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Cortisol Levels - How They Impact Weight, Anxiety & Stress in Menopause

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Dr. Michael Green
Medically Reviewed byDr. Michael GreenMD, OB/GYN Chief Medical OfficerRead Bio
Written ByNancy BelcherPhD

A woman in her late 30s and early 40s is likely moving into perimenopause which is the stage before menopause. Perimenopause and menopause are both caused by changing levels of the hormones estrogen, progesterone, and testosterone. But there is a third hormone, cortisol, that is often thrown off during menopause. Cortisol levels regulate a wide range of vital processes throughout the body including metabolism, mental function, immune responses, and feelings of stress.

Cortisol is best known for the role it plays in how stressed or anxious we feel, and is known as the “stress hormone.” Cortisol levels are often elevated when experiencing menopause and can make menopause symptoms much worse. 1

Hormone Replacement Therapy (HRT) can help reduce unwanted menopause symptoms like weight gain, hot flashes, mood changes. HRT can also play a key role in reducing cortisol levels so those menopause symptoms don’t get out of control. Recent research shows that taking HRT has even more advantages during menopause than was previously thought, and that’s what we will cover in this article. 

What is Cortisol

Cortisol is produced by the adrenal glands and it affects most parts of your body including muscles, bones, heart and blood vessels, lungs, other hormone-producing glands, and even your brain. Almost every cell in the body contains receptors for cortisol and as a result, changing levels of cortisol can impact how all body systems operate. 

Cortisol is a powerful hormone that needs to stay properly balanced. While cortisol helps with some of the most basic functions in our bodies ranging from helping us wake up in the morning to our sex drive, it also impacts emotions and memory formation. Cortisol also controls our energy levels by helping to regulate the body’s blood sugar levels, blood pressure, and metabolism. Interestingly, cortisol also acts as an anti-inflammatory agent too. 2,3,4

When cortisol levels are too high during menopause our sleep is disrupted, we are more stressed, and thyroid hormones fall out of balance which impacts our metabolism.

Causes for Cortisol Changes

Blood levels of cortisol will naturally vary throughout the day. Generally, cortisol is higher in the morning (signaling that it’s time to wake up), and then falls throughout the day (finally signaling drowsy sleep time). Appropriately nicknamed “the stress hormone,” cortisol is responsible for what scientists call the “fight or flight response.” 

When cortisol levels spike, your body quickly increases blood sugar and blood pressure so your body has the energy to help you perform - maybe that’s running or jumping very fast. For thousands of years this hormone has been critical to helping protect humans from life-threatening situations.  

A common example given is if you are being chased by a tiger. As you see the tiger your body senses danger and will release extra cortisol. This fight or flight response helps you to increase your focus, run faster, or leap further than you normally could in order to save yourself.

Even when we aren’t in the jungle being chased by an animal, we can experience an increase in cortisol levels due to perceived stress. This might be due to concerns at work, traffic, or worries about family events. Cortisol can also increase as a result of the stress of dealing with menopause symptoms.

While we all have high cortisol from time to time, having high cortisol over a long period of time can have lasting effects on your health. During menopause, women are under more stress than ever due to menopause symptoms like weight gain, hot flashes, night sweats, poor sleep and so many more. 

Menopause symptoms can have a huge impact on your health by increasing stress levels. Beginning HRT can help reduce symptoms of menopause AND keep cortisol levels in control. 6

Cortisol and Menopause

While we know that cortisol levels can rise during menopause, scientific studies have looked at changes in cortisol levels in relation to stress, menopause symptoms, and health-related factors like sleep, memory, quality of life, weight, and more. 4

Menopause causes the yo-yoing of estrogen, progesterone, and testosterone levels, but the additional change in cortisol levels can affect cognitive function, heighten depression and anxiety, and lead to panic attacks. 3,4 Often described by women as “brain fog,” these cognitive changes can make it disturbingly difficult to remember even the simplest things.

One of the main concerns women have with peri- and menopause is weight gain. Cortisol manages how your body uses (metabolizes) carbohydrates, fats and proteins, and controls your sleep-wake cycle. 2 We know without enough sleep people gain weight steadily.  

Raised cortisol causes increased blood sugar and can lead to comfort-eating and weight gain. The increased incidence of Type 2 Diabetes and heart disease with menopause is partially associated with these changes in cortisol levels. 3,4,5,7 

Our hormones have to work together and balance one another in order to maintain balance. If one hormone is too high, it can throw off the whole system. During menopause our bodies are doing their best to adapt however, our hormones aren’t always able to keep up with the changes. 5

Before menopause, our bodies were good at buffering cortisol and stress because we had the right levels of the ‘feel good hormone’ progesterone. Progesterone helps to keep our cortisol levels under control. Once the levels of progesterone start to decrease with perimenopause, cortisol is less ‘buffered,’ and we feel the stressful effects. 

High cortisol can cause the following stress response symptoms, which are also symptoms of perimenopause:

  • Fatigue & low energy

  • Weight gain esp. around the middle

  • Brain fog

  • Anxiety, depression & low mood

  • Insomnia

  • Cravings for unhealthy foods

  • Digestion problems like bloating

  • Low sex drive

  • More aches and pains

HRT and Cortisol Levels

Hormone replacement therapy (HRT) can help reduce your perimenopause symptoms and help you feel less stressed. Most of us are walking around with higher than normal levels of cortisol, and this built-up stress can further deplete the already decreasing levels of estrogen, progesterone, and testosterone that normally occur during menopause.  High cortisol levels don’t just make you feel stressed out or cause symptoms like fatigue, it can have major impacts on your health, and can be a vicious cycle.

HRT has been shown in recent studies to counteract the effects of excess cortisol. 7 During menopause, when estrogen levels start to decline cortisol levels rise and trigger stress responses. Studies show how critical cortisol levels are in sleep-wake patterns, eating, physical activity, and basically how a person adapts to challenges in life. 4 When women are on HRT they have lower levels of cortisol and may react more calmly to stress during and after menopause. 8  

How to Normalize Cortisol Levels

  1. HRT - HRT is available as an oral tablet, a topical lotion or patch, or vaginal cream and can counteract the effects of excess cortisol.

  2. Healthy Sleep - Keep your sleeping and waking time the same each day, try to get at least 7 hours of uninterrupted rest, and limit electronics use before bedtime.

  3. Exercise - Regardless of which kind of exercise you choose, exercising throughout menopause reduces stress and helps improve cortisol levels.

  4. Diet - Focus on a diet that doesn’t cause spikes in your blood sugar. Spikes in sugar can cause cortisol spikes too.

  5. Relaxation - Relaxation practices can reduce cortisol and stress levels. Try deep breathing exercises and meditation.

  6. Cut Back On -  You don’t have to completely get rid of them, but reducing alcohol and caffeine can significantly reduce cortisol levels.


Your cortisol level, if not balanced, can adversely impact your life. But effective menopause treatments like hormone replacement therapy (HRT) are available to help you. With support from Winona, you have the opportunity to take preventive action against health risks as you age. 

Hormone replacement therapy is a safe and natural way for you to regain your vitality and can restore proper hormone levels using substances that are bioidentical to those produced by your own body. Winona’s healthcare platform is a place to connect with a healthcare provider to receive the quality care you deserve.

At Winona, we are dedicated to women’s wellness. Our providers take the time to listen closely and understand what you’re experiencing. They collaborate with you to design a personalized treatment plan. Go online now and interact with our doctors about your symptoms. Winona is here for you!

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”

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