'Tired and wired' - experts reveal the key signs of high cortisol in women to look out for

It's worth checking out the signs of high cortisol in women if you're feeling under the weather and not quite sure why. As one of the body's essential hormones, we need cortisol for breaking down nutrients, reducing inflammation, and regulating our sleep cycle, but too much of it can cause issues. 

The most common cause of elevated cortisol is burnout from work that's become chronic (otherwise known as habitual burnout) with years of stress. Other causes include side effects of medication, pituitary gland problems, and Cushing syndrome, although these are much rarer. 

The good news is that high cortisol levels are often benign, which means they don't have a serious or long-term impact on your health, says Dr Natasha Fernando, GP. If you spot the signs, you can make simple lifestyle changes to lower cortisol levels. 

Signs of high cortisol in women

1. Mood changes

When cortisol is elevated, our body goes into what is known as the 'fight or flight' response as it thinks it's in danger. This response is embedded in our brains from prehistoric times and is designed to control fear and motivation, taking us out of life-threatening situations. Unfortunately, the body can't tell the difference between being chased by a lion and receiving a challenging email. 

Naturally, if the body is in a constant state of elevated cortisol, this impacts our mood as the body is permanently in this 'fight or flight' mode. 

Irritability and feelings of anxiety are common, as well as some symptoms of depression as excess cortisol can lead to a deficiency of serotonin - aka 'the happy hormone', per a review by the Medical University of Gdansk. 

2. Weight gain

Cortisol creates a surge of energy in the body which is useful in stressful situations - but a side effect of this surge is increased metabolism and appetite. It's often why we feel hungrier and crave high-sugar foods when experiencing the early signs of burnout. "If cortisol is consistently high, and therefore consistently increasing your appetite over a prolonged period, this can lead to weight gain," says Dr Fernando, who is also the medical director at Medichecks, a home blood testing service. 

This is especially true if you've noticed more weight around your middle recently. "Fat around the midriff (known as a cortisol belly) is a common sign," says Dr Sohère Roked, a GP, functional medicine and hormone doctor. "It's like a protective layer - your body feels under stress and is trying to protect you." 

Dr Natasha Fernando

Dr Natasha Fernando is a practising GP, with over 12 years experience with the NHS. She completed her undergraduate medical training at the University of Cambridge and Imperial College London, and has a Diploma in Lifestyle Medicine. 

As medical director of Medichecks, Dr Natasha Fernando drives the continuous improvement of service quality and helps safeguard high standards of care. She gives clinical support to the team of reporting doctors, ensuring excellent standards in providing customer-centred, evidence-based advice.  

3. Skin problems

One of the signs of elevated cortisol is acne as "it triggers the sebaceous glands to produce more sebum, which can block your pores and exacerbate acne," Dr Fernando says. 

However, more serious skin conditions like eczema and Psoriasis can develop if cortisol levels remain high over time, says Mike Kocsis, a hormone specialist and medical case manager for Balance My Hormones. "High cortisol levels play havoc with the skin's protective barrier as it reduces fats and ceramides, both of which play an instrumental role in preventing the skin from losing hydration." 

You'll also likely experience dry and inflamed skin with elevated cortisol levels as it "hinders the skin's ability to produce hyaluronic acid," says Kocsis. "As a result, the skin encounters dryness, can itch, and even appear inflamed. This then leaves the skin susceptible to infections and irritation."

4. Disrupted sleep

If you're struggling to sleep through the night, even after trying to sleep better with improved sleep hygiene techniques, it's certainly worth looking at your cortisol levels. Dr Fernando says, "When your body is in a constant state of high stress due to raised cortisol levels, it can lead to an imbalance in your adrenal system. This can prevent you from getting restful sleep, leading to fatigue the next day."

'Tired and wired' is how Dr Roked describes the feeling. "That's feeling tired all day, exhausted, can’t wait for your bed and then when you get to your bed, your cortisol peaks, your thoughts are whirring, and you cannot sleep as you feel a burst of energy you didn't have all day."

5. Difficulty concentrating

You might also experience the 'startle response' as one of the key signs of high cortisol in women. This response can prevent you from feeling relaxed and focused throughout the day. Dr Roked says, "For example, if a waiter drops a tray of cutlery or smashes a glass in a restaurant, everyone goes quiet for a moment and then resumes normal conversation. But if you have high cortisol, you feel it in your body and even though everything is back to normal, you feel agitated." 

This is also one of the key differences between stress vs burnout. With stress, you're likely to be able to return to regular functioning with regular breaks and time away from the stressor, whereas burnout often requires more than this to get back to 'normal'.   

6. Thinning hair

There are many causes of thinning hair and elevated cortisol levels is one of them, unfortunately. The pressure that conditions like stress, Cushing syndrome, or gland issues put on the body can lead to a type of alopecia called telogen effluvium. 

This is when there's a disruption to the growing and shedding cycle of the hair and the ends become thin and straggly.  

7. Digestive issues

While some people get hungrier with stress, others don't want to eat at all - and this is one of the other signs of high cortisol in women. It's also one of the causes of bloating. 

"Research from the University of Pennslyvania suggests that digestion is one of the systems shut down by the stress response, to reserve energy for fending off danger," says Dr Fernando, and when the digestive system stops operating as it should, it can cause some unpleasant side effects. 

"Cortisol specifically increases stomach acid production, which can cause constipation and indigestion. Stress has also been linked to Irritable Bowel Syndrome (IBS), which causes symptoms including stomach cramps, bloating, diarrhoea and constipation," she says. 

How do you tell if you have a cortisol imbalance?

You might have a cortisol imbalance if you experience a few signs of high cortisol in women at once. "When symptoms occur alongside difficulty sleeping and concentrating, a flushed face, and mood swings, it strongly suggests something is out of balance," says Dr Fernando. This is often what burnout feels like as well, so it's worth paying attention to. 

Dr Roked agrees. "These symptoms can be caused by other things such as anxiety and depression, but I think looking at cortisol is often a good starting point especially if they are quite long-standing and you have tried to explain your symptoms away with other things," she says. 

Both experts say if you're concerned about these symptoms, speak to your doctor as the first approach. 

When to worry about high cortisol levels

If you think you may be experiencing high cortisol levels, then it's always worth consulting your doctor for a proper diagnosis as it can become a problem when levels are too high. As noted, these signs may be a symptom of a serious health issue - including Cushing syndrome or an illness linked to the adrenal or pituitary glands. 

When high cortisol levels are linked to stress, the long-term side effects can "vary from an impaired immune system and sleep disturbances to high blood pressure and an increased risk of cardiovascular disease, just to name a few," says Dr Fernando.