Cortisol

Cortisol is a hormone made by the adrenal glands. It is often called the stress hormone, and the Urdu Roshara uses says the same: stress wala hormone.

It matters. The NHS website describes a condition, Cushing's syndrome, caused by having too much cortisol in the body. But it calls that condition rare, and says its most common cause is taking high doses of steroid medicine, such as prednisolone, for a long time.

Cortisol does not appear in the menopause guidelines. NICE NG23, the guideline doctors in England follow, and the Pakistan Menopause Society's 2026 recommendations do not mention it. Neither lists a cortisol test or a cortisol treatment for perimenopause.

What you may be seeing on your phone: cortisol belly, cortisol face, adrenal fatigue, morning routines to lower cortisol, drinks and supplements to balance it. The posts tend to describe real things women feel in midlife, such as tiredness, broken sleep, feeling on edge and weight around the middle, and give them a single cause.

Those feelings are real. The Pakistan Menopause Society lists sleep disturbance, tiredness, anxiety and weight concerns among the symptoms of perimenopause itself (Table 1), and sleep disruption and anxiety each have their own page. The single cause is the part the evidence does not support.

The best evidence we found on cortisol across the menopause transition comes from the Seattle Midlife Women's Health Study, which followed women for years and measured hormones in first-morning urine samples.

In a 2014 paper, the researchers looked at 130 women from that study, with an average age of 48 and a half, most of them white, well educated and in work, with data gathered between 1990 and 2011. They report:

• An earlier analysis of the same group found cortisol rose in the late menopause transition, the stage when periods become far apart.
• The larger SWAN study in the United States reported no difference in cortisol across the transition stages.
• In this analysis, cortisol was not related to any of the three symptom groups the researchers found, including the group with severe hot flushes.
• Earlier work on the same women had not linked cortisol to hot flushes, low mood, memory and concentration, pain or sleep. If anything, higher cortisol went with less trouble falling asleep and less back pain.

The authors call the role of cortisol puzzling. That is a fair summary of where the science is: the hormone may shift in midlife, but nobody has shown it causes the symptoms that the posts blame on it.

One caution in the other direction. The women studied were mostly white Americans, and there is no study we know of on cortisol and the menopause transition in Pakistani or South Asian women.

See a doctor if stress, low mood or poor sleep are affecting your days, whatever you think is behind them. Perimenopause, stress and low mood can overlap, and a doctor can look at them together.

The Pakistan Menopause Society's recommendations ask doctors to take mental wellbeing seriously. They describe stress reduction, better sleep habits and mindful practices as ways to improve mental health, and recommend CBT, a talking therapy, for mood (section 4.2.4). Stress management covers what the guidance lists.

If you take steroid medicine for a long-term condition and notice changes in your body, raise it with whoever prescribes it. A steroid is not something to stop on your own.

If you are thinking of paying for a cortisol test, it is fair to ask your doctor first what the result would change.