Cortisol and PCOS: Everything You Need to Know

Cortisol and PCOS: The link between stress and PCOS
The stress hormone cortisol plays into all four subtypes of PCOS

PCOS, or polycystic ovary syndrome, is a complex and multifaceted condition that effects multiple hormone pathways in the body. When we think of PCOS we usually think of a problem with blood sugar regulation, but did you cortisol and PCOS can go hand in hand? In fact, there are four types of PCOCS: Insulin resistant PCOS, adrenal PCOS, inflammatory PCOS, and post birth control PCOS. Cortisol plays into all of them and is a main driver of adrenal PCOS! Read on to learn more about the significant link between cortisol and PCOS and how to balance your adrenal hormones to improve your PCOS symptoms. Book a free 30-minute Discover Call with Danielle here to discuss your specific symptoms in depth and outline a plan of action to achieve hormonal balance – fast.

Adrenal PCOS

Let’s first talk about adrenal PCOS, a condition where high levels of stress hormones, especially cortisol and DHEA-S, drive up male sex hormones like testosterone. This throws off the balance of female sex hormones and can create irregular cycles and hinder fertility. Women with this subtype should focus especially on calming the adrenals with proactive stress management. Easier said than done in our busy modern lives, right? A good place to start is to make a list of the main stressors in your life and then separate them out into negative vs positive stressors. Examples of negative stressors include a toxic work environment, an unhealthy relationship, or financial strain. Positive stressors are things like getting a promotion, caring for a baby, or being in a demanding degree program.

Managing Stress

Ideally you’d eliminate or at least reduce the negative stressors. Then you’d find healthy and productive outlets for managing positive stress as well as unavoidable stress. From there, carve out 5-20 minutes at the same time each day for a mindful, relaxing stress outlet such as a creative outlet, a hobby, reading, yoga, meditation, or even a warm bath or relaxing skincare routine. The key here is to do something that puts you in the present moment. There, you’re less likely to have stressful thoughts about the past or future, and you’re in your natural parasympathetic state. Also called the “rest and digest” state, the parasympathetic nervous system is the opposite of the sympathetic fight or flight mode that most of us are in all day. It’s not possible to heal your adrenals and lower cortisol and DHEA-S if you’re constantly operating from the fight or flight mode! You may also take 400-600 mg of magnesium glycinate nightly before bed. The glycinate form of magnesium is a natural parasympathetic activator. While this shouldn’t replace healthy stress management, it can help improve your stress response and adrenal health.

Physical Stress

In addition to addressing mental and emotional stressors, be mindful of physical stressors that might be increasing your cortisol. Common physical stressors include poorly regulated blood sugar, too much exercise or the wrong kind of exercise, going too long between meals, prolonged fasting, overuse of caffeine and other stimulants, and being chronically underslept. Since this is a long list, consider tackling just your top 2-3 physical stressors first. For example, if you’re normally getting 6 hours of sleep and relying on venti cups of coffee to get through the day, prioritize going to bed at least an hour earlier and start cutting back your coffee intake by a half cup or 4 ounces at a time until you’re down to one 8-10 ounce cup per day. Women with adrenal PCOS typically benefit from eating within an hour of waking up and every 3-4 hours thereafter.

Pregnenolone Steal

Managing cortisol is critical for women with adrenal PCOS. Not only will reducing cortisol help drive down testosterone, it will also help boost progesterone, the sex hormone that’s responsible for healthy ovulation and embryo implantation. Cortisol and progesterone share the same parent hormone, pregnenolone. Any time cortisol is in high demand there’s a risk of pregnenolone being diverted from the progesterone pathway to help create more cortisol. This results in lower levels of progesterone, which can mean you’re not ovulating regularly and your fertility is at risk. Many women with PCOS may assume they’re not ovulating due to high testosterone, but high testosterone is only part of the problem in adrenal PCOS. The root cause is abnormally high adrenal hormones including cortisol.

Insulin Resistant PCOS & Cortisol

If you have insulin resistant PCOS you may think cortisol has nothing to do with your hormone imbalance. Unfortunately this isn’t true. In insulin resistant PCOS, chronically high glucose, or blood sugar levels, drive up androgens including testosterone. There is a very clear link between cortisol and elevated blood sugar, so it’s important to manage your stress levels in addition to your diet.  

We know that stress increases blood sugar, but why does this happen? When we experience a physical or emotional stressor, such as being late for work or missing a meal, our primal brains enter the sympathetic “fight or flight” nervous system. Our bodies don’t understand the stressor isn’t posing an immediate danger, and literally prepare to fight a threat or flee from it. And fighting and fleeing both require a big surge of energy, so it makes perfect sense that our bodies would prepare by releasing a surge of stored sugar into our blood streams. Unfortunately most of us don’t need the blood sugar. We’re sitting on the subway stuck underground, or sitting at our desk stressing over an email. So our glucose temporarily elevates. While most of us can quickly clear this excess glucose from our blood stream, people with insulin resistance have a slower response. This can result in elevated glucose for a prolonged period of time. It’s easy to see how chronically high cortisol can worsen insulin resistant PCOS.

Cortisol Drives Inflammation

Inflammatory PCOS is also negatively impacted by cortisol. The three main sources of inflammation in our modern lives are poor gut health, chronic lack of sleep, and chronic stress. That means that cortisol, a pro-inflammatory hormone, is a direct root cause of inflammatory PCOS. Many of us are under stress for most of our waking hours, and you may even experience stress when you’re sleeping…or tossing and turning trying to sleep. While this is common, it’s not normal or healthy. We’re meant to switch into the sympathetic nervous system to respond to an occasional stressor, then return to homeostasis in a parasympathetic state. When we spend most of our lives in fight or flight mode, our chronically high levels of cortisol can create systemic inflammation that impacts many body systems including our sex hormones. 

Post Birth Control PCOS and Cortisol

If you’re experiencing post-birth control PCOS (also called post-pill PCOS), you’re not off the hook when it comes to managing cortisol. That’s because high levels of cortisol can interfere with healthy progesterone rebound. Cortisol can also cause your body to make abnormally high levels of androgens, which interfere with natural, healthy sex hormone production. You should experience a natural period within 2-3 months of stopping hormonal birth control. If you don’t, consider whether high cortisol levels may be hindering healthy progesterone production or driving up testosterone.

Putting It Together

The link between cortisol and PCOS is clear. PCOS is not only a sex hormone problem! Adrenal hormones play significant roles in sex hormone balance. Cortisol is implicated in the development of every type of PCOS. This is why it’s crucial to approach PCOS management from a holistic angle, taking every body system into account when developing a lifestyle optimization plan. If you’re struggling with PCOS and need an expert plan of action tailored to you, there’s help. Click here to book a free 30-minute Discover Call with Danielle. PCOS is reversible. I help women optimize their diets and lifestyles to achieve hormonal balance and healthy, vibrant fertility every day!

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