Thanks Ema.
We followed the protocol @ stopthethyroidmadness.com, which uses temperature and symptoms to guide. Her temps were within .2 degrees F for 5 days, so that would indicate that she was on a stable dose. However, thinking about it, the result may have been different if she took her temps during PMS. It seems that if you need to stress dose often then you are not on enough, but I'm not sure if that takes into account cyclical occurrences, such as PMS, and repeated occurrences, such as PEM. I don't think everyone with adrenal fatigues suffers from these two issues and ME.
While what you say, regarding the problem of needing more steroid every time one is active, is true, not all activity leads to PEM. In my daughter's case, she spends 95% of her day in bed (the other 5% would include things like going to the bathroom, sitting on a couch). PEM would arise from a big phone consult with a doctor, a rare outing, a visit with someone that goes on too long. So it certainly doesn't happen from everything, but she is careful to avoid the things that could cause PEM. Given these PEM-inducing scenarios, the rule would be to stress dose for the event, but would she continue to stress dose for the PEM, which usually kicks in later the next day?
Do you get migraines every cycle? Do you find yourself stress-dosing for those every cycle? Does it help?