Virtual Clinic for Women's Hormonal Health & Digestion in Ontario

When Stress turns to BURNOUT

Have Chronic Stress? Turn the Tides and Prevent Burnout

Having difficulty coping?

If you overworked and under-rested, and juggling too many things, we can help improve your stress resilience to avoid or recover from burnout.

Our modern lifestyles are busy and demanding, and sometimes straight up not manageable. We see many women in our practice either fully in a burnout, or on their way. They are juggling the high demands of their job, parenting or caring for aging parents, inconveniently paired with a hormonally fluctuant stage in their lives.

The standard care provided to women with burnout is a) time off work, and b) an antidepressant. This is only very superficially addressing the woman’s physiological situation. We must dig deeper and also assess and address her hormones and nutrients. 

We use lab testing, lifestyle counselling, dietary support, herbs and supplements to nourish the adrenal system and reset the stress response.

Burnout and How it Affects Women

Burnout is not born of a single event. Burnout is due to a million micro-stressors piling to the point of breaking. With any multifactorial problem, you need a multifactorial solution. Naturopathic doctors address the complexity of issues that have led you to burnout, and also have an arsenal of tools available to help treat burnout. We not only address the symptoms, but also the source.

Most burnout literature points towards organizational changes that need to occur, and that the affected individual gets treatment by time off from work and antidepressant medication, with no attention given to the individual’s physical health. As there is great value in addressing nutrient deficiencies and hormonal imbalances, it is imperative to assess the whole person for true resolution of burnout.

According to the International Classification of Diseases (ICD-11) Workplace burnout (Z73.0), or Burn-out state of vital exhaustion is “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

  1. feelings of energy depletion or exhaustion;
  2. increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
  3. reduced professional efficacy.


Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

It is important to note that parental/caregiver burnout is also real, and getting more attention since the pandemic.

Parental burnout is a form of burnout that occurs as a result of the demands and stress associated with parenting. It is characterized by emotional exhaustion, feelings of detachment or cynicism towards one’s children, and a sense of ineffectiveness or inefficacy as a parent.

Like other forms of burnout, parental burnout can have serious consequences for individuals and their families. It can lead to reduced emotional and physical well-being, strained relationships, and reduced job performance if the parent is also employed.

Dr. Sarah Goulding a Naturopathic Doctor

Your Doctor: Meet Dr. Sarah

Dr. Goulding is a Naturopathic Doctor who has a special focus on digestion and hormone health. She completed her doctor or naturopathic medicine degree at the Canadian College of Naturopathic Medicine, and holds a Bachelor’s of science in neuroscience and biology from Dalhousie University

Dr. Goulding navigates the boundaries of burnout herself when balancing her clinical practice, managing her virtual and Ottawa clinics, mothering 2 amazing and intense kids, while doing her best to prioritize exercise, rest and nutrition. She understands how unreasonable your schedule demands likely are, and wants so very much to help set you up biologically for success, so that your delicate body can sustain this super human level of effort as long as needed.

Need help checking for medical reasons why you're burning out?

 Why Women are Vulnerable to Burnout

The majority of our female patients are working full time and peaking in their careers, plus pulling the majority of the parenting (or caregiving) weight, as well as trying to do the health promoting activities to keep themselves healthy and functional. We see a huge patient-directed focus on weight loss, and women are often over-exercising and under-eating, which only further contributes to the depletion of the resources they need to actually stay healthy and operational in this high intensity time. 

 Causes of Burnout

Burnout stems from the sense of lack of control. 

According to the Canadian Centre for Occupational Health and Safety (CCOHS), various factors cause burnout, including:

Lack of work-life balance

Lack of support

Unreasonable demands

Unclear job expectations

Bullying, harassment, & dysfunctional workplaces

Symptoms of Burnout and How Burnout Affects the Brain and Body

Feel drained and tired most of the time.

Back aches and headaches

Loss of  appetite or unhealthy eating patterns

Sleep disruption

Feelings of overwhelm and helplessness

The HPA axis

Your brain is the master controller of hormonal balance. An area of the brain called the hypothalamus communicates with the pituitary gland located at the base of the brain. The pituitary gland in turn communicates with the adrenal gland and governs the amount of cortisol secreted in response to stimuli. When we are re-setting the cortisol response we often have to work at the level of the adrenal glands themselves, making sure they have all the nutrients necessary to perform their function, but we also need to re-balance the hyopthalamus’ stimulation as well.

In a healthy individual, cortisol secretion is highest at 6am and declines throughout the day. Such a person has good energy in the morning, which is sustained through the working day, but they are tired at bedtime and sleep well across the night.

Patterns of cortisol dysfunction

Inverted curve: their cortisol secretion is highest in the evening. For these people they often have low energy in the morning, and a surge of energy in the evening paired with some for of insomnia. A keynote of this state is waking at 2-4am with an inability to get back to sleep.

Hyperstimulated adrenals: these people are oversecreting cortisol, cranking it out all day long, and are performing well in the day but may have symptoms of stress or anxiety with heart palpitations, restlessness, digestive concerns, breathing irregularities, etc. Many people actually feel good in this state, like they are naturally caffeinated or something of that nature. The problem is that this is not a sustainable state, damages the thyroid and eventually leads to burnout.

Images courtesy of Experience Life.

Burnout: all roads lead to burnout. The adrenal glands can only be overtaxed for so long. Eventually they lose their ability to respond to the high demands of the hypothalamus and pituitary and they start to under function. These are the people who are strung-out, exhausted, and sometimes on leave from work. And often the other hormones have been impacted at this point, and we also see thyroid issues or female hormone imbalances.

Let’s catch you before you get to burnout!

Burnout FAQ

Stress inherently is not bad. It is actually our most helpful biological response. Without it, we would not be the successful species that we are. However, it was designed to be a short burst reaction, and in our modern lives we are pushing it to be a chronic response, leading to depletion of the adrenal nutrient stores, dysregulation of the circadian hormonal curves and eventual exhaustion of the system.

Stress can be viewed in 3 buckets:

  1. The stressor. If your stress source is primarily your job, then maybe changing jobs is really the best option. Elimination of the stressor is often truly the root cause solution.
  2. Reframing the stressor. Let’s say that it’s your boss at work that really triggers you, then perhaps working with a therapist is the best option as they can give you tools to alter your view of your boss and to stop seeing them as stressful.
  3. Then there is the physiology of stress. This is where a naturopath can help. This is the body and brain’s biological response to stress. It is the adrenaline and cortisol release that happens when you get to the office. It’s the tension in your shoulders and your digestive upset when you’re stressed. We can help identify and retrain your body when it is stuck in fight or flight or freeze.


Research shows that people who see their stress as bad have more physical consequences of that stress. Burnout happens when the stress response starts to fail, and the person is not able to optimally respond to the stressors any longer.



Adequate performance: Despite high demands at home and at work, you are able to push through and mostly successfully complete your day

Reduced performance: The high demands of home and work are overwhelming, and you are not meeting the necessary targets

Normal mood: you are strained but coping well.

Low mood: you are feeling emotionally defeated and down.

Energy: your energy varies from great to poor, but with adequate rest your energy can bounce back.

Extreme exhaustion: your energy is low and does not vary, even given adequate rest.

Sleep: your sleep is normal with periods of insomnia directly related to acute periods of stress.

Sleep: you are either sleeping more than you think is normal, or unable to sleep much at all. Sleep is not restorative.

Job satisfaction: you find your job rewarding and are motivated to perform well and make a difference.

Job cynicism: you feel negative or cynical about your job, and don’t feel like you’re making an impact.

A person who is stressed tends to be over-reactive and hyperactive, whereas burnout presents more as disengagement and produces a sense of helplessness and hopelessness, with loss of motivation and hope.

Chronic stress can lead to a cortisol imbalance which can manifest as insomnia, anxiety, and other physical symptoms that are difficult to manage on a day-to-day basis, and that contribute to more serious health concerns. 

Insomnia | Heart palpitations | Tension | Overwhelm

Stress and anxiety have a HUGE impact on hormonal health. When we are stressed or anxious we are telling our bodies to be in a fight, flight or freeze state. This causes the release of cortisol from the adrenal glands and the redirection of blood flow and nutrients to our stress responses, rather than to regular body processes such as digestion, reproduction, sleep, etc.

When this demand for higher cortisol continues long term, the adrenal glands become depleted of the ingredients needed to build cortisol, and therefore search for comparable ingredients in the bloodstream that can be converted to cortisol. One of these molecules is progesterone, so what we see in clinical practice is a chronically stressed woman presenting with a relative progesterone deficiency (such as PMS, menstrual irregularities, etc). To correct for this imbalance we must lower estrogen (to reduce the relative estrogen dominance produced by the low progesterone levels), boost progesterone, fuel the adrenal glands’ production of cortisol, and ideally reduce stressors.

The thyroid gland is also very sensitive to chronic stress, as are prolactin levels. To fully support the stress response we must investigate the entire hormonal system, as well as determine the patient’s nutrient status and level of inflammation.

  • Burnout questionnaires
  • 4 point diurnal cortisol curve
  • Cortisol awakening response: there is a brisk increase in cortisol within the first 30-45 minutes after awakening in the morning.4 This occurrence is termed the cortisol awakening response (CAR). It is a discreet and distinct component of the circadian rhythm and is unrelated to the HPA axis cortisol signaling throughout the rest of the day. In healthy individuals, CAR ranges from 50-150% (average 50%), is a measure of overall HPA axis resiliency, and can be viewed as an HPA axis “mini-stress test.” Deviations from a typical CAR profile are assumed to indicate maladaptive neuroendocrine processes and HPA axis dysfunction (reference).
  • As well as test for any other causes of symptoms: iron, B12, vitamin D, thyroid, estrogen, progesterone, blood sugar and insulin, etc

Yes. During times of high stress we develop impairments in attention-shifting tasks, but they return to normal with time away from stress (reference: APS William James Fellow Bruce McEwen (The Rockefeller University) researches the interplay of stress hormones, the brain, and the body.

And if we correct for any underlying imbalance of nutrients and hormones, in combination with the creation of systems and boundaries at home and at work, there is a very high likelihood that burnout can be reversed.

  1. Notice your signs of burnout: low energy, low motivation, digestive concerns, insomnia, etc
  2. Acknowledge and accept that you have burnout and take the time to rest.
  3. Distance yourself from the sources of strain
  4. Restore your health: catch up on sleep, eat well, prioritize gentle exercise daily, and see your naturopath to make sure there isn’t anything more serious going on under the hood. Create a clear structure for your day, including restorative time and activities. 
  5. Make a list of the things that are making you feel stressed and what’s draining your energy. What job tasks wear you out the most? Can you reduce these or build in more recovery afterwards?
  6. Determine the causes of your strain. This may be something you can do on your own by project managing your life in an objective manner, or you may need the assistance of a therapist to reign in unhelpful personal traits like perfectionism, etc.
  7. Reevaluate your values: do you even like your job anymore? Is it just too stressful? Are you bored at work? Are you lacking life balance? What is most important to you? What do you need in your day-to-day life to feel fulfilled?
  8. Create boundaries plan to preserve your energy: at work and at home
  9. Build your community
  • Who at work is on your team?
  • Who supports you in your personal life? Who makes you laugh? Who makes you motivated? Who makes you feel creative? Who brings you into learning mode?
  • Who builds you up (you feel more energized after seeing them, not more drained)?
  1. Let go of stress and the idea that stress is harmful for you. Stress is not bad for your health unless you believe it to be. Step back into your modified life with gusto and confidence that your body is now rebalanced and able to carry you through even challenging times.

We serve naturopathic patients all across Ontario!

Our service area includes:

Ottawa | Toronto | Hamilton | Kitchener | London | Oshawa | Windsor | St. Catharines | Barrie | Guelph | Kingston | Milton | Brantford | Thunder Bay | Sudbury | Peterborough | Belleville | Sarnia | Sault-Ste-Marie | Northbay | Cornwall | Timmins | Carleton Place

… And all small towns and rural areas in between! As we offer virtual appointments, our naturopathic patients have the flexibility to see us from the convenience of their home or office. And we rely on local laboratories (Lifelabs and Dynacare) to complete the testing required to do a complete assessment.

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