What role does Cortisol play in Wechseljahre?

Cortisol, the primary stress hormone, plays a significant role during menopause. The decline in estrogen alters the hypothalamic-pituitary-adrenal (HPA) axis, often leading to a flattened cortisol rhythm with higher evening levels. Observational studies indicate that perimenopausal women frequently exhibit elevated cortisol, which can contribute to sleep disruption, mood swings, abdominal fat accumulation, and insulin resistance – symptoms that overlap with classic menopause complaints. Chronically high cortisol also accelerates bone resorption, increasing osteoporosis risk postmenopause. The evidence is human-moderate: mostly observational, with no large RCTs directly linking cortisol to menopausal symptoms. Cortisol testing (saliva, serum, or 24h urine) may be considered if adrenal insufficiency or Cushing's is suspected, but it is not a routine menopause test. Lifestyle interventions – stress reduction, regular exercise, and good sleep hygiene – can help normalize cortisol. Hormone replacement therapy (HRT) may stabilize the HPA axis in some women, but effects on cortisol are variable. Caveat: Do not use cortisol-lowering supplements or medications without medical supervision, as they can disrupt essential physiological functions.