Cortisol and menopause: what is known and what a test can show

Menopause is a change in the ovaries and the hormones they make. Cortisol comes from the adrenal glands. The two meet in people’s questions because sleep, mood and energy shift around menopause, and cortisol is known as the stress hormone. This page covers what the research does and doesn’t show about cortisol and menopause, why a blood test is not usually needed to diagnose menopause, and when a cortisol test makes sense for a different reason.

Menopause is not usually diagnosed with a blood test

The Office on Women’s Health (OWH) says you reach menopause after 12 months in a row with no period. In the United States the average age is 52. The run-up, perimenopause, lasts about four years on average and can last up to 10. It usually starts in the mid to late 40s, and some women notice symptoms in their mid to late 30s.

OWH adds that your provider can usually tell whether you are in perimenopause from your age, your symptoms and changes in your periods. It suggests tracking your periods and symptoms and sharing them. If your periods stop before age 40, it says you can ask about testing.

So a cortisol test doesn’t tell you whether you are in menopause, and OWH says blood hormone tests are not usually needed. Vaginal bleeding after menopause is not normal, and OWH says to see your provider right away if it happens.

What the official pages say about hormones

OWH says estrogen, progesterone and testosterone act in nearly every system of the body and that their levels fall during perimenopause and after menopause. That, it says, is why menopause can affect sleep, mood, hair, skin, bones, joints, muscles, the bladder, genital tissue and weight.

A hot flash is a sudden feeling of heat, often with flushing and sweating. Night sweats are hot flashes that happen during sleep. OWH says hot flashes and night sweats last 7 to 12 years on average. Neither OWH page mentions cortisol.

Cortisol levels and menopause

Do cortisol levels change at menopause? The research points to differences by sex and age, not to a clear menopause effect that anyone uses to diagnose or manage anything.

A 2024 review in Endocrine Reviews says cortisol levels differ between men and women, with further differences across the menstrual cycle and menopause. It reports that men have higher cortisol output than premenopausal women, and that the daily peak rises gradually with age in women but not in men, so there is no longer a difference after menopause. It says studies across the menstrual cycle give mixed results. It also says age reduces the daily swing in cortisol, and that age-specific cut-offs are typically not used in clinical practice.

For the usual pattern through the day and published ranges, see normal cortisol levels and normal cortisol in women and men.

Cortisol in perimenopause

Perimenopause is when hormone levels change and periods can become irregular. We found few usable studies of cortisol in this stage.

One pilot study in Frontiers in Psychology followed 15 women aged 45 to 55 for 12 weeks. The more a woman’s estradiol fluctuated, the more depressive symptoms and negative mood she reported, and the higher her heart rate went during a laboratory stress test. Estradiol fluctuation was not significantly linked to blood pressure or salivary cortisol during that test. Fifteen women is too few to settle anything. It does show why a simple “menopause raises cortisol, and cortisol causes symptoms” story isn’t established.

Hot flashes and cortisol

Does cortisol cause hot flashes? No source we can cite says so. OWH lists hot flashes and night sweats among menopause symptoms and links menopause symptoms in general to the fall in estrogen, progesterone and testosterone. A cortisol result can’t tell you whether hot flashes are menopausal.

OWH also notes that night sweats, bladder symptoms and mood changes can disrupt sleep, and that menopause can cause insomnia or sleep apnea. If hot flashes, night sweats or poor sleep are bothering you, those are reasons to talk to your provider. This site doesn’t cover treatment. For more on cortisol and sleep, see cortisol and sleep.

When symptoms may not be menopause

Some midlife symptoms show up in other conditions too. Government sources list these overlaps:

• Thyroid. MedlinePlus lists trouble sleeping, nervousness or irritability, fatigue, and sweating or trouble tolerating heat for too much thyroid hormone. For too little, it lists fatigue, weight gain, depression, dry or thinning hair, and heavy or irregular periods. A TSH blood test is the usual first check. See cortisol and the thyroid.
• Adrenal insufficiency. NIDDK lists long-lasting fatigue, muscle weakness, loss of appetite, weight loss and abdominal pain as the most common symptoms. Irregular or no periods and loss of interest in sex are on its longer list.
• Cushing’s syndrome. NIDDK says weight gain and fatigue have many causes and that periods may become irregular or stop. It says Cushing’s syndrome caused by the body’s own overproduction of cortisol is rare, with estimates of about 40 to 70 people per million.

None of this means your symptoms aren’t menopause. Menopause is common and expected at this age. It means a clinician should look at the whole picture, and that tiredness or sleep trouble shouldn’t be assumed to be one thing. See tests for tiredness.

If you take estrogen by mouth

Estrogen taken by mouth raises the protein that carries cortisol in the blood, corticosteroid-binding globulin. A blood test for total cortisol can then read high without any change in how much active cortisol you have. A 2023 laboratory review in Diagnostics says this happens with oral estrogens but not with estrogens absorbed through the skin. A 2024 review in the Journal of the Endocrine Society puts the rise in total cortisol at about 67 percent in women who take birth control pills, a figure it takes from one earlier study, and says tests of free cortisol in urine or saliva are not affected.

Whoever orders the test needs to know about it, because it changes how the result is read. Any change to a medicine is a decision for your prescriber. Don’t stop or change a hormone medicine on your own. Tell whoever orders the test what you take. See cortisol and birth control.

When a cortisol test does fit

There is no menopause reason to test cortisol. A test fits when symptoms point to an adrenal problem, whatever your age. NIDDK lists these signs:

• For too little cortisol: long-lasting fatigue, muscle weakness, weight loss, loss of appetite, and dizziness or fainting when you stand.
• For too much: easy bruising, wide purple stretch marks, a round face, a fatty hump between the shoulders and weak muscles.

Either set is a reason to see a clinician first. MedlinePlus says cortisol blood samples are usually taken twice in a day: once in the morning, when levels are normally highest, and again around 4 p.m., when they are much lower. It says a cortisol test alone can’t identify the cause of an abnormal level. Tests for Cushing’s syndrome are different: a late-night saliva test, a 24-hour urine collection or a dexamethasone suppression test, arranged by a clinician. If you want to look at the timing, see AM and PM cortisol timing. Prices for the same type of test vary widely between sellers, and it is worth comparing. See cost and where to buy.

What about DHEA-S?

You may see DHEA-S sold with midlife “hormone panels”. MedlinePlus says DHEAS is mostly made in the adrenal glands, peaks around puberty and gets lower with age. It lists the test’s uses as checking adrenal function, finding adrenal tumors, looking at ovary or testicle disorders, finding the cause of early or late puberty in boys, and looking for the cause of masculine features in women. Menopause isn’t on that list. See the DHEA-S test.

When to see a clinician

Book a visit if you have periods that stop before 40, any bleeding after menopause, symptoms that disrupt your sleep or daily life, or any of the adrenal or thyroid signs above. If you take a steroid medicine, ask your prescriber before changing anything, and ask how it affects any test.