Cortisol levels and stress: how cortisol levels and stress are connected

Medically reviewed by Rosanna Sutherby, PharmD on January 12, 2020. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


If you’ve ever found yourself in a stressful situation, you may have experienced symptoms associated with the common “fight or flight” response—such as heart pounding, heavier breathing, muscles tensing, and increased sweating. This is your body’s way of reacting to stress, such as when you’re in danger. But what role do cortisol levels play when it comes to stress?

That’s what we’ll explore in more depth here, so read on if you’re interested in learning more about the connection between cortisol levels and stress.


See how your cortisol levels change throughout the day and whether they may be too high or too low with the easy-to-use, at-home Sleep & Stress Test.


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What role does cortisol play in stress?

Before talking about how cortisol affects stress, let’s first discuss what cortisol is.

Cortisol is a hormone produced by the adrenal glands that helps regulate several important functions in your body. One of the most prominent functions is regulating how your body responds to stress.

When you experience stress, your adrenal glands release cortisol into your body which temporarily increases your blood sugar levels to provide the body with a boost of energy (adrenaline, a hormone commonly associated with the “fight-or-flight” response, is also released by the adrenal glands in times of stress). This process helps you perform better in stressful situations that have a relatively short duration (acute stress), such as when you are in danger or striving to hit a tight deadline at work.

However, if you experience stress over a long-term, sustained length of time—otherwise known as chronic stress—the body’s stress response makes negative health outcomes more likely. That’s largely because chronic stress can cause consistently elevated cortisol levels, and this can alter bodily processes and functions in harmful ways.

Chronic stress weakens immune function (making you more vulnerable to infections) and can raise the risk of diabetes, lead to ulcers that damage the gastrointestinal system, result in a buildup of plaque in the arteries (or atherosclerosis), and take a serious toll on one’s mental health—among many other possible consequences. In fact, according to research, chronic stress can impact nearly all of the body’s systems. Situations that are commonly associated with chronic stress include caregiving for a family member, financial uncertainty, and toxic relationships.

How long does cortisol stay elevated after a stressful event?

In situations involving short-term or acute stressors, cortisol levels typically remain elevated for several hours following a stressful event. If cortisol levels remain elevated for a prolonged amount of time (such as 6 or more months), this is a good indicator that someone is experiencing chronic—or long-term—stress.

Symptoms of high cortisol levels

Chronically high cortisol levels, or hypercortisolism, can ultimately lead to a medical condition known as Cushing syndrome. According to Mayo Clinic, signs and symptoms associated with Cushing syndrome can include:

  • Rapid weight gain mainly in the face, chest, and abdomen
  • A flushed and round face
  • High blood pressure
  • Osteoporosis
  • Skin changes (such as bruises and purple stretch marks)
  • Muscle weakness
  • Anxiety, depression, or irritability
  • Increased thirst and frequent urination

Reducing excess cortisol levels

If your cortisol is consistently elevated, be sure to collaborate with your healthcare provider to learn what the cause might be and what they recommend to help balance your levels.

If excess cortisol is the result of chronic stress, then reducing this stress is a great way to potentially dial down your cortisol levels. Here are some ideas that can help lower stress:

  • Practice mindfulness with breathing exercises and meditation
  • Take a long walk in nature to help clear your head
  • Fuel your body with fresh vegetables, fruit, and hearty whole grains
  • Find someone you can vulnerably talk to about life stressors, whether that’s a mental health professional, a family member, or a close friend Create a regular sleep routine and stick to it as much as possible

How is cortisol measured?

Cortisol can be measured using urine, saliva, and blood tests—which are described in more detail below.

Cortisol urine test: This kind of test measures free cortisol (cortisol that isn’t attached to proteins) in your urine three to four times throughout the day. Urinary free cortisol tests, like the Everlywell at-home Sleep & Stress Test, are useful for checking how your cortisol levels change over a 24-hour period and can help provide insight into sleep problems, stressors, and more.

Cortisol saliva test: This test also measures the amount of free cortisol in the body, but through a saliva sample. Late-night salivary cortisol⁠—the measurement of cortisol in a saliva sample collected late at night⁠—is a reliable way to screen for Cushing syndrome.

Cortisol blood test: Blood tests measure either free cortisol or total cortisol. Blood total cortisol tests are helpful for diagnosing certain conditions, such as adrenal insufficiency in patients with critical illnesses like severe pneumonia and respiratory distress syndrome.

Checking your cortisol levels from home

Want to gain a better understanding of the hormones that play a role in your stress response and sleep cycle? Check on your cortisol levels and other key hormones from the convenience of home with the at-home Sleep & Stress Test. Everything you need for collecting a urine sample at home and shipping it to a CLIA-certified lab for testing is included with the kit. The test results will reveal how your cortisol levels fluctuate throughout a 24-hour period and whether your levels are high or low compared to the reference range.


What are cortisol levels?

What is adrenal insufficiency?

Symptoms of adrenal insufficiency

Cortisol and sleep: Do cortisol levels affect sleep?


References

1. Physiology, Cortisol. StatPearls. URL. Accessed January 12, 2020.

2. Hannibal KE, Bishop MD. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Phys Ther. 2014;94(12):1816-1825.

3. Salleh MR. Life event, stress and illness. Malays J Med Sci. 2008;15(4):9-18.

4. Epel ES, Crosswell AD, Mayer SE, et al. More than a feeling: A unified view of stress measurement for population science. Front Neuroendocrinol. 2018;49:146-169.

5. Cushing syndrome. Mayo Clinic. URL. Accessed January 12, 2020.

6. Stress management. Mayo Clinic. URL. Accessed January 12, 2020.

7. Cortisol urine test. MedlinePlus. URL. Accessed January 12, 2020.

8. Cortisol Test. MedlinePlus. URL. Accessed January 12, 2020.

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