Is adrenal fatigue driving your PCOS? Keep reading to learn how to manage your PCOS and cortisol balance

a stressed woman with her hands covering her face

Adrenal Fatigue and PCOS: How Stress Impacts PCOS

If you’ve landed here, you’ve probably heard the term “adrenal PCOS” floated around before, right? In the case of adrenal PCOS, classically we would think about our adrenals being in overdrive, pumping out excess cortisol and androgens and potentially creating more of our PCOS symptoms compared to the ovaries. This term comes from an approach to PCOS management where it is believed that the cause stems from one of 3 specific roots : Blood Glucose Dysregulation (this may or may not include insulin resistance), Inflammation, or Stress (may be from coming off of the birth control or related to a more dysregulated adrenal picture).

The problem with this viewpoint is that it tries to create neat and tidy containers for each person with PCOS to fit into cleanly, when this simply isn’t the case. While all of these factors can absolutely play a role in the development and worsening of PCOS symptoms, the fact of the matter is that it’s much more complicated than simply dividing all women with PCOS up into three camps. Most women deal with all of these factors in varying degrees, and stress is almost always a factor. In fact, stress is so intertwined with PCOS that some women that I see in my practice have been mis-diagnosed with PCOS and truly had more of an adrenal stress, imbalanced sex hormone, or hypothalamic amenorrhea picture at play – and at the end of the day, these things are really all related to the same common roots.

All this to say, understanding how stress and PCOS interact is key to not only managing your symptoms, but truly addressing one of the common drivers of PCOS. But before we dive into how adrenal fatigue and PCOS can go hand-in-hand, we need to ground ourselves in what it really means to have stressed adrenals and what dysregulated cortisol levels look and feel like. If these concepts are new to you, you can read this post on hormonal health and adrenal stress to learn more about adrenal fatigue and cortisol.

a stress woman holding her hands to the back of her neck

Drivers of PCOS

Blood Glucose Dysregulation

One of the hallmark drivers of PCOS is blood glucose dysregulation. Many (but not all!) women with PCOS struggle with insulin-resistance, which can lead to issues with blood sugar management. This is part of why we sometimes see Metformin prescribed for women with PCOS. Insulin, estrogen, leptin and other hormones are all deeply intertwined, and an imbalance in one can impact the others, which can lead to a vicious cycle in the PCOS picture. Even without insulin resistance – chronically dysregulated blood glucose can lead to a state of chronic inflammation, so learning to support our blood sugar is critical in a PCOS support plan.

Inflammation

In a long-term state of low-grade inflammation, ovaries can produce greater amounts of androgens or precursors to androgens, our male sex hormones such as testosterone. We all need androgens, women included, but in the case of PCOS by diagnosis there is an excess of androgens. This excess of androgens is associated with some of the symptoms we see in PCOS such as acne and hair growth. Inflammation is also perceived as a stressor by our bodies, which can continue to worsen our PCOS symptoms. In about 20-30% of PCOS pictures we actually see adrenal involvement in elevated androgen levels as a result of a higher level of androgen precursors (like DHEA-S).

Stress

And now that brings us back to stress. If we’re experiencing elevated blood sugar levels, chronic inflammation and the typical daily stressors, it’s no wonder that our body is going to be stuck in a state of stress. Managing our stress levels and supporting our adrenals is key for treating PCOS. So if we really want to manage our PCOS holistically, we need to think about how to get our stress levels under control. But what constitutes stress?

an exercise mat with a resistance band, phone, weights and a water bottle

Physical and Emotional Stressors

Physical stressors

Think of physical stressors as being any external source of stress. These types of stressors are all around us, keeping us in fight-or-flight mode. This can be from our environment such as noise pollution or chronic exposure to toxins, or can be in the form of an injury or illness. Our relationships, financial situation and expectations at work can also fall under this category.

Emotional stressors

When you think about stress, what comes to mind? Probably daily responsibilities at home and work – right? That’s a big part of it for sure, but our bodies can actually experience stress from many of our habits that we might perceive as healthy. This can include:

Undereating – Constant dieting, restriction and undereating is perceived as a threat by our bodies. When we’re chronically undernourished, our body will go into overdrive to try and protect itself.
HIIT, over-exercising or skipping rest days – While exercise is critical to promoting our wellbeing, it is a form of stress on our bodies. Our bodies are wise and know how to recover from a certain about of exercise-induced stress, but the more we overdo it, the harder it will be to rebound
Early morning workouts – Our cortisol levels naturally spike in the morning to help wake us up, and when you stack a workout on top of our already heightened cortisol levels, the stress can take a bigger toll
Chronically disrupted sleep – We need sleep in order to repair from all of the stressors we experienced throughout the day, and as mentioned earlier, our cortisol levels spike when we awake from sleep so if this is happening often throughout the night,
Fasting or delayed morning eating – Intermittent fasting has become a really popular method for weight loss and PCOS management, but this pattern of eating isn’t supportive for PCOS, stress or female bodies in general. Living in a chronically fasted state is perceived by our bodies as a form of stress. Furthermore, most people are naturally more insulin sensitive in the morning, so for my friends who struggle with blood sugar management, fasting in the morning can be directly contradictory in your efforts to support your blood glucose levels!
Excessive caffeine – Many of us deal with chronic fatigue, and it’s so easy to reach for that extra cup of coffee when we feel like we’re fighting to make it through the day. But overconsumption of caffeine can drive increased cortisol levels, especially when relying on it to support fatigue
Skipping meals or blood sugar instability – When we’re busy and stressed, oftentimes meal times are one of the first places we make compromises and cut corners. We might have breakfast on the go, miss lunch or simply not have the time to worry about how balanced our meals are. When mealtimes become unpredictable and we’re not practicing balance in our meals, we’re more likely to experience blood sugar instability, which is a major driver of both physical stress and inflammation.

two packs of birth control pills

Stress and PCOS

So what does all of this stress mean for PCOS? When the stress response is activated, our body must prioritize where its resources are going and will turn off certain channels in order to allow our body to function amidst all the perceived threats. One of these pathways that our body sees as non-essential and will stop prioritizing are our hormone production pathways involved in ovulation and fertility (1). Additionally, when levels of the stress hormone cortisol increase, this blocks maturation of ovarian follicles. This means that chronic stressors can exacerbate what’s going on with PCOS, including the buildup of immature follicles in the ovary, infertility and cycle irregularity.

So what do we do about it? Let’s actually back up and talk about what we SHOULDN’T do about it:

Undereating – Eating meals regularly throughout the day will allow our bodies to feel fueled, safe and supported through keeping our hormones in balance
Overexercising – That’s not to say that we shouldn’t be exercising at all. Scheduling in rest days and allowing our body to have adequate time to recover will help us get more out of our workouts
Birth control or spironolactone – Oftentime birth control and spironolactone are simply acting as band-aids to mask what’s going on under the surface, instead of actually helping us get to the root cause. In fact, birth control can exacerbate nutritional deficiencies and keep us further entrenched in a cycle of stress.
Fertility treatments – If we don’t manage the root cause of our stress to create a safe environment for a healthy pregnancy to thrive, we’re ignoring the root of our issues, which won’t necessarily disappear if we were to become pregnant and ultimately can challenge the success rate of those fertility treatments.

plate of radishes, lettuce, avocado and lemon next to a bowl of olives, a bowl of corn, a plate of greens and a two halves of avocado

And that finally brings us to how we can holistically address your PCOS picture through the lens of stress management and adrenal fatigue. These are the non-negotiables if you’re looking to get to the root:

Functional assessment – Stop guessing and Googling! It’s time to get the real data on what’s actually going on in our bodies with the help of an expert. A functional practitioner can help you understand your unique experience and identity a path forward in your efforts to address your unique root causes to your PCOS picture
Identify your unique stressors – Take a look at the physical and emotional stressors that could be playing a role in your life and get specific on how to address them.
Diet and lifestyle – Establishing a nourishing diet and lifestyle foundations for PCOS support is key to actually addressing the issue instead of covering it with a bandaid. Eating enough, moving our bodies in a sustainable way, getting enough sleep, spending time outside and managing our stress levels all play a role.
Advanced lab testing – Completing personalized advanced lab testing will help you get a clear picture of how your body is specifically perceiving stress and what other factors may be playing in your PCOS picture. Partnering up with a functional practitioner can help you build a personalized roadmap to further fine-tune your PCOS healing plan.

Need more support? Take the first step in identifying your unique triggers for your PCOS and stress by scheduling a Discovery Call.