The Ovarian Adrenal Thyroid Axis Connection

Dr. Jolene BrightenPublished: Last Reviewed: Thyroid & Hormone Balance Leave a Comment

The Ovarian-Adrenal-Thyroid Axis or OAT for short is the most important axis to assess when striving for balanced hormones.

The OAT is the way in which these three hormone producing glands (your ovaries, adrenals and thyroid) communicate and truly–rule your world.

The 3-Legged Stool

I like to think of the OAT as a 3-legged stool, which each gland representing a leg. When any one leg is imbalanced, the entire system is affected and begins to falter.

All women depend on proper OAT function to feel their best, but most doctors don’t even know how to address it, let alone test for it.

And it is not uncommon for a patient to find their way to my office feeling unwell after their health care provider has become hyper-focused in treating only one of these glands.

“It’s just adrenal fatigue.”

“It’s just hypothyroidism.”

“It’s just estrogen dominance.”

I’m here to tell you, it’s NEVER just one gland. They all work together so if one isn’t doing it’s job you can bet everyone feels it. And more importantly, you're feeling it — fatigue, anxiety, depression, irregular periods, hair loss…

When the thyroid, adrenals and ovaries stop communicating appropriately or start misfiring, a whole array of symptoms follows.

Common Symptoms of OAT Dysfunction

  • Adrenal Fatigue Symptoms
  • Depression or Anxiety
  • Irregular or heavy periods
  • Hypoglycemia
  • Tender breasts
  • Hair loss
  • Dry skin
  • Mood swings
  • Sugar and caffeine cravings
  • Headaches
  • Irritability between meals
  • Difficulty falling asleep, staying asleep and not waking feeling rested
  • Catching every cold or feeling sick often
  • Lightheaded or dizziness from changing positions
  • Water retention
  • Weight gain or difficulty losing weight

Identifying where the imbalances lie is key! And testing is essential to determining which organs are in need of some love and where to begin working.


Common testing I recommend in my clinic includes:

  • Estradiol, FSH, LH (Best tested on Day 3 of your menstrual cycle)
  • Progesterone (Best tested on Day 19-22 of your menstrual cycle)
  • Adrenal Stress Index test
  • Dutch Complete with Cycle Mapping
  • Thyroid panel: TSH, Free T4, Free T3, Reverse T3, Anti-TPO, Anti-thyroglobulin
  • Free Testosterone
  • Sex Hormone Binding Globulin
  • Additional testing may be necessary based on your individual needs

Your doctor should be ordering these tests for you to correctly evaluate and diagnose your individual condition. I can't emphasize enough how important it is for you to have this testing and understand your hormonal health and the thyroid adrenal connection.

If your doctor won't order these tests or doesn't understand how to relate the results to you, please give my clinic a call and let's get you in with a hormone expert who can help you balance your hormones and resolve your symptoms.

What can you do right now to start correcting OAT dysfunction?

Start with your adrenal glands!

By supporting your adrenal glands, you can improve the communication of the entire OAT system. Of course, having adrenal testing will help ensure you are providing the right kind of support with targeted therapies, but bringing in a little help from adaptogen herbs can get you a head start.

In fact, in my clinic, I begin patients on adaptogenic herbs while we are waiting on test results because these herbs can take some time to work. This adrenal support is one trick that helps my patients get better quicker!

In the my free hormone Ebook, I share with you some adaptogenic herbs that improve hormone imbalance symptoms. Adaptogens support your adrenals and help balance cortisol.

Here are a 3 of my favorite adaptogenic herbs to use when women are struggling with their hormones and ovarian fatigue.

3 Adaptogenic Herbs You Should Know About


Known as the endurance herb, Rhodiola reduce the effects of stress and thyroid issues and improves resiliency. Aim for approximately 200 mg daily of a standardized herb containing 3% total rosavins. Rhodiola should not be taken if there is a history of bipolar disorder.


The focus herb, Eleuthero increases concentration, energy and reduces insomnia. It also helps build muscle and increases mental alertness. Aim for about 1/8 tsp of solid extract 1-3 times daily. Eleuthero should not be taken if you have high blood pressure. Take this herb before noon to ensure a restful night of sleep.

Ashwagandha (Withania).

The calming herb, Ashwagandha reduces inflammation, oxidative stress, anxiety, plus improves sleep and memory. It also promotes healthy energy and a healthy libido. Ashwagandha is in the nightshade family, which can be problematic in some people who have a sensitivity. Aim for approximately 200 mg daily of standardized herb containing 5% withanolides.

Simplifying the Daily Adaptogens

Taking 3 different adaptogenic herbs can feel a little daunting—maybe even overwhelming. This is why I often recommend a combination product as a starting place. The Daily Stress Formula is one of my favorite and simple ways to get all of these herbs, plus nutrients that support a healthy hormone diet.

Remember, herbal therapies can take anywhere from 6-12 weeks to really feel the effects. Be patient and give the herbs an opportunity to help. They are doing some heavy lifting after all.

A Deeper Understanding of the Ovarian Adrenal Thyroid Axis

The only way to gain a deeper understanding of how YOUR OAT is contributing to your symptoms of hypothyroidism, PMS, depression, anxiety, estrogen dominance and adrenal fatigue is to have thorough testing.

Sure you could guess, but in my experience this often makes symptoms worse or significantly delays healing. I never recommend guessing with all hormone types.

If you can’t get access to the OAT testing I recommend or your doctor isn’t willing to order it, come join my clinic! My hormone expert clinicians will get to the root of your symptoms, create a customized treatment plan and educate you on the necessary steps to increase you energy, have easier periods,  more even moods and feel amazing! 

Give us a call today! 

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  1. Lam, M, MD. Hormone Imbalance Symptoms and the OAT Axis.
  2. Sargis, R. An Overview of the Adrenal Glands.
  3. Panossian, A and Wikman, G. Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress—Protective Activity. Pharmaceuticals (Basel). 2010. 3. 188–224.
  4. Brusie, C. Adaptogenic Herbs: List, Effectiveness, and Health Benefits.
  5. NHS. Underactive thyroid (hypothyroidism).
About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.