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Hormones

How Cortisol Affects Women’s Health and the Menstrual Cycle

Stress is something that each and every one of us faces almost on a daily basis, mostly fuelled by our work or personal circumstances. In this article, we shall uncover the basics of understanding the stress hormone - cortisol, its effects and defects on your cycle, and how to control it.

Elara Care

• 9 min read
How Cortisol Affects Women’s Health and the Menstrual Cycle

Article last reviewed January 2024

Have you been waking up in the middle of the night? or waking up feeling like you need another 5 hours of sleep before you feel rested? I can relate. And it's because I can relate that I thought it was important to revisit this article and update it with the latest research.

Let's start with the basics:

What Is Cortisol?

Cortisol is a hormone produced in your body by the adrenal glands, which are located on top of your kidneys, and it's regulated by the pituitary glands.

It's often referred to as the "stress hormone" because it's released into the body in response to stress. But cortisol is involved in several important bodily functions, not just the stress response.

What Does Cortisol Do?

Cortisol is a crucial hormone to protect overall health and well-being. Some of its main functions are:

  • Responding to Stress: When your body is under stress, your adrenal glands release cortisol which triggers a cascade of responses designed to help manage the situation - including increasing glucose release into your bloodstream as an instant source of energy.
  • Regulating metabolism: Cortisol helps manage the metabolism of carbohydrates, fats, and proteins to convert them into usable energy for use by the body. Cortisol acts as an anti-inflammatory agent when your body experiences injury; when this happens, cortisol is released to help decrease swelling.
  • Moderates Immune Function: Cortisol has the power to moderate your immune response, often suppressing it to avoid overactivity. Therefore, long-term use of synthetic cortisol, like medications (e.g. prednisone), may suppress immunity.
  • Blood Pressure Regulation: Cortisol can help regulate your blood pressure by altering the balance between water and salt in your body.
  • Circadian rhythm: Your cortisol levels fluctuate throughout the day and night, often peaking early morning to help you wake up more easily, and then dropping again around midnight as part of a natural cycle known as your body's circadian rhythm.

Examples of Cortisol in Our Everyday Life:

  • When you're under stress at work, your body releases cortisol to help you handle the pressure. However, consistently high levels can lead to sleep disturbances.
  • Your workout also triggers a stress response in the body, leading to cortisol release, which is normal but should be balanced with adequate rest and recovery.

Cortisol's Daily Rhythm:

Cortisol levels fluctuate in a natural 24-hour cycle. Normally, cortisol levels rise during the early morning hours, peaking around 6-8 AM to help you wake up and prepare your body for the day.

As the day progresses, cortisol levels gradually decrease, reaching their lowest point around midnight. This decline is important for allowing your body to wind down and prepare for sleep. So, if you are waking up in the middle of the night, it's a strong sign that your cortisol levels are not dropping as they should in the evening.

Cortisol and Women's Health

As mentioned, cortisol performs serval functions in our bodies, including regulating blood sugar levels, metabolism, and blood pressure, and acting as an anti-inflammatory. However, it also impacts the menstrual cycle and ensures the body is prepared to host a fetus.

How does cortisol affect the menstrual cycle?

Cortisol During the Early Follicular Phase (aka menstruation):

Stress can make your periods heavier, show up late, or stop altogether. High cortisol levels, often due to stress, can disrupt the normal balance of reproductive hormones like estrogen and progesterone. This imbalance can lead to irregular menstrual cycles, changes in menstrual flow (heavier periods), or even missed periods. In some cases, prolonged high cortisol levels can contribute to more significant menstrual disorders.

Note: cortisol is vital for our bodies to function well, however, "prolonged periods of high cortisol" due to stressors, and not bodily fucntions, can be disruptive

Cortisol During the Follicular Phase:

Although Cortisol is often labeled as a "stress hormone," it is not inherently bad. It plays a vital role in many bodily functions, including mood and energy regulation.

In the follicular phase (the first half of the cycle), cortisol levels are generally naturally higher, which can contribute to feeling more energetic and alert. This is a natural response of your body preparing for ovulation. The interplay of cortisol and hormones like estrogen, can support positive feelings of well-being.

It's important to remember that hormonal balance is key, and each hormone, including cortisol, has its role in maintaining health - at the right level.

Cortisol during the Luteal Phase:

In the luteal phase (the second half), cortisol levels typically decrease. Less cortisol doesn't necessarily mean less stress. Cortisol is a hormone that plays a key role in energy regulation and the body's response to stress. It's not just about stress management but also about maintaining energy levels and other bodily functions. In the luteal phase, the lower levels of cortisol, combined with hormonal changes like increased progesterone, can affect your energy and mood. It's the balance of hormones, not just the presence of cortisol, that influences how you feel.

It's important to remember that hormonal balance is key, and each hormone, including cortisol, has its role in maintaining health - at the right level.

Research study: Higher Circulating Cortisol in the Follicular vs. Luteal Phase of the Menstrual Cycle: A Meta-Analysis

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How Does Cronic Stress (High Cortisol) Affect Female Hormones?

Prolonged periods of stress can disrupt the balance of female hormones causing:

  1. Menstrual Cycle Disruption: Chronic stress can interfere with the hormones that regulate the menstrual cycle, such as gonadotropin-releasing hormone (GnRH). This disruption can lead to irregular periods or even amenorrhea.
  2. Ovulation Impact: Elevated cortisol can affect ovulation. Stress can suppress the surge of luteinizing hormone (LH) necessary for ovulation, leading to anovulatory cycles (cycles where ovulation doesn't occur).
  3. Progesterone Levels: Under stress, the body may divert the precursors for progesterone to produce more cortisol, a phenomenon known as "pregnenolone steal." Since progesterone is key for the luteal phase of the menstrual cycle, this can further disrupt menstrual regularity and affect overall reproductive health.
  4. Fertility Issues: Chronic stress, through its impact on ovulation and hormonal balance, can affect fertility. Women under consistent stress may experience more difficulty conceiving.
  5. Mood and Physical Symptoms: Hormonal fluctuations influenced by cortisol can exacerbate premenstrual syndrome (PMS) or lead to mood swings, anxiety, and depression, impacting overall well-being.
  6. Impact on Hormone Therapy: For women receiving hormone therapy, high cortisol levels can affect the efficacy of the treatment, as the hormonal balance in the body is already in a delicate state.

Additionally, chronic stress can also cause:

  • Mid-Section Weight Gain: A high level of cortisol suppresses the reproductive hormones, estrogen and
    progesterone which can result in fat deposits, often in the middle section of the body.
  • Painful Periods: Fluctuation of these hormones could be the cause of painful cramps, night sweats, sleep problems, mood swings spotting, late or skipped periods

Note, that if not managed, chronic stress (high cortisol) can cause many other important hormones to become out of balance.

What happens if you have too much cortisol hormone?

Too much of the cortisol stress hormone can:

  • Shut down digestion
  • Increase blood pressure
  • Suppress thyroid function
  • Delay ovulation
  • Raise blood sugar
  • Impair immune system

What Are Normal Cortisol Levels in Women?

Normal levels can vary, but they generally range from 10 to 20 micrograms/dL in the morning and drop to 3-10 micrograms/dL by the evening.

Higher-than-normal cortisol levels may also be an indicator of:

  • Tumor or excess growth of the pituitary gland
  • Tumor in your adrenal gland
  • Tumors elsewhere in your body that are involved in cortisol production

Lower-than-normal cortisol levels may indicate that:

  • Addison’s disease
  • Hypopituitarism

Symptoms of High Cortisol Levels in Women

  • Easily getting bruised
  • Thinning of your skin
  • Increased acne
  • Weight gain focussed around the upper back and midsection
  • Slow healing
  • Mild swelling or fat gain, causing rounding of your face
  • Easily irritated
  • Increase in blood pressure
  • Headaches
  • Concentration difficulties
  • Weakness in muscle strength
  • High fatigue
Symptoms of high cortisol levels in women

Symptoms of Low Cortisol in Women

As mentioned in the previous section, the underlying reason for lowered cortisol levels in females could be a disease called Addison's. Therefore the symptoms associated with low cortisol levels would be similar to those of Addison's, as given below.

  • Low blood sugar
  • Low appetite
  • High levels of fatigue
  • Loss in body weight
  • Muscle, abdominal or joint pains
  • Depression or irritation
  • Craving for salt
  • Low libido
  • Hair loss

How to Keep Your Cortisol Under Control

There are many natural ways to reduce your cortisol level. Some of them include:

  • Getting the right amount of sleep
  • Exercise (but not too much - opt for low-impact workouts like yoga, or walking instead of strength training or HIIT)
  • Meditation and relaxation.
  • Meet friends and family: anything that fills your bucket
  • Have fun: go to a play, visit a museum, take part in activities that you enjoy
  • Eat Healthy foods that replenish your microbiome and avoid processed foods.
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Key Nutrients to take to control cortisol levels

Some of the key nutrients required to take control of your cortisol levels are:

  • Omega 3-fatty acids: affect physiological and perceived reactions to mental stress.
  • Magnesium: Helps muscle relax, reduces inflammation, and metabolizes cortisol
  • Vitamin C: Helps strengthen and support your immune system as your body is going through chronic stress, also the antioxidant will help lower cortisol levels
  • Fermented Foods: Probiotic-rich and fermented foods can help balance blood sugar and they may also help to protect mental health in the long run as it targets the microbes in the gut.
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How can I test my cortisol levels at home?

There is a simple at-home test that can be done known as the saliva cortisol test. Saliva for cortisol testing is usually collected by inserting a swab into the mouth and waiting a few minutes while the swab becomes saturated with saliva.

Obtaining more than one sample allows the health practitioner to evaluate the daily pattern of cortisol secretion. Most results take 1-2 days, but some take longer. See the test description for an estimate of how long your results might take.

a woman looking into the distance depressed

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