CORTISOL - Why all the fuss?
CORTISOL & MIDLIFE WOMEN
What is Cortisol?
Cortisol is a hormone produced by your adrenal glands in response to stress. It plays a crucial role in energy regulation, metabolism, immune function, and the sleep-wake cycle, and is also critical to our fight or flight response. On it’s own (without an external threat to spike it), Cortisol follows a natural rhythm—highest in the morning and lowest at night and is just one of many hormones coursing through the human body.
What Happens to Cortisol During Perimenopause & Menopause?
Estrogen and progesterone decline, which reduces the body's natural buffering of cortisol.
The HPA axis (hypothalamus-pituitary-adrenal system) becomes more reactive, meaning stress responses activate with less stimuli.
Cortisol spikes may last longer and appear at the wrong times (e.g., evening).
Cortisol is NOT bad, and you should not abandon exercise because of it…
A lot of misinformation is circulating regarding this singular corticosteroid, which is just one of many involved in our stress responses. One theory as to why this particular hormone gets a bad rap is because it’s one we are able to measure, so it’s gotten more attention than those more difficult to monitor.
It’s true that exercise DOES spike our adrenal responses in a way similar to what we experience when we perceive an external threat. However, regular exercise also hones our ability to naturally LOWER these stress responses.
What does that mean?
In simple, actionable terms (which is where I always want to live):
Women over 40 should still engage in strenuous exercise to keep this response and the body’s ability to regulate it working, and there are numerous other benefits to vigorous exercise as well. However, if we’re planning our exercise week, high intensity cardio might be less of a focus than it was when we were younger, and we might need to devote more time to actively working to lower stress responses.
Cortisol is not the problem. Stress is the problem.
As we go through the hormonal shifts of perimenopause, our body (cortisol included) works to regulate our hormonal load to keep the body in a steady state where we are most prepared to deal with things. But hormone shifts are a stressor, as are so many of the other things women over 40 tend to be managing: teenagers? aging parents? demanding careers? complicated interpersonal relationships? All of these contribute to our stress load, making it tougher for our bodies to regulate the stress.
Lots of women of perimenopausal age begin to suffer the impacts of chronic stress.
What does that look like?
metabolic imbalances (insulin deregulation and an increase in fat)
cardiac issues
anxiety
sleeplessness
And what’s unfair is that all these things are stressful. Leading to MORE stress.
What should we do about it?
Glad you asked. Focus some of the days you used to spend on high intensity exercise on handling your stress. (and by the way, restrictive diets are a form of stress). Breathwork, yoga, meditation, tissue work like SMR or massage, heat like a hot bath or sauna — these are all ways to actively manage stress.
Scientific References:
2009 Jul–Aug;16(4):708–718. Cortisol Levels during the Menopausal Transition and Early Postmenopause: Observations from the Seattle Midlife Women’s Health Study. Menopause.
Sauer T, Tottenham LS, Ethier A, et al. Perimenopausal vasomotor symptoms and the cortisol awakening response. Menopause. Published online (June 22, 2020).
Linda M. Gerber, Lynnette L. Sievert. Joseph E. Schwartz (2017). Hot flashes and midlife symptoms in relation to levels of salivary cortisol. Maturitas.
Accessible Resources:
The Huberman Lab Podcast (Episode: “How to Control Your Stress Response”) – Andrew Huberman, PhD, Stanford University
Dr. Stacy Sims Blog – Focus on women's physiology and exercise science
Hit Play, Not Pause podcast (Episode: “What menopausal women need to know about cortisol with Carla DiGirolamo, MD, PhD” - Episode 142)