Cortisol and Menopause: Signs, Tests, and What Helps

The menopause cortisol effect can be rough: When the estrogen that helps regulate cortisol (aka the stress hormone) declines, you might suddenly find yourself giving your partner the stink eye just for loading the dishes backward or snapping at a colleague who didn’t respond to your email fast enough.  

Meanwhile, you find yourself exhausted but somehow still wired each night when you get in bed, then you (infuriatingly) wake up at 3 a.m. Plus, your waistline seems to keep expanding, no matter how healthy you’re eating.  

Although it isn’t the sole culprit, too much cortisol could be partially to blame for these midlife annoyances. But don’t fall for the overhyped cortisol info on social media—let’s look at what science says is actually going on with cortisol and menopause. 

Below, we’ll go over what cortisol does in the body, what factors can raise it or cause dysregulation, the symptoms of high cortisol in women, how estrogen and menopause play in, and what can help normalize your cortisol. And we’ll tell you how a Midi clinician can help you navigate these tricky years and beyond.

What Cortisol Does, and Why Menopause Changes the Picture

Although cortisol is often villainized, it’s actually essential: Cortisol helps wake you up in the morning, fights inflammation, and regulates blood sugar and blood pressure. And, yes, it manages your body’s stress response by releasing energy. (But chronic stress is one of many things that can dysregulate cortisol, which can have negative effects.)

Cortisol is typically highest in the morning, right after you wake up, then lowers in the evening. When that curve gets out of whack, research shows, it’s associated with certain mental and physical health problems, like depression, diabetes, and more. A flattened curve typically means there’s something off with your hypothalamic-pituitary-adrenal (HPA) axis, which is your body’s master stress response—or, basically, your internal alarm system that triggers the release of cortisol.  

During menopause, cortisol levels and that curve can look a little different from your premenopausal days, since estrogen helps regulate the hormone. 

“As estrogen lowers, some women can get a little bit of higher cortisol levels,” says Midi clinician Heather Hofflich, DO, a board-certified endocrinologist and internist. “But not everyone. And it doesn't necessarily mean there will be an abnormality—menopause won’t cause a cortisol disorder like Cushing syndrome.” (Cushing syndrome is a rare medical condition where the body has dangerously high cortisol levels.)

Still, even if your cortisol levels aren’t high enough to qualify for a clinical diagnosis, a slight rise can feel like a lot, especially when you’re experiencing the already overwhelming midlife stress load of responsibilities like taking care of children, aging parents, and career obligations—while also dealing with hot flashes and disrupted sleep.

How Falling Estrogen and Progesterone Affect Cortisol

Estrogen and cortisol have a complicated, intertwined relationship—each one affects the other. Estrogen helps regulate your stress response; research has shown that when levels of estrogen fluctuated, women had higher cortisol responses to stress.

The fact that menopausal women also lose progesterone, which helps calm you down by activating the GABA neurotransmitters that promote relaxation, doesn’t help stress levels, either. Meanwhile, the sleep deprivation that’s brought on by night sweats and menopausal insomnia can exacerbate the cortisol surge. 

This isn’t to say it’s a critical issue, though: “Yes, cortisol might rise in perimenopause, but that doesn't mean that it's necessarily worrisome,” Dr. Hofflich says. “It won't cause any pathological changes or lead to major disorders.”

What Else Can Impact Cortisol?

It’s not just fluctuating estrogen and progesterone levels that can impact your cortisol levels—there are a whole host of factors that can raise or dysregulate your cortisol levels, including but not limited to:

• Psychological and emotional stressors: Chronic stress from work, finances, or relationships; unresolved trauma or PTSD; anxiety disorders; loneliness or social isolation; and a perceived lack of control over one’s circumstances
• Sleep-related factors: Insomnia, sleep deprivation, obstructive sleep apnea, and shift work
• Physical and medical stressors: Chronic pain, infection, or illness; thyroid dysfunction; and untreated or poorly controlled medical conditions
• Eating habits and metabolic factors: Calorie restriction, frequent blood sugar swings from high-glycemic diets or skipped meals, or overdoing caffeine or alcohol
• Medications and substances: Some antidepressants, stimulants, and hormonal contraceptives; corticosteroid medications

Is It Menopause or High Cortisol? Where the Symptoms Overlap

It can sometimes be tough to suss out what’s a matter of high cortisol and what’s menopause, since many of the signs of each overlap, such as:

• persistent fatigue
• mood changes (like anxiety, depression, or irritability)
• poor sleep 
• cognitive changes like brain fog
• mid-section weight gain

Many of these symptoms can also be signs of conditions like thyroid disease, anemia, sleep apnea, and depression. So, you really can’t self-diagnose yourself with high cortisol through a symptom checklist. 

What Is “Cortisol Poisoning” in Menopause, and Is It Real?

If you’ve spent any time on the menopause corner of TikTok, you’ve probably heard about “cortisol poisoning,” where chronic stress wreaks havoc throughout your body. To be clear, this is a social media term, not real medicine. It often goes viral alongside myths that stress can cause a puffy “cortisol face” or use up all of your cortisol until it causes “adrenal fatigue” (usually alongside questionable products promising to “detox” or “flush” cortisol).

That said, even though cortisol poisoning is a catch-all term for social media chatter and not a medical diagnosis, cortisol dysregulation is real. Chronically elevated stress levels can genuinely affect your cortisol and your mental and physical health, and that deserves attention. 

Cortisol, Belly Fat, and Menopause Weight Gain

Some research has found an association between higher cortisol and weight gain. For instance, in one six-month study, people who had higher cortisol levels at the start gained more weight over the following six months. Other research has found that cortisol may reduce insulin sensitivity, increasing insulin resistance—and that may make it harder to regulate weight.  

But if you’re looking to fend off midlife weight changes, lowering cortisol on its own is unlikely to be the answer. Overdoing lifestyle changes can also backfire: Cutting way back on calories can increase cortisol, and working out so hard that it qualifies as overtraining will mess with your HPA axis. The best approach is a mindful, holistic strategy that involves nutrient-dense foods, daily movement, quality sleep, and—yes—stress management.   

How Cortisol Disrupts Sleep, Mood, and Hot Flashes

While chronic stress can raise cortisol, elevated cortisol can respond by causing symptoms that can make stress worse, causing a frustrating cycle: 

• Insomnia: If you’re staring at the ceiling at 3 a.m., cortisol could be partially to blame. Levels of the hormone naturally begin to rise around this time of the night to jump-start the cortisol awakening response, and if you’re in a high-stress state, that slight increase can be enough to wake you up. 
• Hot flashes: For perimenopausal women, a dysregulated HPA can deliver a one-two punch by making hot flashes more frequent and more intense.
• Mood: Chronic stress and chronic high cortisol can cause structural changes in stress-sensitive areas of the brain like the hippocampus and amygdala, leading to anxiety and irritability—which are already common in perimenopause.  

How Do You Test Cortisol Levels in Menopause?

Your cortisol levels can be tested in a few different ways. All of these tests take more than one sample because cortisol levels naturally rise and fall throughout the day, so one random measurement doesn’t reveal much.  

• Saliva cortisol test: This at-home kit has you take a sample of spit directly when you wake up, about 30 minutes later, at noon or early evening, and then again at bedtime. This helps show how your cortisol rises and falls over the course of the day, and it can reveal HPA axis disruption.
• Cortisol blood test: Done in a lab, this is typically used as a first-pass screening for adrenal disorders like Cushing syndrome or Addison’s disease. It involves a blood draw (often first thing in the morning and then again in late afternoon). Results from these blood tests can be variable, so if an adrenal disorder is suspected, further testing will be done.
• 24-hour urine test: This at-home test involves collecting all of your urine over a 24-hour period to screen for Cushing syndrome.

Since blood and urine cortisol tests are used to diagnose adrenal disorders, Midi doesn’t use those tests to assess a person’s stress levels. If your clinician thinks an adrenal disorder could be at play, they can coordinate a referral to an endocrinologist for further care.

And rather than ordering an at-home test online, it’s best to work with a clinician who can help you avoid mistakes that lead to inaccurate results and help you interpret the findings.

How to Lower Cortisol During Perimenopause and Menopause

Dr. Hofflich says that most women can get their menopause cortisol levels in a healthy place with a few lifestyle tweaks. These strategies have strong data behind them  that can be very effective in reducing cortisol levels:

• Sleep better: Getting enough deep, restorative sleep modulates the HPA axis. You can set yourself up for better nights by sticking to a consistent bedtime, avoiding late caffeine or alcohol (and large dinners), and sleeping in a cool and dark room. 
• Exercise: Research shows that regular physical activity lowers cortisol levels, potentially because it helps you sleep better.
• Eat healthy foods: Focusing on whole, nutrient-dense foods (including high-quality proteins) and avoiding cortisol-triggering foods can stabilize your blood sugar to help minimize cortisol spikes. Getting enough calories is also key, since undereating can increase cortisol.
• Consider mindful practices: Breathwork and meditation both have substantial evidence behind them as effective stress-reduction techniques. 
• Connect with friends: Something as simple as chatting up your bestie can markedly lower your cortisol levels.    

If lifestyle improvements don’t feel like enough, another research-backed option is cognitive behavioral therapy. A mental health professional can help you reframe negative thought patterns to reduce your stress response.

Do Supplements and Adaptogens Actually Lower Cortisol?

Some research-backed supplements may gently help your body relax:

• Ashwagandha: normalizes the body's stress response and modulates the HPA axis to lower stress-related cortisol levels 
• L-theanine: may increases alpha-wave activity in the brain, promoting relaxation
• Magnolia bark extract: contains compounds that might blunt stress-related cortisol spikes
• Phosphatidylserine: may modulate the body's cortisol response, according to a limited study, and is particularly useful after intense exercise or acute stress
• Relora: may reduce cortisol levels and feelings of stress, according to a small study
• Magnesium glycinate: might lower overnight cortisol, thanks to magnesium’s role in regulating the HPA axis

Yes, that’s a long list of potential stuff to take. But Midi’s Daily Cortisol Support capsules combine several of these ingredients—ashwagandha, L-theanine, magnolia bark extract, phosphatidylserine, and magnesium glycinate—into one serving. 

Generally, it’s best to review any supplements you want to try with your clinician first, since there are certain precautions to know about, and some supplements could interact with medications like thyroid drugs, sedatives, and blood pressure treatments. 

Where Hormone Therapy Fits In

Hormone therapy isn’t specifically prescribed to reduce cortisol. But since balancing hormones can help balance cortisol, it can help you manage some of the menopause symptoms that worsen stress, like insomnia, hot flashes, and mood shifts.

For women who can’t or don’t want to use hormone therapy, there are a number of other ways to manage menopause symptoms. Chatting through the options with a healthcare professional like a Midi clinician can help you determine which might be best for you. 

Key Takeaways

• Fluctuating estrogen in menopause can raise cortisol levels, although the stress hormone typically still stays within a healthy range.
• Many of the symptoms of elevated cortisol—like fatigue, mood changes, and weight gain in the belly—overlap with the shifts that happen during the menopause transition. 
• Cortisol levels can be evaluated through blood, saliva, or urine tests, although these are typically ordered only if a clinician suspects a medical disorder. 
• Lifestyle habits like consistent exercise, quality sleep, mindfulness practices, and social connections are significant ways to help manage cortisol and stress levels. Certain supplements may also help. 

Frequently Asked Questions (FAQs)

What flushes cortisol out of your system?

You can lower cortisol levels through lifestyle shifts and stress-management techniques, and certain supplements may help. But the body needs cortisol, since it’s essential for blood sugar regulation, blood pressure stability, the sleep-wake cycle, and more. 

What are the symptoms of high cortisol?

Chronically elevated cortisol levels can lead to fatigue, mood changes, sleep disturbances, weight gain in the mid-section, and brain fog. Cushing syndrome (a rare medical condition involving clinically high cortisol) has distinct symptoms, like a fat pad between the shoulder blades, purple stretch marks, and easy bruising.  

Is it possible to lose weight after menopause?

Although lower hormone levels can slow down your metabolism, it is possible to lose weight after menopause. It can help to focus on nutrient-dense foods, consistent exercise, and quality sleep. A Midi clinician can help get you on a healthy track.

What are the top 3 vitamins for menopause?

The best vitamins to focus on in menopause depend on the symptoms you’re trying to target. But many clinicians will talk about the importance of calcium and vitamin D for bone health, and omega-3. 

Can cortisol levels affect A1c?

Cortisol can raise A1C levels. That’s because it tells your body to release stored glucose, increasing blood sugar levels for quick energy (since stress makes your body think it might need to, say, fight off a bear). Cortisol can also lead to insulin resistance because it weakens your cells’ response to insulin.