Stress, Adrenal Health & PCOS

Guest post by  Dr. Fiona McCulloch BSc ND

Adrenal health is one of the most talked-about topics in health today, and for good reason: We lead hectic lifestyles, are constantly plugged in, and rarely ever get deep restorative rest. It’s a whole different lifestyle than the average person had 20 years ago, and as women, we are all learning to adapt—often at great expense to our health. You’ve also probably heard that stress is problematic for women with Polycystic Ovary Syndrome (PCOS) in particular, and it really is. In fact, we are far more susceptible to stress than others due to our unique hormonal imbalances. So, as both a woman with PCOS and a naturopathic doctor who has done extensive research into hormonal health, I want to help clarify exactly how stress can create further imbalance in our bodies.

As I’m sure you already know, stress is bad for humans, period. That said, for women with PCOS, stress can seriously imbalance the delicate interplay between hormones and can even interrupt the progress you are making as you put in the hard work to change your diet, exercise and balance your hormones with supplements or medications.

Physical Impact of Stress

Firstly, I just want to go through a little bit of anatomy and physiology with you. The adrenal glands are two small, triangular glands that sit right on top of your kidneys.  These glands have a very special job to do: they secrete crucial hormones in response to stress. The outer part of the adrenal gland is called the cortex, and it secretes cortisol and male hormones (androgens) like DHEA.

It’s really important to know that the adrenal cortex is controlled by the pituitary gland, which is a small, pea-sized structure within the brain. The pituitary is actually considered the “master gland”, as it controls most of the hormone function in the body, and the connection from the brain to the adrenals is called the hypothalamic pituitary adrenal axis (HPA axis).

Here’s why it’s worse for women with PCOS:

1)   Women with PCOS have low progesterone, and stress “steals” that particular hormone.

In a normal menstrual cycle, there is a predominance of estrogen that rises up until the time of ovulation at mid-cycle. After ovulation has happened, the progesterone levels should rise, and the second phase of the cycle is dominated hormonally by progesterone.  There needs to be a good balance between these two hormones for normal cycling and healthy fertility to be possible.

In women with PCOS, when ovulation is delayed, there is a relative excess of estrogen to progesterone.  The first part of the cycle is often longer, allowing more estrogen to accumulate. In cases where ovulation doesn’t happen, there is actually very little progesterone at all. This means that with PCOS, we are almost always dealing with progesterone deficiency as a major aggravating factor. Progesterone is needed to help embryos implant, and to promote normal menstrual cyclicity.

Knowing that cortisol is released in times of stress, it’s important to have a look at the way that cortisol is made. As you can see from this diagram, cortisol is actually synthesized from progesterone. Thus, if you are under stress, and your adrenals need to make more cortisol, they are going to use up whatever progesterone you have floating around to do it.

This “theft” of progesterone by your adrenals can result in further disruption of your cycles, inability of embryos to implant, and miscarriage. Natural progesterone is also a mild anti-androgen, so low progesterone levels can exacerbate the effects of excessive male hormones such hirsutism and acne. Not good.

2)   Women with PCOS actually make more cortisol than women without PCOS.

A study found that women with lean PCOS made more cortisol than the lean control group. They chose lean women in this study because it is known that being overweight itself can increase cortisol. We now know that even outside of weight itself, women with PCOS produce more stress hormones, and as I just mentioned, being overweight—which is a common tendency in PCOS—only exacerbates this problem. The cause of the additional cortisol in PCOS is related to the way that it is metabolized; our bodies just have higher levels of this stress hormone based on the way we break down our hormones. So, as we already produce more cortisol, stress is actually more aggravating to us as we are just adding to levels that are already elevated.

3)   Women with PCOS have higher statistical rates of anxiety, depression and other emotional disorders.

These are all aggravated by stress. There is substantial evidence that there is a huge psychological component to PCOS, and stress can only aggravate this, making it more challenging to deal with. If you are overweight, the effect is actually compounded, as obesity itself has a psychological component as well. Stress will aggravate preexisting anxiety or depression.

4)  Women with PCOS struggle with blood sugar regulation.

Women with PCOS typically have insulin resistance as a key component. High cortisol causes insulin resistance, and after an elevation in cortisol, insulin resistance develops 4-6 hours after said elevation and persists for more than 16 hours. This proves that stress actually aggravates the insulin resistance that you already have present. Insulin resistance and high insulin levels also delay ovulation, cause excess androgens to be produced, and increase fat storage—all bad things for PCOS.

5)   Your hormones become less effective.

High cortisol causes abnormalities in the way that many of the sex hormones and thyroid hormones work in the body. Raised cortisol levels make the cells in your body less able to use estrogen,  progesterone, and thyroid hormone, and also reduce the conversion of the inactive form of thyroid hormone T4, into the active form of thyroid hormone, T3. As hypothyroidism is more common in PCOS, this can really aggravate your condition, and high cortisol also reduces the cellular sensitivity to thyroid hormone. Basically, stress makes your hormones work in a less effective way.

As you can see, there are very good reasons to reduce stress in your life if you have PCOS. Not only can it both create and aggravate hormonal imbalance, but stress also profoundly impacts the systems of women with PCOS in particular. Stress can also decrease your fertility in many ways, so if you’d like to learn more about this in detail, please read my blog on Stress and Fertility.  It’s really important to give yourself the opportunity to heal from the weight of stress if you are trying to conceive.

Tips to restore the adrenals and reduce the effects of stress:

1)   Yoga, meditation, breathing, and mindfulness activities are restorative to the hypothalamic-pituitary-adrenal axis. Practice daily for best results.

2)   Going to bed by 10 pm is ideal. Cortisol reaches its lowest point at 11 pm, and melatonin begins to peak at 1 am. A 10 pm bedtime allows deep sleep to set in, prevents a second wind, and promotes a healthy balance of melatonin and neurotransmitters. High quality sleep is crucial to adrenal health.

3)   Reduce sugar and high glycemic carbs, as ups and downs in blood sugar stress your adrenals.

4)   Eat whole, natural foods, and eliminate processed foods. Include high quality sources of protein and fiber to help regulate your insulin.

5)   Eat breakfast by 10 am.

6)   Include high quality salt, such as Himalayan or Celtic Sea salt in your diet.

7)   Minimize caffeine.

8)   See a counselor or psychologist who can help you to learn the tools to manage stress.

9)   Learn to say “no”.  Know your limits, and enforce them to protect yourself from stressful situations. For example, if you are struggling with infertility and baby showers stress you, you can excuse yourself from the event.

10)  Adrenal tonics: many herbs and vitamins can help reduce stress. These can include Siberian ginseng, rhodiola, hawthorn, vitamin C, and B vitamins.

References:

Açmaz G, Albayrak E, Acmaz B, Başer M, Soyak M, Zararsız G, IpekMüderris I. Level of anxiety, depression, self-esteem, social anxiety, and quality of life among the women with polycystic ovary syndrome. ScientificWorldJournal. 2013 Jul  9;2013:851815.

Bazarganipour F, Ziaei S, Montazeri A, Foroozanfard F, Kazemnejad A, Faghihzadeh S. Psychological investigation in patients with polycystic ovary syndrome. Health Qual Life Outcomes. 2013 Aug 16;11(1):141.

Magiakou MA, Mastorakos G, Webster E, Chrousos GP. The hypothalamic-pituitary-adrenal axis and the female reproductive system. Ann NY Acad Sci 1997;816:42-56.

Renato Pasquali, Alessandra Gambineri. Cortisol and the Polycystic Ovary Syndrome. Expert Rev Endocrinol Metab. 2012;7(5):555-566.

Shabir I, Ganie MA, Praveen EP, Khurana ML, John J, Gupta N, Kumar G, Ammini AC. Morning plasma cortisol is low among obese women with polycystic ovary syndrome. Gynecol Endocrinol. 2013 Aug 19.

Tsilchorozidou T, Honour JW, Conway GS. Altered cortisol metabolism in polycystic ovary syndrome: insulin enhances 5alpha-reduction but not the elevated adrenal steroid production rates. J Clin Endocrinol Metab. 2003 Dec;88(12):5907-13.

Dr. Fiona McCulloch is a board certified Naturopathic Doctor who has been in practice for 13 years in Toronto, Canada.  She graduated with aBachelor of Science degree (Biological Sciences) from the University of Guelph and went on to graduate from the Canadian College of Naturopathic Medicine. She is the founder and owner of White Lotus Integrative Medicine, a busy clinic specializing in women’s health and fertility.  Her clinical focus is on the treatment of a wide range of fertility and hormonal conditions, and she is an avid writer and researcher, having published articles in major naturopathic journals.  Fiona has been able to reverse her own PCOS with natural methods and is thrilled to be able to share what she has learned with other women suffering through the same concerns.  Her first book: 8 Steps to Reverse Your PCOS is now available.  She lives in Toronto with her husband and 3 boys.