Addison's disease is a rare autoimmune condition that causes damage to the adrenal glands. The adrenal glands play a critical role in hormones like cortisol and aldosterone necessary for everyday functions.
Addison's is also called adrenal insufficiency or adrenal failure, but it's important not to confuse this diagnosis with HPA axis dysregulation, or what some people call adrenal fatigue. HPA axis dysregulation is a cluster of symptoms associated with an overactivation of the stress response, but it's reversible with lifestyle habits.
Oppositely, Addison's is a lifelong, serious endocrine disorder which means it impacts your hormones– including those that regulate your menstrual cycle. As a result, a common symptom of Addison's is a missing or irregular period.
This article will dive into the basics of Addison's disease, how it impacts your hormones, and what you should know about Addison's and your period.
What is Addison's Disease?
Addison's Disease occurs when the adrenal cortex, located on the outside of the adrenal glands, is damaged. The adrenal glands are found on top of your kidneys.
The adrenal cortex produces hormones involved in stress response, metabolism, electrolyte balance, blood pressure, and reproduction. With Addison's, the production of these hormones drops (primarily cortisol and aldosterone, as you will learn about below), leading to symptoms.
Symptoms of Addison's include:
- GI upset (nausea, vomiting, abdominal pain)
- Weight loss and appetite changes
- Skin color changes
- Muscle and joint pain
- Mood changes
- Low blood pressure
Autoimmunity is the most common reason for Addison's, where the adrenal cortex is mistakenly attacked by the immune system. Women are more likely to be diagnosed than men (as with many autoimmune conditions). Other causes include tuberculosis, cancer, surgical removal of the adrenal glands, genetic disorders, or medications.
Addison's disease can progress gradually as damage to the adrenal cortex builds over time, leading to an adrenal crisis. An adrenal crisis (or Addison's crisis) can happen when cortisol drops so low it becomes life-threatening. It usually occurs if medication is stopped or due to trauma, illness, or a sudden stressful event that uses available cortisol.
What Hormones Do the Adrenal Glands Produce?
The adrenal glands, specifically the adrenal cortex, produce many vital hormones that, among many other roles, connect to ovarian function and reproductive hormones that impact your menstrual cycle and sexual health.
- Cortisol. Cortisol is a glucocorticoid (steroid hormone) known as your stress hormone because it's released in response to a stressful event or perceived stress.
While an imbalance of cortisol from chronic stress has adverse effects on the body, you need cortisol for your immune system, metabolism, inflammation, blood pressure regulation, and more.
- Aldosterone. Aldosterone regulates the balance of sodium and potassium electrolytes, impacting blood pressure and maintaining fluid balance.
- Dehydroepiandrosterone (DHEA). DHEA is a precursor for androgens and estrogen. A precursor means it's needed to make other hormones, so low amounts can influence levels of these critical sex hormones.
How Addison's Disease Can Impact Your Menstrual Cycle
Our hormones don't work alone but in balance with each other in the body. Even hormones that aren't considered sex hormones can influence your reproductive health. As a result, people with Addison's often have menstrual cycle irregularities.
It's estimated that approximately 25 percent of women with Addison's will develop amenorrhea (lack of a period), possibly due to the stress of the illness or weight loss.
Primary ovarian insufficiency (POI), formerly called premature ovarian failure, is also higher among women with Addison's disease. POI is not the same thing as menopause but means that the ovary isn't releasing eggs as it should. But a comprehensive review also found that one in ten women with Addison's disease develops early menopause before 40 (usually this milestone occurs in the late 40s or early 50s). For one-third of these women, menopause starts before age 30, clearly impacting fertility. As a physician board certified in naturopathic endocrinology, I always investigate Addison’s disease in cases of early menopause.
However, it's really important to note that people with Addison's can have healthy pregnancies by working closely with the right healthcare team, so just because you have Addison's doesn't mean you can't have children if that's something important to you. If you have Addison’s or any autoimmune disease for that matter, work with a maternal fetal medicine specialist to ensure you have the healthiest pregnancy.
But why does this happen? Here are some of the hormone imbalances seen with Addison's that could impact your menstrual cycle or reproductive hormones.
Remember that cortisol is the hormone released by the adrenal cortex in response to stress. For HPA axis dysregulation, cortisol is chronically elevated, so we often think of the negative impacts of cortisol when it's too high. High stress impacts your reproductive cycle by shutting down ovulation, leading to irregular or missing periods.
But you do need cortisol in healthy amounts (as you learned above). Any abnormality with hormones can impact your menstrual cycle. With Addison's disease, cortisol is too low (and can be dangerously low). In some cases, low cortisol levels can lead to inflammation, which in turn can elevate estrogen levels and throw off menstrual cycles.
Hypothyroid means your thyroid gland isn't making enough thyroid hormone. Hashimotos is the most common form of hypothyroid and is an autoimmune condition where the immune system attacks the thyroid gland. While Addison's doesn't necessarily cause autoimmune hypothyroid, it's closely linked.
Autoimmune hypothyroid, or Hashimoto's, impacts the menstrual cycle and can cause long or heavy periods, missing or irregular periods, and in some cases infertility.
Addison's is linked to androgen deficiency because of decreased production by the adrenal glands. Androgens are steroid hormones that play a role in sex drive, hair growth, muscle mass, and energy. They are often thought of as a male sex hormone, but women produce small amounts too.
However, one study found that women didn't report reduced sexual activity despite low androgens compared to people without Addison's, so it may differ from person to person.
Addison's can cause weight loss due to gastrointestinal symptoms like vomiting, diarrhea, and loss of appetite. Rapid weight loss can lead to menstrual irregularities because of the stress it puts on your body.
When your body senses nutrient scarcity – whether from a restrictive diet or weight loss related to a medical condition, it shuts down non-essential functions, including hormones related to reproduction.
How to Treat Addison's Disease
Addison's disease requires lifelong medical care and a close relationship with your medical providers.
You and your healthcare team will create an individualized plan to support your symptoms, so treatment can vary between people.
Specifics about treatment for Addison's are best discussed with your medical provider, but available treatments usually include:
- Medications to replace hormones like cortisol and aldosterone.
- Electrolytes to support low sodium and electrolyte imbalance.
- DHEA to support low androgens.
Once again, your treatment plan for Addison's must be overseen by your healthcare provider as it is a lifelong, serious condition.
Can Nutrition Help with Addison's Disease?
General nutrition guidelines for Addison's include high salt diets for those with electrolyte imbalances and supplements like vitamin D and calcium to support bone health that may be affected by long-term use of steroid medications.
Foods high in potassium, like salt substitutes, potatoes, oranges, or bananas, are often discouraged since people with Addison's tend to have high potassium levels in their blood.
Avoiding foods that put excess stress on the body, like caffeine or alcohol, is also recommended.
Some research has also suggested that since Addison's could increase your risk of low blood sugar (because cortisol helps raise blood sugar), eating carbohydrates (or foods the researchers called comfort foods) could support low energy or brain fog.
There isn't necessarily a specific Addison's diet plan. Still, a general anti-inflammatory diet, as seen with the Mediterranean diet, rich in healthy fats, fiber-filled carbs, and lean protein, can support autoimmunity.
How to Manage Addison's During your Period
While some with Addison's won't get a regular cycle, others do and may notice worsening symptoms. Unfortunately, there's not a lot of research on period symptoms and Addison's, so it comes down to paying attention to your body.
Aside from medical treatment, understanding how you respond to stress becomes essential. More stress means your body uses more cortisol, so avoiding excessive stress becomes vital for people taking medication to increase cortisol. Changes in hormones, period pain, or emotional stress could be a problem.
An adrenal crisis can occur for people with Addison's disease for different reasons, including during their period. Tracking symptoms may help you see patterns, and you can use these patterns to discuss whether you need to adjust medication dosages during your period.
Addison's is Lifelong but Treatable
Addison's is a rare but serious lifelong health condition, not to be confused with adrenal fatigue (HPA axis dysregulation). Because Addison's impacts your hormones, it can cause menstrual irregularities or missing periods, but it is possible to have children with Addison's if that's a goal.
Addison's symptoms could worsen during their period due to the hormonal shifts or added stress for those who get periods.
Working closely with your provider is important for hormone balance, managing symptoms, and providing all the support you need for living your life.
- Dutt M, Wehrle CJ, Jialal I. Physiology, Adrenal Gland. StatPearls.
- Betterle C, Presotto F, Furmaniak J.. Epidemiology, pathogenesis, and diagnosis of Addison's disease in adults. J Endocrinol Invest. 2019. 42. 1407-1433.
- Angum F, Khan T, Kaler J, Siddiqui L, Hussain A. Epidemiology, pathogenesis, and diagnosis of Addison's disease in adults. The Prevalence of Autoimmune Disorders in Women: A Narrative Review. 2020. 12. 8094.
- Elshimy G, Chippa V, Jeong JM. Adrenal Crisis. StatPearls [Internet].
- Scott JH, Menouar MA, Dunn RJ. Physiology, Aldosterone. StatPearls [Internet].
- Labrie F. DHEA, important source of sex steroids in men and even more in women. Prog Brain Res. 2010. 182. 97-148.
- Burke CW. Adrenocortical insufficiency. Clin Endocrinol Metab. 1985. 14. 947-76.
- Vogt EC, Breivik L, Røyrvik EC, Grytaas M, Husebye ES, Øksnes M. Primary Ovarian Insufficiency in Women With Addison’s Disease. he Journal of Clinical Endocrinology & Metabolism. 2021. 106. 2656-2663.
- Bensing S, Giordano R, Falorni A. Fertility and pregnancy in women with primary adrenal insufficiency. Endocrine. 2020. 70. 211-217.
- Nagma S, Kapoor G, Bharti R. To evaluate the effect of perceived stress on menstrual function. J Clin Diagn Res. 2015. 9. 1-3.
- Erichsen MM, Husebye ES, Michelsen TM, Dahl AA, Løvås K. Sexuality and Fertility in Women with Addison’s Disease. The Journal of Clinical Endocrinology & Metabolism. 2010. 95. 4354-4360.
- Arlt W. Androgen therapy in women. Eur J Endocrinol. 2006. 154. 1-11.
- Sophie Gibson ME, Fleming N, Zuijdwijk C, Dumont T. Where Have the Periods Gone? The Evaluation and Management of Functional Hypothalamic Amenorrhea.. J Clin Res Pediatr Endocrinol. 2020. 6. 18-27.
- Gurnell EM, Hunt PJ, Curran SE, Conway CL, Pullenayegum EM, Huppert FA, Compston JE, Herbert J, Chatterjee KV. Long-Term DHEA Replacement in Primary Adrenal Insufficiency: A Randomized, Controlled Trial. The Journal of Clinical Endocrinology & Metabolism. 2008. 93. 400-409.
- NIDDK. Eating, Diet, and Nutrition for Adrenal Insufficiency & Addison's Disease What should I eat if I have adrenal insufficiency?. NIDDK.
- Klement J, Hubold C, Cords H, Oltmanns KM, Hallschmid M, Born J, Lehnert H, Peters A. High-Calorie Glucose-Rich Food Attenuates Neuroglycopenic Symptoms in Patients with Addison’s Disease. The Journal of Clinical Endocrinology & Metabolism. 2010. 95. 522-528.
- Tsigalou, C., Konstantinidis, T., Paraschaki, A., Stavropoulou, E., Voidarou, C., & Bezirtzoglou, E. Mediterranean Diet as a Tool to Combat Inflammation and Chronic Diseases. An Overview. Biomedicines. 2020. 8. 201.