High Cortisol Levels in Women During Menopause

Do you ever feel like you’re wired at night, but exhausted all day? Many women in perimenopause and menopause describe experiencing a strange mix of fatigue and restlessness that seems to defy logic. One of the key hormones behind this is cortisol—your body’s main stress hormone.¹

Cortisol helps you rise to the occasion. In small amounts, it increases energy, regulates blood sugar levels, and enhances alertness. But, when women have high cortisol levels—especially during the wrong times, like right before bed—they may feel anxious and drained or suffer from sleeplessness.²

Social media has recently exploded with cortisol content. In a Time Magazine article from this past March, Dr. Molly McBride, an OB-GYN in New York City said, “In all my years of being a doctor, I’ve never heard cortisol being mentioned so much by patients,” “Now with TikTok running amok, everybody is asking for cortisol checks.”³

Here’s what many don’t realize: hormonal shifts during menopause—especially the decline of hormones estrogen and progesterone—may throw off cortisol’s natural production. These sex hormones help buffer the body’s stress response. When they decline, cortisol regulation goes haywire.⁴

Women toward the end of their menopausal transition may be especially vulnerable to high cortisol levels, particularly if they’re also experiencing sleep disturbances or hot flashes.⁵ Bonafide Chief Medical Officer, Dr. Alyssa Dweck, goes on to explain, “The hypothalamic-pituitary axis in the brain regulates both reproductive hormones, including estradiol and progesterone, and cortisol, produced by the adrenal glands. The significant decline in estrogen during menopause—and the sleep disruption it causes—can lead to altered cortisol production.”⁶

Here we’ll explore the connection between cortisol and estrogen and seek to provide more information around why high cortisol levels in women often peak during perimenopause, and how to balance cortisol through simple, supportive strategies.

Cortisol and Estrogen Are Connected

Cortisol is produced by your adrenal glands and follows a natural daily rhythm—peaking in the morning and tapering off by night. This balance is key for supporting healthy energy, mood, and metabolism.⁷

But declining estrogen during menopause often disrupts this pattern. The relationship between cortisol and estrogen means that when estrogen drops, your body may become more sensitive to stress and less able to return to baseline.⁸

It may present as an inability to cope with even minor stressors you could have easily handled in the past. Additionally, you may be experiencing increased stress levels due to caregiving roles, divorce, career advancement, and other major life events. Therefore, increased stress and poor coping may make perimenopause symptoms worse.⁹

In fact, research from The Menopause Society found that women with elevated hair cortisol levels showed poorer levels of attention and memory, while high salivary cortisol was linked to more intense depressive symptoms.¹⁰

Signs of Cortisol Imbalance

There are several ways in which elevated cortisol may contribute to the severity of symptoms experienced during the menopausal transition.

Dr. Dweck explains, “Elevated cortisol levels are often associated with sleep disruption, including commonly reported nocturnal awakenings during menopause. Elevated cortisol is also associated with increased central adipose tissue, insulin resistance, and dyslipidemia through altered metabolic pathways. Finally, the severity of depressive symptoms can be associated with higher cortisol levels, and chronic stress also elevates cortisol levels.”¹¹

In other words, many symptoms that women often chalk up to “just menopause” may actually signal cortisol dysregulation, especially during perimenopause. These may include: ^12,13

• Hard-to-lose belly fat
• Poor sleep or waking up tired
• Mood swings or irritability
• Weak bones
• Hair thinning

How to Balance Cortisol Levels

Balancing or lowering cortisol levels in women often requires a multi-layered approach.

Lifestyle Support ^14,15,16

• Consider eating a Mediterranean-style diet with healthy fats, fiber, and protein to support hormonal stability
• Move your body—but gently. Walking, yoga, and light strength training help without overloading your stress system
• Do your best to prioritize consistent sleep routines and wind-down rituals, including limiting caffeine intake throughout the day and before bedtime
• Try meditation, breathwork, or guided relaxation—these have been shown to improve cortisol patterns and resilience

Integrative Options ^17,18,19

• Adaptogens, like ashwagandha and rhodiola may boost energy and reduce cortisol – but it’s always important to check with your healthcare provider first before incorporating any adaptogens just to be sure they’re right for you.
• Magnesium and omega-3s help to ease stress-related symptoms

Medical Interventions ^20,21

• Hormone therapy (HRT) may help some women, although its effects on cortisol are still unclear. It’s important to discuss your options with your healthcare provider.
• If symptoms feel unmanageable, consider asking about cortisol testing (saliva or urine) to gain clarity on your stress patterns.

Dr. Dweck advises, “Evidence suggests that managing vasomotor symptoms (i.e., hot flashes), optimizing sleep hygiene, cognitive behavioral therapy (CBT), and using stress reduction techniques can effectively moderate cortisol levels—especially when those changes are tied to shifting hormones during menopause.” ²²

In other words, when your stress goes up, so do your cortisol levels—meaning one of the most impactful ways to lower cortisol is by taking consistent care of yourself, inside and out. ²³

Your Stress Isn’t Just in Your Head

The exhaustion, the restlessness, the brain fog—these are potential signs your body is responding to hormonal changes driven by the interaction between cortisol and estrogen in your body during menopause.

Understanding your body’s patterns is the first step to feeling better. Start small: track your symptoms, incorporate some daily movement, take care of your stress levels, and talk to a trusted healthcare professional.

 Resources:

1. https://my.clevelandclinic.org/health/articles/22187-cortisol
2. https://my.clevelandclinic.org/health/articles/22187-cortisol
3. https://time.com/7267244/cortisol-levels-hormones-throughout-the-day/
4. https://www.sciencedirect.com/science/article/pii/S0091302224000402
5. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0284627
6. https://pubmed.ncbi.nlm.nih.gov/38909441/
7. https://my.clevelandclinic.org/health/articles/22187-cortisol
8. https://www.webmd.com/women/estrogen-and-womens-emotions
9. https://www.sutterhealth.org/health/perimenopause-or-stress
10. https://menopause.org/wp-content/uploads/press-release/stress-in-the-body-and-hair-and-salivary-cortisol-levels-and-depression.pdf
11. https://pubmed.ncbi.nlm.nih.gov/39689250/
12. https://my.clevelandclinic.org/health/articles/22187-cortisol
13. https://www.healthline.com/health/high-cortisol-symptoms#symptoms
14. https://www.medicalnewstoday.com/articles/322335#how-to-lower-cortisol
15. https://www.healthline.com/nutrition/ways-to-lower-cortisol
16. https://www.medicalnewstoday.com/articles/322335
17. https://pmc.ncbi.nlm.nih.gov/articles/PMC6750292/
18. https://www.ncbi.nlm.nih.gov/books/NBK507250/
19. https://www.sciencedirect.com/science/article/abs/pii/S0306453019303488
20. https://pmc.ncbi.nlm.nih.gov/articles/PMC2663529/
21. https://www.medscape.com/viewarticle/behind-cortisol-trend-misinformation-could-drive-unnecessary-2025a100090t
22. https://pubmed.ncbi.nlm.nih.gov/34636353/
23. https://www.cedars-sinai.org/blog/what-is-cortisol.html