Mention menopause, and we usually think of changing levels of estrogen, progesterone, and testosterone. But did you know that levels of cortisol also change? High or low cortisol in perimenopause and menopause can be associated with several health challenges. Let’s understand cortisol better and explore how to manage these changing levels.
What is cortisol?
Cortisol is made by the adrenal glands and has far-reaching effects in the body, as nearly every cell in the body has cortisol receptors. Therefore, when levels of cortisol change, the impact can be far-reaching.
The hormone cortisol is involved in many processes in the body, including metabolism, immune system responses, stress, and mental function, but it is probably best known as a stress hormone. In fact, it is associated with the “flight or fight” response, which means cortisol levels rise in stressful situations that may require immediate response, such as jumping out of the way of an oncoming car. Cortisol levels then return to normal once the threat is gone.
Cortisol is also involved in regulating blood sugar and energy levels, blood pressure, and emotions. It even has anti-inflammatory powers.
Persistent cortisol levels can lead to adrenal fatigue (hypothalamic-pituitary-adrenal, or HPA). Symptoms of adrenal fatigue are similar to those of perimenopause and menopause and include low mood, insomnia, fatigue, cravings, weight gain, low libido, and digestive problems such as gas and bloating.
Low cortisol is the hallmark of adrenal insufficiency, which is when the adrenal glands cannot make enough cortisol and other steroid hormones. The most common type is secondary adrenal insufficiency, in which the pituitary gland cannot make enough adrenocorticotropin hormone (ACTH). This hormone tells the adrenal gland to make cortisol. Without enough ACTH, cortisol levels drop.
How is cortisol associated with menopause?
During our premenopausal years, progesterone helps keep cortisol at a healthy level and stress under control. However, the onset of perimenopause and menopause sends progesterone levels on a decline, which reduces its control over cortisol and stress reduction.
Elevated cortisol levels are common in the menopause years, and they can make menopausal symptoms much worse. When cortisol hormone levels are too high in perimenopause or menopause, you will likely experience sleep problems, more stress, and changes to your metabolism because cortisol changes also affect thyroid hormone balance.
Although it is natural for cortisol levels to spike when there is a real threat, your levels can rise due to perceived stress as well. This may include worrying about a relationship, finances, or traffic. Cortisol levels also increase in women who experience stress when trying to cope with menopause symptoms and the changes in their lives associated with them.
For some women, the stress of managing menopause and its symptoms, such as hot flashes, insomnia, chronic pain, weight gain, urinary incontinence, and other changes, keep cortisol levels high all the time. This can have a lasting impact on your health, resulting in lowered immune response and a greater risk for infections and disease.
High cortisol can impact mental function, contributing to brain fog, anxiety, memory problems, loss of sex drive, and heightened depression. Elevated cortisol causes a rise in blood sugar, which can increase the risk of type 2 diabetes, weight gain, and heart disease. It is also associated with low bone density and a greater risk of osteoporosis.
How to manage cortisol levels naturally
Some doctors prescribe hormone replacement therapy for women to manage cortisol levels. However, several lifestyle approaches can work as well, without the side effects.
Healthy sleep. Get 7 to 9 hours of sleep. Easier said than done? We hear you, but a little effort is well worth it since sleep is critical for your entire body. Check out our sleep tips and incorporate them into your lifestyle right now.
Physical exercise. Both aerobic and strength exercises can improve cortisol levels and reduce stress.
Moderation. Reducing or eliminating your use of caffeine and alcohol can help bring cortisol to healthy levels.
Stress reduction. Incorporate daily stress-reducing activities into your routine, such as meditation, tai chi, yoga, visualization, deep breathing, dance, or other calming techniques.
Health diet. To keep blood sugar levels healthy and steady, significantly reduce or eliminate processed foods, sugary foods and beverages, and fast foods. Focus on fresh fruits and vegetables, whole grains, plant-based and/or lean protein, beans and legumes, healthy fats (olive and avocado oils, fatty fish), seeds, nuts, and pure water.
Herbs. Using adaptogenic herbs that work with the body to manage stress can be helpful. They include Rhodiola, ginseng, holy basil, ashwagandha, licorice root, and cordyceps mushrooms. Take according to package directions or consult a knowledgeable professional for dosing.
When to call your doctor
If you are experiencing symptoms of high or low cortisol and it is impacting your daily activities, contact your doctor. Blood or urine tests can detect cortisol levels, while a saliva test can determine whether Cushing syndrome is responsible for elevated levels. Imaging tests of your pituitary or adrenal glands can identify any tumors or other abnormalities that may be causing your symptoms.
High cortisol levels in perimenopause and menopause can impact menopausal symptoms, and if they persist, they can result in adrenal fatigue. Low cortisol is associated with adrenal insufficiency. Talk to your healthcare provider about your symptoms and whether cortisol changes may be a contributing factor.