The Relation Between Cortisol and Menopause

Women in their late 30s and early 40s are likely entering perimenopause, which is the stage before menopause. Perimenopause and menopause are marked by fluctuating levels of the reproductive hormones estrogen, progesterone, and testosterone. But there is a fourth hormone that is often dysregulated during menopause. Cortisol helps regulate a wide range of vital processes in the body, including metabolism, mental function, immune responses, and stress management.⁽¹⁾

Cortisol, commonly referred to as the stress hormone, is best known for its role in how stress and anxiety are perceived. During menopause, cortisol levels are often elevated, which can heighten menopausal symptoms.⁽¹⁾⁽²⁾

Hormone replacement therapy (HRT) can help alleviate common symptoms of menopause, such as hot flashes and mood fluctuations. In addition, it can help balance cortisol levels, potentially preventing menopause symptoms from becoming more severe.⁽³⁾⁽⁴⁾

What is cortisol?

Cortisol, a steroid hormone produced by the adrenal glands, is often called the "stress hormone" because it’s released during the body’s fight-or-flight response. It affects nearly every part of the body, including the muscles, bones, heart and blood vessels, lungs, brain, and other hormone-producing glands. Almost every cell in the body contains cortisol receptors, meaning changes in cortisol levels can significantly impact how different body systems function.⁽¹⁾

As a crucial hormone, cortisol must remain balanced to support overall health. It plays a key role in fundamental bodily functions, from waking up in the morning to regulating libido. Cortisol also helps maintain energy levels by controlling blood sugar, blood pressure, and metabolism.⁽¹⁾

Additionally, cortisol helps regulate inflammation and the immune system's response to injury or infection, which prevents the body from overreacting to inflammation.^(1)(2)(3)

During menopause, if cortisol levels are too high, they can disrupt sleep, increase stress levels, and throw thyroid hormones out of balance, which in turn affects metabolism.

Causes of Cortisol Changes

The levels of cortisol in the blood naturally fluctuate throughout the day. Cortisol is typically higher in the morning, signaling that it’s time to wake up, and gradually declines throughout the day, eventually promoting drowsiness and sleep.⁽¹⁾ 

The hormone is responsible for what researchers refer to as the "fight-or-flight response." When cortisol levels spike, the body quickly increases blood sugar and blood pressure to provide the energy needed for quick physical actions, such as running or jumping.⁽¹⁾ 

For thousands of years, this hormone has played a crucial role in protecting humans from life-threatening situations. When the body perceives danger, it releases extra cortisol to increase focus and physical abilities, enabling a person to run faster or leap farther than usual to escape harm.

Even in modern life, cortisol levels can rise due to perceived stress. This could be triggered by work challenges, traffic, or concerns about family events. While temporary increases in cortisol are normal, persistently high levels can have long-term effects on health. Cortisol may also increase as a result of managing menopause symptoms. During menopause, women often experience heightened stress due to symptoms such as weight gain, hot flashes, night sweats, and poor sleep.⁽⁵⁾

Cortisol Levels and Menopause

Research has shown that cortisol levels change during menopause, influenced by stress, menopause symptoms, and health factors such as sleep, memory, quality of life, and weight. Fluctuations in reproductive hormones, combined with increased cortisol, can impact cognitive function, heighten feelings of depression and anxiety, and contribute to panic attacks. Women often describe these cognitive challenges as “brain fog,” where even simple tasks become difficult to remember.⁽²⁾

One of the primary concerns during perimenopause and menopause is weight gain. Cortisol plays a role in the following:⁽¹⁾ 

• Metabolizing carbohydrates, fats, and proteins

• Regulating the sleep-wake cycle

Elevated cortisol contributes to weight gain by increasing blood sugar, which often leads to frequent or comfort eating. The increased risks of type 2 diabetes and heart disease during menopause are partially linked to these cortisol-related changes.^(2)(6)(7)

High Cortisol and Menopause

Before menopause, the body effectively buffers cortisol and stress by balancing levels of progesterone and estrogen. As progesterone and estrogen levels drop during perimenopause, the body's ability to manage cortisol weakens, resulting in increased stress.⁽⁸⁾

High cortisol levels during menopause can cause symptoms similar to those of menopause. The following are symptoms of elevated cortisol levels in females:⁽¹⁾⁽²⁾ 

• Fatigue and low energy

• Weight gain, especially around the midsection

• Brain fog

• Anxiety, depression, and low mood

• Insomnia

• Cravings for unhealthy foods

• Digestive issues like bloating

• Low sex drive

• Increased aches and pains

Low Cortisol and Menopause

Low cortisol levels during menopause, although much less common, can also have significant effects on health and well-being. Low cortisol levels are a key indicator of adrenal insufficiency, a condition where the adrenal glands fail to produce adequate amounts of cortisol and other steroid hormones. When cortisol levels drop too low, the body may struggle to manage everyday stressors, leading to the following symptoms:⁽¹⁾⁽⁹⁾

• Extreme fatigue

• Difficulty waking up in the morning

• Decreased focus and motivation

• Muscle weakness

• Low blood pressure

• Increased sensitivity to stress

Balancing cortisol is essential for managing overall health during menopause, as the body requires proper hormone regulation to adapt to the changing physical and emotional demands of this transition.

HRT and Cortisol Levels

Hormone replacement therapy (HRT) can effectively alleviate perimenopause symptoms and reduce the stress often linked to elevated cortisol levels. During menopause, the natural decline in estrogen, progesterone, and testosterone can be exacerbated by heightened cortisol, creating a cycle that impacts both mental and physical health.⁽²⁾⁽⁴⁾

Studies have shown that HRT helps counteract the effects of excess cortisol, particularly during menopause when cortisol levels rise and trigger stress responses. Research emphasizes the role of balanced cortisol in maintaining healthy sleep patterns, appetite control, and overall resilience to stress. Women on HRT tend to have lower cortisol levels, leading to a calmer response to stress throughout menopause and beyond.⁽²⁾⁽⁴⁾

How to Normalize Cortisol Levels During Menopause

1. Hormone Replacement Therapy (HRT)
   HRT can help balance cortisol levels and is available in several forms, including oral tablets, topical creams or patches, and vaginal creams. By supporting hormone levels, HRT can counteract the effects of elevated cortisol.⁽²⁾⁽⁴⁾

2. Quality Sleep
   Establishing a consistent sleep routine by going to bed and waking up at the same time every day can help. Aiming for at least seven hours of uninterrupted rest and limiting electronic device use before bedtime can improve sleep quality.⁽⁷⁾

3. Exercise
   Regular physical activity during menopause can reduce stress and regulate cortisol levels. Any form of exercise — whether it's walking, yoga, or strength training — can be beneficial.⁽¹⁰⁾

4. Diet
   Maintaining stable blood sugar levels through a balanced diet is important. Avoiding foods that cause spikes in blood sugar can help prevent increases in cortisol.⁽⁶⁾

5. Relaxation
   Relaxation techniques like deep breathing, meditation, or mindfulness can help lower cortisol and reduce stress.

6. Limiting Alcohol, Tobacco, and Caffeine
   While complete elimination is ideal, simply reducing alcohol, nicotine, and caffeine intake can significantly help in managing cortisol levels and menopause symptoms.^(11)(12)(13)

Balancing Cortisol Levels and Menopause

Understanding the connection between cortisol and menopause is vital for effectively managing the challenges many women encounter during this transitional period. Elevated cortisol levels can intensify physical and emotional symptoms, making it essential to address this imbalance. HRT is a treatment option that not only alleviates menopausal symptoms but also helps stabilize cortisol levels. Additionally, lifestyle changes — such as maintaining a consistent sleep schedule, exercising regularly, eating a balanced diet, and incorporating relaxation techniques — can further support cortisol balance and enhance overall well-being. By taking these steps, women can navigate menopause with greater ease, fostering resilience and promoting healthier, more fulfilling lives.