What is Cortisol?
Cortisol is a steroid hormone of the adrenal glands, often referred to as the "stress hormone" [1, 2, 3]. It is made from cholesterol and released when your body senses a threat and goes into "fight or flight mode" [3, 4]. The hormone is managed by a network called the hypothalamic-pituitary-adrenal (HPA) axis, composed of your brain’s hypothalamus and pituitary gland and your adrenal glands situated on top of your kidneys [4].
What Does Cortisol Do?
Cortisol is necessary for various physiological functions, including metabolism, immunity and stress regulation [5, 6]. It regulates how the body reacts to stress and reduces your workload so you can focus on the immediate danger [2].
Cortisol exhibits various effects on the body. It increases the glucose concentration in your blood, and the brain more easily utilizes it, increasing the accessibility of substances involved in tissue repair [7]. It also represses unimportant functions in a life-threatening situation, changes the immune system, and slows the reproductive system and growth processes [1, 7].
Cortisol also targets the pancreas to reduce insulin, which increases your blood sugar or glucose by moving the glucose into your brain, making you more alert, and improving your body’s capacity to repair tissue [2].
Moreover, cortisol also stifles your growth process, digestive system, and reproductive system and alters your immune system’s reaction [1].
Risk Factors of Cortisol
This "stress hormone", cortisol, plays a vital role in the body. However, some elements will skew the cortisol and significantly affect your health.
Excessive use of high-dose corticosteroids is one of the most significant risks for high cortisol levels. The drugs are used for a variety of ailments, and in some instances, the long-term effects are diseases such as Cushing syndrome [8].
Some diseases can raise the level of cortisol as well.
These are:
- Pituitary or adrenal tumours
- Adrenal deficiency
- Autoimmune endocrinopathies like hypothyroidism or type 1 diabetes [9, 8, 10].
Age is another risk factor – older women and third-trimester pregnant women are more susceptible to adrenal crisis, which is a condition in which the level of cortisol is suddenly reduced [10].
Other medications slow down the absorption of cortisol or decrease its level, and this can lead to an adrenal crisis.
Examples of medications which influence this include:
- Levothyroxine
- Phenytoin
- Phenobarbital
- Rifampin
- Carbamazepine
- St John’s wort
- Ketoconazole
- Etomidate
- Fluconazole [10].
Psychosocial aspects can also influence cortisol. Stress, cynicism, depression and vital fatigue have all been linked to a flatter cortisol diurnal rhythm, which leads to higher cortisol [11, 12].
Cortisol levels can be affected by genetic background, too. Genetic mutations in the pituitary or adrenal systems (like the inherited congenital adrenal hyperplasia condition) increase the risk of Addison’s disease, a disorder of low cortisol [9].
Lastly, lifestyle factors such as obesity and uncontrolled type 2 diabetes can be risk factors for conditions like Cushing’s syndrome (high levels of cortisol) [13].
What Happens When Cortisol Levels Are Too High?
In extreme cases of elevated cortisol, symptoms spread through the body. The most apparent symptom is weight gain, especially around the midsection and upper back, and a rounded face [14].
Skin changes are another side effect of high cortisol. This can be acne, dry skin, easy bruising and a flushed face. Even the skin can regenerate less quickly than usual [14].
As cortisol goes up, you also experience muscle wasting and drowsiness. This makes everyday activities harder and can significantly affect a person’s life [14].
It is also typical for high cortisol to be irritable and cause a lack of concentration. They can change a person’s mood and mind and result in problems at work or with relationships [14].
Hypertension is another sign of high cortisol. This will increase your risk of heart disease and other cardiovascular diseases [14].
Headaches are common in people with high cortisol as well. These can be mild to severe and happen often [14].
More serious problems, too, are a possibility with elevated cortisol. They can be heart disease, lung problems, obesity, anxiety, depression, and even type 2 diabetes [14, 15].
Will Stopping Birth Control Pills Lower Cortisol Levels?
Hormonal birth control and cortisol are interconnected. There is evidence that hormonal birth control, such as OCPs, can also alter body cortisol.
Women who take hormonal birth control are found to have higher cortisol levels than women who do not use hormonal birth control [16]. This is probably because hormonal birth control increases cortisol during stress [17].
In addition, hormonal contraceptives have also been shown to suppress the cortisol stress response, resulting in a lower cortisol response to stress in women on hormonal contraceptives than in women who don’t use hormonal contraceptives [18].
But do keep in mind that the effect of hormonal contraceptives on cortisol can vary with the kind and dose of the contraceptive. Oral contraceptives with 50 micrograms of oestrogen, for example, significantly increased total plasma cortisol in a single study, while contraceptives with 20 micrograms of oestrogen did not [19].
Concerning discontinuation of birth control, a study reported that a woman had a panic attack – palpitations and dyspnoea were among the symptoms of withdrawal from birth control. This was also associated with an above-normal plasma cortisol level [20].
To sum up, hormonal birth control does affect cortisol levels, but the effects of discontinuing hormonal birth control on cortisol levels are less known, and individualized. Hence, talk to your doctor about changing the contraceptive.