Breakthrough: Cortisol Plays a Critical Role in Menopause

Updated: Jul 29

Medically reviewed by Ioana Bina, MD, PhD



Menopause is one of the biggest biological changes women go through.


After all, it doesn’t only disrupt and end menstrual cycles. For some women, it can upend sleep patterns, metabolic processes, cardiovascular health and even mental wellbeing. Not to mention the random hot flashes. Some of these symptoms can last upward of a decade.


That can be stressful. Seemingly sudden and arbitrary changes to your body always are. But what if we told you these changes didn’t have to feel so sudden? What if women could feel better prepared, less anxious and more in control when menopause hits?


That’s one of the key reasons we started digging into this area of endocrinology. At Pardigm, we’re interested in helping people by exploring the science behind cortisol, the main stress hormone. But stress is only a fraction of the cortisol equation.


Cortisol also plays a role in, you guessed it, menopause. In fact, the more we investigated and consulted with our panel of experts … the more we realized just how important (and overlooked) that role is.


Recently, some Stanford OB-GYN professors introduced us to Professor Sarah Berga, M.D. who made several scientific breakthroughs. Dr. Berga whose research focuses on reproductive endocrinology, specifically stress’s role in reproductive compromise sits on the Mayo Clinic Proceedings and previously on The Journal of Clinical Endocrinology & Metabolism editorial board.


Dr. Berga and the well-known Seattle Midlife Women’s Health Study suggest that cortisol is an underappreciated factor in menopause symptoms, not only estrogen or progesterone imbalances as many scientists previously thought.


But there’s hope. If women are able to sustain an optimal cortisol level, it could dictate just how well the transitional period goes for them…


Cortisol’s Role in Menopause


Menopause is a natural stage in life, despite it only occurring in humans and a few marine mammals. As women enter their 40s, their ovaries tend to produce fluctuating levels of estrogen. This production decreases until they no longer menstruate. At some, point their ovaries “retire” they cease to produce sex hormones and the adrenal glands take over. Once 12 months have passed since their last period, they’ve officially reached menopause.


That’s the simple version of events. But biology is never simple.


To show you what we mean, let’s start with the four main hormones to watch during menopause:


Estrogen: When we think about menopause, we typically first think about estrogen – we’re referring mostly to estradiol (E2) – the sex hormone that regulates the menstrual cycle. When estrogen levels drop, usually around or after the age of 45, this signals perimenopause (the start of the transition to menopause). However, estrogen isn’t simply dwindling during this time. It’s rising and falling like a rollercoaster, right up until it plummets.


This spawns many of the menopausal symptoms women experience, but it isn’t a completely straightforward causal relationship.


For one, low and high estrogen levels are also seen as a stressor for the body, which can affect cortisol levels. That’s why it’s critical to balance cortisol levels throughout our lives, especially during menopause.


Interestingly, as a result of the steep increase in life expectancy, many women will spend the second half of their lives with an estrogen deficiency. Estrogen deficiencies have been linked to degenerative diseases of the cardiovascular, skeletal and central nervous systems. Low estrogen can also enhance metabolic dysfunction, which can lead to obesity, metabolic syndrome, type 2 diabetes, and even cancers (such as breast, colon, and liver cancer).


But here’s something else to consider: As estrogen decreases, it also throws off the balance with progesterone…


Progesterone: Before menopause, women were typically adept at buffering stress because progesterone often called the “feel good” hormone and the pregnancy hormone and dehydroepiandrosteron