Adrenal PCOS: Surprising Ways Stress Affects Your Hormones

Adrenal PCOS: Surprising Ways Stress Affects Your Hormones

Is stressing about your diet and exercise
routine ruining your fertility and causing PCOS symptoms? Learn how to
change your lifestyle and get your hormonal health back on track.

This is a guest post written by staff dietitian, Laura Schoenfeld.

It’s well known that stress can cause the disruption or total loss of menstrual function in women. (1)
And menstrual dysfunction, along with the physical symptoms of hormone
imbalance, has become increasingly common over the past few decades.

It’s
now estimated that up to 10 percent of reproductive-age women in the US
have polycystic ovarian syndrome (PCOS), a health condition that not
only affects a woman’s fertility, but also causes frustrating changes to
her physical appearance, including weight gain, male-pattern hair
growth, acne, and water retention.

Women with PCOS also have
higher rates of anxiety and depression, either caused or exacerbated by
the embarrassing physical changes that often occur with the condition.

And
while there certainly is a genetic component that increases one’s risk
of the syndrome, PCOS is significantly affected—and possibly caused—by
lifestyle factors including diet, exercise, and stress.

Unfortunately,
in an age where high achievement and perfectionism are idolized and
flat abs and “thigh gaps” are considered to be the standard of feminine
physical beauty, there are thousands of women running their bodies and
hormones into the ground in an attempt to lose weight and achieve this
impossibly high cultural standard.

I’ve worked with dozens of women who were undereating, overtraining,
and under constant stress and even fear related to their poor body
image and a desire to be thinner and leaner by any means necessary.

Sadly,
this extreme diet and exercise behavior can backfire when women start
to develop “adrenal PCOS”: the elevation of androgenic hormones by the
adrenal glands that causes symptoms similar to ovarian cyst-driven PCOS.

In
this article, you’ll learn how excessive stress about your diet,
exercise, and life in general might be driving the adrenal hormone
changes that are causing your PCOS symptoms.

Myths and truths about PCOS

There
are many misconceptions about PCOS that cause confusion, misdiagnosis,
and mistreatment in women who are experiencing the multitude of symptoms
associated with the disorder.

Despite the name polycystic ovarian syndrome, having cystic ovaries isn’t a requirement to be diagnosed with PCOS.

In
fact, the NIH has concluded that the name PCOS should be changed, as
the name causes confusion and doesn’t reflect “the complex metabolic,
hypothalamic, pituitary, ovarian, and adrenal interactions that
characterize the syndrome.” (2, 3)

Many
people, including healthcare professionals, also don’t even realize
that being overweight is not a requirement of having PCOS. It’s
estimated that one-third to one-half of women with PCOS are at normal
weight or underweight and that being overweight or obese does not
increase the risk of developing the condition.

While weight loss
in women who are overweight may be beneficial, this recommendation isn’t
useful for women with PCOS symptoms who aren’t overweight. And using birth control pills as a treatment for amenorrhea is often unnecessary and simply masks a deeper diet and lifestyle problem.

Believing
that PCOS is solely genetic, due to excess weight, or simply caused by
cystic ovaries that can be treated using hormone replacement is a
dangerous assumption that prevents many women from getting the help they
need.

Elevated androgenic hormones: not just an ovarian problem

One
of the primary diagnostic criteria of PCOS is elevated androgens,
“male” sex hormones that cause unwanted hair growth, acne, and
reproductive dysfunction.

The two main androgenic hormones causing
these symptoms in women are testosterone and androstenedione. Other
androgens include dihydrotestosterone (DHT), dehydroepiandrosterone
(DHEA), and dehydroepiandrosterone sulfate (DHEA-S).

It’s normal
for women to have some androgenic hormones in their system; in fact, low
testosterone in women is associated with low sex drive, bone loss,
chronic fatigue, weight gain, mood disorders, and cognitive issues.
Calling them “male” sex hormones is a misnomer.

However, when
these hormones are elevated, as is pervasive in PCOS, symptoms of
androgen excess begin to manifest. For some women, this affects their
menstrual function and fertility. For others, they continue to
menstruate but struggle with physical changes like unwanted hair growth,
acne, and weight gain.

And one of the primary confusions over
PCOS is which organ these androgens come from. While the ovaries are
typically blamed for elevated androgens in PCOS, it’s estimated that 20
to 30 percent of women with PCOS have adrenal androgen excess. (5)

The
adrenal glands produce all of the DHEA sulfate (DHEA-S) and 80 percent
of the DHEA in the body. The adrenals also produce 50 percent of
androstenedione and 25 percent of circulating testosterone. Since DHEA-S
and 11-androstenedione are not secreted by the ovaries, they are used
as markers of adrenal androgen secretion. (6)

How your adrenals cause PCOS symptoms

The
chart below shows how both the adrenal glands and the ovaries impact
androgenic hormone production. It illustrates how the hypothalamus and
pituitary gland, both located in your brain, release hormones that drive
the cycle of high androgen output, insulin resistance, increased
abdominal fat, and impaired glucose sensitivity. These systems are
called the hypothalamus-pituitary-adrenal or -gonadal axes. (HPA/HPG.)



While
insulin resistance and elevated insulin often drive the ovarian
production of testosterone, it is the hypothalamus-pituitary-adrenal
(HPA) axis that stimulates the production of DHEA/DHEA-S and
androstenedione. These hormones can be converted to testosterone by
peripheral tissues in the body. This process can occur independently
from the ovaries and any involvement with insulin.

This means that
a woman with PCOS symptoms could have normally functioning ovaries with
no cysts and no insulin resistance, yet still fit the symptomatic
profile of the syndrome.

There is some controversy over whether
elevated androgens cause insulin resistance or if insulin resistance
happens first. The most likely answer is “it depends”; some women likely
develop insulin resistance first, while others develop elevated
androgens first.

Either way, it’s clear that not only is the brain
heavily involved in the output of androgenic hormones, but that the
adrenals may also be responsible for PCOS symptoms in a subset of
patients.

How stress impacts your hormones

The pituitary
gland, stimulated by the brain via the hypothalamus, secretes
adrenocorticotropic hormone (ACTH) in response to stress. ACTH then
stimulates the adrenal glands to produce cortisol, adrenaline, and
noradrenaline. In addition to these stress hormones, ACTH also
stimulates the production of adrenal androgen hormones, including DHEA,
DHEA-S, and androstenedione.

ACTH follows a diurnal rhythm,
meaning it’s higher in the morning and lower in the evening, but it also
spikes in response to physical and emotional stress. Stress activates
the HPA axis, raising ACTH and cortisol output. Cortisol release then
down-regulates ACTH production in a negative feedback loop.

ACTH
also stimulates the production of DHEA/DHEA-S and androstenedione, which
help protect the brain from the negative effects of cortisol and other
stress hormones. (7) But as you learned earlier, these hormones also cause the symptoms of elevated androgens seen in PCOS.

And
these androgenic hormones do not affect the release of ACTH, unlike
cortisol, meaning there is no feedback regulatory loop that controls
androgen secretion in women. (8)

Research
also shows that women who are under extreme chronic stress situations
(for example, PTSD) have a markedly increased DHEA response to ACTH
stimulation, as well as a higher ACTH response to stress and stimulation
from the hypothalamic hormones. (9)
They also have higher levels of baseline DHEA compared to healthy
controls, and traumatized women with the highest DHEA had the least
severe PTSD symptoms.

This means that women who are under chronic
stress not only have more opportunities for elevated ACTH and thus
elevated androgens, but their hormones may also start to react more
severely to stressful situations. It also suggests that a higher amount
of DHEA could be the body’s way of protecting the brain from the
long-term effects of chronic stress.

Where does chronic stress come from?

To review, you’ve learned so far that:

• Elevated
  androgens like testosterone and androstenedione contribute to PCOS
  symptoms like menstrual dysfunction, unwanted hair growth, weight gain,
  acne, and mood disorders
• The adrenal glands are responsible for at least 20 to 30 percent of the elevated androgens seen in PCOS
• Chronic stress elevates ACTH, which stimulates androgen secretion, for which there is no negative feedback loop
• Androgen
  hormones are protective against the long-term effects of chronically
  elevated stress hormones like cortisol and adrenaline

I hope
it’s perfectly clear by now that chronic stress is a major contributor
to the development of PCOS symptoms, especially in normal or underweight
women with non-cystic ovaries and normal insulin sensitivity.

Elevated
androgens, while causing PCOS symptoms, may be the body’s way of
protecting the brain from the harmful effects of chronic stress.

And
chronic stress is everywhere these days; from long work weeks and poor
sleep to new babies and aging parents, to constant negative thoughts
about our bodies and physical appearance, women are bombarded by stress
from every direction.

Combine this with traumatic events, acute
illness and infections, gut dysbiosis, and disrupted sleep, and it’s no
wonder that so many women come to me complaining of reproductive
dysfunction or amenorrhea, weight loss resistance, blood sugar
fluctuations, anxiety and/or depression, acne, chronic fatigue, and
hormonal imbalances.

The worst part is that the more stress drives
up our androgenic hormones, the more our weight, skin, and hair growth
is affected, and the harder we struggle to improve our appearance.

For
some women, this drives them to restrict their diet further, diet
harder, work out more often and more intensely, and push their bodies to
the brink of exhaustion. It’s a vicious cycle that I see all the time
in my practice. (I’ve even struggled with this problem myself.)

Don’t
get me wrong: there are plenty of women whose PCOS is caused by a poor
diet, inadequate exercise, too many refined carbohydrates and sugars,
and a generally unhealthy lifestyle.

But if you’re breaking your
back trying to follow the perfect low-carb Paleo diet, going to CrossFit
five to six days per week, and finding yourself gaining weight, losing
your menstrual function, growing hair in weird places, developing adult
acne when you had clear skin as a teen, or simply feeling like a truck
hit you every morning you wake up, it may be chronic stress causing your
physical symptoms and hormonal imbalances.

How to kick stress to the curb

Getting
your stress under control is a challenging task, and unfortunately,
there’s no quick fix for the long-term effects of regular stress. Our
culture thrives on stress and perfectionism, and many people push
themselves past their physical limits in an attempt to “look better
naked,” make more money, have more possessions, and live an envy-worthy
life that looks great on Instagram.

If you’re ready to break the
cycle of stress and fear-based health pursuits, here are a few tips to
get you started in the right direction.

Diet

As I
explained before, many conventional recommendations for PCOS involve
losing weight and increasing insulin sensitivity, primarily through
reducing carbohydrate intake, cutting calories, and increasing physical
activity. These recommendations work well for the woman eating a typical
American diet and not moving enough.

But if you’re already eating
a low-carbohydrate Paleo diet and your symptoms are getting worse
instead of better, you might be a woman whose body is responding
negatively to the stress of inadequate calorie and carbohydrate intake.

First, start by assessing your total calorie intake.
One benefit of a Paleo diet is a spontaneous reduction in calorie
intake, but for women who are active, this can take their intake too low
to support their exercise routine. Combine this with poor body image
and a desire to lose body fat, and many women are taking their food
intake even lower, either consciously or unconsciously.

Chronic
calorie deficits over a period of months or years raise stress hormones
as your body tries to conserve energy and keep blood sugar stable. Make
sure you are not eating less than 80 percent of your estimated calorie
needs on a daily basis if you are trying to lose weight, and consider
taking a break from any calorie deficit for a few weeks or months.

Too
little carbohydrate intake can have similar impacts as inadequate
calories, especially for highly active women doing glucose-demanding
activities like weightlifting and CrossFit. Use this article to guide your carbohydrate intake depending on your health needs and activity levels.

Eating a calorie-appropriate and macronutrient-balanced diet is a huge step for many of the women I work with in my private practice to improve their hormonal profile.

Exercise

Again,
the typical recommendation for a woman with PCOS is to exercise more.
But if you’re already hitting the CrossFit box five days a week, running
20 miles a week, or squeezing bootcamp classes in at 5:30 a.m. every
morning, you might be damaging your hormones by exercising too much.

Overtraining
is more of a symptom of under-recovery, so eating and sleeping enough
and taking at least one to two rest days per week can help minimize the
impact of a high training volume and prevent hormonal disruption.

If you’re concerned that overexercising is driving your hormonal imbalances, check out this article on exercising with “adrenal fatigue”
(HPA axis dysfunction) for guidelines on how to appropriately scale
back your exercise so that you’re maintaining strength and fitness while
allowing your hormones to recover.

Sleep

Admittedly,
sleep is one of those health behaviors that I still struggle to
prioritize. And yet the benefits to my energy, performance, and
cognitive function I experience when I get adequate, high-quality sleep
are undeniable.

One of the most common factors impacting our
ability to sleep well is our use of electronic devices after the sun has
gone down. Check out the guidelines in this article for ideas on how to mitigate the effects of light exposure at night so that your sleep is more restorative.

And if you’re having trouble falling or staying asleep, review your diet and exercise program. Many of my clients
with sleep difficulties find that stopping any excessive high-intensity
exercise and eating adequate calories and carbohydrates help them sleep
far more soundly and wake up feeling refreshed.

Stress management

There
are dozens of different techniques that can help reduce stress on a
daily basis. Some of the more well-known recommendations include things
like meditation, deep breathing, yoga, and tai chi. These ancient
practices are effective tools that reduce stress hormones, and meditation in particular is one that can easily be done daily.

However,
there are countless other options for reducing stress, so pick one that
works best for your personality and your life. That might mean you get a
pet like a dog or a cat, start volunteering regularly, join a
spiritual/religious community like a church or synagogue, join a meetup group, or even start coloring! (I love these coloring books!)

Whatever
your stress management practice is, commit to doing it regularly.
Meditation isn’t going to help you reduce stress if you only do it once a
week, and a coloring book sitting on your bookshelf gathering dust
isn’t going to magically cut your cortisol down.

Mindset

Changing
your mindset is often the hardest part of stress reduction, but
possibly the most important. There are a lot of mindset issues that
women deal with, but one of the most common mindset issues I see in the
women I work with is poor body image.

Research shows that women with the lowest body image also have the highest levels of cortisol. (10)
Any woman who has struggled with poor self-image and body dysmorphia
knows what it feels like to have negative thoughts and emotions every
time you catch your reflection in the mirror.

Building better body
confidence is a challenging process, and it doesn’t happen overnight.
But if you are struggling with negative thoughts about your body,
constant dissatisfaction with your appearance, and poor mood that is
worsened whenever you break your rigid diet and exercise routine, you
may be sabotaging yourself by causing the very problems you feel
negatively about, including weight gain, hair growth, and problematic
skin!

Start by shifting your focus to all the things you are
grateful for in your life. This could be something as simple as the fact
that you have running water in your house, or as significant as having a
loving partner or children that you adore.

Celebrate the success
that you’ve had in your healthy eating and exercise goals, and don’t be
so hard on yourself for the areas where you’ve fallen short. Everybody
fails, so look at failure as a learning experience and opportunity for
growth.

Stop following anyone on social media who makes you feel
worse about your body or your life. Surround yourself with friends and
role models who promote self-acceptance and self-love, regardless of
what they look like right now.

Find people who inspire you to
shift your focus to the positive things in your life, including what
your body is capable of rather than what it looks like. Self-acceptance
is a practice, and it requires committed effort to shift your mindset
from one of self-loathing to self-love.

If you need more help …

There’s
no way a single article will be enough for you to make a 180-degree
turn in your life and start living totally stress-free. This will be a
lifelong process that you need to commit to on a daily basis in order to
see lasting changes in your hormonal health and wellbeing.

If
you’ve already implemented the recommendations I’ve mentioned above and
are still struggling, there are a few ways you can get additional help.

Chris’s 14Four
program is a fantastic, holistic approach to a healthy diet and
lifestyle that eliminates extremes and focuses not only on diet and
exercise, but also stress and sleep. This is a great basic program for
resetting your approach to a healthy, low-stress lifestyle.

If you’re concerned that your HPA axis dysfunction is more serious than the average person, you’d be a great candidate for Paleo Rehab: Adrenal Fatigue,
a program that will guide you through the diet, lifestyle, and
supplement changes that can help you eliminate stress and support your
body’s ability to respond to stress appropriately. Check out our free 28-page eBook to get started on repairing your HPA axis function.

Finally,
if you are desperate to make major changes in the way you live your
life, including the way you eat, the way you exercise, and the way you
treat your body, and you want to experience the benefits of working
one-on-one with a coach dedicated to your health and success, consider becoming one of my clients.

I
love helping women just like you make evidence-based changes to their
nutrition and fitness plans that not only help them reach their goals,
but also eliminate the stress, confusion, and fear that comes with
trying to do it alone.

Now I’d like to hear from you: Have
you experienced hormonal problems or PCOS symptoms after a period of
extreme stress? Has dealing with the stress in your life helped you
overcome these challenges? Share your story below!

 



About Laura: Laura
uses her knowledge of traditional and biologically appropriate diets to
improve her clients’ health. Growing up with a family that practices
Weston A. Price principles of nutrition, she understands the foods and
cooking practices that make up a nutrient dense diet.

With her
strong educational background in biochemistry, clinical nutrition, and
research translation, she blends current scientific evidence with
traditional food practices to help her clients determine their ideal diet. You can find her at AncestralizeMe.com, on Facebook, and Twitter!