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When we asked you all during Deinfluencing Month what other topics you wanted us to dig into, we heard one thing over and over again: cortisol.
You asked: What is it? Is it bad? Am I supposed to be getting rid of it? Am I doing all the wrong kind of exercise that’s somehow causing it and now my face is puffy?
Friends, I have been down these Instagram rabbit holes and I understand the deluge of questions it can trigger.
Which is why I called up Dr. Tina Zhang, the co-director of the Women’s Wellness & Healthy Aging Program at Johns Hopkins University and an expert in menopause care. And best of all — she’s someone who spends as much time poking around on Instagram as I do.
Cue the expert
Zhang told me that she understands why cortisol keeps coming up online within the context of perimenopause: Cortisol is a hormone.
More specifically, it’s a steroid hormone produced by the adrenal glands and is referred to as the body’s “stress hormone” because it is released in response to stress.
Stress management is one of cortisol’s primary roles. In high-stress situations, it provides energy, breaking down fat to fuel the body. Cortisol also helps to reduce inflammation, controls our blood pressure and blood pressure levels, manages the fight-or-flight response, and regulates the sleep-wake cycle.
In other words, it does a lot of really important things in your body! It is definitely not something to be eliminated altogether, as some influencers would have you believe.
And here’s where our midlife changes come in.
During perimenopause, we see a decline in estrogen and progesterone — two hormones that are key for regulating cortisol. This means cortisol levels can also become less balanced and there can be real concern about them getting too high.
When cortisol is too high, Zhang explained, it becomes harder to fall asleep and stay asleep — two things essential for healthy aging. It can also promote weight gain. That’s because cortisol is there to help you be ready to respond to stress — it cues the body to store more fat, especially around the midsection, so you can have all the energy you need to do hard things. That’s why higher cortisol levels can also increase appetite and trigger cravings.
The stress of this time of life and the lack of sleep that can result from that can also raise your cortisol levels. High cortisol levels can make sleep even harder — and now you’re in a cycle of stress, sleep and weight gain.
What not to do
And that’s when so many influencers enter the proverbial chat.
First things first: Zhang says she does not recommend testing for cortisol. Lots of people inquire about that after seeing influencers insist it is a crucial need.
“I always validate my patients and acknowledge that their symptoms are real. And yes, cortisol does play a role in stress and sleep and weight — but just checking a cortisol level does not give us any helpful information,” Zhang said. The test is just a snapshot as cortisol shifts in response to so many things. “It fluctuates so much that it’s really hard to interpret.”
This doesn’t mean that cortisol may not be influencing your symptoms — Zhang adds that even if a cortisol test came back normal, it wouldn’t mean it had nothing to do with what you’re feeling — but rather that getting that test done isn’t going to provide information that can move the needle in a meaningful way.
What to do
Zhang said that “every single day” she has conversations with patients about cortisol — and explains that the best way to address the symptoms associated with it are through better sleep hygiene, good stress management, regular exercise and a low-inflammation diet.
And despite what you might have read or heard on social media, exercise is not the enemy when it comes to cortisol. At all.
“If I were to check a cortisol level right after you exercise, it’s going to be high,” Zhang said — again, because cortisol is a stress hormone and exercise, by design, stresses the body. But that’s not the whole story. “Consistent exercise over time actually helps reduce your overall cortisol trends.”
Zhang said this duality often feels confusing.
“If I check right after they exercise, yes it’s going to be high — but regular exercise will help manage weight, will improve your sleep and help with stress relief.” And all of these things will reduce your cortisol levels.
If exercise helps reduce your stress, do it. The same is true for other things that can help reduce stress — maybe a breathing practice or meditation.
Sweet dreams
The other biggest factor for reducing cortisol is sleep.
For some people, Zhang said, getting better sleep will be as simple as limiting caffeine, alcohol and screen time before bed and staying on a consistent sleep schedule.
For others, sleep is harder to come by — and she recommends that these people talk to their healthcare providers about things like magnesium and melatonin or the use of cognitive behavioral therapy.
If sleep feels harder during perimenopause, you aren’t just making that up. The decline of estrogen changes how sleep is regulated in your brain.
“You naturally are going to have issues with sleep just because of perimenopause. On top of that, when you have hot flashes and night sweats, you’re not going to be sleeping. And then on top of that, people are stressed and that’s not good for sleep either.”
It’s why talking to your provider about your sleep — and how to get more and better sleep — is so important in midlife.
Supplements? Thank you, next
Zhang also cautioned against the use of supplements that claim to lower cortisol. It’s not that all supplements are bad, per se, but rather that supplements are so much less regulated than prescription medications. And anyone promising they can sell you something that lowers cortisol doesn’t understand what the hormone is anyway.
When it comes to supplements, Zhang recommends that women take vitamin D and calcium for bone health and reiterated that magnesium can be very helpful for sleep and muscle relaxation.
So forever reminder: Talk to your doctor about your medical history to determine any deficiencies that might need to be addressed through supplementation and what makes the most sense for you and your health needs.
The bottom line
“It is so awesome that women are eager to learn more and have more information about their health and the menopause transition, but there is a lot of misinformation out there with regards to cortisol,” Zhang said. “Importantly, I think cortisol is not all bad. We need cortisol in our body for all of the functions that I mentioned. It’s about balancing it.”
The best way to keep cortisol levels healthy in midlife and beyond?
“Focus on sleeping better, controlling stress and exercising.”
