Adrenal PCOS: Everything You Need to Know

Polycystic Ovary Syndrome (PCOS) is a complex hormonal imbalance originating centrally and / or from the ovaries that affects a significant number of women worldwide. Often associated with fertility problems, PCOS is linked to hormonal imbalances affecting ovarian function.

Once the diagnosis of PCOS is made, it is important to investigate the syndrome’s specific type because the strategy will not be the same. PCOS is generally classified into four major categories: insulin-resistant PCOS, inflammatory PCOS, adrenal PCOS, thyroid PCOS, or post-pill PCOS (though the latter is often transitory and not a category in its own right). However, to date, while this categorization has no scientifically proven basis it is still useful for identifying "areas needing work."

The lesser-known adrenal PCOS involves the adrenal glands as a cause of development of this hormonal imbalance.

In this article, we will explore in more detail the origins of adrenal PCOS, examining the underlying hormonal mechanisms, risk factors, and the importance of a specific, yet comprehensive and appropriate management.

What is Adrenal PCOS?

PCOS, known as Polycystic Ovary Syndrome, is a general physiological dysfunction. This condition affects about 10% of women of childbearing age. Additionally, it is often a major cause of subfertility, associated with metabolic problems, increased risks of developing cardiovascular diseases, or type 2 diabetes.

Adrenal PCOS is distinguished from other types of PCOS by the involvement of the adrenal glands in the excessive production of male hormones (androgens), which are very masculinising in women. This hormonal overproduction often leads to a disruption of the hormonal balance, with detrimental effects on fertility, as well as overall health and well-being.

Symptoms of Adrenal PCOS

Common symptoms associated with PCOS include menstrual irregularities, acne, excessive hair growth (hirsutism), hair loss (alopecia), weight gain, and fertility problems. These manifestations can vary in intensity from one woman to another.

Due to this adrenal PCOS profile, women also experience many symptoms stemming from an increased secretion of cortisol (stress hormone secreted by the adrenal glands). A vicious cycle then sets in because this overproduction further stimulates the already overproduced androgens, with the heightened manifestations of hyperandrogenism described above.

Main Symptoms of Adrenal PCOS:

Anxiety, distress
Sleep disorders
Mental fog with attention and memory difficulties
Irritability
Depressive tendencies
Dysfunctional libido

Different Forms of Stress

Stress, whether unconscious or not, even distant, forces our body to respond in "survival" mode.

This positive defence mechanism is normalised to respond to episodic stress. However, when stress persists over time and to the point of becoming chronic, some functions of the hormonal system, such as blood sugar levels, thyroid function, and fertility, can be affected. The body prioritises functions, and if a threat is perceived as endangering its survival, priority will be given to its defence.

Several situations can be perceived as stressful:

Excessive sport or physical exercise
Overwork at home or work
Lack of sleep
Excessive food
Excessive consumption of caffeine, alcohol, etc.

For example:

Psycho-physical stress of an emotional or physical origin (such as excessive sports at a competitive level) can impact the menstrual cycle through excessive cortisol production thereby altering production of FSH and LH, paramount for the proper stimulation of the ovaries.
An acute or chronic infection.
Depression or anxiety disorder
Being underweight: A low percentage of body fat (due to a low-calorie diet) creates physical stress with less activity of aromatase enzymes (transformation of androgens into estrogens). With decreased levels of oestrogen, initiating ovulation will be complicated. Additionally, a low body weight is associated with low levels of leptin (sometimes called the satiety hormone); leptin contained in body fat stimulates the production of FSH and LH, so if there is not enough leptin, the ovaries are not sufficiently stimulated and therefore do not produce enough oestrogen. The consequences are long, irregular, anovulatory cycles, sometimes leading to amenorrhea.
Being overweight: Excess weight is stress for the body because some molecules from adipose tissue are a source of pro-inflammatory factors.

How Stress Plays a Major Role in the Development of PCOS

To cope with stress (whatever it may be), a small gland at the base of the brain, the pituitary gland, secretes an adrenocorticotropic hormone called ACTH, which stimulates the adrenal glands to secrete cortisol (and more). Here are other parameters involved in responding to a stress factor:

Secretion of androgens: Simultaneously, the adrenal glands also secrete DHEA to compensate for the harmful effects of cortisol. From DHEA, the body can produce all categories of androgens. It’s a vicious cycle: the more stress there is, the more male hormones are secreted.
Blood sugar levels (glycemia): Cortisol is a hyperglycemic hormone, meaning it recruits sugar into the blood so that our body has the energy necessary to manage stress. However, long-term hyperglycemia (too much sugar in the blood) can cause chronic inflammation, disrupting all our hormones and allowing weight gain.
Excess cortisol: Excess cortisol leads to decreased thyroid hormone production and inhibits the conversion of T4 (inactive thyroid hormone) to T3 (active thyroid hormone). Thyroid hormones play a crucial role in ovarian activity, which can impact the menstrual cycle.
The hypothalamus and pituitary gland, in response to stress: These will inhibit all non-essential functions, such as the production of hormones responsible for the female cycle, FSH and LH, and therefore estrogens, affecting or even blocking ovulation.
Prolactin production: Stress can also increase prolactin production by 2 or 3 times (this is why you should lie down for 30 minutes before a blood test to check your levels). Prolactin interferes with and sometimes inhibits GnRH and therefore ovarian function.
Progesterone production: If ovulation occurs, cortisol is a hormone with the same precursor as progesterone, called pregnenolone. In a stressful situation, cortisol production is prioritised. The consequence is a decrease in progesterone production. Progesterone is crucial for fertility and avoiding premenstrual syndrome.

Note: It is PCOS that makes you more sensitive to certain manifestations of stress, not the other way around (an anxious personality leading to PCOS!).

How is Adrenal PCOS Diagnosed?

Diagnosis of PCOS varies by country. In the United States, biological or clinical hyperandrogenism is considered the main criterion.

In Europe, diagnosis is governed by the Rotterdam criteria, which are authoritative. To be diagnosed, 2 of the 3 criteria below must be met:

Hyperandrogenism, in other words, elevated androgen hormones (DHEA, DHEA-S, DHT/androstanolone, testosterone, etc.),
At least 12 follicles of 2 to 9 millimetres each and/or an ovarian volume greater than 10 ml, multifollicular ovaries visible on ultrasound,
Irregular, anovulatory menstrual cycles (without ovulation) or completely absent (amenorrhea).

Some practitioners classify PCOS according to the most active contributors in each woman. However, this classification has no scientific or medical basis.

Some women will be more affected by inflammation, hypothyroidism, others by insulin resistance, stress, anxiety, or after stopping hormonal contraceptives like the pill.

In the case of adrenal PCOS, blood/urine tests may show cortisol levels outside the norms or very close to them, as well as elevated androgen levels, particularly DHEA and DHEA-S.

What to Do if You Have Adrenal PCOS: Are There Natural Solutions?

As a naturopath, I practise a functional approach that involves determining and understanding the root of a health problem to act as much as possible at the core (without curing it because that is not possible).

Since no two PCOS are identical and each woman presents different issues, the role of the naturopath will be to recommend what should make a difference for you, specifically.

For this type of PCOS, reducing and managing stress is crucial to feeling better and must be accompanied by a comprehensive protocol, especially dietary, to nourish the adrenal glands.

Nutrition and Micronutrition to Nourish the Adrenal Glands

Have a breakfast rich in proteins and good fats, especially Omega 3 for EPA/DHA,
Supplement with Omega 3, as Omega 3s are recognized by health authorities as promoting better nervous and emotional balance,
Avoid refined sugar,
Adopt a mostly anti-inflammatory diet (avoid refined foods such as white pasta, white bread, saturated fats, coffee, alcohol, sodas, etc.),
Supplement with magnesium and vitamin C as prolonged stress depletes these nutrients,
Supplement with vitamin D. This micronutrient acts more like a hormone than a vitamin. Vitamin D controls the expression of important neurotrophic factors that affect neurotransmission and synaptic plasticity. Finally, vitamin D has a neuroprotective role, and its immunomodulatory activity helps regulate inflammation mediators associated with stress and depression.

Here is a complete article on suitable diets for PCOS.

Phytotherapy with Adaptogenic Plants to Support Adrenal Fatigue

Adaptogens (herbs, plants, and mushrooms) can be very interesting because they allow an adaptive response to stress. However, not all are adequate due to their potential actions on testosterone (anti-estrogenic action favouring elevated testosterone).

The most interesting ones will be:

Licorice (to soothe testosterone secretion and help the adrenal glands produce cortisol, with better vitality - but not if you have blood pressure issues)
Mint (to calm down testosterone)
Stinging Nettle (to mineralize the body and calm down testosterone)
Shatavari (for its antioxidant, tonic, and ovulation-boosting effects)
Ashwagandha for its anti-stress and cortisol lowering effects and thyroid activity support
Chamomile Matricaria, which is not an adaptogen but a hypnotic and anxiolytic, with the added benefit of reducing LH through testosterone reduction and feedback control.

The most interesting forms for these plants can be infusions, particularly for mint, stinging nettle, licorice, and chamomile matricaria, with up to 3 cups per day. Consult a herbalist to create your own herbal tea!

Relax and Act on Emotional Balance

We have discussed the problems related to excess stress (excess cortisol secretion, among others). Let's take the time to step back and define what could make a difference in how we respond to stress.

The goal here is to allow you to establish a personal routine to regain energy and stable emotional balance.

However, let me emphasise that if your mind is stuck on various life events which have not yet been processed while still causing suffering, these tools will not be enough; you will need to turn to a psychologist to express yourself without judgement and feel heard.

Sometimes you may feel like you’re stuck with fears holding you back and affecting your self-esteem and confidence. It will often be necessary to sort through the thoughts generating these emotions. Sometimes, it will also be useful to filter out some people you are currently interacting with.

Several tools can help you work on consciousness with the help of sophrology, for example, and on your subconscious through hypnosis or meditation.

Here are some ideas for establishing a routine that will be unique to you and where you can retreat to take care of yourself:

Cultivate an attitude of openness and acceptance of emotions, feelings, discomfort,
Don't hesitate to express yourself, talk with your family, partner, close friends, women in the same situation as you, don't keep your anxieties and frustrations to yourself,
And when it’s difficult, allow yourself to cry, scream into a pillow, dance, run - the goal being to release this stress and free yourself,
Reread your favourite book,
Treat yourself to a spa complete with face mask and massage with a soothing oil,
Look at photos that remind you of happy days.

To learn more about stress management, feel free to listen to our podcast episode on the subject!

Sleep and Rest, Key Elements in Managing Adrenal PCOS

Lack of sleep is also a source of stress for our body as it will activate the secretion of cortisol (again) and adrenaline, further disrupting hormonal balance. These, if you don’t sleep enough, will replace endorphins and serotonin, potentially leading to negative emotions, causing anxiety disorders, or even depression.

Cortisol also plays an important role in metabolism because it is a hyperglycemic hormone. Increased cortisol levels amplify appetite, sugar consumption, and promote fat storage, mainly in the abdominal area.

Lack of sleep also leads to excessive production of the hunger hormone, ghrelin, and a decrease in its counterpart, the satiety hormone leptin.

Another hormone has a predominant function in our sleep: melatonin. It regulates our circadian rhythm. It guides our phases of wakefulness and sleep and thus our production of hormones related to these phases (melatonin and cortisol). If we disrupt it, communication between these hormones and our brain is disturbed, which can interfere with another communication pathway: the one between our brain and our ovaries!

Melatonin also has a crucial but little-known role: it is a powerful antioxidant!

Oxidative stress is one of the omnipresent elements of PCOS, along with a decrease in intrinsic antioxidant levels.

To reconnect with restful sleep, here are some simple habits to adopt before going to bed:

Take 5 minutes to write down what happened in your day: a thought you had, events, emotions felt. This allows you to quickly review your day, put words to situations to clarify your thoughts and process events. Finally, make it a positive review with 3 things that were pleasant for you.
If you feel stressed about the coming day, don’t hesitate to make a small to-do list of tasks not to forget. This way, your mind will be at ease since the ideas won’t be vanishing by day break. The idea is to replace anxious anticipation with serene anticipation. Be careful, these actions should not take too much time as the goal is not to stimulate or push you into deep thoughts.
Read in paper format or with a blue light-filtering e-reader, comfortably settled with a sleep-specific herbal tea (lemon balm, passionflower, orange blossom).
Diffuse soothing light or listen to soft music.
For those who need to be active to be able to relax, gentle stretches like yoga or Pilates are the most suitable.
Relaxation and meditation exercises aim to stimulate the vagus nerve, which will lower heart rate, relax muscles, and contribute to physiological recovery by promoting emotional calm, proper digestive function, immune function, and sleep.
Ensure you sleep in the dark and expose yourself to the sun during the day (reasonably and safely, not during the hottest hours).
Avoid checking your emails before bed, same for all blue screens.
Take a lukewarm shower before sleeping; if you prefer it hot, it’s better to take it earlier in the evening so as not to affect the onset of sleep.