Interviewer: Gail Edgell
Gail Edgell: What exactly is cortisol?
Dr. Painovich: Cortisol is actually called the stress hormone because it is a hormone that is released when the body is under stress. The reason why it’s such a hot topic today is that elevated cortisol levels can mimic the same symptoms associated with menopause and menopausal symptoms.
Gail Edgell: What else does it affect? Does it affect hormone levels or other glands? Will it affect your immune system?
Dr. Painovich: It definitely can. I think the bigger issue, when you start to look a little deeper into these symptoms, is that of the adrenal glands. The adrenal glands can mimic the same symptoms associated with menopause. The adrenal glands not only produce cortisol but also other hormones in the body such as DHEA, estrogen, progesterone and testosterone. These are obviously big players in menopausal symptoms.
Gail Edgell: What are some things that really affect cortisol levels, as far as our everyday lives go? I think about that fight-or-flight syndrome, when you’re out in the wilderness and you see a tiger. You want to either fight it or run the other way. How does it affect us in our everyday lives?
Dr. Painovich: There are so many stressors in today’s world that people aren’t even aware can affect the adrenal glands. This in turn directly correlates to the levels of cortisol in our systems.
A lot of things are challenges today — our demanding jobs, the fact that we are always under financial stress. If you have a job where the boss is hard to work with, or you have coworkers who are hard to work with, these are chronic stressors that you become used to and think are no big deal. But in actuality, to the adrenal glands and cortisol levels, they’re a very big deal.
Other things that can affect cortisol levels are lack of sleep and even job stability, especially with the current economy and people wondering if they are going to have their jobs taken away. Raising children is a big one. In today’s world, women who are both holding down a job and running a household get used to that. They think it’s not that big of a stressor, but it is. The other thing that most women really are not aware of is that being in an unhealthy or unhappy marriage can directly affect cortisol levels and adrenal fatigue. Unhealthy dieting is a big factor. Even exercising too much can actually reduce adrenal-gland function. Exercising in moderation is good, but there is a fine line between what is good and what is too much.
The other thing that I think is really missed is when women happen to have some unresolved emotional stressors from childhood, whether it’s being an adult who was the child of an alcoholic or some kind of abuse issues that come into play. Believe it or not, the things that happened to us early in life can affect the menopause transition, your cortisol levels and adrenal fatigue. There are so many things that can play a part in that.
Gail Edgell: Like you said, there are so many things that play a role in having elevated cortisol levels. What are some simple things that listeners can do at home to get their cortisol levels back into normal range? Also, what are some more drastic approaches they can take if they cannot control cortisol levels on their own?
Dr. Painovich: Like you said, cortisol was originally meant to be released in something like a man-versus-nature situation — if we were running for safety from an animal or whatever, we would get that flight response to go fast and get away from danger. We would relax after that, when we were safe. That no longer happens — we are under constant stressors. We’re finding that people who have these elevated cortisol levels have symptoms such as fatigue, foggy thinking, memory loss, increased abdominal fat and weight gain. They have decreased immune systems. They can also be more at risk for diabetes. They can also have insomnia and increased inflammation and body aches. When you look at that, like I said, it very much mimics the symptoms that many menopausal women complain of. When you go to a little deeper level and look at adrenal fatigue, it’s all those things that we talked about as well.
The other thing that can happen with adrenal fatigue is decreased sex drive or decreased interest in sex in general, depression and vaginal dryness. It goes deeper and deeper. Those symptoms become greater and begin to mirror those symptoms associated with menopause.
A little bit more about the adrenal gland — not only does it produce cortisol, but it also produces our backup hormone system. I don’t think it’s so much that the ovaries normally reduce our estrogen and progesterone levels. I don’t think that is the problem. I think the problem is the backup system that comes from the adrenal glands, this DHEA, which is a precursor to testosterone, estrogen and progesterone. If the adrenal glands are tired, then they’re not able to produce the backup systems that should make the transition through menopause easier.
The good thing — and there is a good thing — is that there are so many other things that can help women transition through menopause. The easiest thing is good exercise and good diet. I often say to a lot of my patients that if they just exercise and eat well, 90 percent of all their health issues will go away. I think that is true for high levels of cortisol and adrenal fatigue.
Other things that women can do are meditation, yoga and, of course, all the things that you have on your Web site, Gail — other supplements that are offered through naturopathic physicians and other experts. Then again, if single herbs and supplements are not enough, you can go to things like acupuncture and Chinese herbs. Herbs can be a multitude of herbs that are combined together. Often times, we can directly combine them so that the result affects all of your systems.
There are many things that women can do that work very, very well. Usually, if they do these things, a lot of their symptoms can completely disappear or certainly become manageable, so that they do not have to go to that next level of hormone replacement therapy if they do not want to do so.
Gail Edgell: How is cortisol measured?
Dr. Painovich: That is a good question. That is actually a controversial topic. In the study we are doing right now, that I am overseeing, the way that we look at cortisol is through a 24-hour urine analysis. The reason why we need to do at least 24 hours of analysis is because cortisol works from a diurnal pattern, meaning that it is higher in the mornings and then should start to lower as the day goes on. It should be lowest as we go to sleep. If we take a cortisol level from saliva at noon, it’s going to be different from one taken at 5 p.m. Unless we collect it over a 24-hour period, oftentimes, it’s not going to be accurate.
The other thing that we are doing in our study is an adrenal stress test. We do a blood analysis of cortisol levels. We then stimulate the adrenal gland to see how the body responds and how it reproduces cortisol, along with other hormones. There are a couple different ways that we can look at it, but again, that is still controversial. That is probably the best way to do it, but time will tell.
Gail Edgell: You’re saying that from your research so far, you feel as if urine might be the better option, but that you can also measure cortisol via blood and urine as well.
Dr. Painovich: You can. But again, we know that even with blood, if we run our tests first thing in the morning — when our cortisol levels should be the highest — that may not be the best time to take it, but it’s usually the highest. I have heard that saliva is very inconsistent and inaccurate. Like I said, there is a lot of controversy around all of these tests.
Gail Edgell: It sounds like cortisol really is the basis for a lot of issues that may be occurring in menopausal women.
Dr. Painovich: Absolutely. Any time a woman comes into my practice for the control of menopause systems, 90 percent of my focus is on the adrenal glands and cortisol levels.
Gail Edgell: To sum it up, some things that our audience can do are start an exercise program, eat a diet with lots of fruits and vegetables, meditate and do yoga to decrease their stress levels, and get into acupuncture and even herbs. They can move into these areas if they happen to need additional support.
Dr. Painovich: Yes, either additional support or at the same time. The good thing about acupuncture and herbs are that they really work to get the body into a calm, balanced state throughout the day and for a lifetime. That induces all types of good health.
Gail Edgell: Do you have anything else that you would like to add regarding cortisol?
Dr. Painovich: Women need to be proactive in their care of this menopause transition. It should be a transition, and it should be something that they can ease through. If they are proactive with the right, good lifestyle, then the transition should be easy, the cortisol levels should be balanced, and life should be good.
Note: This article is an edited transcript of an audio interview. Changes have been made.