Cortisol Imbalance in Women: 5 Signs Your Adrenals Need Major Support 

Cortisol imbalance plays an essential role in many women’s health challenges. But cortisol itself isn’t the problem. We need cortisol for a healthy stress response. The real issue arises when cortisol patterns become dysregulated, with either chronically high or chronically low levels.

Women are particularly vulnerable to cortisol imbalances because of the intricate relationship between stress hormones and reproductive hormone signaling. Add in hormonal shifts, multitasking demands, and chronic stress, and no wonder symptoms of adrenal fatigue are so common. Let’s discuss five key signs that signal your adrenal glands are crying out for support.

But First, What is Cortisol Imbalance?

Cortisol helps regulate energy, blood sugar, inflammation, and circadian rhythms. When your sympathetic “fight or flight” nervous system is activated, cortisol surges. Cortisol naturally rises in response to stress, low blood sugar, or exercise to keep you safe and fueled. In the short term, cortisol actually has anti-inflammatory properties. On the other hand, in the parasympathetic “rest and digest” state, cortisol production eases. 

Too much or too little cortisol creates problems, and there is a pattern to how cortisol becomes imbalanced. At first, chronic stress drives elevated cortisol levels. Stressors can be mental and emotional or biological – for example undereating, overexercising, nutrient deficiencies, gut dysbiosis, mold illness, or latent infections. Over time, your adrenal glands protectively downshift cortisol production, leading to low cortisol levels. This “burnout” state can feel even worse.

Unchecked, cortisol imbalance contributes to metabolic dysfunction (insulin resistance, blood sugar swings), HPA axis dysregulation, thyroid dysfunction, and hormone-related conditions such as PCOS.

5 Signs of Cortisol Imbalance in Women

1. Unrelenting Fatigue or Energy Crashes

In the early stages of chronically elevated cortisol, you might wake up buzzing with energy, often feeling anxious or even waking with your heart racing. In the evening, however, it’s common to feel “tired but wired,” unable to wind down. Eventually, this “tired but wired” pattern is exhausting, and can cause energy crashes even before cortisol levels become chronically low.

Once cortisol takes a dive and remains chronically low, mornings can feel brutal. Normally, cortisol peaks within 30 to 60 minutes of waking to help you get going for the day. This is called the Cortisol Awakening Response (CAR). Without this natural rise, simply getting out of bed can feel impossible.

2. Unexplained Weight Changes or Difficulty Losing Weight

Cortisol is a type of hormone called a glucocorticoid, and also influences weight distribution. Chronically high cortisol increases the production of other glucocorticoids, which can spike blood sugar and encourage fat storage. Visceral fat is the fat within the abdomen surrounding our internal organs. This type of fat cells contain abundant glucocorticoid receptors, so the more cortisol in circulation, means the more sugar gets stored in these tissues. Over time, this can lead to the “cortisol belly,” another hallmark sign of cortisol imbalance.

In contrast, very low cortisol levels may trigger unintended weight loss in some individuals, combined with severe fatigue, poor appetite, and even low blood pressure. Chronically low cortisol levels have also been associated with insulin resistance and diabetes. Either extreme disrupts metabolism and leads to a myriad of downstream health challenges.

3. Sleep Disturbances

Cortisol production follows our circadian rhythms, or 24-hour body clocks. Normal patterns include the Cortisol Awakening Response followed by a steady decline throughout the day. When this rhythm is disrupted, and cortisol remains elevated into the evening, melatonin (your sleep hormone) is suppressed, making it hard to fall asleep even if you’re feeling exhausted. Many women also experience overnight cortisol surges, leading to those dreaded 2-3am wake-ups. 

With chronically low cortisol levels, even long nights of sleep don’t leave you feeling rested. Sleep becomes unrefreshing, keeping you trapped in fatigue cycles. This in large part can be the result of formerly high cortisol levels and the nutrient depletion that comes alongside that activated nervous system state. 

4. Mood Swings, Depression & Anxiety

Our mood is also impacted by cortisol levels, considering cortisol’s direct effects on neurotransmitters. Chronically elevated cortisol keeps you in a heightened stress state, often leaving you feeling highly irritable, “on edge,” and anxious. Pair this with heart palpitations and poor sleep, and over time this can contribute to generalized anxiety or panic-like symptoms.

On the other hand, research shows the association between a blunted CAR and lower daily cortisol levels with depression and low mood. This, of course, can also be worsened by the other effects of cortisol imbalance related to low energy, poor sleep, and metabolic challenges. For women with hormone imbalances and conditions like PMDD (premenstrual dysphoric disorder), cortisol dysregulation can significantly worsen symptoms, amplifying both anxiety and depression, especially in the luteal phase.

5. Irregular Cycles or Hormone Symptoms

Cortisol is an essential “survival hormone.” When demand is high, your body prioritizes making cortisol at the expense of reproductive hormones. This steals resources from estrogen and progesterone production, disrupting hormone signaling, menstrual cycles, and fertility. This can lead to irregular or anovulatory cycles, amenorrhea (lack of a menstrual cycle), worsening PMS or PMDD, or more challenging perimenopause symptoms. 

Cortisol signaling is part of the HPA axis, going from the hypothalamus in the brain down to the adrenal glands. The hypothalamus is also where thyroid signaling begins. Chronically high cortisol levels impact brain-to-thyroid stimulation as well as thyroid hormone conversion. Suppressed thyroid activity and diminished thyroid hormone conversion further slows metabolism, and worsens the metabolic dysfunction caused by high cortisol levels.

Your Roadmap for Restoring Hormone Balance and Supporting Stress Holistically

Cortisol is essential, but balance is everything. The goal isn’t to eliminate cortisol, but to restore its healthy rhythm. If you suspect cortisol dysregulation, don’t ignore the signs. Early support can prevent deeper hormone chaos.

Ready to take the next step? Learn more about restoring your hormone balance in our Thyroid Fueling Foundations (formerly Inflammation Hormony) group program! We just kicked off our live program, but you can still sign up to join us for our next live session! In the meantime, if you want personalized insights into your unique stress patterns, check out our Cortisol Hormone Testing Package.

Written by Romana Brennan, MS, RDN