Cortisol & Its Impact on Menopause (W/ Tips to Manage Cortisol)

As many as 85% of women find themselves grappling with a myriad of physical and emotional challenges that can often feel like uncharted territory during menopause. As a stress hormone, cortisol mirrors the ups and downs of menopausal hormonal changes and holds significant sway over the severity of menopausal symptoms. The (often unappreciated) role of cortisol in the menopausal journey underscores the importance of addressing cortisol levels as part of comprehensive menopausal care.

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The Role of Cortisol in the Body

Cortisol is a steroid hormone produced by the adrenal glands, specifically in the outer layer called the adrenal cortex. Although primarily known as a "stress hormone," cortisol has receptors in nearly every tissue in the body and serves many other important functions, including:

• Regulating metabolism to ensure there is a steady supply of glucose 
• Suppressing inflammation
• Regulating blood pressure
• Controlling the sleep-wake cycle 

In times of perceived danger triggered by emotional, mental, or physical stressors, cortisol acts in conjunction with catecholamines, such as adrenaline, to mobilize energy reserves, increase alertness, optimize oxygen delivery to cardiac and skeletal muscles, and down-regulate non-essential physiological functions (e.g., digestion) as part of the "fight or flight" stress response to prime the body for survival. 

Cortisol Production and Regulation

Cortisol production and regulation are orchestrated by the hypothalamic-pituitary-adrenal (HPA) axis. Corticotropin-releasing hormone (CRH) secreted from the hypothalamus stimulates the pituitary gland to release adrenocorticotropic hormone (ACTH), which then travels through the bloodstream to the adrenal glands, signaling the production and release of cortisol. Cortisol exerts negative feedback onto the hypothalamus and pituitary to ensure cortisol levels remain within a narrow and optimal range. (19) 

Cortisol secretion follows a diurnal rhythm. Levels peak in the early morning to help facilitate awakening and decline throughout the day, reaching their lowest point in the evening. 

During acute stress, the HPA axis is activated more robustly, increasing cortisol secretion to mobilize energy stores, suppress inflammation, and heighten awareness, aiding the body's response to the stressor. Once the stressor subsides, negative feedback mechanisms restore cortisol to its baseline levels. (19) 

What Is Menopause?

Menopause is a natural biological process that marks the end of a woman's reproductive years. It typically occurs around the age of 51. During menopause, ovarian function diminishes, leading to a decline in estrogen and progesterone levels and the cessation of menstrual periods. Menopause is considered complete when a woman has gone without a menstrual period for 12 consecutive months. 

Common Symptoms of Menopause

While menopause is a normal part of aging, its symptoms can significantly impact the quality of life for many women. This transition is characterized by various physical and emotional symptoms, including (32):

• Menstrual irregularities
• Hot flashes
• Night sweats
• Mood swings
• Vaginal dryness and atrophy
• Low libido
• Urinary urgency and frequency
• Sleep disturbances
• Weight gain
• Thinning hair
• Dry skin

Hormonal Changes During Menopause

The symptoms experienced during menopause can be attributed to the declining levels of estrogen and progesterone. During most of a woman's life, these hormones regulate the menstrual cycle and support pregnancy. However, the body is thrown into a hormonal rollercoaster as a woman must adjust to the fluctuating and dwindling levels of both hormones during the menopausal transition.

Beyond their reproductive functions, estrogen and progesterone play other roles in women's health, such as supporting bone density, cardiovascular health, and the nervous system (16, 50). As such, declining levels of these hormones increase the post-menopausal woman's risk of osteoporosis, cardiovascular disease, and mood disorders. 

The Link Between Cortisol and Menopause

The HPA and the hypothalamic-pituitary-ovarian (HPO) (which governs the production and release of estrogen and progesterone) axes are not entirely separate entities. During the menopausal transition, the decline in estrogen and progesterone levels can disrupt the delicate balance of both axes. Alterations in ovarian hormones can influence HPA axis activity, leading to dysregulated cortisol secretion and heightened stress response, which can further dysregulate the HPO axis. This bidirectional interplay between the HPA and HPO axes can exacerbate hormonal imbalances and menopausal symptoms. (42, 54) 

How Menopause Affects Cortisol Levels

Scientific evidence from studies like the Seattle Midlife Women's Health Study suggests that cortisol is an overlooked player in the menopausal transition. Cortisol levels naturally rise with age, but overnight cortisol levels also increase as women transition from the early to late stage of the menopausal transition (53). 

The characteristic hormonal fluctuations of menopause modulate the HPA axis and contribute to alterations in normal cortisol secretion patterns. For example, one study found that women with greater hot flash frequency had lower morning cortisol, higher bedtime cortisol, and diminished cortisol diurnal variation compared to those with fewer hot flashes.  

Symptoms of Elevated Cortisol During Menopause

Overall, the evidence supports the notion that higher cortisol and perceived stress levels correlate with more severe menopausal symptoms. 

What's more, symptoms of high cortisol mimic menopausal symptoms:

• Weight gain, especially around the abdomen
• Food cravings
• Increased anxiety and irritability
• Insomnia or other disrupted sleep patterns
• Fatigue
• Hair loss
• Impaired cognitive function, such as memory lapses or difficulty concentrating

This can blur the line between symptoms caused by high cortisol/stress versus those associated with menopause, especially in the early stages of the menopausal transition. 

3 Ways To Manage Cortisol Levels During Menopause

Understanding the link between cortisol and menopause provides a new therapeutic strategy for women needing support through the menopausal transition: stress management. 

In one study, 69 postmenopausal women were treated for menopausal symptoms with hormone replacement therapy (HRT), phytoestrogens, or acupuncture. Researchers observed that the women with the most significant reductions in menopausal symptoms had larger decreases in cortisol levels.

1. Lifestyle Changes

The first step to overcoming stress is establishing lifestyle habits that lay the foundation for a well-functioning HPA axis and healthy cortisol levels (24, 27):

• Eat a well-balanced, anti-inflammatory diet that incorporates lean proteins, healthy fats, and complex carbohydrates. The Mediterranean diet is one example linked to lower cortisol, anxiety, and stress (2, 7).  
• Engaging in regular moderate-intensity resistance and aerobic exercise is linked to improved hormonal levels and health outcomes. Avoid overtraining with inadequate recovery and nutritional intake, which are correlated to a decline in female hormones and chronic cortisol elevations. 
• Mitigate stress by using healthy stress reduction techniques, such as mindful meditation, yoga, and deep breathing. These mind-body practices are an effective way to reduce cortisol levels and alleviate menopausal symptoms. 

2. Medical Interventions

HRT is the use of estrogen, progesterone, and/or testosterone to reduce common menopausal symptoms and prevent menopause-associated health conditions, such as osteoporosis. HRT has been shown to improve menopausal symptoms and reduce the risk of osteoporosis, heart disease, and dementia. To minimize the potential risks associated with HRT, a licensed healthcare professional should always prescribe and monitor it. 

Research findings on the impact of HRT on cortisol levels have yielded mixed results, with studies suggesting that HRT may increase, reduce, or have no effect on cortisol levels. These conflicting findings highlight the complexity of hormonal interactions and the need for individualized menopausal care with close monitoring. (26) 

3. Alternative Therapies

Exploring evidence-based alternative therapies and supplements can offer additional avenues for managing cortisol levels, especially for individuals seeking holistic approaches to support their well-being during menopause.

Adaptogenic herbs like ashwagandha, rhodiola, and holy basil have been studied for their ability to help regulate stress response, promote adrenal health, and lower cortisol.

Other supplements, such as phosphatidylserine, omega-3 fatty acids, and magnesium, have also been researched for their cortisol-lowering and stress-relieving effects.

Biofeedback is a technique that enables individuals to gain awareness and control over physiological processes through real-time monitoring of bodily functions such as heart rate, muscle tension, and skin temperature. In addition to being an effective adjunctive therapy for reducing hot flashes and psychological symptoms of menopause, biofeedback has also been shown to improve mental health and lower cortisol levels (34, 43).  

While these interventions may offer benefits in managing cortisol levels and promoting overall well-being, individual responses can vary, and professional guidance can help ensure safe and effective integration into a comprehensive health plan.

Frequently Asked Questions 

Here are answers to frequently asked questions about the cortisol-menopause connection.

Can High Cortisol Cause Early Menopause?

Stress and high cortisol levels may not be the sole cause of early menopause, but they can exacerbate existing hormonal imbalances and mimic menopausal symptoms, such as irregular or skipped menstrual periods. This is often reversible by managing stress and restoring cortisol levels to within an optimal range. (37)

Does Cortisol Increase at Night During Menopause?

Menopausal hormonal changes can interfere with normal HPA axis signaling pathways. 

Deviations from cortisol's natural diurnal pattern, including elevated levels at night, can result from this HPA dysfunction and have been measured during the menopausal transition. (53) 

How Can I Check My Cortisol Levels at Home?

Cortisol and its metabolites can be conveniently measured with at-home salivary and urine tests. These are popular test options available to order through Rupa Health:

• Diurnal Cortisol by ZRT Laboratory
• DUTCH Plus by Precision Analytical (DUTCH)
• ASP with CAR by Genova Diagnostics

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Conclusion

• Menopause marks a significant biological milestone for women, defined by the natural decline in estrogen and progesterone production. 
• Research indicates that cortisol, one of our body's stress hormones, plays a substantial role in this transition. Optimizing cortisol levels may mitigate the severity of menopausal symptoms. Understanding the intricate relationship between cortisol and menopause unveils new insights into managing this transformative phase of a woman's life. 
• Integrative approaches such as mindfulness practices, adaptogenic herbs, and dietary modifications offer promising avenues for optimizing cortisol levels and supporting overall health during menopause.