Understanding the stress response in perimenopause and menopause and what you can do about it.
If stress seems to affect you more deeply during perimenopause or menopause, you are not imagining it and you are not alone. Anxiety, low mood, poor concentration, fatigue and difficulty sleeping are all recognised symptoms during the menopausal transition, although every woman’s experience is different.
Hormonal change is only one part of the picture. Sleep disruption, hot flushes, work, caring responsibilities, relationships and wider life pressures can all add to the load. At the centre of the body’s biological response to that load is the hypothalamic–pituitary–adrenal axis, better known as the HPA axis.
Understanding this system can help explain why stress and menopause sometimes seem to amplify one another. It can also point towards gentle, realistic ways to support wellbeing.
What is the HPA axis?
The HPA axis is a communication network linking the brain and adrenal glands. It helps the body adapt to physical and psychological challenges and maintain homeostasis; the stable internal conditions the body needs to function.
It involves three key structures:
- Hypothalamus: the brain’s command centre, which detects a threat or demand and releases corticotropin-releasing hormone (CRH).
- Pituitary gland: the hormone “control tower”, which responds by releasing adrenocorticotropic hormone (ACTH).
-
Adrenal glands: glands above the kidneys that respond to ACTH by releasing cortisol.
Cortisol is often called the stress hormone, but it is not inherently “bad”. It helps regulate energy availability, blood pressure, immune activity and the sleep–wake cycle. In a short-term challenge, cortisol is part of a useful survival response.
Once enough cortisol is circulating, it signals back to the hypothalamus and pituitary gland to reduce CRH and ACTH. This braking mechanism is called negative feedback. In simple terms, the body is saying: “The message has been received; you can slow down now.”
All hormones are connected, but not in a simple domino effect
When we think about menopause, oestrogen often comes to mind first, followed by progesterone. Yet hormones do not work in isolation. The HPA axis communicates with the reproductive and thyroid axes, while the brain, immune system, metabolism and sleep system also influence how we feel.
This does not mean that one “imbalanced” hormone automatically forces another to compensate. Hormone relationships are dynamic, and symptoms such as anxiety, tiredness and brain fog can have several overlapping causes. The useful takeaway is that changing ovarian hormones can interact with stress biology, not that every symptom is caused by a single hormone or a single cortisol pattern.
What happens during perimenopause and menopause?
During perimenopause, ovarian hormone production becomes more variable. Menstrual cycles often become irregular, progesterone exposure commonly falls as ovulation becomes less consistent, and oestrogen may fluctuate before eventually settling at a lower level after menopause.
Oestrogen and progesterone, as well as progesterone-derived neurosteroids such as allopregnanolone, interact with brain systems involved in mood, sleep and the stress response. As these signals change, some women become more vulnerable to anxiety, low mood or sleep disturbance. Research supports an interaction between hormonal change and stress sensitivity, but it does not show that every woman develops a weaker cortisol feedback loop or persistently high cortisol.
Individual responses vary. Chronic stress can be associated with higher, lower or altered daily cortisol patterns depending on the person, timing and health context. That is why it is more accurate to describe the HPA axis as potentially dysregulated or differently regulated, rather than simply “overactive”.
Why stress can feel harder to manage in menopause
Several factors can converge during the menopausal transition:
- Hormonal fluctuations may influence mood and stress processing. Changing oestrogen and progesterone signalling can affect brain networks involved in emotional regulation.
- Sleep can become more fragile. Night sweats, hot flushes and insomnia may reduce recovery and make the following day feel more stressful.
- Stress and symptoms can reinforce each other. Worry can disturb sleep; poor sleep can worsen fatigue, irritability and perceived stress.
- Midlife can carry a high practical load. Careers, caring responsibilities, family changes and health concerns may all occur at the same time.
Discover how to restore your natural sleep rhythm during. perimenopause and menopause
In everyday language, the brain and body may have more demands to manage while restorative sleep and familiar hormonal rhythms are changing. This can make it easier to feel overwhelmed, anxious or exhausted, but it is not a personal failing. A clinical review highlighted the changes in stress contributing to vulnerability and potential depression during this phase of life.
Do the adrenal glands “take over” hormone production?
The adrenal glands produce DHEA and other androgen precursors, which can be converted in peripheral tissues into small amounts of oestrogens after menopause. However, the common idea that the adrenals are “too busy making cortisol” and therefore cannot make progesterone is an oversimplification.
The ovaries do not simply hand progesterone production over to the adrenal glands, and there is no established clinical diagnosis of “adrenal fatigue”. Chronic stress can influence endocrine signalling and wellbeing, but tiredness, anxiety or low mood should not automatically be attributed to depleted adrenal reserves. Persistent symptoms deserve a proper clinical assessment.
How does the HPA axis affect the thyroid?
The stress and thyroid systems communicate. Severe illness, prolonged physiological stress and pharmacological doses of glucocorticoids can alter thyroid-stimulating hormone (TSH) secretion and the conversion of thyroxine (T4) to triiodothyronine (T3). However, ordinary psychological stress does not inevitably cause hypothyroidism.
In one controlled human experiment, acute psychosocial stress temporarily increased TSH but did not increase T3 or T4. This illustrates why the relationship is more complex than “cortisol suppresses the thyroid”. If fatigue, low mood, feeling cold, constipation, hair changes or unexplained weight changes persist, ask a GP about appropriate assessment rather than assuming the HPA axis is the cause.
What may help support stress resilience during menopause?
There is no single way to “reset” the HPA axis. Small, repeatable habits are usually more useful than chasing a perfect routine.
-
Create a daily downshift. Try slow breathing, a short mindfulness practice, gentle stretching or time outdoors. Even five to ten minutes can create a transition out of “always on” mode. Evidence suggests mindfulness may improve perceived stress and sleep in postmenopausal women, although the quality of the evidence is still limited.
- Protect sleep. A clinical study in a multi-ethnic community confirmed sleep disturbances. To support your sleep keep a consistent waking time, create a cool and dark bedroom, reduce late caffeine and build a calm wind-down routine. If night sweats, insomnia or anxiety are repeatedly waking you, seek advice: lifestyle support, menopause-specific cognitive behavioural therapy and medical treatments may be appropriate.
- Move in a way that feels sustainable. Walking, resistance exercise, yoga and other enjoyable movement can support mood, sleep, cardiovascular health, muscles and bones. Start at a manageable level and build gradually; more is not always better when you are already depleted.
- Eat regularly and nourish yourself. Build meals around vegetables and fruit, fibre-rich carbohydrates, protein and healthy fats. Foods containing magnesium include leafy greens, beans, nuts, seeds and wholegrains. Regular meals may also help avoid the jittery or drained feeling that some people experience after long gaps without food.
- Hydrate consistently. Keep water accessible through the day. Hydration supports normal physical and cognitive function, although it should be viewed as one wellbeing habit rather than a treatment for hormonal symptoms.
- Make room for support. Talk to someone you trust and seek professional help if anxiety, low mood or exhaustion is affecting daily life. Menopause symptoms are treatable. A GP or menopause specialist can discuss evidence-based options, including HRT and non-hormonal treatments, in light of your symptoms and medical history.
Which foods help to calm menopausal symptoms?
Can supplements help?
Supplements can complement but should not replace a nourishing diet, restorative habits or appropriate healthcare. Evidence varies by ingredient, preparation and dose, and a study of one standardised extract cannot automatically be applied to another extract or to a multi-ingredient formula.
Rejuvenated offers two formulas for people considering nutritional support:
Cellular Calm Complex combines L-theanine, magnesium, rhodiola, ashwagandha and acetylchoine. Research on some individual ingredients has explored stress, sleep and mood outcomes. For example, small randomised trials of particular ashwagandha extracts have reported improvements in perceived stress and cortisol measures, but larger independent studies are needed.
Female Hormone Support combines botanicals, vitamins and minerals, including B vitamins, ashwagandha, magnesium, red clover and hops. It is designed as a daily nutritional supplement during hormonal transitions. Research on red clover for menopausal symptoms has produced mixed findings, and results from individual extracts do not establish that a finished combination product prevents or treats menopause symptoms.
If you would like to take both supplements please limit them to no more than one of each per day.
Supplement safety matters
“Natural” does not always mean suitable for everyone. Speak to a GP or pharmacist before taking supplements if you:
- use prescription medicines
- have a thyroid, liver or autoimmune condition
- have a history of, or increased risk for, a hormone-sensitive cancer
- are pregnant, breastfeeding or trying to conceive
- are due to have surgery - or
- are already taking other products containing the same nutrients or botanicals.
- don't take this supplement if you suffer from endometriosis, polycystic ovaries or fibroids
Red clover contains isoflavones with oestrogen-like activity, while ashwagandha may not be appropriate for some people. Do not stop prescribed medication in favour of a supplement.
To summarise
The HPA axis is one part of a much bigger conversation between stress, sleep, the brain and changing reproductive hormones. During perimenopause and menopause, that conversation may become less predictable, helping explain why familiar pressures can suddenly feel more difficult to carry.
You cannot eliminate every stressor, and you do not need to “fix” your hormones on your own. Consistent sleep support, nourishing food, movement, calming practices and professional care when needed can all help you feel steadier and more supported through this transition.
Suggested call to action: Explore Rejuvenated’s menopause and stress-support range, or speak to a healthcare professional to find the approach that is right for you.
You might find further helpful information on the links below.
