WHAT IS CORTISOL AND WHY DOES ITS LEVEL CHANGE DURING THE MENOPAUSE
By now, we all associate cortisol with stress. In fact, cortisol is known as the ‘stress hormone’, although in reality it is much more than that. Cortisol, also known as hydrocortisone, is a steroid hormone synthesised in the adrenal glands under the control of the hypothalamic–pituitary–adrenal (HPA) axis. Cortisol is essential for our homeostasis (the body’s balance) and survival in stressful situations. Millions of years ago, its production would skyrocket at the sight of a predator, for example. Today, stressors have changed… Insomnia, fatigue, work-related stress, overactivity… Even overexposure to social media stimuli can place a strain on our bodies.
Stress and its management are just two aspects of the complex transition that is the menopause. For a comprehensive overview of how this hormonal stage affects all symptoms – from menstrual changes, hot flushes and skin changes to fatigue and hormonal imbalance – see our complete guide to perimenopause and medicinal mushrooms, which covers the scientific evidence for each manifestation of this transition.
During perimenopause and the menopause, physical changes, hot flushes and insomnia are clear examples of stress triggers to which our body may react as follows:
- The hypothalamus releases corticotropin-releasing hormone (CRH).
- The pituitary gland responds by releasing adrenocorticotropic hormone (ACTH).
- ACTH stimulates the adrenal glands to produce and release cortisol.
No matter how many stressors we are exposed to, cortisol release is not constant; rather, it follows a specific rhythm, predominantly during the day. However, physical or psychological factors can also alter this release pattern, and the menopausal stage can affect this release.
Under normal circumstances, cortisol—which helps us survive by enabling us to adapt to our environment as effectively as possible—also supports specific physiological functions:
- It maintains the availability of glucose and energy during fasting, physical activity or stress.
- It modulates the metabolism of carbohydrates, fats and proteins.
- It helps maintain blood pressure and vascular response.
- It regulates immune and inflammatory activity.
- It plays a part in the body’s response to illness, injury and stress.
- It influences the brain, alertness, memory and the sleep–wake cycle.
- It contributes to water and electrolyte balance, although this is not its primary function.
In general, and based on published evidence, it cannot be stated that the menopause leads to an increase in cortisol in all women. Published studies monitoring urinary and capillary cortisol do not show a direct causal link, at least for the time being. This would undoubtedly make things much simpler. However, during pre-menopause and menopause, hormonal fluctuations (particularly the decline in oestrogen) can indeed alter cortisol regulation and our response to stress, causing it to be exaggerated in many cases. Regardless of the hormonal stage, some clinical reviews have described metabolic, cardiovascular, muscular, bone and neuropsychiatric complications arising from excess cortisol. For this reason, it is recommended that you consult a specialist in this field to guide you through this process of change and development.
HOW STRESS AND MENOPAUSAL SYMPTOMS ARE LINKED (THE STRESS-HOT FLASHES-INSOMNIA CYCLE)
It has been shown that increased perceived stress and one’s attitude towards the menopause (fears, uncertainty, lack of knowledge, etc.) can intensify symptoms such as insomnia, fatigue, mood swings and even muscle and joint pain, which can increase the overall sense of discomfort (Nosek et al., 2010). In fact, this heightened perception of stressful situations has a direct impact on one of the most common menopausal symptoms: hot flushes.
Several studies have shown that stress can make hot flushes feel more intense and distressing. For example, in the SWAN study, perceived stress was significantly associated with hot flushes and night sweats, although no direct causality was demonstrated; and in a follow-up to the Seattle Midlife Women’s Health Study, the intensity of hot flushes was determined primarily by reproductive ageing and anxiety. This suggests that anxiety may amplify the experience of the symptom without actually triggering it (Mitchell et al., 2015).
Furthermore, anyone familiar with daytime hot flushes will be familiar with night-time awakenings characterised by sudden changes in temperature and a racing pulse. It is estimated that night-time awakenings are the most common sleep problem during the menopausal transition, affecting approximately 40 per cent of women at this stage.
At this point, it seems more logical to speak of a vicious circle involving stress, hot flushes and insomnia. Whilst none is the direct cause of the other, there is certainly an interplay between them all, with each fuelling the others, and other factors such as anxiety, depression and the need to urinate at night also playing a part. For decades, it has been shown that high levels of stress are linked to an increase in sleep disorders, cognitive difficulties and physical symptoms such as hot flushes, palpitations and night sweats, which contribute to a significant reduction in quality of life during the menopause (Ballinger, 1985). Furthermore, a reduction in oestrogen levels can make it harder to manage stress and increase emotional sensitivity, leading to frequent and sudden changes in mood (Hogervorst et al., 2022).
WHAT SCIENCE SAYS ABOUT REISHI AS AN ADAPTOGEN
In 2008, the European Medicines Agency defined adaptogens as natural substances that can normalise bodily functions and strengthen systems affected by stress. In this regard, they are considered to have a protective effect on health in the face of stressful situations, whether environmental or emotional in nature. Under this definition, the anti-stress effects of adaptogenic substances such as Reishi (Ganoderma lucidum), Siberian ginseng (Eleutherococcus senticosus), Rhodiola (Rhodiola rosea) and Ashwagandha (Withania somnifera), amongst others, are being studied.
If we focus on the field of mushrooms in Traditional Medicine, in which we have over 25 years’ experience, the mushrooms most extensively studied for stress management and relief are Reishi, Cordyceps (C. sinensis), Lion’s Mane (Hericium erinaceus) and Chaga (Inonotus obliquus). Their triterpene and polysaccharide content is studied, in particular, in relation to:
- improved mood
- reduced fatigue
- longevity
During the menopause, the decline in oestrogen alters the functioning of key neurotransmitters such as serotonin and GABA, which are fundamental in controlling anxiety (Bossé & Paolo, 1996). The polypeptides and triterpenes in Reishi act as precursors to neurotransmitters and endorphins. These may help to elicit an appropriate response in stressful situations, which is why Reishi is said to have sedative effects and to inhibit neuronal activity, thereby inducing general relaxation; all of this according to a study using animal models published in 2008.
Furthermore, in a small randomised trial, 1,000 mg of Ganoderma lucidum taken daily for 30 days reduced perceived stress and improved certain autonomic, inflammatory and antioxidant markers in female university students. Meanwhile, in another randomised, placebo-controlled trial, a Ganoderma lucidum polysaccharide extract administered over eight weeks produced a statistically significant, albeit moderate, improvement in fatigue, well-being and overall clinical assessment in people diagnosed with neurasthenia (extreme physical and mental exhaustion in response to minimal exertion).
Although the results are promising, further scientific evidence is still required in this field to confirm efficacy and, above all, studies on specific clinical samples are needed. Nevertheless, the mushrooms used in Traditional Medicine – which have been utilised for centuries by the world’s longest-living societies – must now have their properties and effects validated in accordance with current scientific methods. At Hifas da Terra, a biotech company specialising in the study and development of mushroom-based supplements, we are helping to generate this evidence, both by optimising production systems to increase the content of bioactive compounds of interest and by conducting our own clinical studies in collaboration with research centres and universities around the world.
COMPLEMENTARY TECHNIQUES (BREATHING, EXERCISE, SLEEP)
If the aim is to limit the impact of stressors that lead to chronic stress, there are breathing techniques that can help us manage these situations, including hot flushes and night-time awakenings. Yes, it’s true, there is no conclusive evidence regarding a universal method, but from all the studies reviewed, it is clear that regular, controlled diaphragmatic breathing can help mitigate the impact of stress on the body. Give yourself five minutes when faced with a difficult situation; breathe and help yourself manage that challenging moment. At night, you can do the same: create the right atmosphere and promote relaxation through your breathing. There are guides available to help you get started.
Staying active is essential at all ages, but at this stage of life it is almost a matter of mental and physical survival. Depending on your mobility, combine strength training with aerobic exercise and walks. Go for walks away from screens, in nature and at a leisurely pace. This stimulates your body and brings balance to your mind.
And as if that weren’t enough, a meta-analysis of 26 trials involving 2,170 postmenopausal women found that exercise reduced symptoms of depression and anxiety (Han et al., 2024).
Sleep is another essential pillar of our wellbeing and balance. Here you can find a basic guide to maintaining good sleep hygiene. This, combined with relaxation techniques and physical exercise, will help you navigate this new stage of life positively.
HOW TO INCORPORATE HIFAS INTO YOUR SUPPLEMENTATION ROUTINE
If you’ve chosen to supplement naturally and safely during this stage to leave behind imbalance, irritability and general malaise, at Hifas da Terra we offer capsule supplements containing active ingredients such as highly concentrated extracts of adaptogens, vitamins and minerals, including HIFAS-Menopause (with Reishi, Lion’s Mane, Cordyceps, Ashwagandha, green tea, probiotics, vitamin B6, vitamin D and zinc). Not only are these formulas designed for effective dosing, but they are also supplements manufactured to pharmaceutical standards, meaning they are fully certified by the European regulatory bodies in the countries where they are produced. Furthermore, a team of experts is behind the selection of each ingredient (for a comprehensive effect in 100% plant-based capsules), as well as a commitment to demonstrating their potential through our own clinical studies and those of our partners.