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Does estrogen therapy have the ability to help severe insomnia 11 years into menopause; if so, does it do this by lowering high cortisol and/or raising neurotransmitters?

By Anonymous September 6, 2014 - 8:13am
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I'm a 62 year old woman who sailed through menopause at 51 with the use of 15 mg. of progesterone per day. No sleep troubles and a cast iron stomach. My estrogen has since always tested low. In the past 2 yrs. I have developed severe insomnia, hypothyroid symptoms, high cortisol, GI issues, muscle tension (particularly in my stomach), palpitations, left lower abdominal pain, low grade anxiety, etc. Have seen a couple of doctors who offered only sleeping pills and antidepressants. Another has started me on compounded PLO gel, 1 mg. estriol + .25 mg. estradiol + 20 mg. progesterone, applied to labia/entrance to vagina. Now on my 8th day and insomnia has gotten way worse, if that's possible! Is this a case of symptoms getting worse until the 4th week? I've also been tried on Nature-Throid, but as I raised it, my symptoms came back at 1-1.5 gr., so I am now only on 1/2 gr. By the way, doctors consider my TSH to be normal. I also am seeing a DOM acupuncturist; he is treating me with herbs for high cortisol. Is it possible that the high cortisol is the underlying problem for low sex hormones, thyroid resistance, GI problems, and severe insomnia? Any help is appreciated; I am hoping for some relief soon. Doctors in Las Cruces, NM seem not to have a clue, and I need to know I'm on the right track. Kathy B.

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Hello Kathy B,

My late father-in-law told his medical students,"Never become an interesting patient." Let's see if we can fill in some pieces of your medical puzzle.

High levels of cortisol may be the starting point.

The most common cause of increased plasma cortisol levels in women is a high circulating concentration of estrogen. This happens with estrogen therapy and during pregnancy. The result is increased concentration of cortisol-binding globulin. In your case, your cortisol levels tested low until two years ago. The question is what changed in the last two years to cause blood levels of cortisol to increase.

Cortisol levels are regulated by adrenocorticotropic hormone (ACTH), which is synthesized by the pituitary in response to corticotropin-releasing hormone (CRH). CRH is released in a cyclic fashion by the hypothalamus, resulting in peaks between 6 a.m.-8 a.m. and a drop around 11 p.m in plasma ACTH and cortisol levels.

Insomnia, low sex drive, constipation,irritable bowel syndrome, increased susceptibility to getting upper respiratory infections, and increased risk for cardiovascular heart disease are signs of high cortisol levels.

An increased or normal cortisol concentration in the morning along with a level that does not drop in the afternoon and evening suggest an overproduction of cortisol and Cushing syndrome. If this excess cortisol is suppressed during a dexamethasone suppression test, it suggests that the excess cortisol is due to increased pituitary ACTH production.

In response to your question about the correlation between cortisol and neurotransmitters, the adrenal glands secrete glucocorticoid, such as cortisol, which interact with the serotonin receptors in the brain. Serotonin is a neurotransmitter.

Kathy B., I suggest you schedule an evaluation with an endocrinologist who can take a closer look at your adrenal glands and pituitary glands.

I hope this is helpful.


September 7, 2014 - 5:24am
HERWriter Guide

Hi Kathy B -

Thanks for your question and welcome to EmpowHER!

You are certainly dealing with a lot right now, and you've asked some good questions. I did a literature search trying to find answers for you, and found it very frustrating. There were reports stating that estrogen therapy would help reduce cortisol levels, as well as reports indicating no impact. Getting answers may take a while.

High levels of cortisol (stress hormones) can definitely lead to insomnia, as well as many other issues. You mentioned that you are being treated with herbs for that - I'm wondering if you have considered taking additional measures.

This article, from the EmpowHER community, provides good information on cortisol as well as suggestions for reducing levels. Please read Understanding cortisol - our friend, our enemy - and let us know what you think. As the author notes, stress reduction can play a huge role in reducing cortisol levels. She says "the big picture is to keep trying to lower your daily stress level, by changing your lifestyle where you can. And the smaller picture is to learn ways to relax your body and mind, like journaling, deep breathing, meditation, yoga, listening to music and so on. It doesn't matter how you do it, but it matters that you do it."

We also have a section of the site dedicated to cortisol information where you can find clinical information, articles and videos. You just may find some of the answers you're seeking there.

I hope other women will see your "Ask" and chime in with their own personal experiences and observations. We can certainly learn a lot from each other!

Hope this helps, and I hope we are starting you on the right path toward getting the answers you need so that you can start getting a good night's sleep.




September 6, 2014 - 8:22pm
EmpowHER Guest

I think your site is great. Hope to receive some comments on my post. Thank you. Kathy B.

September 6, 2014 - 8:19am
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