Cortisol is a crucial hormone produced by the adrenal glands that helps regulate metabolism, immune function, and the body's response to stress. However, when cortisol levels remain persistently high, it can lead to a range of serious health issues. Understanding the signs of high cortisol in women is essential for early detection and proper treatment.

Signs of High Cortisol in Women: What You Need to Know

Understanding the Signs of High Cortisol in Women

Women are particularly susceptible to the effects of excess cortisol due to hormonal fluctuations throughout life, including pregnancy, menopause, and the use of birth control or hormone replacement therapy. The signs of high cortisol in women can be subtle at first but often worsen over time if left untreated.

Common Physical Signs of High Cortisol in Women

One of the most noticeable signs of high cortisol in women is unexplained weight gain, especially around the midsection, face, and upper back. High cortisol levels can lead to fat redistribution in the body, resulting in a "buffalo hump" between the shoulders and a round, puffy face known as "moon face."

Other physical signs of high cortisol in women include:

• Thin, fragile skin that bruises easily
• Slow wound healing
• Muscle weakness
• Severe fatigue and low energy levels
• Frequent infections due to a weakened immune system
• Osteoporosis or bone loss, increasing the risk of fractures

Figure 1. Common symptoms of high cortisol in women. Remember that cortisol affects every cell of the body, so symptoms can be very individual and variable. Not all patients have all symptoms!

Emotional and Psychological Signs of High Cortisol in Women

High cortisol does not only affect the body—it also has a profound impact on mental health. Women with excess cortisol often experience:

• Severe anxiety or panic attacks
• Depression or mood swings
• Memory and concentration problems (brain fog)
• Irritability and emotional instability
• Insomnia or disturbed sleep patterns

These symptoms can make daily life challenging and may be mistaken for other mental health disorders, delaying proper diagnosis and treatment.

Hormonal Imbalances as a Sign of High Cortisol in Women

Excess cortisol can interfere with the body's normal hormonal balance, leading to issues such as:

• Irregular or absent menstrual periods
• Infertility or difficulty conceiving
• Increased facial and body hair growth (hirsutism)
• Lowered libido

These symptoms are particularly concerning for women of reproductive age and can be mistaken for conditions such as polycystic ovary syndrome (PCOS).

How to Diagnose the Signs of High Cortisol in Women

If you suspect you may have high cortisol levels, it's important to undergo proper diagnostic testing. The Carling Adrenal Center specializes in diagnosing and treating adrenal disorders, including Cushing’s syndrome. Common diagnostic tests include:

• ACTH = Low to low-normal. The elevated cortisol from the adrenal tumor provides negative feedback to the pituitary which lowers the ACTH levels. If you have high ACTH levels, you do not have MACS, you may have a pituitary tumor causing Cushing’ syndrome.
• Low dose (1mg) dexamethasone suppression test (LDDST) = high, i.e. above 1.8 μg/dl. 1 mg of dexamethasone (a natural hormone; glucocorticoid; your endocrinologist will provide you a prescription for this) is given at 11 pm in the overnight test and the serum cortisol is measured the next day at 8-9 am (simple blood test). A normal person will “suppress” their cortisol to below 1.8 μg/dl. Patients with MACS fail to suppress and thus will have a cortisol level above 8 μg/dl.
• DHEA-S (Dehydroepiandrosterone-sulfate) = Low to low-normal, often below 100 μg/dl.

Read more about DHEA-S here: https://www.adrenal.com/blog/what-is-dhea-and-what-does-it-tell-me-about-my-adrenal-tumor 

Two other tests are often used to evaluate too-high cortisol in women and they are useful sometimes. But remember these tests are normal in most patients. They are only abnormal if your cortisol levels are severely elevated.

• 24-hour urinary free cortisol test to measure cortisol excretion over a full day
• Late-night salivary cortisol test to detect abnormal cortisol rhythms

Treatment Options for Women Experiencing High Cortisol

Once a diagnosis is confirmed, the appropriate treatment depends on the underlying cause of high cortisol. The Carling Adrenal Center offers expert surgical intervention for adrenal tumors causing excess cortisol production.

Adrenalectomy: The Best Treatment for Adrenal-Related High Cortisol

For women diagnosed with an adrenal tumor leading to high cortisol levels, minimally invasive adrenalectomy is often the most effective treatment. It is the only potentially curative treatment. This procedure involves the removal of the affected adrenal gland(s), which allows cortisol levels to return to normal.

The best surgical option for almost all patients with high cortisol is the Mini Back Scope Adrenalectomy (MBSA).

When to Seek Expert Care for Signs of High Cortisol in Women

If you are experiencing multiple signs of high cortisol in women and they are affecting your quality of life, it is essential to seek expert medical advice. The Carling Adrenal Center specializes in diagnosing and treating adrenal-related conditions, ensuring that patients receive the best care possible.

Why Choose the Carling Adrenal Center for High Cortisol Treatment?

Dr. Carling is a world-renowned adrenal surgeon and widely regarded as the best adrenal surgeon, with extensive experience in treating Cushing’s syndrome and other adrenal disorders. The Carling Adrenal Center provides state-of-the-art diagnostic tools and the latest surgical techniques to ensure optimal outcomes for women suffering from high cortisol levels.

Conclusion: Recognizing and Treating the Signs of High Cortisol in Women

Understanding the signs of high cortisol in women is crucial for early intervention and treatment. From weight gain and skin changes to severe mood swings and hormonal imbalances, high cortisol levels can significantly impact overall health and well-being. Proper diagnosis and expert treatment at the Carling Adrenal Center can help women regain their health and lead a better quality of life.

If you suspect you may be experiencing the signs of high cortisol in women, contact the Carling Adrenal Center today for expert evaluation and treatment.

Dr. Tobias Carling, of the Carling Adrenal Center, is one of the world's leading experts in adrenal gland surgery. Dr. Carling performs more adrenal operations than any other surgeon in America. Dr. Carling left Yale University in 2020 to open the Carling Adrenal Center in Tampa, Florida.

To discuss the details of your case with Dr. Carling and become his patient, fill out the new patient form and he will be in touch with you shortly.

Additional Resources: 

• Learn more about the Carling Adrenal Center
• Learn more about Dr. Tobias Carling
• Learn more about our sister surgeons at the Norman Parathyroid Center, and Clayman Thyroid Center.
• Learn more about the Hospital for Endocrine Surgery