OAT Axis Imbalance: Causes, Symptoms and Treatment | Sepalika
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Ovarian Adrenal Thyroid Axis Imbalance: Why Every Woman Should Know This!

Jul 4, 2017

Women know the few days before the period only too well – the physical and emotional roller-coaster of fatigue, tears, depression, tantrums and sweet cravings. However, many women experience these PMS or Pre-Menstrual Syndrome symptoms through most of their cycle, and it goes from bad to worse during menstruation. A healthy woman may feel like sleeping in a little longer, having a second helping at meals or experience mild cramps and crankiness. But anything beyond that it is time to take a closer look at what is going on. Often, there’s an Ovarian Adrenal Thyroid (OAT) Axis Imbalance at the root of such troubles.

OAT Axis Imbalance: Mulitple Hormones Out of Sync

I see women in my clinic who complain of fatigue and hair loss, along with other symptoms that suggest they have Polycystic Ovary Syndrome (PCOS). Although when we check, there are no ovarian cysts! Others come with symptoms as varied as weight loss or weight gain, muscle and joint aches, dry skin, low tolerance to cold and even a low libido.  What exactly is causing such metabolic mayhem?

Most often when you visit a doctor with these symptoms, they run a few tests and trace the trouble back to an individual organ or system, such as the thyroid or the ovaries. These days the adrenal glands have also been gaining much needed attention with the emergence of the concept of Adrenal Fatigue, so some doctors may even go there.

However in women, hormonal harmony is dependent on the functional relationships and communication between several hormone systems.

For optimal health throughout the menstrual cycle, the ovarian-adrenal-thyroid axis (OAT axis), a term coined by Dr. Michael Lam, takes center stage.

Trouble in any one of these glands causes the others to go low and slow, resulting in women feeling tired, lifeless, emotionally unstable, achy, having memory problems, as well as very often having to deal with the pains of weight gain and a frustratingly low sex drive.

What is happening can be best understood by starting with our adrenals. In addition to sitting at the center of our ‘fight or flight’ system, it has several other equally crucial functions to perform.

Start With The Adrenals for Happy Hormones

The adrenal glands are the cornerstone for hormonal balance because that is where pregnenolone is produced. Pregnenolone is called the ‘mother hormone’ and it is what other hormones such as estrogen, progesterone, testosterone, cortisol, and DHEA are made out of.

These hormones have many jobs, including the regulation of metabolism, energy levels, the menstrual cycle, vaginal health, sleep cycles, libido, immunity, skin and hair health, and brain function.

When we are in a prolonged state of stress – caused by overwork, poor nutrition, little sleep, chronic disease, or psychological/emotional trauma, the adrenals literally get ‘fatigued’. Cortisol is the main hormone that helps us deal with stress, but when we are stressed for too long, the adrenals are no longer able to sustain the production of cortisol to meet continued demands. Also, cortisol is built out of progesterone. When the adrenals cannot keep up with cortisol demands of the body, they start to steal progesterone in order to keep producing enough cortisol.

OAT Axis Out of Balance: The Perfect Hormonal Storm

Hormones are a little tricky to understand, but I am going to break it down for you, so you can understand how it goes all the way from too much cortisol and too little progesterone to full-blown OAT axis imbalance and the dizzying array of symptoms that bring. The two central hormones of a woman’s menstrual cycle, created in the ovaries, are progesterone and estrogen.

Remember where we started: Due to stress, poor nutrition, overwork etc., the adrenals cannot keep up with the demand for cortisol production, so they steal progesterone to make more cortisol. Where there is too little progesterone, estrogen begins to dominate, causing symptoms of estrogen dominance. When in excess, estrogen interferes with the function of thyroid hormones and the adrenals.

Thyroid hormone is made in the thyroid gland, mostly in the form of an inactive hormone called T4. This is converted into its active form T3, by various cells in the body, so that they can create energy and go about their work.

Estrogen prevents the conversion of T4 into T3, causing more thyroid hormone to be bound in the tissues instead of free and active. This can lead to fatigue and sluggishness since active metabolism has slowed down.

Too much estrogen also disrupts communication from the brain to the adrenals, so that more necessary cortisol is not produced by the adrenal glands in response to the continuing stress.

Meanwhile, sensing the lowered adrenal function to mean long term stress (such as famine or chronic illness, the body begins to convert the limited supply of active T3 into something called Reverse T3. This is done to conserve energy (to help the woman last through the non-existent famine or the real chronic illness). As a result, the body begins to store fat, especially around the middle.

Finally, the lowered thyroid function also pushes down the already lowered progesterone, completing the vicious cycle and ensuring that women stay in it for long.

Ovarian-Adrenal-Thyroid Axis Imbalance: Learning to Spot It

Now you can see how troubles along the OAT axis are felt as several symptoms, seemingly unrelated to each other. Ignore them and they increase in number and strength, leading eventually to serious long-term consequences such as infertility.

Usually, doctors not trained in a functional medical approach are unable to look at the OAT axis as a whole and fix the root cause leading to temporary relief at best.

For instance, they may just notice the low thyroxine levels and choose to give you synthetic thyroid hormone, thyroxine.  But if the adrenals are not dealt with before this is done, it will worsen your hypothyroid symptoms – more fatigue, more hair fall, more depression and so on.

Good functional medicine doctors will ask to run tests for adrenal and sex hormone levels along with the thyroid hormone tests, so a full picture can be assessed and the right intervention made.

Common Symptoms of Dysfunctional OAT Axis

You may have gone through the mind-boggling list of 300-plus hypothyroid symptoms associated with hypothyroidism. This is because of the OAT axis and when it is off, women will present with a combination of symptoms of hypothyroidism, estrogen dominance, and adrenal fatigue.

Common Symptoms of Dysfunctional OAT Axis

Common Symptoms of Dysfunctional OAT Axis

Additional Symptoms:

  • Sleeplessness or unrestful sleep
  • Difficulty losing weight and weight gain
  • Irregular, scanty, or heavy menstrual cycles
  • Difficult PMS, water retention
  • Hypoglycemia
  • Sugar and caffeine cravings

Dos and Don’ts For Hormonal Balance


  • get a full hormonal panel test done: TSH, free T4, free T3, reverse T3, TBG, TgAb, TPOAb, estradiol, FSH, LH ( best on day 3 of cycle), progesterone (best on day 19-22 of cycle), DUTCH test, Adrenal Stress Index test, free testosterone
  • find a physician specialized in integrative hormonal health
  • establish healthy sleeping patterns (11 pm-7am)
  • quit coffee or have max. 1 cup a day (adrenals suffer at the hands of caffeine)
  • eat meals at regular times
  • learn stress coping mechanisms such as meditation
  • eat whole, organic foods, ensure protein and fat intake at every meal
  • use sea salt or Himalayan salt
  • incorporate even a light exercise routine or yoga and pranayama
  • support digestive and liver health (ensures proper nutritional support for hormones and elimination of excess estrogen)


  • eat conventional meat, particularly chicken (pumped with estrogen and growth hormone)
  • drink conventional or A1 milk
  • eat pesticide sprayed foods (the chemicals can act as estrogen mimickers)
  • eat gluten until healthy function is recovered (could lower thyroid function)
  • drink sodas
  • use white sugar
  • use table salt
  • indulge in calorific or multiple snacks, especially those containing high fructose corn syrup
  • eat after 7-8 pm
  • supplement with over-the-counter DHEA or pregnenelone without working with a skilled physician

OAT Axis Balance: Foods, Supplements, and Herbs To Support

OAT Axis

OAT Axis


  • Coconut oil (1-3 tbsp a day), ghee, organic butter
  • Berries
  • Bananas, oranges, melons, sweet potatoes, dark green leaves and vegetables
  • Fish, eggs
  • Ground flaxseeds and sesame seeds
  • Ginger, garlic, turmeric


  • Vitamin C (75 mg a day)
  • Vitamin D (dose depends on level of insufficiency, get tested before you supplement)
  • Brewer’s Yeast (great source of B vitamins and minerals)
  • Krill oil (great source of Vitamin A and Omega-3)
  • Magnesium (300-400 mg a day)
  • Zinc (8 mg a day)
  • Quality probiotic


  • Ashwagandha
  • Shatavari
  • Holy Basil (Tulsi)
  • Rhodiola
  • Vitex Agnus-Castus
  • Milk Thistle

Take herbal supplements under the advice of an expert only, to ensure proper dosage and avoid harmful interaction.

OAT Axis Imbalance: Final Thoughts

So if you find your periods going repeatedly out of cycle or you are facing a variety of symptoms from fatigue to hair loss to fading memory and weight gain, don’t just blame your reproductive hormones. Work with a qualified functional practitioner to fix the entire OAT axis and enjoy vibrant good health all year round.

Dr. Radhika Dontala, M.D.
Dr. Radhika is an M.D. on a mission. She believes in healing her patients through a holistic approach that includes personalized diets, supplements, yoga, acupressure, and meditation. She is inspired by patients who partner with her and use the right knowledge to return to vibrant health, naturally.