Adrenal glands in menopause: what they do and how to help

Author: Jessica Lloyd
Senior Vulvovaginal Specialist Naturopath | BHSc(N) | ISSVD, ISSWSH, BSSM, ATMS

Last reviewed: July 13, 2026

In menopause, the adrenal glands take over the production of oestrogens once the ovaries lose their powers. The adrenal glands become the powerhouse of oestrogen, progesterone, testosterone, cortisol and adrenaline.

They don’t do it the way the ovaries did. The adrenals mostly supply the raw material – androgens like androstenedione and DHEA – which other tissues, particularly fat, convert into oestrogen. After menopause, that conversion outside the ovaries is where most of your oestrogen comes from³.

Because the adrenals are being asked to do a lot more work, the added pressure may result in symptoms of adrenal overwork, like fatigue, overwhelm and symptoms of menopause, such as hot flushes. If you are already stressed, especially with chronic stress, menopause may appear early or be more uncomfortable.

Seeking support for the adrenals’ health well before menopause is recommended, but you can support these glands any time without spending a cent.

What your adrenal glands actually make

The adrenal glands produce androstenedione, which can be converted into oestrone, a conversion that occurs in fat tissue. Androstenedione is also converted into testosterone. Testosterone can be converted into oestradiol via aromatisation in fat cells³.

The adrenal glands also produce the hormone precursor dehydroepiandrosterone (DHEA).

DHEA and its storage form, DHEA-S, act as a reservoir. Tissues draw on that reservoir and convert it on the spot into the oestrogens and androgens they need. That local conversion matters enormously for the vagina, and we’ll come back to it.

What happens to the adrenals during the menopausal transition

Here is what the research shows about the adrenals during these years.

DHEA-S rises during the menopausal transition in around 85 per cent of women, and the rise only begins once the transition is under way^1,2. It sits on top of the slow decline in DHEA-S that comes with age, so the overall trend is still downwards – but the transition itself produces a genuine, measurable bump in adrenal output rather than a smooth wind-down².

Cortisol climbs too. Urinary cortisol rose across the menopausal transition and into early postmenopause in the Seattle Midlife Women’s Health Study⁴.

So the adrenal glands are handling a genuinely different hormonal job during these years.

Stress, and why it makes the whole thing harder

Under stress, the adrenal glands also pump out extra adrenaline and cortisol, placing a large burden on the adrenals with the increased demand for cortisol, DHEA and androstenedione.

At menopause, this can create excessive demands on the adrenal glands, which may continue for years, without adequate recovery.

If you’re not stressed now but were during your menopausal transition, you may have been in a weak starting position, adrenally speaking, and some restoration may be in order.

What this means for your vagina

The adrenal picture has a direct bearing on vulvovaginal tissue.

Vaginal tissue can take DHEA out of the bloodstream and convert it, inside the cells, into both oestrogens and androgens, then use them on the spot without raising hormone levels in the rest of the body. That process is called intracrinology, and it is the whole reason intravaginal DHEA works: in randomised, placebo-controlled trials, a 6.5 mg vaginal DHEA (prasterone) insert significantly improved vaginal dryness and painful sex in postmenopausal women, with serum oestrogens staying within the normal postmenopausal range⁵.

That makes your adrenal output part of the raw material your vulvovaginal tissue has to work with.

When oestrogen falls, the vaginal wall thins and lays down less glycogen. Glycogen is what protective lactobacilli feed on, so less of it means fewer protective bacteria, a higher vaginal pH, and a more mixed, diverse microbiome⁷. Women with signs of vaginal atrophy are considerably more likely to have a vaginal microbiome low in lactobacilli⁶.

That shift is also the doorway to bacterial vaginosis and aerobic vaginitis, which is why a dry, irritated postmenopausal vagina so often has a microbiome problem sitting underneath it.

Cortisol may have a hand in this too. Sustained cortisol is thought to interfere with glycogen deposition in the vaginal lining, and that is one of the proposed routes by which long-running psychosocial stress raises the risk of genital tract infections – a mechanism, not yet a demonstrated one⁸.

By the time menopausal dryness and irritation reach me, the vaginal microbiome has usually thinned out alongside the tissue – and supporting the adrenals does nothing for that on its own, so we work on both.

If that sounds like you, a comprehensive vaginal microbiome test shows what is actually growing in there, and local support such as a fennel pessary works on the tissue directly while you deal with the bigger picture.

How to support your adrenal glands

The main supportive mechanism of the adrenal glands is to reduce the pressure on them, which comes mainly in the form of reducing stress. Stress triggers the extra production of adrenaline and cortisol from the adrenals. Thus, reducing or augmenting our stress response can be a meaningful way of supporting adrenal recovery and function.

There are many ways to modify stress, and you’ve heard them all: sleep well, eat well, deliberately relax and exercise regularly. Incorporating mindfulness techniques into your day can also help.

Herbs for adrenal support

Supportive adrenal herbs are traditionally liquorice and rehmannia, and may include adaptogens like Panax ginseng, withania and others.

Two of these have been trialled in menopausal women, though it is worth being precise about what the trials measured, which was symptoms and wellbeing rather than adrenal hormones.

In a randomised, double-blind, placebo-controlled trial, withania (ashwagandha) root extract at 300 mg twice daily reduced menopausal symptom scores in perimenopausal women over eight weeks¹⁰. It is one small trial, but a well-conducted one.

The ginseng evidence is more modest than it is often made out to be. In a double-blind, placebo-controlled trial in symptomatic postmenopausal women, a standardised ginseng extract improved several psychological wellbeing measures – depression, general health and overall wellbeing – but overall symptom relief did not reach statistical significance, and hot flushes were unaffected⁹.

Liquorice comes at cortisol from another angle. Its glycyrrhizin slows the breakdown of cortisol in the tissues, so more cortisol stays available to them. That has been shown in people: adding liquorice to cortisone acetate replacement increased the cortisol available to tissues in patients with Addison’s disease¹¹. Herbalists dose liquorice carefully for exactly this reason.

Rehmannia’s use as an adrenal and kidney tonic comes out of Chinese herbal medicine, where the tradition is long and the clinical use well established. The modern research on it is still mostly laboratory work rather than trials in women.

Get good herbal advice from a trained herbalist or naturopath if you’re unsure whether herbs are safe or appropriate in your case, and always check the safety and warnings before taking them.

Frequently asked questions

Do your adrenal glands really produce oestrogen after menopause?

Mostly not directly. The adrenals produce androgens – androstenedione and DHEA – and other tissues, especially fat, convert those into oestrone and oestradiol. After menopause, that conversion outside the ovaries is where the bulk of your oestrogen comes from³.

Can stress make menopause worse?

Cortisol rises across the menopausal transition on its own⁴, and chronic stress adds to a demand the adrenals are already stretching to meet. In our clinical experience, the women who find the transition hardest are very often the ones who came into it already depleted.

Does supporting your adrenals help vaginal dryness?

It helps the background supply of hormones, though it rarely fixes the tissue on its own. Adrenal DHEA is the raw material vaginal cells convert into local oestrogens and androgens⁵, so it genuinely matters – but a dry, thinning vagina usually needs local treatment as well, and the microbiome usually needs attention too.

What does adrenal overwork actually mean?

It describes what it feels like when the adrenal glands are being asked for more cortisol, DHEA and androgens than they can comfortably supply, over a long stretch: fatigue, overwhelm, poor recovery, and menopausal symptoms that feel louder than they should. Cortisol and DHEA-S both measurably shift across the menopausal transition^2,4, and the lived experience of that shift is what the phrase is pointing at.

This article is general information and not a substitute for personalised medical advice. If you are worried about your symptoms, or your menopause is hard going, please see an experienced practitioner.