Date Published: 27th March 2026
Author: Dr Wendy Sweet (PhD)
Overview Menopause and Cortisol
Cortisol and menopause are closely connected. When stress levels rise – especially due to poor sleep, hormonal changes, and daily life pressures – cortisol can stay elevated. This can worsen symptoms like hot flushes, anxiety, weight gain, and fatigue. Managing stress, sleep, and overall lifestyle is key to reducing cortisol and improving menopause symptoms.
"If women aren't sleeping, their cortisol levels are high and this changes their bone density." [Dr Leo, NZ]
“Are you writing a novel?” he enquired standing next to my table at the cafe. An elderly man in his 70’s whom I hadn’t met before.
He had noticed my concentration and hands flying across the keyboard. I looked up. “No, but I used to in the past” I mentioned. “A few years ago I was sitting at this very table, writing my thesis. It must be something about this table and the good coffee and my ability to concentrate” I said laughingly.
I was writing this very article here in the newsletter and had been reading research about the powerful connection between menopause and cortisol, and how this stress hormone influences our symptoms.
With his intrigue peaked, the inevitable question emerged about my thesis topic. “I interviewed women about their health as they aged and their experiences of exercise through the menopause transition” I said.
He moved closer to my table so I could hear him. He spoke slowly and thoughtfully. “I once presented at a conference in Invercargill on Hormone Replacement Therapy” he said.
“I was a medical Doctor and a specialist in women’s health. I told the conference attendees that the best thing for women wasn’t to go on HRT but to go hiking. Back in those days the rationale for HRT was for bone health, but there is only one way to improve bone health and that is to stress the body through hiking and exercise. This stimulates bone re-development.
As well, a lot of my patients weren’t sleeping so they are high in cortisol and this causes bone deterioration and worsening cardiovascular health. At that conference, I wasn’t popular as the drug companies were pushing for us all to prescribe HRT for menopause. But I stand by what I said, even today – because if women aren’t sleeping then their cortisol is high and this thins the bones and changes their heart health, no matter how much medicine they take.”
Dr Leo had my attention.
His insight was remarkable, especially as I was reading an article on the connection between cortisol and menopause symptoms. I showed it to him.
“All this research wasn’t out in my day” he said. “Such a shame.” Then he wandered off leaving me reflecting on our conversation and remembering my own struggle with HRT. I wish I had his insight back then.
I had no idea that what I needed instead, was a good night’s sleep and to change the exercise I was doing and reduce my stress levels, so that my cortisol levels weren’t so high.
It’s the same today – women not sleeping during menopause, whether they are on HRT or not, and as such, their blood pressure, heart rate and cortisol levels remain higher than normal. But there is something else contributing to this too, and that is the ageing of the adrenal glands.
As women move through menopause, organs and tissues are ageing. The rate of ageing is associated with inflammatory changes, which tend to accelerate as women move from menopause to post-menopause. This increased inflammation due to biological ageing, is a relatively new condition called ‘inflammaging’ which is known to impact the rate of ageing, and the occurrence of lifestyle diseases as women age.
High Cortisol Levels and Menopause: Why Symptoms Can Spiral
Cortisol is a pesky hormone. Hormones are chemical messengers that relay messages to organs in the body. Cortisol is one of our stress hormones, and balancing it is important.
Cortisol is produced by your adrenal glands which sit on top of your kidneys.
Because cortisol enters the circulation, it affects many parts of your body — including your muscles and bones, heart and blood vessels, lungs, hormone-producing glands, and your brain.
This valuable hormone has lots of functions — controlling how you respond to stress, how your body fights infections, adjusting blood sugar levels, and regulating blood pressure. Hence, not all cortisol is negative – it has positive health benefits too.
But problems arise, when our stress levels are chronically high—something that directly impacts cortisol levels and menopause symptoms. When this happens, sleep may be disrupted even further, causing thyroid and pituitary hormones to become unbalanced and causing belly fat and weight gain to increase.
When I went into peri-menopause, the time of our lives when our ovaries gradually stop producing oestrogen and our progesterone declines as well, I had no idea that not sleeping all night was connected to my night sweats, hot flushes and mounting feelings of daily stress, anxiety, brain-fog and fatigue.
Like thousands of women going through menopause, I felt emotionally and physically exhausted but boxed-on – as we tend to do when there is so much to be done. Danni, who has done the Transform Me programme, was the same. She kindly shared her story about her changing health in mid-life with you on the Success Stories page as well as in this video below.
Increased cortisol comes from many sources of 'stress'.
From insomnia to hot flushes, to night sweats to sore joints, to weight gain (or loss), palpitations and changing bone density, our symptoms in menopause often impact on our day-to-day life.
When this happens our body is under even greater stress. The accumulation of all of these sources of stress is known as ‘allostatic load’.
Cortisol levels rise among some women during the late stage of the menopausal transition, especially at night. This is the time when cortisol levels should be low.
The Seattle Midlife Women’s Health Study (2009) offers wonderful insight into the role of higher cortisol levels overnight.
Higher overnight cortisol levels during the menopause transition were significantly and positively associated with adrenaline (epinephrine) and nor-adrenaline (norepinephrine) levels. These are your other stress hormones and they exert an influence around your body.
Cortisol and Menopause Symptoms: What You May Notice
If you’ve been experiencing an increased heart rate, anger, frustration, memory lapses and/or hot flushes and night sweats, then, as women on the MyMT™ programmes discover, it’s time to manage your production of cortisol.
When cortisol is out of balance and it stays high throughout the day and night, then your menopause symptoms may become worse. Just as Dr Leo mentioned as he wandered past my table in the cafe that day. As the Seattle Midlife Women’s Health Study (2009) suggests,
“Rising cortisol levels have been associated with poor health, including lower bone density in older women, minor cognitive complaints, and could be hypothesized to be related to perceptions of poor health overall.” (p. 2).
Understanding Allostatic Load
When the allostatic load from various sources of stress increases during menopause, our symptoms become worse.
Emotional and physical stress are accumulative – and it’s not just the ‘here and now’ stress.
I’m also talking about the decades-long build-up of oxidative or physical stress that manifests as inflammation and metabolic chaos in our body too. If your muscles are sore, if you have fibromyalgia, if your gut health has changed, if you have put on weight, and if you are feeling hot and bothered all the time, and you aren’t sleeping, then yes, these are all signs that your body is ‘stressed’.
Because your body is stressed, then your chronic stress hormone called cortisol, stays elevated for longer during the day and night. And it shouldn’t. It should only be elevated in the morning.
When Cortisol is elevated, it depletes Progesterone
Just like over-trained female athletes, when our body is under stress, then we produce more of our chronic stress hormone called cortisol.
With this extra production of cortisol, the production of our lovely calming hormone called progesterone, is affected as well.
Progesterone is ‘stolen’ to make more cortisol in a condition called ‘pregnenolone steal’ (see the image below). Normally, progesterone balances out oestrogen in the body and when progesterone is crashing down too quickly, our symptoms become worse.
I talk about this in my Masterclass on Menopause (now available online for you) – I always get women nodding in agreement as they have their ‘aha’ moment.
The balancing act between oestrogen and progesterone over the decade (yes!) that we move through menopause is important. It’s why many of you are put on progesterone as hormonal therapy during this stage of life. But here’s the thing – often your various sources of stress are overlooked.
All these sources of stress accumulate.
Then this increased allostatic load of cortisol ‘steals’ progesterone. That’s why, although you might go on HRT to manage your symptoms, other sources of stress in your life need to be managed as well.
Often your high amounts of exercise (or low amounts of exercise), or your lack of sleep or your workplace and family stress and anxiety don’t get a mention. And they should. Because to manage symptoms in menopause and to improve your health as you age, you need to address these sources of stress too.
Exhaustion is not a 'badge of honour'!
If women are feeling exhausted, then their cortisol levels are increased. When cortisol is high during our menopause transition then our pain receptors are more sensitive, our sleep becomes worse, our blood sugar levels become erratic, our muscles become sore (restless legs anyone?), our blood pressure and heart rate increase and our anxiety levels go up a notch too. As Dr Leo mentioned, our bone density changes too.
How to turn this around is some of what I teach you in the MyMT™ programmes. I hope you can join me sometime because learning how to turn around the various sources of stress from not sleeping to joint pain and inflammation to weight gain, during our menopause transition is crucial to the reduction of your symptoms.
I can’t reinforce this enough. And there’s another reason for this.
Oxidative or cellular stress and high levels of cortisol production are becoming well recognised as a cause of age-related diseases.
Oxidative stress is a term that refers to chronic inflammation building-up deep inside our cells and tissues.
This chronic inflammation arrives in our gut, liver, heart and kidneys as well as muscles and joints as we age. And yes, the brain doesn’t escape the effects of damaged and inflamed cells and tissues either.
In a study about the brain and stress, the authors state, ‘Allostatic load represents the ‘wear and tear’ of chronic stress on the brain and body and … women show gender-specific variation for numerous factors such as age, race/ethnicity, adversities and health behaviours, that influence associations between allostatic load and their mental health.’ (Kerr, Kheloui, et el., 2020, p.1).
When I began to understand how our cells and tissues become ‘stressed’ and added this physical stress to the psychological stress that I felt, not only from not sleeping, but from my busy, active life as well, suddenly, there appeared to be a multitude of sources of stress in my life!
I had no idea at the time that managing or reducing ALL of the sources of stress in my life (physical and emotional), helps to reduce menopause symptoms and/or weight.
Wendy from Australia was the same.
The MyMT™ Programmes are for you!
That’s how the MyMT™ programmes differ (choose between weight loss or not). When you come on board with me and let me share your menopause journey with you, then I help you to turn this chaos around.
You learn how my scientifically evidenced sleep strategies, liver health improvement, and how to adjust your nutrition to not only improve your energy levels, but so that you get the specific nutrients your body needs as you move through menopause – every programme has a specific Food Guide and recipe book designed with your nutritional needs in mind depending on your stage of life.
There are also mindfulness strategies, as well as my Joint Restoration and Gut Health restoration modules.
Wherever you are in the world, I hope you can join me when you can. Check your inbox for any promotions too or get hold of me on wendy@mymenopausetransformation.com
FAQ: Cortisol and Menopause
Cortisol is your body’s primary stress hormone, produced by the adrenal glands. During menopause, hormonal changes combined with lifestyle stressors can cause cortisol levels to stay elevated for longer than normal.
This matters because cortisol affects:
- Sleep quality
- Blood pressure and heart rate
- Weight and fat storage
- Brain function and mood
- Bone density
When cortisol is balanced, it supports normal body function. When it stays high, it can amplify menopause symptoms.
High cortisol during menopause can worsen symptoms such as poor sleep, hot flushes, night sweats, weight gain (especially around the abdomen), anxiety, irritability, brain fog, fatigue, and increased heart rate. Elevated cortisol keeps the body in a constant stress state, which disrupts hormone balance and intensifies both physical and emotional menopause symptoms.
Allostatic load refers to the cumulative burden of chronic stress on the body.
During menopause, this includes:
- Emotional stress (work, family, life pressure)
- Physical stress (poor sleep, inflammation, pain)
- Hormonal stress (declining oestrogen and progesterone)
Over time, this “wear and tear” increases cortisol levels and worsens symptoms.
Yes. High cortisol levels are linked to increased abdominal fat storage and changes in metabolism, especially during menopause.
For some women, cortisol levels increase during menopause—particularly at night—due to hormonal changes, poor sleep, and accumulated stress.
Cortisol should be low at night, but disrupted sleep during menopause can keep it elevated. This prevents the body from recovering properly and contributes to ongoing hormonal imbalance.
References:
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Davis, S., Castelo-Branco, C. et.al. (2012). Understanding weight gain at menopause. Climacteric, 15: 419–429.
Ebong IA, Quesada O, Fonkoue IT, Mattina D, Sullivan S, Oliveira GMM, Spikes T, Sharma J, Commodore Y, Ogunniyi MO, Aggarwal NR, Vaccarino V; American College of Cardiology Cardiovascular Disease in Women Committee. The Role of Psychosocial Stress on Cardiovascular Disease in Women: JACC State-of-the-Art Review. J Am Coll Cardiol. 2024 Jul 16;84(3):298-314.
Kerr, P., Kheloui, S. et al. (2020). Allostatic load and women’s brain health: A systematic review. Frontiers in neuroendocrinology, Vol 59, 100858.
Mathis, B. J. (2021). The Intricate Web of Fatigue in Women. Women, 1(4), 267-279. https://doi.org/10.3390/women1040023
Sievert LL, Jaff N, Woods NF. Stress and midlife women’s health. Womens Midlife Health. 2018 Mar 16;4:4. doi: 10.1186/s40695-018-0034-1. PMID: 30766714; PMCID: PMC6297937.
Woods, N. F., Mitchell, E. S., & Smith-Dijulio, K. (2009). Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. Menopause (New York, N.Y.), 16(4), 708–718. https://doi.org/10.1097/gme.0b013e318198d6b2
Yiallouris A, Tsioutis C, Agapidaki E, Zafeiri M, Agouridis AP, Ntourakis D and Johnson EO (2019) Adrenal Aging and Its Implications on Stress Responsiveness in Humans. Front. Endocrinol. 10:54. doi: 10.3389/fendo.2019.00054
