Cortisol Harmony: Unveiling Cortisol’s Pivotal Role in Menopausal Wellness

Cortisol, oft-termed the "stress hormone," originates from your adrenal glands, playing an indispensable role in governing numerous essential functions in your body - from metabolism and mental acuity to immune responses and stress management. The intricate dance of your body’s cortisol production and maintenance is influenced by myriad factors, with the hormonal fluctuations of perimenopause and menopause being more impactful than many realize.

As women traverse through the menopause transition (MT), estrogen experiences a turbulent journey of falls and rebounds before stabilizing at a lower level. This diminished estrogen baseline correlates with elevated cortisol levels, which, in turn, influences progesterone production. A crucial element, progesterone buffers the effects of estrogen. The absence of adequate progesterone, especially against a backdrop of reduced estrogen levels, can usher in estrogen-dominance symptoms such as bloating, heavy periods, breast tenderness, and PMS.

The symbiotic relationship between cortisol and lifestyle stressors adds another layer to this hormonal tableau. Your work, traffic woes, relationship strains, parental care duties, financial hardships, or unexpected health dilemmas — all of these elevate cortisol levels. The duration and intensity of these stressors further disrupt optimal physiological function.

Recognizing Cortisol Disruption

Sleep Interference: Elevated cortisol suppresses melatonin production, impacting your ability to fall and remain asleep. An elevation in night time cortisol also is significantly correlated with adrenaline and nor-adrenaline levels which are stress hormones that act all over your body (heart rate, vasomotor symptoms, mood swings and memory lapses). This means that what is happening at night with cortisol, ultimately impacts your day.

Metabolic Impact: High (and low) cortisol levels contribute to weight gain. There is an intricate relationship between cortisol and the hormone insulin which controls our blood sugar.  As cortisol levels rise, as it does in some women during the late stage of the menopause transition (especially at night)- the cells of our body can become resistant to insulin which may lead to an increase in blood sugar, weight gain and Type 2 diabetes.  

Mental Health Ramifications: While estrogen can enhance cognition and cerebral blood flow, its fluctuation alongside elevated cortisol can spur memory issues, mood dips, and brain fog. In addition, chronic stress  resulting in higher cortisol levels (as studied in caregivers) , may dampen mitochondrial function.  The mitochondria are known as the “power house of the cell”. When the mitochondria produce less energy, women experience more fatigue.  Studies are being done to see why some people respond this way, while others are more resilient to the impact of chronic stress, without the elevation in cortisol.

Digestive Upset: Cortisol can compromise gut barrier function by altering our gut microbiome. This leads to intestinal dysbiosis, where toxins can enter the bloodstream, initiate an immune response  and ultimately turn on a cascade of signaling all over the body.  Resulting symptoms range from bloating and constipation to fatigue and skin issues to health effects we are only beginning to understand.

Unmasking Stress Inducers

Emotional Stress: Encompassing depression, anxiety, relationship issues, and other mental health challenges.

Physical Stress: Involves over-exercising, injuries, allergies, and autoimmune conditions.

Environmental Stress: Includes smoking, excess alcohol, sedentarism, household toxins, poor air quality, sleep deprivation, and financial stress.

Food-Related Stress: Pertains to consuming ultra-processed foods, sugar, late-night eating, and hypernutrition.

Navigating Stress Amidst Menopause

Before I share a way to frame a path forward, I need to first take a moment and emphasize, life happens. Bad things happen. Mental health gets compromised. Often, there is nothing we can do about that.

So the goal here is not to eliminate the stressors of life on this planet. That is an impossible feat. But what we can do, is to provide our bodies with the necessary armor to defend us against the inevitable stress.

This means, reduce the insult when possible, create a barrier and finally to find adaptations that work uniquely for your situation. We are all different. 

Here are some suggestions:

Reduce the insult when possible--Minimize Dietary Stressors:

Avoid sugar, particularly in liquid form, to prevent cortisol and glucose spikes and safeguard against metabolic disorders. Due to the impact on metabolism, liver function, and its direct impact on the brain, think of sugar as a toxin. 

Which it is. Elevated glucose levels from consistent sugar intake is a stressor that impacts chronic insulin release from the pancreas. Cortisol also increases human growth hormone and IGF1. This causes sleep disruption, which, combined with the impact on melatonin, is a recipe for metabolic disaster-including non-alcoholic fatty liver disease, diabetes, and obesity. These conditions will pave the way for significant chronic diseases such as cancer, cardiovascular disease, and neurodegenerative diseases like Alzheimer’s disease.

Sugar is not your friend. Especially in liquid form, which causes sudden sharp spikes as it is so easily absorbed from your gut.  DON’T DRINK YOUR CALORIES!

Create a barrier--Shield Your Gut Microbiome:

Cultivate a robust microbiome by consuming fiber-rich foods. When fiber is broken down and metabolized,  short-chain fatty acids are produced that protect you from diseases of the gut, including colorectal cancer and even obesity.  Specifically, when your microbiome metabolizes fiber, butyrate, a fatty acid, is produced which acts as fuel for the cells that make up your intestine. Women should aim for at least 25 grams of fiber daily— a nice mix of soluble and insoluble fibers. Consider: raspberries, beans, leeks, asparagus, pears, garlic and bananas!  A quick google search will help you find fiber rich foods and recipes to help you care for your microbiome with foods you enjoy.  You should not add processed foods to your list, even if they claim to contain fiber!

Find Adaptations: Craft Your Stress Adaptation Strategy:

This requires trial and error. That said, exercise is non-negotiable due to its cortisol-mitigating and microbiome-protecting effects. Exercise increases brain derived neurotrophic factor, or BDNF, which helps with brain plasticity and our ability to adapt. 

Engage in a relaxation practice.  Play around to see what works for you. Consider prayer, a mindfulness practice, breathing exercises, meditation, guided imagery, yoga, Tai Chi, journaling, work with a therapist, and make time for hobbies or any other grounding activities.  Really, anything that allows you to realign your body with your mind and tethers you to the present moment.

Understanding cortisol’s nuanced interactions during menopause not only enlightens but also empowers you. Navigating this journey with knowledge, resilience, and a dedicated adherence to self-care allows you to maintain a hormonal balance, transitioning smoothly into a new phase. Emerge from this process as a beacon of unparalleled strength and vibrancy, ready to confront life's challenges with grace and celebrate triumphs with enduring joy.

Wellness always,

Integrative Menopause MD

his blog is intended for educational and entertainment purposes only. Please consult your own health care provider before acting on any information or advice in my blog or on my website. Remember, healthcare and wellness are unique to your personal history and needs.