High cortisol in women: What the symptoms mean (and what social media gets wrong)

Cortisol has become the wellness world’s latest villain. On TikTok alone, the hashtag #cortisol has racked up millions of views, spawning everything from “cortisol face” explainers and hormone-balancing smoothies to stress-reducing morning routines involving ice water and dozens of supplements before 8am.

The word has become so embedded in online culture that even my 12-year-old recently came home chanting “cortisol” while doing the now-famous TikTok hip-swivelling dance.

According to clinical psychologist at Private Space Medical, Dr Tabitha Mok, it is not difficult to see why the idea has taken hold so powerfully online. “It gives a biological explanation that feels validating. It tells women: ‘Your symptoms are real. Your body is reacting.’”

But cortisol is not the villain. It is a hormone made by the adrenal glands to help the body respond to stress, regulate energy and stay alert.

Mok cautions against diagnosing “high cortisol” from TikTok symptom lists: “A puffy face, bloating or fatigue alone do not prove cortisol excess. True cortisol disorders, such as Cushing’s syndrome, require proper medical assessment.”

Modern life, unfortunately, has trained us to treat the body like a badly behaved employee: silence its complaints, push it through deadlines, then act shocked when it eventually resigns.

Cortisol: The hormone with the worst PR

Gerontologist Heike Cushway says cortisol is not — as the Internet may have you believe — some rogue chemical personally plotting against your jawline. She claims the reality is far more nuanced.

“Cortisol is an essential survival hormone,” she says. The real issue, she explains, is the state of the nervous system driving it.

Cushway likens the nervous system to a car with two gears: drive and parked. Ideally, we should spend much of our lives in the parasympathetic state — the “parked” mode where the body can rest, repair, digest and think clearly. The sympathetic state, better known as fight-or-flight mode, is designed for short bursts of danger.

The nervous system, unfortunately, cannot always distinguish between a charging tiger and replying to Slack messages at 11pm.

“Constant notifications, productivity pressure, caregiving, emotional labour, overstimulation and poor sleep all signal to the body that it is under ongoing threat,” she says.

In Singapore, this lands in a particularly specific way. Stress here does not always arrive as a dramatic breakdown. Sometimes it arrives as a perfectly updated Google Calendar, a child’s tuition schedule, a parent’s medical appointment, and a work email marked “gentle reminder”.

Dr Victor Kwok of Private Space Medical says women here also appear to be seeking support for stress in greater numbers.

“Most studies suggest 2:1 for women to men, which also reflects the ratio we see in our clinics,” he says, adding that the stigma around seeking help has decreased dramatically since Covid-19, as mental health awareness has grown. “My patients are highly driven and often feel guilty when they cannot do everything well.”

However, Dr Mok says one of the biggest misconceptions is that every stress-related symptom automatically points to “high cortisol”.

“Stress involves multiple systems — adrenaline, the autonomic nervous system, inflammatory pathways, sleep disruption and behavioural changes,” she explains. “Cortisol is only one piece of the picture.”

The signs your body is running on chronic stress

Kwok says chronic stress often shows up first through sleep, appetite and mood changes.

“Feeling wired but exhausted, waking at odd hours, appetite disruption, palpitations, restlessness or persistent anxiety can all be warning signs,” he says.

For women in perimenopause, Cushway says fluctuating estrogen and progesterone levels can further heighten stress sensitivity at a stage of life already filled with career pressure, caregiving and cognitive overload.

“Oestrogen and progesterone are deeply connected to the brain and nervous system,” she says. “As they fluctuate, women often become more sensitive to stress physiologically and emotionally.”

The timing, unfortunately, is rarely ideal.

For many women, Cushway says perimenopause arrives during one of the most demanding periods of adulthood: careers peaking, children needing support and parents ageing: “So we see this collision between hormonal transition and chronic modern stress.”

She believes prolonged stress can eventually push the nervous system beyond fight-or-flight mode into what specialists sometimes call a “freeze” state.

“This is when the body essentially says: ‘I cannot sustain this level of activation anymore,’” she says.

It does make one wonder whether some of the internet’s infamous “Karens” are not simply difficult women demanding to see the manager, but women whose nervous systems have been running without proper maintenance for far too long.

How to lower cortisol and put down those magnesium gummies

Before panic-buying another cortisol-lowering supplement stack, Cushway says women should first pause and look at the fundamentals.

This means consistent sleep, protein-rich meals, reducing excessive caffeine, gentle movement and small nervous-system resets throughout the day, whether that means stepping outside between meetings or taking a few slower breaths before opening the laptop again.

“We live in a culture obsessed with ‘hacking’ the body,” she says. “I often speak about moving away from biohacking towards what I call bioharmonising.”

To Cushway, many women have also become disconnected from their own body signals. She encourages women to reconnect with “interoception” — the ability to notice and interpret what the body is actually trying to communicate.

Sometimes, she says, simply pausing to ask, “What does my body actually need right now?” can be more useful.

She adds that many women convinced they have a cortisol problem are sometimes simply deficient in nutrients such as iron, vitamin D, B12, zinc or magnesium — deficiencies that can themselves contribute to fatigue, anxiety, brain fog and poor stress resilience.

Mok says the goal is not to become less ambitious or less caring, but to stop treating rest and emotional needs as optional extras rather than biological necessities.

“The most powerful changes are sustainable boundaries around energy, responsibility and recovery,” she says. “One thing I tell female patients — and remind myself constantly — is that resilience is not the ability to function endlessly without needs.”

So perhaps cortisol is not the villain of the story after all. It may simply be the word women have found — somewhere between TikTok and multiple parents’ WhatsApp chats — to describe the feeling of being permanently at capacity.

As for my 12-year-old’s cortisol dance, I can only hope his nervous system is having more fun than mine.