The Truth About Cortisol, Menopause, and Weight Loss

Social media loves to blame cortisol for menopause weight gain. All you need to regulate the hormone is to drink a “cortisol cocktail,” and your extra pounds will melt away.  

Cortisol levels rise during perimenopause, but the stress hormone isn’t the sole culprit behind your changing body. Reduced muscle mass, lack of sleep, increased stress, and shift in fat distribution during this time are also to blame (1, 2, 3). 

Yes, high levels of cortisol can contribute to weight gain. Changes in other hormones during the menopausal transition—estrogen, progesterone, testosterone—also have much to do with those unwanted pounds (4). And like those other hormones, cortisol is crucial for all bodily functions. 

“We all tend to demonize cortisol a little bit, but the fact is, we’d all be dead without it,” says Megan Lyons, D.C.N., a certified nutrition specialist and licensed dietitian nutritionist in Dallas. “It’s just that in our modern day and age, cortisol tends to get dysregulated from chronic stress.”

So, what exactly is the connection between extra cortisol and weight gain during menopause, and can you make it work in your favor and shed those extra pounds?

About the Experts

Megan Lyons, D.C.N., is double-board certified in clinical and holistic nutrition and a certified nutrition specialist and licensed dietitian nutritionist in Dallas.

Fred Pescatore, M.D., is an internal medicine physician in New York City specializing in nutrition, hormone balance, and chronic illness.

Robin Noble, M.D., is an OB-GYN, certified menopause provider through the Menopause Society, and chief medical advisor for Let’s Talk Menopause based in Maine.

Neha Lalani, M.D., is a triple-board-certified physician in endocrinology, internal medicine, and obesity medicine in Austin, Texas.

Tara Scott, M.D., is a board-certified OB-GYN, a functional and integrative medicine physician, and a menopause specialist.

What Is Cortisol?

Cortisol is a hormone that helps regulate metabolism, blood pressure, and blood sugar. It suppresses inflammation, stimulates appetite, and controls your sleep/wake cycle. But it’s best known as the “stress hormone.” 

When the brain detects a threat, the pituitary and hypothalamus signal the adrenal glands to release cortisol through the hypothalamic-pituitary-adrenal (HPA) axis. Cortisol triggers the release of glucose into the bloodstream, giving your cells a quick hit of fuel to fight, run away, or hide (5, 6).

In short bursts—when you’re dodging traffic, preparing for a big presentation at work, or being chased by a saber-tooth tiger—this response is helpful. But when an onslaught of cortisol regularly floods your system, it can lead to weight gain, among other health issues.

Cortisol and chronic stress

Chronic stress—the kind that comes from endless job rejections, caregiving worries, and never-ending to-do lists—produces a steady flow of cortisol that keeps your body in a constant state of high alert. 

“Your brain doesn’t know if you’re running from a bear or if you are stressed by a deadline at work, so cortisol remains high,” says Tara Scott, M.D., an OB-GYN who specializes in menopause.

Internal medicine physician Fred Pescatore, M.D., says chronic stress can impact metabolism and contribute to weight gain in several ways.

• Metabolic changes: Constantly elevated cortisol levels during the stressful perimenopause years interfere with metabolism, blood pressure, and blood sugar. These factors can lead to weight gain, usually in the form of belly fat. 
• Increased hunger: Cortisol increases hunger. Technically, it increases ghrelin, the hormone that controls appetite. A boost in both hormones leads to high-carb, high-fat comfort food cravings (carrot cake instead of carrot sticks) (7). “Cortisol, in an attempt to lower blood sugar, causes insulin to be released,” Pescatore says. “Insulin is a fat-storage hormone, hence the weight gain.”
• Increased inflammation: At normal levels, cortisol decreases inflammation. But when cortisol remains elevated, inflammation does, too. This can lead to insulin resistance, higher blood sugar, and increased fat storage.

Chronic inflammation can also lead to leptin resistance, throwing off the hormone that controls appetite and metabolism. Research suggests obesity itself can increase inflammation, creating a vicious cycle with cortisol in the perimenopausal years (8, 9, 10).

Cortisol, Menopause, and Weight Gain

Estrogen and progesterone levels decline as you approach menopause, and cortisol levels increase, which can contribute to weight gain (11). 

“The fluctuations of estrogen and progesterone essentially trigger a heightened stress response, increasing cortisol production, which raises insulin levels and drives the inherent weight gain and hunger associated with that,” Pescatore says. 

Cortisol naturally rises in the morning and tapers off throughout the day (12). This rhythm isn’t rigid; levels fluctuate based on stress, activity, and other factors. However, during perimenopause, that cadence shifts. Hormones don’t work in isolation—they function like an orchestra, each playing a role to maintain balance. When one is off, the others adjust. 

“Cortisol dysregulation makes estrogen and progesterone fluctuations feel much more pronounced,” Lyons says.

Menopause symptoms

Estrogen and cortisol influence each other’s production in the adrenal glands, so when estrogen levels fluctuate during menopause, cortisol spikes become more pronounced. Pescatore says this amplifies symptoms like hot flashes, sleep disruptions, and joint pain.

Amplified menopause symptoms can lead to weight gain. Disrupted sleep is a significant driver of cortisol-mediated weight gain (13). If your joints ache, you’re less likely to exercise and more likely to comfort eat.

Blood sugar

Cortisol spikes trigger the liver to release glucose to help you move into “fight or flight” mode. But without an actual threat to burn through that energy, excess glucose lingers in the bloodstream (14). Over time, these constant cortisol-driven glucose surges make the body less responsive to insulin, leading to insulin resistance—a key driver of type 2 diabetes (15).

“This effect becomes more pronounced during menopause as estrogen levels drop, removing its balancing effect on cortisol and insulin,” says certified menopause specialist Robin Noble, M.D.

Fat Production

Cortisol stimulates fat production by triggering insulin. High insulin increases the enzyme activity that breaks down triglycerides from lipoproteins (fats) in the bloodstream (16). Those triglycerides accumulate in the adipose tissue, resulting in the so-called “menopause belly.”

“Cortisol can contribute to weight gain by promoting fat storage, particularly around the midsection, Noble says. “It’s a hormonal domino effect.”

Metabolism

Cortisol helps regulate metabolism, but when levels are chronically high during the stressful menopause years, it disrupts how the body processes and burns fat, carbs, and protein. Instead of efficiently using nutrients for energy, the body shifts into fat-storage mode (17).

Noble also says high cortisol levels contribute to muscle loss, further slowing metabolism since muscle is the body’s most efficient fat-burning tissue.

Sleep

High cortisol limits the time spent in deep sleep, the stage where human growth hormone—a chemical that stimulates metabolism—is produced. 

Poor sleep affects up to 47 percent of women in perimenopause and up to 60 percent of women after menopause (17). Restless sleep from elevated cortisol levels can disrupt the production of ghrelin and leptin, hormones that regulate hunger (18). Ghrelin, which signals hunger, increases, while leptin, which signals fullness, decreases. The result? You eat more—and research shows sleep deprivation makes you more likely to crave high-calorie comfort foods (19, 20).

Research into sleep and the HPA axis has found high cortisol levels keep the body too wired to rest. Deep sleep, on the other hand, suppresses cortisol production. When sleep is disrupted, cortisol production stays elevated, making it even harder to fall asleep—creating a vicious cycle (6).

Cortisol Levels and Perimenopause

According to the Seattle Midlife Women’s Health Study (SWAN), which examined the health of middle-aged women over 17 years old, cortisol levels increase when estrogen declines during perimenopause. 

The researchers noted that cortisol levels in women during the late reproductive stage hovered around 43 mg, rising to nearly 45.5mg at early menopause (11). At late-stage menopause, that number jumped to almost 55 mg, finally dropping to 46 mg in post-menopausal women (11).

This rise in cortisol coincides with the disrupted sleep that many women experience during this time of life. Women also experience higher overnight cortisol levels during this stage, often linked to hormonal shifts and life stressors (11). 

Lyons noted that caring for aging parents or your own family is a common source of stress during this time of life.

“Oftentimes, we go through perimenopause, we also have teenage kids, and we’re also getting to that point in our career where we have so much responsibility,” he says. 

Testing Cortisol Levels

Your physician can order a blood, urine, or saliva test to measure your cortisol levels. However, a single reading is usually inadequate since cortisol fluctuates throughout the day. 

“I prefer a diurnal saliva cortisol test, where you spit into a tube four times a day,” Lyons says. “ It’s much less subject to momentary stress.”

How to Manage Weight in Menopause

Managing weight gain during menopause requires a different approach. What worked in your 20s and 30s likely won’t be as effective now. It requires a holistic approach that helps lower cortisol and influences other factors that lead to midlife weight gain.

HRT

Most forms of HRT increase estrogen, which in turn may reduce cortisol. Some studies suggest that hormone therapy may reduce menopause-related weight gain (21). Though not FDA-approved for weight loss, HRT can improve sleep, reduce hot flashes, and ease joint pain, making maintaining a healthy diet and exercise routine easier. 

It can also reduce belly fat and improve metabolic health by stabilizing hormone levels, says Noble. Options include estrogen-only therapy and combined estrogen-progesterone therapy (both are needed if you still have a uterus). 

Better Sleep

Prioritizing sleep is essential to reducing cortisol and combating menopause weight gain. Aim for 7 to 9 hours of sleep per night and create a sleep-friendly environment: use blackout curtains, keep the room cool (65–68°F), and avoid screens before bed (22). Following these habits helps regulate cortisol so it peaks in the morning and declines at night,  Lalani says.

Healthy Diet

What you eat can either fuel cortisol spikes or help keep it in check. Avoid ultra-processed foods, refined carbs, added sugars, and alcohol, which can increase cortisol levels. 

Instead, focus on nutrient-dense foods that help lower cortisol, including foods high in vitamin B, omega-3 fatty acids, magnesium, fiber, and protein (23).

“Foods like eggs, yogurt, fish, bananas, and spinach contain these necessary nutrients,” Pescatore says.

Exercise

Exercise is one of the easiest ways to reduce cortisol levels. When you exercise, you release the feel-good neurotransmitters dopamine, serotonin, and endorphins, which can tamp down excess cortisol (25). Several studies have shown that physical activity can boost the moods of menopausal women.

In Australia, a three-year study found that menopausal women who consistently exercised had increased feelings of well-being (24). Similar research linked lower depressive symptoms to a community-based walking program for African American women (24).

The most important thing to do is move⸺run, swim, walk, or ride a bike. Aim for at least 150 minutes of exercise weekly, which amounts to five 30-minute intervals (25).

Stress Reduction

Managing stress is key to keeping cortisol levels in check (26).

“Relaxation habits, like yoga, meditation, or mindfulness practices—like tai chi—can help to regulate your cortisol level,” says Lalani.

These practices don’t have to be time-consuming. Pescatore suggests walking away from your desk and cell phone for a minute or two several times throughout the day or incorporating brief mindfulness or meditation sessions.