Recently, I’ve noticed an uptick in social media content focusing on cortisol. Much of it heavily targets those in perimenopause and menopause. Taking adaptogens, doing somatic exercises, and biohacks like carefully timing your morning coffee are a few tips I’ve seen. Each claims to help you manage cortisol in perimenopause.
Great. More things to add to our ever-growing to-do list.
But is managing cortisol in perimenopause actually necessary? And if so, are supplements the best way to do this?
In today’s post, I’ll cover:
- what cortisol is and does in the body
- what to do if you think your cortisol is high
- how cortisol changes in perimenopause
- my take on supplements and what you really want to focus on when it comes to managing cortisol in perimenopause
Reviewing biohacks for cortisol will have to wait for another day.
Let’s get into it, shall we?
Cortisol is having a moment (again)
Cortisol has been a convenient contrivance used by wellness influencers for some time now. Weight gain, “puffy cortisol face,” headaches, bloating, anxiety and fatigue are commonly attributed to high cortisol levels.
These symptoms are present in those with Cushing’s syndrome—a cortisol disorder that we’ll discuss later in the post, but they are non-specific and can be explained by other conditions or life stages. Or even several because there isn’t always a simple answer to what ails us.
If you’ve been pregnant, you probably experienced most of the symptoms on that list. Perimenopause and PCOS can also explain them. So could congestive heart failure and lung cancer.
See what I mean by non-specific?
Let’s not forget that it wasn’t that long ago that “adrenal fatigue” was the reason we all felt like crap and needed to buy the latest supplement from our wellness coaches on social media (use the code SNAKEOIL20 to get 20% off your first order! 😉).
And with the explosion of discourse on menopause and everything related, it was only a matter of time before supplement pushers pivoted to a new strategy: perimenopausal women burnt out from juggling careers, homes, parenting, and keeping up with the latest performative self-care #GRWM💅.
So now we drop the term “adrenal fatigue” and update it to “high cortisol” (or “balancing cortisol” because it’s all about balancing hormones these days).
And influencers everywhere tell perimenopausal women they must balance their cortisol.
And my cortisol goes through the roof every time I see this trope being pushed down my throat by the algorithm.
What is cortisol, and what does it do in the body?
Cortisol is a hormone that is produced and secreted by the adrenal glands, which sit on top of the kidneys. Cortisol has many roles in the body, including its most famous job—responding to stress. It also plays an important role in regulating our sleep-wake cycle.
Other roles include involvement with energy metabolism, regulating blood pressure and fluid balance, having anti-inflammatory properties (hello, topical hydrocortisone), and memory formation.
The adrenal glands usually secrete a relatively stable amount of cortisol within a normal range. There are two exceptions. Cortisol levels change in response to stress and fluctuate throughout the day to regulate our sleep-wake cycle.
CORTISOL & STRESS
Stressors on the body, such as injury, intense temperatures, pain, or psychological stress, cause the release of cortisol. When cortisol is released, it sets into motion a cascade of events designed to help your body with “fight-or-flight, ” or the stress response.
You’ve probably heard the classic example of running away from a Sabre-tooth tiger. There’s a real (or perceived) threat to the body, and it gears up to run away (or fight if that’s your thing). Our heart rate increases, blood pressure goes up, nutrients are made available for energy, and non-essential services (at least in this context), such as digestion, are temporarily shut down.
What’s really cool about cortisol is that it not only facilitates the stress response but also turns that response off. This is referred to as negative feedback.
During a normal stress response, when cortisol levels get high enough, negative feedback stops more cortisol from being produced.
So yes, cortisol levels can increase after an episode of meno-rage or intense exercise, but they will return to normal.
Of course, there are always exceptions.
In cases of extreme stress, such as trauma, cortisol levels may not respond as expected. Research suggests that a chronically activated stress response may become overly sensitive or even less responsive. This means that we may see cortisol levels that are higher or lower than usual. Both can have negative health implications.
Chronically high cortisol levels can lead to insulin resistance, changes in heart health and decreased immune function.
CORTISOL & THE SLEEP-WAKE CYCLE
Cortisol has a daily pattern of release to regulate the sleep-wake cycle. Under usual conditions, cortisol levels rise in the early morning to help us wake up. Levels continue to increase and we see a peak around mid-morning. Following this, there is a steady decline through the day, and by evening there is a very low level of cortisol in bloodstream.
When cortisol levels behave outside of this typical pattern, sleep goes awry. Changes to normal daily cortisol secretion are associated with health issues, such as cardiovascular disease. Research also shows that high evening cortisol levels are associated with insomnia.
Our “me time” habits also have the potential to affect our cortisol levels. Staying up late, like in the case of revenge bedtime procrastination, can result in cortisol levels higher at bedtime the next day.
So, the relationship works both ways: We can have trouble falling asleep when we are stressed and cortisol is elevated. The loss of sleep can lead to higher-than-usual cortisol levels, which can set us up for a continued pattern of sleep difficulties.
How can you tell if your cortisol levels are too high?
If you were to ask the TikTok tricksters, you would get that list of non-specific symptoms again: weight gain, headaches, bloating, anxiety, and fatigue. Sometimes, they cherry-pick a few more.
These are additional signs of high cortisol. Some are a bit more specific, meaning they are likely to point to high cortisol versus another condition:
- Purple stretch marks or other skin changes
- Fat deposits behind the shoulder blades, typically shaped like a hump
- Muscle weakness, usually in the arms and legs
- Excessive hair growth in females
- Weak bones and fractures
- Menstrual changes
- Decreased sex drive
It is rare to have consistently high cortisol levels above the normal range. Cushing’s syndrome is the name of the condition that results from excess cortisol secretion. It is typically caused by long-term corticosteroid medication use. A tumor in the pituitary gland, lungs, pancreas, or one of the adrenal glands can also cause Cushing’s syndrome.
If you suspect that your cortisol levels are high, it’s crucial that you see your doctor for appropriate testing and diagnosis, rather than follow the advice of some random on Instagram. In addition to reviewing your symptoms, your doctor will need to consider your medical history and run some lab tests. Multiple tests are usually needed, as cortisol levels fluctuate throughout the day.
When it comes to the common symptoms of perimenopause (that also overlap with high cortisol), it’s possible you may have higher than your usual cortisol levels but still be within the normal range.
The link between perimenopause and cortisol levels
The hallmark of perimenopause is fluctuating hormones. This can cause symptoms such as inconsistent and unpredictable periods, fatigue, weight and body changes, and headaches (there’s that list again), to name a few. These changes can also mean sex hormones are outside of the normal range.
One menstrual cycle might produce estrogen levels well above what would be considered the normal range. In the next cycle, we could have estrogen levels consistent with menopause—virtually none at all. And we might even return to a normal range of estrogen for a few cycles. All the while, progesterone is declining. The fluctuations are truly chaotic.
The same hormones that fluctuate in perimenopause interact with the stress response system. Research shows that changes in ovarian hormones during the menstrual cycle alter the sensitivity and function of cortisol and, therefore, our stress response.
Cortisol levels rise during late perimenopause
Studies that have examined these interactions show an increased level of cortisol is associated with ovarian hormones and menopause symptoms. This typically occurs during late perimenopause. Vasomotor symptoms, along with mood, cognition, and sleep changes, are all associated with changes in cortisol levels.
The connection between cortisol levels and vasomotor symptoms is not surprising. If you’ve experienced one, it can be pretty stressful. It’s not uncommon to experience anxiety or heart palpitations with a hot flash.
So, what’s going on with perimenopause and cortisol?
Perimenopause is one mother of a stressor on the body
Cue Captain Obvious.
Still, let’s walk through this. We have research showing cortisol levels rise during the menopause transition as a function of perimenopause. We also know that cortisol can become dysregulated from chronic stress. And, perimenopause often occurs during a stressful phase of life—kids, ageing parents, careers, and all that.
So yeah, stress and perimenopause seem like best buds.
And it seems like the stress hormone, cortisol, would be a natural target to help “fix” this problem.
Here’s my take on all this;
Elevated cortisol isn’t the driver of stress in perimenopause. It is evidence that our bodies are going through a major physiological change and needs extra support to defend against any additional stress.
It’s tempting to turn to a quick fix, like a supplement. They are so heavily marketed towards women in perimenopause. Over time, it gets easier to believe the hype. Honestly, I’ve been tempted (okay, duped) into purchasing supplements that, deep down, I know aren’t what I really need.
Supplements *might* lower cortisol, but they are a band-aid solution at best
Sure, there may be some evidence to show that supplements like ashwagandha can lower cortisol levels. And with a boost from the Placebo Effect, you might even feel good for a bit. But this is a band-aid solution, at best. It is potentially harmful if a supplement is contaminated or interacts with our medications.
Often, I see blends of supplements that claim to reduce cortisol without high-quality evidence supporting these claims.
Some supplements contain blends of multiple ingredients. As if throwing in every herb, vitamin or mineral that has had a whiff of association with cortisol will do the trick.
And if there is an ingredient with a bit of evidence, there is often less than the therapeutic dose contained in the supplement.
It’s too easy to sell supplements that don’t work
There is no requirement for a robust body of research to demonstrate they work. The same is true for safety.
Additionally, there’s no incentive for a supplement manufacturer to put up the funds for such research. Why would a company waste time and resources on large clinical studies with long-term follow-up, when that may end up disproving the products they are already allowed to sell?
When it comes to cortisol and perimenopause, supplements won’t provide the whole person care that’s needed. Even with all the promises of a holistic and natural solution that supplement bottle offers.
We need to acknowledge that perimenopause is, in itself, a stressor on the body.
This doesn’t mean perimenopause is going to be an awful experience for everyone either. The experiences people have through the menopause transition vary greatly. Your health status when you enter this phase of life will have a large impact on how you experience perimenopause.
Your best bet to feeling good is to support your changing body in a way that increases resilience to stress.
On the individual level, it means that in between the school drop-offs, board meetings, and mountains of laundry, we need to carve out time for the basics of self-care: restorative sleep, a nourishing eating pattern, daily movement, and meaningful connection to others and through pursuits we enjoy.
Consistently, with self-compassion, and to the best of our ability.
On a societal level, we need equitable access to health care and equity in pay and domestic labour.
And that, is the hard part.
A supplement won’t help with either.
The Takeaway
What you really need to know about managing cortisol in perimenopause, is that you don’t need to manage your cortisol. At least, not in the way we’ve been made to believe on social media.
Micromanaging cortisol with supplements doesn’t improve your stress-response system in the long run. At best, they may offer a band-aid solution.
Adequate sleep, nourishment, movement, and meaningful connection, along with other stress management tools, are the best ways to support your body through the menopause transition and increase your resilience to stress.
And maybe stop following people on social media that sell supplements for managing cortisol in perimenopause.
Especially if that crap stresses you out.
