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Do you have PCOS, yet many of your labs look normal?
Frustrated that conventional treatment doesn’t seem to be helping your symptoms?
We know that no two people with PCOS are the same. And that means that you need an individualized approach.
In this article, we will discuss adrenal PCOS: what it is, how it differs from other PCOS types, and special nutrition and lifestyle treatments that may help.
How Is PCOS Diagnosed?
Polycystic ovarian syndrome is a complex metabolic condition that is estimated to affect 6-12% of American women. PCOS is diagnosed by the presence of 2 out of 3 symptoms:
- Multiple cysts on one or both ovaries
- Elevated androgens (“male” hormones) or signs of elevated androgens, such as excess hair growth
- Irregular menstrual periods
Despite its name, it is possible to have PCOS without having cysts on your ovaries. PCOS may still be diagnosed with elevated androgens and irregular periods.
Androgens are typically thought of as “male” hormones. However, women need these same hormones, just in lower amounts than men.
Elevated testosterone or DHEA-S levels in PCOS can be identified by a lab test. Often, women will notice excess androgen symptoms, such as hair loss around their hairline, excess face or body hair, and acne.
Many women with PCOS will have irregular periods or no periods altogether. This can also result in some difficulties getting pregnant.
Signs and symptoms will vary depending on the different types of PCOS.
What are the adrenal glands?
The adrenal glands sit on top of the kidneys and create hormones that manage multiple body functions. The primary hormones released from the adrenal glands are cortisol, aldosterone, epinephrine, and sex hormones.
Cortisol is typically thought of as the stress hormone, but its impact is so much more. Major functions of cortisol include:
- Managing the breakdown of nutrients
- Controlling inflammation
- Regulation of sleep-wake cycle
- Increasing blood sugar
- Provides energy during stress
The adrenal glands also release aldosterone, which plays a role in regulating blood pressure, blood pH, and electrolytes.
Epinephrine, also known as adrenaline, is commonly known as your fight-or-flight response. This is the hormone that is released during times of stress.
Many sex hormones are also made in the adrenal glands, such as DHEA, that can be converted to estrogen in the ovaries.
What Is Adrenal PCOS?
“Adrenal PCOS” is not a medically defined diagnosis. Meaning, you more than likely will not see the term “adrenal PCOS” on your papers from the doctor.
Rather, adrenal PCOS is a term used for individuals with PCOS who have normal insulin levels and do not have polycystic ovaries (despite the name of the condition).
Adrenal PCOS Symptoms
People with adrenal PCOS may feel like they don’t fit the traditional PCOS box.
Their blood sugars may be fine.
Their insulin levels may be fine.
They may have regular periods and don’t have polycystic ovaries.
So why do they have many of the physical symptoms of PCOS, such as unwanted facial hair, excessive body hair, or acne?
This is where the adrenal glands may play a role.
The adrenal glands can make androgens, such as DHEA and DHEA-S, that are converted to testosterone.
With other types of PCOS, the theory is that insulin resistance increases androgens.
But with “adrenal PCOS,” there is suspicion that the adrenal glands are responsible for the increased androgens that are causing these symptoms.
PCOS and Stress
What is the relationship between PCOS and stress?
There are two parts of your brain that signal a stress response.
The first is your hypothalamus. The hypothalamus is a gland toward the center of your brain. This gland creates hormones that signal several of the automatic processes your body needs for survival, such as regulating body temperature, blood pressure, and hunger/fullness signals.
Your hypothalamus releases a hormone called CRH (Corticotropin-releasing hormone) that goes to your pituitary gland.
The pituitary gland is the second part of your brain that helps create a stress response. This gland sits just below the hypothalamus in your brain.
Once your hypothalamus “tells” your pituitary gland that there is a stressor, the pituitary then creates another hormone called ACTH (Adrenocorticotropic hormone).
This hormone from the pituitary gland then “tells” your adrenal glands that there is a stressor. In response, your adrenal glands also start releasing hormones to respond to stress.
The adrenal glands release cortisol, which is commonly known as the stress hormone, but also may release DHEA. DHEA may then be converted to testosterone.
The increased testosterone levels may contribute to a lot of the signs and symptoms of PCOS.
Whew, that was a lot.
That’s the technical version. Here’s the simple version:
Did you ever play the game “Telephone” as a kid? This is a game where a message is whispered from person to person around a circle to try to get the same message to the last person.
This is essentially what your hormones are doing.
The hypothalamus sends a message to the pituitary gland, which then sends a message to the adrenal gland that your body is going through something stressful.
The adrenal gland responds by releasing hormones to help your body manage the stress, but it can also inadvertently create more testosterone making your PCOS symptoms worse.
Cortisol and DHEA are both released by the adrenal glands in response to stress. DHEA may even help protect the brain from some of the effects of stress.
So then how do we manage adrenal PCOS?
PCOS Adrenal Fatigue
Adrenal fatigue is a theory that your body, when under chronic stress, cannot produce enough stress hormones to keep up with the demand.
Something important to note is that adrenal fatigue is not a recognized medical diagnosis.
While research has not proven PCOS adrenal fatigue, you may have some very real symptoms from being under chronic stress.
High DHEA and Anxiety
We also know that women with PCOS statistically tend to have higher levels of anxiety and depression.
Some research also indicates a relationship between high DHEA and anxiety. Women with high levels of DHEA, which is often elevated in people with PCOS, have been associated with higher levels of anxiety in several studies.
Whether “adrenal fatigue” or chronic stress alone, let’s look at a few ways to manage the stressors that may be driving some of your PCOS symptoms.
Adrenal PCOS Treatment
Adrenal PCOS treatment involves managing our body’s stress levels.
Easier said than done, I know.
Life is stressful, and I don’t want to throw cliche stress management advice at you. But there are some ways that we can start tackling some of the low-hanging stress fruit.
Stressors can be stressors on your brain, your body, or both. Both need to be managed to help manage symptoms of adrenal PCOS.
So how do we manage stress on our minds and bodies?
Adequate Nutrition
Eat Enough Fat
Fats in particular are supportive of hormone health. Here are some ways to add more fat to your diet:
- Cook your foods in olive oil or avocado oil.
- Eat full-fat dairy.
- Add a dollop of nut butter to your meals.
- Snack on nuts or trail mix.
- Stir flax seeds, chia seeds, pumpkin seeds, etc. into foods that you already eat and enjoy.
Include a Variety of Antioxidants
Antioxidants are a key part of managing inflammation, which is common with the presentation of “adrenal PCOS.” There are several types of antioxidants found in various plant foods. This is one reason why eating a variety of foods is important.
When the body is under stress, rather physical stress or psychological stress, it often creates free radical, which are unstable molecules in our bodies. Free radicals can lead to a process called oxidative stress, which can in turn cause damage to our cells. Cell damage from free radicals is suspected in increase the risk of many chronic diseases.
To treat adrenal PCOS with diet, we need to look at increasing intake of antioxidants from a variety of foods.
No More Chronic Dieting
Y’all, I’m so sorry that culture and often the medical community has been telling you to follow some ridiculously strict PCOS diets.
I’m not just saying to stop dieting because it’s hard to sustain long-term, although that is also true.
Calorie restrictions put a lot of stress on the body. Conventionally, the thought is that losing weight at any cost will create the hormonal changes needed to help PCOS.
But this doesn’t take into consideration that the hormones themselves are the issue.
Chronic dieting is creating stress, and stress is worsening your PCOS symptoms.
So then what do we do instead of dieting?
Eat Enough Calories
For some people, that’s exciting news. For others, it is terrifying.
Your body will be so much better off if you give it enough fuel to be able to function optimally.
Sure, you can absolutely live life and function off of fewer calories. But you are more likely to function your very best if your body has the energy and nutrients that it needs.
Think “More Nutrients” Rather Than “Fewer Calories”
What if we lived in a society where instead of eating less and less, we focused on adding more and more nutrients?
I suspect that our health would be better and our minds and bodies would be less stressed.
Surrender the calorie counts (including mentally tracking) and add in foods with lots of nutrients.
Physical Activity
We may need to look at adding some additional movement into your week to help with PCOS. This doesn’t mean that you have to take up running or HIIT classes.
Evaluate any ideas or “rules” you may have around exercise. Does it feel like you may have some ideas about types of activity or duration of activity to make the movement “count?”
Exercise does not have to be all-or-nothing. Find something that you enjoy, and commit to consistently engaging in that activity for a certain period of time. Ten minutes of walking on your lunch break every day is better than planning a 60 minute gym session that you can’t realistically make most days.
Walking, kayaking, rock climbing, dancing, ice skating, hula hooping, and tossing a frisbee or ball can all help incorporate more movement into your day.
On the other hand, women with adrenal PCOS who are already very active may need to reduce the intensity of their exercise regimen. While this may seem counter-intuitive, exercise puts stress on the body.
There are also a lot of benefits to exercise, but intense exercise, such as running or HIIT, can actually increase inflammation and cortisol. This is a very important piece of adrenal PCOS. Working out more and more while eating less and less puts a lot of stress on your body.
If you are already engaging in intense physical activity most days of the week and not seeing any improvement in symptoms, it may be that the exercise itself may be stressing your body.
If this is you, consider replacing some of your intense exercise days with gentler movement, such as walking, Pilates, or yoga.
Sleep: Managing PCOS Fatigue
Many women with PCOS have issues sleeping. In fact, it has been estimated that people with PCOS are twice as likely to have issues falling asleep or staying asleep. So it makes since that PCOS and fatigue are related.
It is generally recommended to aim for 6-8 hours of sleep per night, but that also varies depending on the person.
So what can we do to improve sleep and PCOS fatigue?
Here are some ways to help you get a good night’s sleep:
- Avoid drinking alcohol before bed.
- Avoid tobacco.
- Go to bed and wake up at the same time each day (yep, even on weekends).
- Avoid taking naps during the day, or keep daytime naps to less than 30 minutes
- Avoid doing anything else in your bedroom besides sleeping
- Do not spend time in your bed (unless you’re asleep, of course)
- Make sure that you are not hungry or thirsty as you go to bed.
- Avoid going to bed when you are overly full
- Make a list of things that need to be done for the next day before bed.
- Take a warm bath two hours before bed.
- Avoid the use of screens before bed.
Work on Coping Skills and Stress Management
I’m going to go out on a limb here and assume that advising you to “stress less” isn’t helpful. This is real life, and real life can be a lot.
Consider working with a therapist to gain coping skills to help you be the healthiest version of you. Mental stressors have a huge impact on our bodies, including our hormones. By working on your stress, you are also managing your adrenal PCOS.
You can explore options for local therapists through directories on Psychology Today, The American Association of Christian Counselors, or with a simple Google search.
Final Thoughts
Adrenal PCOS is a term used for women who have many PCOS symptoms yet do not have polycystic ovaries, irregular menstrual periods, or insulin resistance.
However, they may have acne, excess face and body hair, and other symptoms commonly associated with PCOS.
It is suspected that the adrenal glands, which play a role in hormone production, are the primary culprit for these symptoms. Excessive production of stress hormones from the adrenal glands can make these symptoms worse.
Thankfully, adrenal PCOS can be improved by managing stress on your body, such as:
- Eating enough
- Getting a variety of nutrients from food
- Engaging in moderate amounts of physical activity
- Improving sleep quality and getting plenty of sleep
While conventional treatments to PCOS may help, the techniques discussed in this article may also help alleviate some of your symptoms.
Interested in learning more about holistic nutrition for PCOS? Check out these other articles about NAC for PCOS or teas for PCOS.