Why You’re Tired but Wired: Cortisol, Perimenopause & the Nervous System
Many women entering perimenopause experience a frustrating pattern: persistent daytime fatigue paired with nighttime alertness, racing thoughts, or insomnia. While this is often attributed to “stress” or poor sleep habits, the underlying issue is frequently nervous system dysregulation.
During perimenopause, hormonal communication between the brain, ovaries, and adrenal system becomes less predictable. Cortisol, the body’s primary stress hormone, may no longer follow its natural circadian rhythm.
Instead of rising in the morning to support alertness and energy — and lowering in the evening to promote rest — cortisol can become misaligned.
Common patterns include:
Low morning cortisol, leading to fatigue and difficulty focusing
Elevated evening cortisol, contributing to anxiety and sleep disruption
Increased sensitivity to stress, inflammation, and weight changes
Because most standard lab testing does not assess cortisol timing or nervous system responsiveness, results may appear “normal” even when symptoms are significant.
At Mind & Body Renew Medical Spa & Psychiatry, we focus on function, patterns, and lived experience, not just lab values. Our hormone-informed approach considers sleep-wake cycles, mood regulation, stress reactivity, metabolic shifts, and physical symptoms together to guide care.
This integrated model allows us to support regulation first — creating a foundation for long-term balance, resilience, and well-being.
If you’re experiencing symptoms that don’t match your lab results, you’re not imagining them — and you’re not alone.
📍 Raleigh, NC
📲 Schedule a consultation to explore hormone- and nervous-system-informed care
