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Women's Metabolic Clarity · Topic 6 of 15

Cortisol and Stress

You may be carrying a lot. Stress hormones can show up in your body.

Educational disclaimer: This content is for education only. It is not medical advice, diagnosis or treatment. Pinnacle Coordinated Wellness is an education-first coordination layer, not a medical office, and Dr. Pat Pachciarz® is not a clinician. Nothing here is a protocol, dose or promise of results. Always talk with your own licensed clinician before making any health change. If you have chest pain, trouble breathing, thoughts of self-harm, or another emergency, call 911 (or call or text 988 for mental health crisis support).
On this page
  1. What is cortisol, and does it change in menopause?
  2. Can stress make belly fat worse?
  3. Is 'adrenal fatigue' real?
Question 16 of 45

What is cortisol, and does it change in menopause?

Short answer

  • Cortisol is a stress hormone. It helps you wake up and handle challenges.
  • A long-term study found that cortisol levels went up for some women during the late menopause transition.
  • Hot flashes, poor sleep and life stress can all link to higher cortisol.
  • Cortisol is not 'bad.' Problems come when stress never shuts off.

What to look out for

  • Feeling 'tired but wired.'
  • Waking up at night with a racing mind.
  • Stress that feels bigger than before.

Top 3 things to act on or ask your clinician

  1. Ask: 'Could stress be part of my symptoms?'
  2. Ask: 'Is a cortisol test useful for me, or not?'
  3. Ask about stress support options, like counseling.
Expert vs. evidence: Some wellness voices promote at-home saliva or dried-urine hormone panels to 'map' cortisol and sex hormones. Society guidance (Endocrine Society 2015; The Menopause Society 2022) does not support using these panels to diagnose menopause or guide treatment. We go with the society guidance.
Sources for this answer
  1. Peer-reviewed Woods NF et al. Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study. Menopause. 2009;16:708-18. PMID: 19322116. DOI: 10.1097/gme.0b013e318198d6b2
  2. Peer-reviewed Epel ES et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat. Psychosom Med. 2000;62:623-32. PMID: 11020091. DOI: 10.1097/00006842-200009000-00005
  3. Peer-reviewed Stuenkel CA et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100:3975-4011. PMID: 26444994. DOI: 10.1210/jc.2015-2236
  4. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  5. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
  6. Expert commentary, not research Dr. Sara Gottfried on Huberman Lab: How to Optimize Female Hormone Health for Vitality & Longevity (podcast episode, Jan 2023)
  7. Non-clinical wellness opinion, not research Gary Brecka, The Ultimate Human, Ep. 227: Menopause: Symptoms, Hormones, Tests & Solutions (podcast episode, Dec 2025)
Question 17 of 45

Can stress make belly fat worse?

Short answer

  • Research found that women with more belly fat tended to release more cortisol under stress.
  • This shows a link. It does not prove stress alone causes belly fat.
  • Stress also affects sleep, cravings and movement, which all matter.
  • Managing stress is part of caring for your metabolism.

What to look out for

  • Stress eating or skipping meals.
  • Little time for rest or joy.
  • Feeling like you are 'always on.'

Top 3 things to act on or ask your clinician

  1. Ask: 'How might stress be affecting my health?'
  2. Ask about support for stress, sleep or mood.
  3. Ask: 'What small step could help this month?'
Sources for this answer
  1. Peer-reviewed Epel ES et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat. Psychosom Med. 2000;62:623-32. PMID: 11020091. DOI: 10.1097/00006842-200009000-00005
  2. Peer-reviewed Woods NF et al. Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study. Menopause. 2009;16:708-18. PMID: 19322116. DOI: 10.1097/gme.0b013e318198d6b2
  3. Expert commentary, not research Dr. Sara Gottfried on Huberman Lab: How to Optimize Female Hormone Health for Vitality & Longevity (podcast episode, Jan 2023)
Question 18 of 45

Is 'adrenal fatigue' real?

Short answer

  • 'Adrenal fatigue' is not a recognized medical diagnosis. A research review found no proof it exists as a condition.
  • Feeling exhausted is real. But the cause needs real checking.
  • Thyroid issues, low iron, poor sleep, depression and menopause can all cause fatigue.
  • Rare adrenal diseases do exist and are tested in specific ways.

What to look out for

  • Being sold supplements for 'adrenal fatigue.'
  • Long-lasting tiredness with no clear cause.
  • Weight loss, dizziness or salt cravings (get checked).

Top 3 things to act on or ask your clinician

  1. Ask: 'What could be causing my fatigue?'
  2. Ask: 'Should we check thyroid, iron and blood count?'
  3. Ask: 'Could sleep or mood be part of this?'
Evidence note: A systematic review (Cadegiani 2016) found no evidence for 'adrenal fatigue.' Gary Brecka's views on hormones and testing are wellness commentary, not clinical guidance.
Sources for this answer
  1. Peer-reviewed Cadegiani FA et al. Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord. 2016;16:48. PMID: 27557747. DOI: 10.1186/s12902-016-0128-4
  2. Peer-reviewed Baker FC et al. Sleep and Sleep Disorders in the Menopausal Transition. Sleep Med Clin. 2018;13:443-456. PMID: 30098758. DOI: 10.1016/j.jsmc.2018.04.011
  3. Non-clinical wellness opinion, not research Gary Brecka, The Ultimate Human, Ep. 227: Menopause: Symptoms, Hormones, Tests & Solutions (podcast episode, Dec 2025)
Sources

Every source on this page

Peer-reviewed research comes first, then society guidance, then expert commentary. Dr. Mary Claire Haver and Dr. Stacy Sims are listed first among the experts. Expert voices are commentary, not research. When an expert claim differs from the evidence, we follow the evidence and say so.

  1. Peer-reviewed Woods NF et al. Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study. Menopause. 2009;16:708-18. PMID: 19322116. DOI: 10.1097/gme.0b013e318198d6b2
  2. Peer-reviewed Epel ES et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat. Psychosom Med. 2000;62:623-32. PMID: 11020091. DOI: 10.1097/00006842-200009000-00005
  3. Peer-reviewed Stuenkel CA et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100:3975-4011. PMID: 26444994. DOI: 10.1210/jc.2015-2236
  4. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  5. Peer-reviewed Cadegiani FA et al. Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord. 2016;16:48. PMID: 27557747. DOI: 10.1186/s12902-016-0128-4
  6. Peer-reviewed Baker FC et al. Sleep and Sleep Disorders in the Menopausal Transition. Sleep Med Clin. 2018;13:443-456. PMID: 30098758. DOI: 10.1016/j.jsmc.2018.04.011
  7. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
  8. Expert commentary, not research Dr. Sara Gottfried on Huberman Lab: How to Optimize Female Hormone Health for Vitality & Longevity (podcast episode, Jan 2023)
  9. Non-clinical wellness opinion, not research Gary Brecka, The Ultimate Human, Ep. 227: Menopause: Symptoms, Hormones, Tests & Solutions (podcast episode, Dec 2025)
Your next step

Take this to your clinician.

  • Bring your questions and a short symptom log to your next appointment.
  • Want help organizing your questions and care team? Pinnacle Coordinated Wellness is here to listen and connect.
  • Practitioners: share this page with the women you serve.
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All 15 topics · Other topics: Weight and Body Changes · Muscle and Strength · Why HIIT or Cardio-Only Can Backfire · Insulin Resistance and Blood Sugar · Sleep and Night Sweats · Brain Fog, Mood and Anxiety · Thyroid · Bloodwork: What to Ask For · Heart and Bone Risk After Menopause · Hormone Therapy Basics · Gut Health · Nutrition and Protein · Alcohol · The Shame and Guilt Cycle, and Identity