High Cortisol: The Hormone Hijacker You Didn’t See Coming

There are several things that can start to go haywire for a women after the age 35. As our hormones start to fluctuate more, we tend to have more anovulatory cycles and our ovaries start to have difficulty maintaining nice and normal levels of hormones. The most common hormonal imbalance that can further exacerbate our already challenging normal fluctuations of hormones include: high cortisol, low cortisol (or combination of both), estrogen dominance, low estrogen, or low progesterone. There are other things that can affected too, but these are the most common. With high cortisol being the most common. So I thought I'd start there, on how cortisol can make us feel when it's too high, and some ways we can try to lower it. If you have symptoms of high cortisol, I would highly recommend checking in with your primary care provider first to get some baseline labs to confirm and help reinforce the need for treatment options.

Cortisol's Role in Women's Health

Elevated cortisol levels can have various effects on women's health, including:​

• Metabolic Changes: High cortisol can lead to increased abdominal fat, contributing to metabolic syndrome and insulin resistance.​

• Bone Density Reduction: Chronic cortisol elevation is associated with decreased bone mineral density, increasing the risk of osteoporosis.​

• Mood Disorders: Elevated cortisol levels are linked to anxiety, depression, and cognitive impairments.

Symptoms of High Cortisol

If you experience five or more of the following symptoms, high cortisol is highly indicative. Three to four symptoms still suggest suspicion:

• Constantly feeling like you’re racing from one task to the next

• Feeling wired yet tired

• Struggling to calm down before bed

• Difficulty falling or staying asleep

• Feeling anxious or nervous

• Quick to anger or rage

• Memory lapses or trouble concentrating

• Sugar cravings after each meal

• Increased abdominal circumference (not bloating)

• Skin conditions such as eczema or thin skin

• High blood pressure or rapid heartbeat

• Indigestion or GERD

• History of elevated blood sugar

Diagnosing High Cortisol

If you suspect high cortisol, consider testing:

• AM cortisol levels

• Diurnal salivary cortisol test (measuring cortisol fluctuations throughout the day)

Effects of High Cortisol

1. Lower Thyroid Hormones

   • High cortisol suppresses thyrotropin-releasing hormone (TRH) from the hypothalamus, reducing thyroid-stimulating hormone (TSH) production.

   • It inhibits the pituitary gland from releasing TSH, leading to impaired thyroid function.

   • It reduces the conversion of T4 (inactive thyroid hormone) to T3 (active thyroid hormone), leading to hypothyroid symptoms.

2. Magnesium Depletion

   • Increases magnesium loss through urine.

   • Reduces stomach acid, impairing magnesium absorption.

   • Increases the body's demand for magnesium to regulate the nervous system.

   • Prevention: Consume magnesium-rich foods (dark leafy greens, nuts, seeds, avocados, dark chocolate) or supplement with magnesium glycinate or citrate.

3. Vitamin C Depletion

   • Increased vitamin C usage by the adrenal glands.

   • High oxidative stress increases the body's demand for vitamin C.

   • Higher urinary excretion of vitamin C.

   • Prevention: Increase intake of citrus fruits, bell peppers, berries, kiwi, and leafy greens; supplement with 1,000 mg daily.

4. B Vitamin Depletion

   • Increased demand for B5, B6, and B12 to support stress hormones.

   • Higher excretion of B1, B2, B6, and B12 through urine.

   • Poor absorption of B12 and folate (B9) due to gut dysfunction.

   • Prevention: Consume eggs, meat, fish, leafy greens, nuts, and whole grains; supplement with a high-quality B-complex.

5. Tyrosine Depletion

   • Increased demand for dopamine, norepinephrine, and epinephrine production.

   • Impaired thyroid hormone synthesis.

   • Prevention: Eat lean meats, fish, dairy, eggs, nuts, seeds, soy products, bananas, and avocados; consider L-Tyrosine supplements (500–2,000 mg daily).

Managing High Cortisol

1. Adaptogens

   • Ashwagandha: Regulates the HPA axis. Several human studies have shown that ashwagandha supplementation (250-600mg daily) can reduce cortisol levels by 14-30% in stressed individuals, leading to improvements in anxiety, sleep, and overall well-being.

   • Rhodiola: Modulates stress response, lowers cortisol, and improves mood and energy levels. Studies have shown that Rhodiola supplementation (200-600mg daily) can lower cortisol levels by 10-30%, especially in people under chronic stress. It improves symptoms of fatigue, burnout, and cognitive function, which are commonly associated with high cortisol levels.

   • Caution: Avoid if you have autoimmune diseases, are pregnant, or are on prescription medications. Both Ashwagandha and Rhodiola have been shown in some studies to increase immune cell activity, which could complicate those with an autoimmune condition.

2. Phosphatidylserine (PS)

   • Regulates the HPA axis, lowering stress-induced cortisol spikes.

   • Enhances dopamine and acetylcholine signaling for better mood and cognitive function.

   • Dosage: 300–800 mg per day, often split into multiple doses.

3. Sigh Breathing

   • Instructions: How to Perform Sigh Breathing- To effectively utilize sigh breathing for cortisol reduction, follow these steps:

     Basic Sigh Breathing Protocol (Double Inhale + Extended Exhale)

     1. Inhale through the nose deeply (expand your lungs fully).

     2. Take a second, smaller inhale at the peak of the first inhale (this maximizes lung inflation).

     3. Slowly exhale through the mouth for at least twice as long as the inhale (this is key to engaging the vagus nerve).

     Repeat 3–5 times, focusing on the sensation of relaxation with each exhale.

   • Activates the vagus nerve, lowers HPA axis activity, and increases heart rate variability (HRV).

4. Yoga & Meditation

   • Reduces HPA axis activation and increases parasympathetic nervous system activity.

   • Enhances GABA and serotonin, promoting relaxation and lowering cortisol.

5. Fish Oil (Omega-3s)

   • Lowers HPA axis hyperactivity, reducing cortisol production.

   • Reduces pro-inflammatory cytokines that trigger cortisol release.

   • Enhances HRV and vagal tone, improving stress resilience.

   • Dosage: 1,000–3,000 mg of EPA/DHA daily.

6. Limit Alcohol

   • Chronic alcohol use disrupts the HPA axis, leading to prolonged cortisol elevation.

   • Affects brain regions responsible for stress regulation, worsening anxiety and sleep disturbances.

7. Prioritize Sleep

   • Sleep regulates circadian cortisol rhythms; lack of sleep leads to prolonged cortisol elevation.

   • Poor sleep impairs HPA axis function, leading to metabolic and immune dysfunction.

   • Solutions: Maintain a consistent sleep schedule, reduce blue light exposure, and avoid caffeine before bed.

8. Cold Plunge Therapy

   • Initially spikes cortisol but lowers baseline levels over time.

   • Enhances HRV, dopamine, and norepinephrine, improving mood and stress resilience.

   • Reduces inflammatory cytokines (TNF-α, IL-6), preventing cortisol overproduction.

   • Recommendations: 2–5 minutes in cold water (50–59°F) 3–4 times per week.

Final Thoughts

Chronic stress and persistently high cortisol levels can wreak havoc on overall health, leading to thyroid dysfunction, nutrient depletion, and an increased risk of metabolic disorders. Managing cortisol effectively through lifestyle modifications, adaptogens, and stress-reducing techniques can restore balance, improve well-being, and optimize long-term health.

Before starting any of the supplements mentioned above, it's always a good idea to talk with your provider first to see if one or more may be right for you. Also consider getting some of the vitamin levels checked to see if you are indeed deficient or need supplementation.