalances (heavy or irregular bleeding, cramping, irregular periods, PMS)
- low libido
- weight gain (difficulty losing or gaining it easily)
- ongoing fatigue
- cognitive difficulties (brain fog, poor concentration)
- mood problems (depression, irritability)
- skin or hair issues (dry, falling out)
- gut symptoms
- sugar cravings
- muscle or joint pain
Why? First a brief overview of what each organ or gland in this axis actually does.
Women normally have two ovaries located in the pelvis that regulate the reproductive cycle via hormones. In a healthy menstrual cycle, oestrogen is higher during the first phase before ovulation (follicular phase), while progesterone increases between ovulation and menstruation (luteal phase).
The adrenal glands are located on top of the kidneys and help the body respond to stress by producing a range of hormones including epinephrine (adrenalin), norepinephrine (noradrenalin) and cortisol.
The thyroid gland is located in the throat and regulates the body’s metabolism via two hormones – T4 (thyroxine) and T3 (triiodothyronine). These hormones determine how effectively each cell in the body produces energy by influencing the speed at which each cell works and uses protein, fat and carbohydrates and therefore how much energy is produced. Thyroid hormones are also involved in the synthesis of sex-hormone binding globulin, prolactin and gonadotropin-releasing hormones, which along with adequate progesterone, are important for a healthy menstrual cycle and fertility.
Each of these are controlled by the hypothalamus in the brain and each part of the axis influences others. If one part of the axis isn’t working properly, the whole axis (and body) system won’t work properly hormone imbalance onset of health issues or symptoms like the ones listed above.
One underlying factor that strongly influences how well (or not) this axis works is excessive/chronic stress, whether it is physiological or psychological stress, such as: busyness, physical pain, emotional distress, sleep deprivation, excessive exercise, nutrient deficiencies (macro and micronutrients) or inadequate food intake, infections, alcohol, heavy metals.
Chronic stress stimulates a hormonal cascade that in the initial phases (this can be from months to years depending on the individual) includes high cortisol levels. Think of the thyroid is the engine, the adrenals are the petrol tank and the cortisol is the petrol. The car (your body) needs the right amount of petrol (cortisol) to work well but if the engine is flooded with too much petrol (cortisol) the car won’t work properly.
This is because the body is doing what it can to slow the body down to promote healing. It does this by downregulating systems and organs involved in energy production (including thyroid) and reproduction (ovaries), as well as digestion and immunity.
High cortisol levels results in less active thyroid hormone (T3) being available to the cells in the body. This means metabolism slows down (less energy, weight gain) and because T3 stimulates the release of progesterone from ovarian cells, less active T3 = low progesterone.
High cortisol can also mean less progesterone being made.
(Think of this process as cortisol and progesterone being 2 young children playing with a basket of toys. When the children are balanced and happy (there are ‘normal’ stress levels in the body) they share the toys equally (the body has enough progesterone because cortisol levels are ‘normal’). But when stress levels are high, one of the children (cortisol) gets greedy and takes all the toys. This means there aren’t enough toys to go around (more progesterone is needed to make the extra cortisol) = low progesterone levels = high oestrogen).
As well as contributing to a multitude of symptoms or health issues high oestrogen/low progesterone cause higher inactive thyroid hormone levels circulating in the blood that cannot enter the cells.
The result? Low energy and libido levels, menstrual irregularities (e.g. heavy more frequent or infrequent/absent periods), infertility, weight issues, mood imbalances and cognitive difficulties (brain fog, poor concentration).
Some women present with all 3 parts of the axis under-functioning, while for other women 1 part of the axis is under-functioning more than the others. (e.g. thyroid dominant are often really low in energy and have hypothyroid symptoms; adrenal dominant people often have low energy with anxiety and irritability; while ovarian dominant can have brain fog and poor memory and PMS symptoms).
The 3 main key points to addressing OAT-axis associated health issues are:
- Getting the right clinical assessments done to determine which part/s of the axis is causing or contributing to your health issues.
- Addressing all parts of the OAT axis (and other body systems/processes consequently affected) rather than focusing on 1 part of the axis or treating only the symptoms.
- Using the correct nutritional, supplemental, exercise and lifestyle strategies to bring the axis (and body) back to balance and therefore address the presenting health issues/symptoms.