If you’ve been feeling symptoms like fatigue, anxiety, insomnia, or PMS and you’re wondering where they’re coming from, you’re not alone. I hear this every single week in the clinic.

Often, women come in feeling confused. They know something feels off, but the symptoms seem scattered. Low energy. Feeling wired but exhausted. Trouble sleeping. Increased anxiety. PMS that feels more intense than it used to.

It can feel like a lot. And it can feel random.

But these symptoms are rarely isolated. They’re often connected. And they’re often being driven by the same underlying system.

Hormones Don’t Work in Isolation

One of the most important things to understand about hormone health is that hormones are always responding to information.

That information comes primarily from your nervous system.

Your nervous system is constantly sensing what’s happening internally and externally. Hormone levels. Blood sugar. Sleep. Stress. Emotional load. Environmental input. Your pace of life.

All of that information influences how your hormones are produced, released, and regulated.

We’re very accustomed to thinking of the body in parts. Different systems. Different specialists. And while that model is incredibly important and necessary, it can sometimes miss how interconnected everything really is.

You might see one practitioner for sleep, another for hormones, another for mood. But without zooming out, we can miss the common thread connecting all of it.

This is where a whole-person, integrative lens becomes so powerful.

Who I See Most Often in Clinic

The women I most commonly work with are between the ages of about 35 and 50.

They’re high-functioning, capable, and used to managing a lot.

They might be caring for kids. Supporting aging parents. Growing in their careers. Holding relationships, friendships, and community roles. They’re often very good at keeping all the balls in the air.

Until their body starts to push back.

What I often see is a mismatch between output and input. A lot of giving. A lot of doing. Not nearly as much recovery.

And that’s when symptoms start to show up.

Fatigue and the Stress Response

Fatigue is one of the most common symptoms I see, and it doesn’t always mean you’re not sleeping enough.

Often, it means your body is working in overdrive.

Cortisol, our primary stress hormone, follows a natural daily rhythm. It should rise in the morning to help you wake up, feel alert, and get going. Then it should gradually come down throughout the day so you can wind down at night.

When stress levels are consistently high, that curve can become elevated across the entire day.

This is where the tired but wired feeling comes from.

You might feel buzzy. On edge. Productive but unable to truly relax. Your mind keeps going. Your body has a hard time shifting into rest and recovery mode.

Over time, this contributes to fatigue because the nervous system never fully powers down.

Anxiety Through a Hormone Lens

Anxiety is another symptom that often shows up alongside fatigue.

Part of this comes directly from elevated cortisol. Cortisol increases alertness, vigilance, and reactivity. When it stays high, it can closely mirror anxiety symptoms like racing thoughts, chest tightness, and a sense of urgency.

There’s also an important hormone piece here involving progesterone.

Progesterone is a calming, grounding hormone that is most prominent in the second half of the menstrual cycle. It also supports the neurotransmitter GABA, which helps quiet the nervous system.

Progesterone and cortisol are both made from the same building blocks in the body. When stress demand is high, the body prioritizes cortisol production over progesterone. This is sometimes referred to as the pregnenolone steal.

The result is higher cortisol, lower progesterone, less GABA support, and a nervous system that feels less settled.

This is one reason anxiety can feel more pronounced during perimenopause or periods of chronic stress.

Insomnia and Circadian Rhythm Disruption

Sleep is deeply tied to stress hormones.

Cortisol and melatonin work together to regulate your circadian rhythm. Cortisol should be higher in the morning and lower at night. Melatonin does the opposite, rising in the evening to support sleep.

Cortisol directly inhibits melatonin.

If your body perceives stress, it will not prioritize sleep. From a survival standpoint, that makes sense. Your nervous system stays alert because it thinks you need to stay awake.

On top of that, stress often leads to more screen use at night. Blue light further suppresses melatonin and can increase cortisol, creating a double hit to sleep quality.

This is why sleep hygiene alone doesn’t always solve insomnia when stress physiology is the bigger driver.

PMS as a Stress Sensitivity Signal

PMS is another place where the stress–hormone connection becomes very clear.

Symptoms like irritability, mood changes, anxiety, headaches, breast tenderness, sleep disruption, and painful periods are often linked to lower progesterone levels.

As stress increases and progesterone decreases, the body becomes more sensitive to normal hormonal shifts in the cycle.

PMS is not something you just have to tolerate. It’s often a sign that the nervous system and hormonal system need more support.

The Bigger Picture

Fatigue, anxiety, insomnia, and PMS are some of the most common symptoms I see in clinic. And while they can look different on the surface, they are often different expressions of the same underlying imbalance.

This is what I refer to as the stress–hormone connection.

Your body is not failing you. It’s responding to the load it’s under.

When we start by supporting the nervous system, regulating stress physiology, and rebuilding foundational resilience, hormone symptoms often become much easier to work with.

If you’re curious how stress may be impacting your hormones specifically, I’ve created a free two-minute quiz that helps you understand your unique stress–hormone pattern and what support might help most.

You can take it at rachelmark.ca/quiz.