Elevated cortisol: what it means and what to do

Cortisol is an essential hormone. It helps us respond to stress, takes part in metabolism and follows a daily rhythm in which its levels change throughout the day.

But what happens when you feel permanently stressed, sleep badly or have symptoms that make you think your cortisol is high? The answer is not as simple as "you need to lower your cortisol".

What is cortisol?

Cortisol is a hormone produced by the adrenal glands and is part of the system that regulates the body's response to stress.

We need cortisol to function properly. The problem appears when there is a persistent alteration of its levels or its regulation.

A high result in a single test does not automatically mean disease. Cortisol varies with the time of day and can be influenced by many circumstances, so any result must be interpreted in context.

What can raise cortisol?

Several situations can influence cortisol levels.

Sustained stress and sleep disturbances may be linked to changes in the body's stress response. In women going through menopause, a relationship has also been observed between certain changes in sleep architecture and cortisol levels.

There are also medical causes that must be ruled out. Glucocorticoid excess caused by medication is in fact the most frequent cause of Cushing's syndrome. Excess cortisol production may also relate to adrenal gland disorders or excess ACTH production.

So not all elevated cortisol is caused by stress.

Symptoms of elevated cortisol

When there is clinically relevant cortisol excess, different signs may appear: weight gain, particularly in specific areas of the body; high blood pressure; menstrual cycle changes; mood changes; muscle weakness; metabolic alterations and skin changes.

However, many of these symptoms are also common in other situations. Having one or several of them does not necessarily mean pathological cortisol excess.

What to do if you think your cortisol is high

1. Do not try to lower it without knowing why it is high. Reducing cortisol simply because an isolated test showed a high value is not recommended. Endocrine guidelines advise against normalising cortisol when there is no established diagnosis of Cushing's syndrome.

2. Review your sleep. Rest is fundamental to how the body regulates itself and responds to stress. A review of scientific studies has found a relationship between certain sleep problems and the response of the hypothalamic pituitary adrenal axis, the system cortisol belongs to.

3. Review stress levels and daily habits. Regular physical activity, balanced nutrition, rest and stress management strategies are part of an integrative approach to health. Avoid simplistic messages such as "if you are stressed your cortisol is high": the relationship between stress, sleep and cortisol is complex.

4. Review your medication. If you take corticosteroids, for example certain anti inflammatory treatments, discuss it with a healthcare professional. Never stop corticosteroids on your own. Prescribed glucocorticoids are a recognised cause of cortisol excess.

5. Seek advice if there is genuine suspicion of cortisol excess. When a professional considers that Cushing's syndrome may be present, specific tests exist to investigate it.

Cortisol, sleep and menopause

During the menopausal transition, looking after sleep may be especially important: recent research has found associations between poorer sleep architecture and certain cortisol patterns in perimenopausal and postmenopausal women.

Simultaneous changes in sleep, mood, metabolism and hormonal function mean this stage requires a joint reading, not the isolated interpretation of a single hormone.

When to see a professional

With persistent symptoms or altered results, a medical assessment is advisable. Recommended tests to study possible cortisol excess include late night salivary cortisol, 24 hour urinary free cortisol and the dexamethasone suppression test. A random blood cortisol is not the recommended test for this diagnosis.

An integrative view of hormonal health

At SHOMMA this is precisely our focus. A woman's hormonal health cannot be understood by looking at a single hormone in isolation. Sleep, stress, nutrition, physical activity, sex hormones, metabolism and emotional health are part of one interconnected system.

So with persistent symptoms the question should not only be "how do I lower my cortisol?", but "what is happening in my body and why?". That shift in perspective is the basis of more preventive, personalised and integrative medicine.

Medical note. This content is for informational purposes and does not replace a medical assessment. Symptoms related to cortisol can have multiple causes. If you have altered hormonal results or persistent symptoms, consult a healthcare professional. Source: Endocrine Society guideline on the diagnosis of Cushing's syndrome.