Increased urinary cortisol levels during the menopause transition

Abstract

To determine whether cortisol levels change prospectively during the menopausal transition (MT); whether these changes are associated with changes in the hypothalamic-pituitary-ovarian axis (follicle-stimulating hormone [FSH] and estrone glucuronide [E1G]), stressors, or menopause symptoms; and whether women who experienced a rise in cortisol levels during the transition had behavioral practices, stressors, vasomotor symptoms, or mood or sleep disturbances that affected hypothalamic-pituitary-adrenal axis function. One hundred sixty-nine women in the middle or late MT or early postmenopause stages provided monthly urine specimens for cortisol, FSH, and E1G, and rated symptoms and stress levels as part of a longitudinal study of the MT. Of these women, 91 completed a transition to the next MT stage: from early to middle (n = 30), middle to late (n = 39), or late to postmenopause (n = 22) and were eligible for inclusion in the analyses. Cortisol increased from 7 to 12 months before the late MT stage to 7 to 12 months after onset of the late MT stage. There were no differences before and after the middle MT stage or the final menstrual period. Women with increased cortisol (>10 ng/mg creatinine) during the late MT stage had more severe vasomotor symptoms than those without changes, but did not differ in terms of age, body mass index, levels of FSH or E1G, health practices, exercise, mood, sleep, cognition, or stress levels. Cortisol levels rise with age, but have not been linked to stages of the MT. Increased cortisol levels during the late MT stage, when menstrual irregularities are greatest, suggests increases in adrenal androgens and intraabdominal fat with menopause, and may influence risk of cardiovascular disease, vasomotor symptoms, mood, cognition, and bone loss.