PCOS, Stress and the Adrenals
PCOS, Stress and the Adrenals
Can stress cause PCOS? What is Adrenal PCOS?
Hello everyone,
Before I go into today’s topic, I would love to invite you to a Free Live Webinar on the 24th of May.
I will host a webinar with Najwa (The PCOS Coach). We will unpack the vicious cycle of PCOS, discuss the most common symptoms and share the most impactful changes you can make to manage your PCOS. I have been writing this newsletter for almost five months, and I would love to meet some of you in person (well, kind of in person, over Zoom 👀).
You can register at the link below. Even if you can’t make the time or date, please still register, and you will get the recording afterwards.
Let’s dive into today’s topic: PCOS and Stress.
Can stress cause PCOS? What is Adrenal PCOS?
Stress is one of those things that everyone talks about these days. It has also been blamed as the cause of many diseases, and it’s often linked to Adrenal PCOS. But what is stress, and how does it manifest in the body? Is it really linked to PCOS?
In this newsletter, you will learn the following:
What is stress, and how it manifests in the body?
What is Adrenal PCOS?
Does stress cause Adrenal PCOS?
How does stress impact us beyond Adrenal PCOS?
Can stress alone cause PCOS?
What is stress?
Stress is our body’s response to danger. I am sure you know this by now, but this response was developed to ensure our body reacts appropriately when we might be in danger. It does so by activating two processes:
The Hypothalamic-Pituitary-Adrenal Axis releases a hormone called Adrenocorticotropic Releasing Hormone (ACTH) which tells our adrenals to make Cortisol. We will discuss this in relation to Adrenal PCOS below.
The Sympathetic Nervous System (SNS) releases Epinephrine and Norepinephrine (Adrenaline).
The activation of these two systems means that our body prioritises short-term survival and increases heart rate, blood pressure, and the release of glucose in the blood and shuts down digestion. For a short period of time, it’s life-saving, but prolonged for a long time can really it impact our health. In this modern age, stressful situations are always present: the traffic jam, the work presentation, relationship fighting, etc.
How does stress affect PCOS?
The process that seems to impact our hormones the most is the Hypothalamic-Pituitary-Adrenal Axis.
The most spoken-about hypothesis is that stress is able to increase the production of androgens from the adrenals leading to hyperandrogenism. The adrenal glands are two triangle-shaped endocrine glands. One sits on top of each kidney and is responsible for producing hormones such as adrenaline, noradrenaline, cortisol and aldosterone.
Having said that, I could not find any research to suggest a direct correlation between chronic stress and the production of androgens for women with PCOS. If anyone has it, please share it with me, as I spent a lot of time trying to find it. With that in mind, from what I know, PCOS can’t be directly caused by stress.
However, as we are used to by now, there are nuances to that. A specific type of PCOS seems to be characterised by high androgens produced by the adrenals. Let’s unpack this.
Adrenal PCOS
PCOS is well known to be characterised by excess androgens. We have a few types of androgens: Testosterone, Androstenedione, Dehydroepiandrosterone (DHEA), and Dehydroepiandrosterone Sulfate (DHEA-S).
Overall, women with PCOS have increased levels of androgens in general. These androgens are produced in the ovaries, adrenals and specific tissues. However, some women only have DHEA-S increased. This androgen is 100% produced within the adrenals, which is why this variation of PCOS is called Adrenal PCOS. Approximately 20–30% of PCOS cases demonstrate this type of PCOS.
Interestingly, this type of PCOS manifestation tends to be mostly present in lean PCOS types without insulin resistance. This means that women with Adrenal PCOS usually can ovulate and have regular cycles whilst experiencing many high androgen symptoms: acne, hirsutism, and hair loss. In addition to these classic symptoms, an increase in DHEA can usually be linked to anxiety and depression. We know that we are more susceptible to these mental conditions, and this could be one of the reasons why.
Does stress cause Adrenal PCOS?
There is not a clear correlation. This question is often discussed because the hormone that stimulates the production of cortisol (ACTH) is the same one that stimulates the production of DHEA-S. However, when they analysed the levels of ACTH in women with PCOS and compared them to healthy individuals, they weren’t different. What was different was the sensitivity of the adrenals to this hormone. For an unknown reason, the adrenals react stronger to the effect of this hormone in women with Adrenal PCOS. There is no clear understanding of why, but the strongest hypothesis is that it is genetic. Scientists are also considering if stress before puberty might result in this exaggerated response.
What makes it a bit more confusing is that short-term stress has been shown to increase DHEA in healthy individuals, but prolonged stress decreases it. This makes the hypothesis that stress causes adrenal PCOS questionable.
If you suspect that you have Adrenal PCOS, I would recommend bringing your concerns up with your doctor. There are other conditions with similar manifestations, such as Cushing’s syndrome, thyroid and prolactin dysfunction, that should be ruled out. DHEA-S levels are easily tested via a blood test, either by your doctor or using at-home kits.
Are there other ways stress impacts PCOS?
Yes, there are some other mechanisms by which we might be impacted by stress, independent of the adrenal one discussed above.
Cortisol activates the release of glucose into the bloodstream, so we have enough energy to act on the dangers we might encounter. Chronic stress could mean we have a constant drip of glucose, which can contribute to the development of insulin resistance or the worsening of it.
In addition to stimulating the release of glucose, stress hormones are known to increase the sensation of hunger leading to an increase in appetite, food intake and, consequently, weight gain.
Chronic stress is also known to weaken our immune system, which might mean we have higher levels of inflammation (if you want to revise the effect of inflammation of PCOS, head over here).
A less clear mechanism is through the Kisspeptinergic system. This system is made out of neurons that can have an effect on GnRH. Under stress, these neurons decrease their activity and, as a result, decrease the pulsatility of GnRH, which in turn decreases the levels of FH and LH (the two hormones responsible for ovulation and our period). We know that when it comes to PCOS, the issue is in the imbalance between the FSH: LH ratio rather than a decrease in both of them them. For this reason, I am not entirely sure this mechanism massively affects us. If you want to know more about the hormones mentioned above and missing periods, please visit my article on PCOS and Irregular periods.
So, can stress cause PCOS?
The answer to this question is that we don’t really know, and it’s very unlikely that stress is the main driver. PCOS is such a complex condition, and it has substantial research behind it. The fact that we don’t know its cause means that it is incredibly complex, and probably stress alone won’t be the cause. However, we know that being under long-term stress is not good for our health, so it is probably a good idea to invest in decreasing our stress levels through exercise, meditation, rest, good nutrition and removing ourselves from situations that are not good for us.
I hope you have learnt something new in this newsletter. If you have further questions, please don’t hesitate to get in touch by submitting here, commenting or hit reply to my emails.
See you next Sunday,
Francesca
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Disclaimer: We are all so unique in our own ways, so this information is for educational purposes only. My training is in Nutritional Therapy, and I am not Medical Doctor. Please further consult your healthcare provider about your health needs.