Menopause and Cortisol: Are You Focusing on the Wrong Hormone?
Have you ever wondered why some women seem to sail through perimenopause whilst others feel as though their entire body has fallen apart? Why one-woman experiences little more than a few changes to her periods, whilst another is awake at four in the morning with a racing mind, struggling to remember words, feeling anxious for no apparent reason and wondering where on earth her energy has gone?
We tend to assume that the difference must be down to hormones, and of course, our hormones play a significant role. But I want you to consider something else, because after more than twenty years of studying Chinese medicine and working with women, I've come to see another pattern emerging time and time again.
The term ‘depletion’ I talk about isn’t about whether you’re losing your womanhood; but it is entirely about how life has exhausted you with the demands that it places on you as a woman and what nutrition can help you with.
Today I want to really highlight that you do not get enough nutrients in your daily life to support the amount of effort that you put into living and as your body enters into your menopause era the changing hormone pattern magnifies the gaps in this lifestyle pattern. From my experience how you transition through perimenopause to menopause and beyond has a lot more to do with your cortisol hormone levels; and this when elevated and without the amount of nutrition it requires to do its job IS the cause of a majority of your symptoms.
How well is your body is coping with the demands being placed upon it?
We're constantly told that menopause is about declining oestrogen and that replacing it is the answer to our symptoms. For some women, HRT makes a tremendous difference and is absolutely the right choice; but there is another hormone that deserves much more attention in this conversation, particularly during perimenopause, and that's cortisol, our principal stress hormone.
My question is this: before we automatically look at what we can add, shouldn't we also consider what we might need to reduce?
The Hormone We Rarely Talk About Enough- Cortisol
Cortisol has something of a bad reputation because we tend to associate it with stress, anxiety and everything that goes wrong when life becomes overwhelming. Yet cortisol is essential to life; it helps regulate blood glucose, blood pressure, inflammation, metabolism and our response to physical and emotional demands. We need it to rise and fall in a healthy daily rhythm, giving us the energy to get going in the morning whilst allowing our bodies to wind down when it's time to rest.
The problem isn't cortisol itself, but the demands placed upon the systems that regulate it.
Think about the life many women lead in their forties and fifties. Working, managing households, raising children or worrying about them as they leave home, supporting ageing parents, navigating relationships and trying to keep all the plates spinning. You may have spent decades putting your own needs at the bottom of the list, running on coffee, grabbing whatever food is convenient and pushing through tiredness because there simply isn't time to stop.
Then perimenopause arrives, bringing its own biological changes, and suddenly the strategies that kept you going for years doesn’t seem to work anymore.
If you’ve become anxious when you never used to be; sleep becomes elusive, patience disappears, and now your memory seems unreliable plus you’re exhausted despite having achieved very little that day. You may feel wired when you should be tired, and for some you just can’t see how to go on.
I know this pattern because I've lived it myself, and I see it regularly in my consultations.
The hormonal transition is a genuine physiological change, and research has found associations between cortisol patterns and certain menopausal symptoms, including hot flushes and night sweats. Cortisol is a hormone that is released alongside adrenalin – this is important to know. When you feel that adrenal surge cortisol is the silent partner in the background and it gets to work when the initial rush is over. Cortisol requires nutrients to do it’s job effectively and this is where the issues arises. If cortisol can’t get enough available nutrients it starts to leech them from other symptoms such as joints your brain and gut; leaving you with possible pain brain fog or anxiety.
I'm not suggesting that every hot flush, every sleepless night or every mood change is caused by cortisol; menopause is far more complicated than that. What I am suggesting is that the stress your body is already carrying may influence how well you cope with the hormonal transition, and that supporting your stress response deserves a place alongside the other approaches available to you.
Perimenopause Is Not Happening In Isolation
One of the things I find fascinating about the human body is that nothing works entirely on its own. Your reproductive hormones, nervous system, digestive system, immune function and metabolism are all communicating with one another, constantly adapting to what's happening inside and around you.
When your ovaries begin producing hormones less predictably, your body has to adjust. If you're already exhausted, undernourished, sleeping poorly or carrying a considerable burden of stress, you have more demands competing for your body's resources at precisely the time when you may be feeling less resilient.
This is where I believe we sometimes miss an opportunity.
If focusing on the hormonal change itself, yet overlooking the conditions in which that change is taking place is fundamentally the wrong approach. The medical and marketing machines ask how you can replace oestrogen, but perhaps should be asking how you can improve sleep, replenish nutritional shortfalls, support digestion and reduce the constant demands that leave the body struggling to recover.
Chinese medicine has always encouraged me to look at the whole picture rather than treating each symptom as an isolated problem. Modern nutritional science and research into stress physiology give us additional ways to understand why this matters.
Your hormones don't operate in a vacuum, and neither do your symptoms.
What If You Need To Take Away Before You Add Anything Else?
I'm not anti-HRT as it can be an appropriate treatment for symptom relief that is strictly reliant on oestrogen but that isn’t many of the extensive symptom list. HRT has its benefits and risks that should be considered individually with a qualified healthcare professional.
What I do question is the idea that the only answer to changing hormones is to add more hormones when this just isn’t the correct way of looking at it.
Imagine trying to keep a car running when it's low on fuel, the engine is overheating and the oil needs changing. Then you’re told that the solution is to fit a turbo booster?! That would be bad advice and in next to no time your car would run out of fuel or over heat or kill the engine as the oil had clogged up with toxins. If we don’t do this to our cars…. Why do we do it to our bodies?
That's how I think about menopause. I want to understand what your body is dealing with before deciding what support it needs. For some women, that will include HRT; for others, nutritional changes, lifestyle adjustments and holistic support will be important parts of their approach, and many will benefit from a combination of these options.
Rather than reaching for the hormonal equivalent of a sledgehammer to crack a nut, I want us to look at the whole picture and consider whether there are simpler, more immediate changes that could help you feel better.
And one of the first places I look is nutrition.
Your Stress Response Needs Nutritional Support
Here's something that I don't think women hear often enough: dealing with stress isn't simply a matter of changing your mindset or learning to relax. Your body has to carry out the physical work involved in responding to stress, and that work depends on having the energy and nutrients needed to support normal physiological processes.
When life becomes demanding, it's easy to forget to eat properly, skip meals, rely on caffeine to get through the afternoon or reach for sugary foods when energy levels plummet. You may feel that you're eating reasonably well, yet still struggle to get enough variety, protein, healthy fats, fibre, vitamins and minerals to meet your needs.
Think about the building blocks your body needs to function well. Protein supplies amino acids; fats provide essential fatty acids (Omega 3 oils); carbohydrates provide energy, and vitamins and minerals support the many processes that keep your brain, nervous system and other organs working. Your body needs a reliable supply of these resources, particularly when you're coping with multiple demands.
If you've been under pressure for years, sleeping badly and eating on the run, it makes sense to look at whether your nutritional foundations are strong enough.
You cannot always remove the stress in your life, but you can start changing how well equipped your body is to cope with it.
You Can Start To Feel Better Quicker Than You May Expect
One of the most encouraging things about improving your nutritional intake is that you don't necessarily have to wait until you've transformed your entire life before noticing a difference.
Removing all of the stressors in your everyday life isn’t a feasible ask but giving your body the resources to cope with it … is! Start by eating more regularly, choosing more nourishing foods and addressing any nutritional shortfalls that may be contributing to your symptoms.
See my supportive supplements guide here >>
The first improvements you can notice is better energy, fewer afternoon slumps or feeling more emotionally resilient. Others notice that their sleep begins to improve or that they feel less overwhelmed by things that previously seemed impossible to manage. The timing varies, and nutrition isn't a guaranteed quick fix for every menopause symptom (though a majority do start to lessen measurably), but it is a practical starting point whilst you work on the bigger picture.
I also want to make an important distinction here. Eating well supports the body's normal stress-response systems; it doesn't mean that a particular food or supplement will reliably lower cortisol within days. The evidence for stress-management approaches is stronger in this respect: a 2024 systematic review and meta-analysis of 58 studies involving 3,508 participants found that interventions such as mindfulness and relaxation had measurable effects on cortisol. Read the research here.
For me, the two approaches belong together. Nutritional support helps provide the building blocks your body needs, whilst lifestyle changes can gradually reduce the demands being placed upon it.
One supports your capacity to cope; the other helps change the conditions you're coping with.
Your Emotions Are Physical Too
Anxiety, so many women tell me they don't understand why they suddenly feel anxious when nothing in their lives seems to have changed.
They've always been capable, organised and resilient. They've dealt with difficult situations, raised families, built careers and managed responsibilities without falling apart. Yet now they find themselves worrying at four in the morning, crying at the smallest thing or feeling a wave of panic that seems to come from nowhere. This got me – big time! I’d overcome everyday anxiety in my 30s when I first started studying Chinese medicine so it distressed me when it reappeared in my mid-40s and my head was in a good place. I had to find out what the trigger was when it was no longer my mind.
Your first instinct is to blame yourself or wrack your brain for the emotional cause; this isn’t necessarily the case. Don't be so hard on yourself anxiety in perimenopause and especially if you’ve never had it before can have a physical cause.
Your emotions are connected to your physical state, and the brain depends on a constant supply of energy and nutrients to function. Sleep disruption, hormonal fluctuations, prolonged stress and nutritional deficiencies can all influence mood and emotional resilience. That doesn't mean anxiety is always a nutritional problem, or that improving your diet will resolve every emotional difficulty; it does mean that your physical health deserves attention when your emotions begin to feel unfamiliar.
In Chinese medicine, I learnt to look for patterns rather than assuming that every emotional symptom has a purely psychological origin. When a woman tells me she's anxious, exhausted, waking in the early hours and struggling to think clearly, I don't simply tell her to relax. I look at the combination of symptoms and ask what they might reveal about the state of her body.
Sometimes there are several contributing factors, and we need to address more than one. But understanding that your physical state may be influencing your emotional experience can be a huge relief in itself. You haven't lost the person you used to be; your body simply needs a different kind of support.
Menopause - Reduce The Stress, Not Just Cope With It
Nutritional support can be a useful starting point, but if you continue living in a state of constant pressure, you may find yourself repeatedly returning to the same place. This is where the longer-term work begins.
It means looking honestly at how you live, how much rest you get and whether your expectations of yourself are realistic. It means recognising that being the person who always copes can come at a cost, particularly when you never allow yourself the time or space to recover. Also, I hear time and again: ‘ but when I was in my 30s I could…’; please stop competing with your younger self.
Maturing emotionally with menopause can involve learning to say no without feeling guilty, changing how you respond to stressful situations, reducing the caffeine that keeps you going when you're exhausted or reconsidering an exercise routine that leaves you more depleted than energised. For some women, it means introducing regular relaxation, meditation, yoga, qigong or other mind-body practices that help them step out of constant activity and reconnect with themselves.
These aren't indulgences, and they aren't signs of weakness. They are ways of changing the conditions in which your body has to function.
The research supports taking this seriously. The 2024 review I mentioned earlier found that stress-management interventions can influence cortisol, particularly approaches involving mindfulness and relaxation. That doesn't guarantee a reduction in menopause symptoms for every woman, but it does support the principle that our stress response is something we can work with rather than simply endure.
You don't have to change everything overnight, and I would never want the process of improving your health to become another source of stress. Small, consistent changes are often a much more realistic place to begin.
Menopause and Cortisol - What Are Your Symptoms Trying To Tell You?
This is where everything comes together for you.
When a woman comes to see me, I want to know how she's sleeping, what happens to her energy throughout the day, whether she feels anxious, how her digestion is working and what else has been happening in her life. I want the whole story because symptoms rarely appear in isolation. The combination of symptoms, the order in which they developed and the history behind them can help me recognise patterns that might otherwise be missed.
Perhaps your body is struggling to recover from prolonged stress. Maybe your diet isn't providing everything you need, or your digestion is affecting how well you absorb nutrients. Is your disrupted sleep making everything harder to manage, or the hormonal changes of perimenopause are interacting with pressures that were already there.
This is why I say that I decode symptoms. Your body doesn't speak English; it speaks through the changes you experience, and those changes can provide valuable clues about where to begin.
Rather than chasing another supplement or assuming that one hormone explains everything, we can start asking better questions and building a plan around what your body is actually telling us.
Before Adding Hormones, Give Your Body A Chance To Tell Its Story
I want you to understand that you have options. You don't have to choose between ignoring your symptoms and assuming that hormones are the only answer. You can work with your healthcare professional to understand the hormonal changes taking place whilst also looking at nutrition, sleep, stress and the other factors that influence how you feel.
What matters is that society stops treating the body as though it were a collection of unrelated symptoms and start understanding the connections between them.
Your body is remarkably adaptable, and it responds to the conditions in which you ask it to function. When you begin giving it the nourishment it needs, allowing it time to recover and reducing the pressure where you can, you create a better foundation for health, even while the hormonal transition continues.
You may not be able to remove every stressor from your life, and you cannot prevent every symptom of menopause. But you can begin to change the way you support yourself through it.
So, before you ask, "Which hormone do I need to add?", ask yourself another question:
"What can I give my body, and what can I take away, to help it cope with the changes it's going through?"
Sometimes the most useful place to begin isn't with another intervention; it's with understanding what your body has been trying to tell you all along.
And that is where real change begins.
I'm here to support your in taking your first steps - whether it's self help or a consultation - you can start here.
About Andrea at Cotswold Menopause
Andrea is a shiatsu and chinese medicine practitioner who uses the principles of chinese medicine in a completely practical way to help you resolve your symptoms naturally and for good. If you live locally you can book in for wonderfully relaxing Shiatsu for Menopause where we start to relieve your symptoms on the same day. Otherwise Andrea does online indepth consultations where you'll leave with an actionable plan to follow. Andrea is also passionate about doing workplace talks and is passionate about getting this message out to as many women as possible: Give your body what it wants to create the hormones that it needs!
KNOWLEDGE . PAUSE . FLOURISH
