How Cortisol Affects Women's Health and the Menstrual Cycle

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Dr. Khoshaba

April 30, 2023

Cortisol, commonly known as the "stress hormone," plays a crucial role in regulating various physiological processes in the human body. Produced by the adrenal glands, cortisol is involved in the regulation of metabolism, immune function, and the body's response to stress. 

While cortisol is essential for maintaining overall health, its impact on women's health and the menstrual cycle is often overlooked. This article explores how cortisol affects women's health and the menstrual cycle, specifically how it influences the menstrual cycle and overall well-being. We’ll talk about the following topics:

Understanding Cortisol and its Functions 

Cortisol structure
Cortisol structure

Cortisol is a steroid hormone produced by the adrenal glands, which are located on top of each kidney. It belongs to a class of hormones called glucocorticoids and plays a vital role in regulating various bodily functions. The production and release of cortisol are mainly controlled by the hypothalamic-pituitary-adrenal (HPA) axis in response to stress.

Here are some of the primary functions of cortisol:

  • Regulation of metabolism: Cortisol helps maintain blood sugar levels by promoting gluconeogenesis, the process by which the liver produces glucose from amino acids and other non-carbohydrate sources. Cortisol also influences the metabolism of fats, proteins, and carbohydrates, ensuring the body has a constant energy supply.
  • Immune system function: Cortisol has anti-inflammatory and immunosuppressive properties, which help regulate the immune system's response to infections or injuries. While short-term elevations in cortisol can be beneficial in reducing inflammation, chronic high cortisol levels can weaken the immune system and increase susceptibility to infections.
  • Blood pressure regulation: Cortisol helps maintain healthy blood pressure by constricting blood vessels and increasing the sensitivity of blood vessel receptors to the hormone epinephrine, which narrows blood vessels and increases blood pressure.
  • Central nervous system (CNS) effects: Cortisol can influence mood, memory, and cognition. It is involved in maintaining alertness and the ability to cope with stress.

The stress response is an adaptive mechanism that helps the body cope with short-term stressors. However, chronic stress can lead to continuously elevated cortisol levels, which can negatively affect health, including women’s menstrual cycle.

How Cortisol Affects the Menstrual Cycle

As mentioned above, it can have negative effects on various body systems when cortisol levels are consistently high due to chronic stress, including the menstrual cycle. Here's how cortisol can affect the menstrual cycle:

Hormone Imbalance

Cortisol can interfere with the balance of reproductive hormones, including estrogen and progesterone, which are essential for regulating the menstrual cycle. High cortisol levels can suppress the secretion of gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH). 

These hormones are responsible for triggering ovulation and maintaining a regular menstrual cycle. Disruption in their release can lead to irregular periods or anovulation (absence of ovulation).

Altered Menstrual Patterns

Chronic stress and elevated cortisol levels can change the length and regularity of the menstrual cycle. Women may experience shorter or longer cycles, missed periods, or heavier or lighter bleeding than usual.

Premenstrual Syndrome (PMS)

High cortisol levels can exacerbate the symptoms of PMS, including mood swings, irritability, fatigue, and physical discomfort. This is because cortisol can influence neurotransmitters like serotonin, which affect mood regulation.

Polycystic Ovary Syndrome (PCOS)

Evidence suggests that high cortisol levels might be associated with developing or exacerbating PCOS, a hormonal disorder characterized by irregular periods and high levels of androgens (male hormones), and the presence of small cysts on the ovaries. 

High cortisol levels may contribute to insulin resistance, a common feature of PCOS, which can further worsen hormonal imbalances and menstrual cycle irregularities.

It is important to note that cortisol is just one of many factors that can influence the menstrual cycle, and individual responses to stress and cortisol levels can vary. If you are concerned about your menstrual cycle or cortisol levels, it is recommended to consult a healthcare professional for a thorough evaluation and personalized advice.

The Effects of Cortisol Imbalance on Fertility and Pregnancy 

Cortisol imbalance, particularly high cortisol levels, can also significantly impact fertility and pregnancy. Here are some of the ways:

Fertility issues

As mentioned earlier, high cortisol levels can contribute to fertility problems by affecting ovulation. Irregular ovulation makes it difficult for women to conceive. Additionally, hormonal imbalances caused by high cortisol levels may increase the risk of miscarriage.

Irregular ovulation or anovulation 

Hormones are responsible for triggering ovulation and maintaining a regular menstrual cycle. Disruption in their release can lead to irregular periods or anovulation (absence of ovulation), making it difficult for women to conceive.

Pregnancy complications

Elevated cortisol levels during pregnancy have been associated with an increased risk of complications, such as gestational diabetes, preeclampsia (a condition characterized by high blood pressure and damage to organs like the liver and kidneys), and preterm birth. These complications can pose risks to both the mother and the baby.

Fetal development

High cortisol levels during pregnancy can cross the placental barrier and affect the developing fetus. Excess cortisol exposure in utero has been linked to changes in fetal growth, development, and long-term health outcomes. Some studies suggest that increased cortisol exposure during pregnancy may be associated with increased stress reactivity, behavioral problems, and cognitive issues in the offspring.

Postpartum depression

Elevated cortisol levels during pregnancy may increase the risk of postpartum depression, a mood disorder affecting some women after childbirth. Postpartum depression can impact the mother's ability to bond with and care for her baby and her well-being.

Symptoms and Other Health Risks of High Cortisol Levels 

Symptoms of high cortisol levels, women's health and the menstrual cycle

High cortisol levels can have various associated symptoms and health risks, affecting the menstrual cycle and overall health. Here are some symptoms and health risks related to high cortisol levels:

  • Weight gain: High cortisol levels can contribute to weight gain by promoting visceral fat accumulation (fat around the organs) and increasing appetite. Cortisol can also cause insulin resistance, which may lead to further weight gain and an increased risk of type 2 diabetes.
  • Insomnia and sleep disturbances: High cortisol levels can interfere with the body's natural sleep-wake cycle, leading to difficulty falling asleep, staying asleep, or experiencing restorative sleep. This can result in chronic fatigue and reduced overall well-being.
  • Anxiety and depression: Chronic stress and elevated cortisol levels have been linked to an increased risk of anxiety and depression. Cortisol can affect the production and function of neurotransmitters, like serotonin, which play a role in mood regulation.
  • Weakened immune system: High cortisol levels can suppress the immune system, making it more difficult for the body to fight off infections and increasing susceptibility to illnesses.
  • Cognitive difficulties: Chronic stress and high cortisol levels can negatively impact memory, concentration, and overall cognitive function.
  • High blood pressure and cardiovascular risks: Elevated cortisol levels can contribute to high blood pressure, which increases the risk of heart disease, stroke, and other cardiovascular problems.
  • Reduced bone density and muscle mass: High cortisol levels can interfere with bone formation and increase the rate of bone breakdown, potentially leading to osteoporosis. Additionally, cortisol can cause muscle atrophy by breaking down muscle proteins for energy.
  • Gastrointestinal problems: Chronic stress and high cortisol levels can cause or exacerbate gastrointestinal issues, such as irritable bowel syndrome (IBS), ulcers, and acid reflux.

Strategies to Manage Cortisol Levels and Promote Hormonal Balance

Managing cortisol levels and promoting hormonal balance is crucial for maintaining overall health and well-being. Here are some strategies to help you manage cortisol levels and promote hormonal balance:

  1. Stress management: Engage in activities that help reduce stress, such as meditation, deep breathing exercises, or yoga. Incorporating these practices into your daily routine can help you manage stress and keep cortisol levels in check.
  2. Regular exercise: Moderate exercise can help regulate cortisol levels, improve mood, and support overall hormonal balance. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with muscle-strengthening exercises two or more days per week.
  3. Prioritize sleep: Getting enough sleep is crucial for regulating cortisol levels and maintaining hormonal balance. Aim for 7-9 hours of quality sleep each night, and establish a consistent sleep schedule to support your body's natural circadian rhythm.
  4. Balanced diet: Eat a balanced diet rich in whole foods, including fruits, vegetables, lean proteins, whole grains, and healthy fats. A nutritious diet can help provide the nutrients needed to support hormone production and maintain hormonal balance.
  5. Limit caffeine and alcohol intake: Excessive caffeine and alcohol consumption can contribute to increased cortisol levels and hormonal imbalances. Limit your intake of these substances to support healthy cortisol levels and overall hormonal balance.
  6. Stay connected: Social support is essential for managing stress and maintaining emotional well-being. Stay connected with friends, family, or support groups to help you navigate life's challenges and manage cortisol levels.
  7. Practice relaxation techniques: Engage in activities that promote relaxation, such as progressive muscle relaxation, guided imagery, or mindful self-compassion. These techniques can help reduce stress and promote healthy cortisol levels.
  8. Cognitive-behavioral therapy (CBT): CBT is a type of psychotherapy that can help you identify and change unhealthy thought patterns and behaviors, thereby reducing stress and promoting hormonal balance. Consider working with a therapist specializing in CBT if you're struggling with stress management.
  9. Supplements and adaptogens: Some supplements and adaptogens may help manage cortisol levels and support hormonal balance. However, it is essential to consult with a healthcare professional before starting any new supplement regimen.
  10. Maintain a healthy body weight: Being overweight or underweight can contribute to hormonal imbalances, including elevated cortisol levels. Aim to maintain a healthy body weight through a balanced diet and regular physical activity.

It is important to note that individual responses to stress and cortisol levels can vary. If you are concerned about your cortisol levels or hormonal balance, consult a healthcare professional for a thorough evaluation and personalized advice.


We asked a psychiatrist to give us insight into how physical maladies such as cortisol levels can affect mental health. This is what she said:

"In my practice at Zensible Psychiatry, I routinely see patients whose mental distress is exacerbated by physical health issues like chronic high cortisol. Through integrated care and collaborative approach to mental health, we can help to address the complex interplay between physical health ailments and mental wellbeing. It’s imperative to view mental health through a holistic lens, considering all aspects of health - physical, emotional, and environmental as they are interrelated and integral parts of overall well-being."

Kimberly Kuopus | Zensible Psychiatry in Phoenix, AZ.

Conclusion: Embracing a Holistic Approach to Women's Health

Cortisol plays a significant role in women's health, particularly in relation to the menstrual cycle. Chronic stress and elevated cortisol levels can disrupt hormonal balance, leading to irregular menstrual cycles, fertility issues, and exacerbated PMS symptoms. By adopting effective stress management strategies, women can better manage cortisol levels.

If you suspect that you have high cortisol levels or are experiencing symptoms related to elevated cortisol, it is essential to consult with a healthcare professional for a thorough evaluation and personalized advice. There are various stress reduction techniques and treatments available that can help restore cortisol balance and improve overall health.

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Dr. Linda Khoshaba is the Leading Integrative Health and Hormone Doctor in Scottsdale, Arizona. She has extensive experience working in the field as a Hormone Specialist and Natural Endocrinologist.

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