“(Management of) stress is just as important as diet and exercise in the management of PCOS. It’s a piece that has to be addressed because, unless you do, you can’t get the hormones in check.”
– Dr. Shawna Darou
Stress hormones inter-play with the hormones we most often hear associated with PCOS. Progesterone, testosterone, estrogen, and thyroid hormones either bring your body balance or wreak havoc on your health. For women with PCOS, they often worsen symptoms like abdominal weight gain, acne, facial hair growth, or hair loss on the head. Dr. Shawna Darou recently sat down with me to explain the role of stress on hormones in women with PCOS and left us with some important take-aways on how to reduce stress and its effects. Listen in and learn about:
- unexpected sources of chronic stress
- tips for controlling stress
- how stress effects the thyroid hormones and makes your blood work appear normal when it’s not
- why stress causes weight around the central abdomen, particularly in women with PCOS
- the danger of over-exercising
- adrenal fatigue and how you can test for it
A complete transcript follows.
Dr. Shawna Darou is a licensed and registered Naturopathic Doctor, who graduated from the Canadian College of Naturopathic Medicine (www.ccnm.edu) at the top of her class and was the recipient of the prestigious Governor’s Medal of Excellence. Naturopathic medicine is her second career, her first being Engineering Chemistry from Queen’s University. She now uses her analytical brain and problem solving skills especially in the complicated arena of hormonal health, and in solving health puzzles.
Dr. Shawna Darou N.D. is a specialist in women’s health care and fertility who has treated thousands of women in her Toronto clinic since 2004. She is a dedicated and caring doctor with a gentle approach who is committed to the health of her patients. Dr. Darou’s is also an avid health writer, and her popular health blog can be found at http://darouwellness.com/blog-posts/
Outside of the office, Dr. Darou is the mother of two beautiful children who inspire her to evolve the medical model in order to reform healthcare for the next generation.
Amy Medling: Hello, and welcome to another edition of the PCOS Diva Podcast. This is your host, Amy Medling. I’m a certified health coach, and I’m the founder of PCOS Diva, and today we’re going to be talking about a lifestyle aspect of PCOS that we rarely hear about in the doctor’s office. I hear from so many women, everyday about their experience going to the doctor, and certainly it was mine. When we go, we’re told to lose the weight, go on a low-carb diet, start exercising more. We’re given a prescription for metformin and the birth control pill, and sent on our way, but there’s a really important aspect of managing our PCOS that I know we need to learn more about, and that is stress.
Stress really wreaks havoc on our hormones, and can really increase our PCOS symptoms. So today we are talking to Dr. Shawna Darou, and she is a licensed and registered naturopathic doctor. So she’s going to share some of her tips about controlling stress, and really give us a good background about how stress effects our PCOS. So, welcome, Shawna.
Dr. Darou: Thank you, thanks for having me.
Amy Medling: So, let me just tell our listeners a little bit more about your background. You graduated from the Canadian College of Naturopathic Medicine as the top of your class, and you were the recipient of the Prestigious Governors Medal of Excellence. Naturopathic medicine is actually your second career, after being in engineering, you studied engineering chemistry from Queens University, but now you use your analytical brain and problem solving skills, especially in the complicated arena of hormonal health, and in solving women’s health puzzles. So, welcome, so glad that your’re going to be here, and sharing your knowledge about hormone health and stress.
Dr. Darou: Great. Thanks a lot. One of the things that I’ve learned through the years of practice is that our hormonal systems are all connected together, and I think that’s where my engineering background comes in handy is that I’m able to grasp the interconnection rather than looking at things one piece at a time.
Amy Medling: Everything is on a cellular level. It all is connected, and I think maybe you could explain how stress hormones, like cortisol inter-plays with the hormones that we hear about that associated with PCOS. The progesterone, and testosterone, and estrogen, and thyroid hormone. How does those hormones all interact.
Dr. Darou: Sure! When our bodies are under a prolonged period of high stress, our stress hormones go up, and that’s hormones like cortisol, for long periods of stress, adrenalin for short burst of stress, and they interact with the function of your ovaries, the function of your thyroid, your pancreas. In terms of PCOS what we find is that there’s an expression that says, “Cortisol steals progesterone.” So we end up with lower progesterone levels.
If there’s lower progesterone, it could be that you’re not ovulating, or the phase after ovulation called the luteal phase becomes shorter, less strong, so there’s more PMS.
Stress definitely effects blood sugar regulation, and I’m sure most of your listeners are aware, there’s a huge component of most cases of PCOS with blood sugar regulation and insulin resistance, and prolonged high cortisol levels can make that regulation more difficult. So it like it compounds the effect of high cortisol. So with most women, when they’re under high periods of stress, their blood sugar will go off, they’ll start gaining weight around the central abdomen, but that’s much more amplified in PCOS with the underlying hormone imbalance already.
In terms with the thyroid, stress effects the conversion of your T4 to T3, which means how active the thyroid hormones are. So your blood-work may look normal, but you have a lot of thyroid symptoms, like weight gain, feeling tired, feeling cold, hairless. Those types of things, and it may not be caught unless somebody actually does a full thyroid panel on you.
Another part is that when you’re under prolonged period of stress, an adrenal hormone called DHEA will also be higher, and in a lot of women with PCOS DHEA is already elevated, and if you increase that further you end up with more of this adrenal androgen, because it’s an androgen it has testosterone-like activity on the body. So that will worsen the symptoms like acne, or hair growth on the face, or hair loss on the head. It means that a woman with PCOS is more sensitive to that hormonal shift.
Amy Medling: I think that studies have shown, and this something that I was looking into during PCOS awareness month. I put out a great tip every day, and looking at stress, there’s some interesting studies that show that women with PCOS already have elevated levels of cortisol compared to their non-PCOS counterparts in this studies. We’re already dealing with high levels of cortisol, but then adding the daily stressors that’s increasing the cortisol even more, and adding to, I like to call it the perfect storm for women with PCOS, the low progesterone, the elevated DHEA, the disruption in thyroid function. So it really does lead to a lot of PCOS symptoms becoming worse.
Dr. Darou: Yeah, I consider stress just as important as diet and exercise in the management of PCOS. It’s a piece that has to be addressed because unless you do, you can’t get the hormones in check, and as a naturopath I don’t put women on birth control to manage their symptoms. I’m looking at how can we do this with diet and lifestyle, which is actually possible. With an improved diet, with regular exercise, and stress management is the third leg of that stool, absolutely.
Amy Medling: So let’s talk about sources of stress. I think when we think of stress, it’s the crazy work schedules, or trying to balance the home/family life with work. That’s definitely for me one of my biggest stressors, but it isn’t all that mental, emotional stress. Tell us what other stressors really impact our PCOS.
Dr. Darou: Basically, there are a lots of things that can raise your stress hormones, and yes like you described the high paced life, and the not enough breaks in the day, and balancing work-life is a huge one, but other sources of stress are anything that causes inflammation in the body. So, any chronic health issue like an autoimmune thyroid condition, or rheumatoid arthritis, or an injury is a huge stress on the body. Lack of sleep, people often miss that one, puts your stress hormones into overdrive. So when sleep, especially when they sleep hours get less than six per night, your bodies alarm bells go on, and your blood sugar regulation goes off. So it greatly reduces insulin sensitivity, and the other one that I often address is over-exercising.
Let’s say your baseline levels of stress is already fairly high, and then you decide that you’re already going to the gym going full out, and do boot camps and spin classes, and boxing, and really high intensity exercise, and what people forget is that’s also a stress on the body. If your baseline level of stress is fairly low, that form of exercise can be fantastic, and you’ll get great results, but I find that a lot of my patients who go too hard too fast end up getting results that they’re not looking for. Meaning, they’re not losing weight, or they might be gaining weight, they’re feeling more tired, they’re not gaining muscle tone. It can be really discouraging, so exercise that’s in proportion to your hormone balance and your stress levels really important as well.
Amy Medling: So, Shawna, can you tell us what types of exercises you think would be optimal for women with PCOS who are really are feeling under stress, and they know they’re stressed out. So they probably shouldn’t be running marathons, I’m taking it.
Dr. Darou: That’s right. The key is to avoid exercises that will be compounding the stress. So things like boot-camps, and high long distance running, and boxing classes, and that type of thing, but there are better exercise programs for you. Generally, when somebody is under a lot of stress I recommend that their workouts are no more than 40 minutes of cardio. Things like yoga, and pilates, can be at a fairly vigorous pace, are a fantastic forms of exercise because build-in breathing and relaxation which is great for the stress hormones, and then walking is always fantastic to maintain fitness without putting additional stress on the body, possibly with some high intensity interval thrown in. It really depends on the level of stress as to whether I would recommend that or not. So it is really important to stay active, because that helps to lower stress, but not to over-do it at the gym.
Amy Medling: Well I will have to tell everybody about an exercise that I’ve discovered in the last six months or so. My husband and kids gave me a membership to Pure Barre, it’s a ballet bar, workout place, for Mother’s Day. So I’ve been doing this for a while, and I’m working my way up to a 100 classes, but what I really love about Pure Barr is that you get a little bit of a cardio workout.
My heart rate is going up and down during class, but it’s strength building, based on your own body weight. Some small weights, are optional in class, but you’re really working with your own body weight doing these small isometric movements, and there’s really a nice mind body connection almost like yoga, and it’s just fun. The music’s fun, and for me I just can go there and just veg out an hour, and then get a great workout. I know it’s not elevating my cortisol, so it really works for me.
Dr. Darou: I think that sounds fantastic. The key is how do you feel at the end of it, and how is your hormone balance while your following this type of a workout plan, and for everyone that is a bit different. So I do have some patients with PCOS who seem to need a whole lot of cardio. I wouldn’t go as far as marathons, but more than the average person, and again we have to balance that out depending on the stress as well.
Amy Medling: So I think that is important. The type of exercise that you select for yourself can really help your PCOS symptoms or they can make them worse. There’s something to certainly think about.
Dr. Darou: Definitely.
Amy Medling: So, tell us a little bit about adrenal fatigue. I think it’s something that we’re hearing more of, especially online, but we may not be hearing about it at the doctors office, or if we ask our doctor, which I did one time, “I think I have adrenal fatigue. Can you tell me about that?” and he was like, “What? I don’t really believe in adrenal fatigue.” So, what’s going on there with the lack of knowledge in maybe mainstream medical community about adrenal fatigue? Is it really something that we should be concerned out? Can you speak to that?
Dr. Darou: Yes, certainly. It’s something I treat and talk about a lot, and I get the same response from peoples regular doctors all the time. It’s different training, and different things that we’re looking for. So a medical doctor when they think of adrenal glands is looking for an acute disease with the adrenal gland. Something like Cushing Syndrome where your cortisol is too high, or Addison’s disease where your cortisol is too low, and they don’t really care what’s happening in between. Meaning, you’re not going to die from it.
As a naturopath, what we’re looking at is how are your adrenal glands functioning in response to stress. There are ways of measuring your cortisol levels, and in a functional range. Meaning, is your adrenal system producing too much cortisol and other stress hormones, or not enough in response to stress. Adrenal fatigue means that your adrenal are under-active, which happens after a prolonged period of high stress. So prolonged period of high stress that varies how long that will be from person to person. I’ve had some patients who have been under high stress their whole life, and still run on high cortisol, and I’m not sure how that happens, and other where they go through a 3 year, really intense work period or personal changes, and their adrenal glands just crash afterwards.
So, some symptoms of adrenal fatigue, the main one is poor tolerance to stress. Meaning that everyday stressors become overwhelming. Felling un-rested after sleeping, there might be some depression or feeling low. It could be more colds or flus. Symptoms of low thyroids, feeling dizzy or light-headed when you stand up too quickly. Those would be some of the classic signs, but keep in mind sometimes the signs of the adrenals being overdrive look quite the same. The poor tolerance for stress and fatigue go both ways. So it is important to test, because you can do a lot of harm by assuming you’re an adrenal fatigue when you’re not, and then trying to bump up the adrenals. You’ll feel much worse for it, and hormones will feel much more out of balance as well.
So, I do recommend testing before treating. There are exceptions. There are excellent supplements which I consider adaptogens, which help your body adapt to stress, and usually with those you won’t do any harm no matter where your adrenal pattern is at, and they’re quite safe, but if we’re actually looking at repairing, and re-building the adrenal system we want to sure that we’re working in the right direction.
Amy Medling: So can you tell us a little bit about the testing for somebody that’s interested in getting their adrenals tested. What would they ask for?
Dr. Darou: So, usually the way we test the adrenal system is with a saliva panel rather than blood-work, and with the saliva panel you can map out the cortisol rhythm, which is your cortisol pattern through the morning, daytime, afternoon, and before bedtime. Which should have a pattern of being high in the morning, come down at daytime, and dropping really low at night.
That rhythm is just as important as the absolute level of cortisol as well. The reason we do saliva rather than blood is number one, going to the blood lab four times in a day is not very practical, but number two, the saliva levels tend to be better at marking out dysfunctional range, because they’re giving you tissue level hormones, the amount of hormone, every cell in your body is exposed to not just the blood levels that fluctuate even on the hour. So that’s typically how I would test.
Occasionally I will do just the one point morning cortisol blood test, especially if there is a budget concern with a patient, because we can ball park of is the adrenal system in overdrive or under-functioning, but usually does come back within the normal reference range. I’m just looking at is it running on the high or the low side. Saliva panel is a lot more accurate.
Amy Medling: So somebody could actually have a reverse curve then where their cortisol is really low in the morning. It’s hard to get out of bed, and then elevated in the evening when it should be low and it’s hard to settle down. You have that “tired but wired” feeling. That’s what I call it.
Dr. Darou: Yeah, that does happen fairly often. One of the most common scenarios that I see that is postpartum, where I think our bodies naturally raise our cortisol in the night to watch our babies, but sometimes if you have a baby who’s a very poor sleeper for a prolong period of time, you’re own cortisol rhythm doesn’t go back to normal again very easily on its own. So I’ll see that pattern stay for two or three years after having a baby, where a woman just doesn’t sleep very.
It also happens with menopause or perimenopause changes, or somebody who’s naturally a night owl, or is taking a night course, that’s another classic example. Where they’re turning they’re brain on at a time when their body should be winding down.
Amy Medling: I think that’s why shift work is so difficult for so many women with PCOS.
Dr. Darou: Yeah, shift work is really hard to maintain hormone balance. I would expect that would be very difficult for a woman with PCOS because we’ve got so many stressors on the hormone regulation.
Amy Medling: So, now that we know how to discover whether we’re having adrenal issues. What are some things you tell your patients to help them manage and keep their adrenal system healthy.
Dr. Darou: Well, the first thing we look at is how is somebody going through the day, and what paces their life, and is there any downtime. So, one of the best ways to help to manage the adrenal system is actually just taking small breaks through your day.
So, if we look at the nervous system as being two parts, the sympathetic nervous system which is going and doing, and the parasympathetic nervous system which relaxing and digesting. We’re meant to have a rhythm with these two systems where the going and doing sympathetic system goes on for two to three hours, and then the parasympathetic nervous system of relaxing and digesting is meant to take over for 20 to 30 minutes. So, if we go, go, go, go ,go without a break for too many hours, which most of us do, our stress hormones build, and we end up with a more overwhelmed feeling at the end of the day.
So one of the simplest tools to manage stress is to just build-in some regular breaks, and I usually have people set alarms on their phones or their computer to remind them, and the break doesn’t have to be half-hour it could be 5 or 10 minutes of breathing, getting a breath of fresh air, a walk around the block, a cup of tea, socializing, just standing up and moving around. It helps to discharge the stress hormones so that they’re not climbing and building though the day. So that’s one really simple way of helping to lower the stress hormones through the day.
Of course exercise, fantastic, asking for help, staying active, and then the other part of this is looking at a regular practice to activate relaxation response, because there have been many studies now that show that practicing something that puts you into what they call the relaxation response for 15 to 20 minutes a day can have a profound effect on how you manage stress through the rest of the day. It can be active or it can be passive. It could be meditation, it could be a guided meditation, it could be a gentle yoga practice. It could be breathing exercises. Another favorite I have is the gratitude journal- helping to shift the thought pathways. Looking at heart-rate variability which I think you’ve already discussed before in another podcast. So, there’s a lot of tools to access there, and the thing to remember is that it doesn’t have to be sitting still and breathing. Some people are more anxious when they do that, and are better to be actively relaxing.
Amy Medling: Something that I have, I put it away when guess come over, but it’s in the corner of my living room, is a rebounder- one of those mini-trampolines with the handle on it, and I work from home, and so I try to work in these breaks, and I do have to set an alarm to remind me to step away from the computer, but I’ll go and I’ll jump on that rebounder for five minutes.
Dr. Darou: Fantastic, that’s great.
Amy Medling: Yeah, it really is great way to discharge, and the other thing that I love is called the detox bath. If I’m having a tough day and feeling really stressed out, and I think women with PCOS tend to, I’ll relate it with my kids, my computer is on the fritz, and I need to reboot it so it comes back. Well, I think a lot of us are on the fritz, we need a reboot, and taking a detox bath does that for me. So I put two cups of epsom salt, a cup of baking soda, some essential oils like lavender and clary sage, maybe some rose oil, and I’ll just soak in there for 30 minutes, and I’m like a new person when I come out.
The magnesium helps, and I can lock the door. Nobody can bother me for 30 minutes.
Dr. Darou: Oh that’s heaven and a good idea.
Amy Medling: Yeah. Quiet music, and it’s a great way to unwind at the end of the day.
Dr. Darou: Yeah, what a great idea. The other part of managing stress I think, which I know a lot of my patients with PCOS have issues with is just basic self-acceptance. Looking at how to get it back in touch, and appreciate your body and your hormones, and all of those things a little bit better. There was something I posted on my Facebook account last week, and it’s a little excerpt from a poem, and it got such a huge response. So it’s from a poem called Tree by, I’m probably going to mispronounce this, Nayyirah Waheed, and the middle of the poem says, “And I said to my body softly, ‘I want to be your friend.’ It took a long breath and replied, ‘I’ve waiting my whole life for this.'”
Amy Medling: Oh, gosh, that’s beautiful. I’m going to have to go look and share that on PCOS Diva, that’s really good.
Dr. Darou: The whole poem is lovely as well, but middle excerpt, it rang true with so many people. This is a huge piece of our stress. Never mind the holidays and the family and all of that, as if we have more grounding within ourselves, which I know is more difficult when the hormones are out of balance, it can change things profoundly.
Amy Medling: I think talking about stress, and being out of balance, we’re coming up on the holidays when this podcast goes out it will be in mid-November, and if our lives aren’t already stressed, adding that whole holiday season can really exacerbate the situation. You’ve given us some wonderful tips, the meditation, taking breaks, self-acceptance. Anything else… you’ve mentioned the adaptogen herbal formula, maybe you could talk about those adaptogen herbs, and would something like that be helpful to get us through the holidays?
Dr. Darou: Yeah. I do often recommend things like that proactively when know you’re going into a period of high stress, because it can help to protect your hormone balance. So, why wait until you’re already overboard? So, adaptogen herbs can be things like, well if tend to be on overdrive and always running, rhodiola is one of my favorite there. Just one caution, if there’s any tendency for bi-polar disorder, that’s not a great one. Other favorites are, the lactium extract, so it’s from a dairy peptide, and it actually lowers stress from the brain receptor level, that’ ones fantastic, and other support could be ashwagandha, that very calming, passion flower if there’s a tendency for anxiety. There’s great inclinations with these things, and again the point of taking something like that proactively is to protect your hormonal system, so that the period of high stress doesn’t cause your periods to go out of balance, and your PMS to get worse, and your skin to break out and all of that.
Amy Medling: And you mentioned anxiety, we have a couple more minutes left. Could you talk about the connection between PCOS and an anxiety? I know so many drugs-
Dr. Darou: Sure, yeah. I find that there’s a big connection there, and there’s several reasons. Number one, is the issues with regulating blood sugars and insulin. So, when someone has more difficulty regulating their blood sugar and insulin, they’re on more of a roller coaster with their blood sugar levels, and drops in blood sugar can definitely create more feelings of anxiety, which usually comes with feelings of hunger and needing to overeat, and feeling like compulsively eating as well. Another part of the anxiety piece is the fact that women with PCOS tend to already have elevated stress hormones, like you mentioned before. So, if your cortisol and you DHEA levels are already a little bit elevated, it’s harder manage the day-to-day stressors, which basically means having some of these great self-care things in place is even more important.
The third piece that I’m just going to touch on a little bit has more to do with personal genetics, which I look at a lot these days because we can learn a lot about peoples susceptibilities. And there’s an enzyme that’s called COMT, which is something I test for when I’m looking at what are called methylation cycles, and COMT is an enzyme that breaks down your what are call catecholamines, like dopamine, norepinephrine, adrenaline, and there’s a fairly large portion of the population that have a defect in this enzyme. So it’s inherited through your parents, and what it means is that they have a much harder time breaking down those stress hormones, so they tend to be much more prone to anxiety and worrying, but the part that’s relevant for PCOS is that this enzyme also is really important for breaking down estrogen.
And because most women with PCOS are in an estrogen-dominant state, the imbalance and the stress hormones is more exaggerated. So I find that’s just helpful because we know these women who have struggles with estrogen dominance, and breaking down their stress hormones need to build more tools into their life to manage stress, but it also tends to be really helpful in the self-acceptance sphere of learning, “Why do I have such a hard time with stress, and why is so much harder for me than somebody else?”
I found personally learning about my own genetics extremely helpful in that frame of knowing that I didn’t mess myself up. It wasn’t that I didn’t eat well enough, or do this as a child. It just stays with the genes I was dealt in, you learn how to manage them better. So the gene gives us a lot of information about peoples’ susceptibility, and it is something I find really helpful in my practice. In looking at how much do we need to focus on the stress to get the PCOS hormone imbalance with these women.
Amy Medling: I think that it’s true, knowledge really is power. That the more that you learn about this syndrome, the more I think you come to that place of not feeling so out of control, and empowered. I think you go through Elizabeth Kubler Ross’s five stages of grief when you get your PCOS diagnoses.
So hopefully you can come to a place of acceptance, and there was an interesting study, I don’t know if you saw it. It came out last week, and there was an animal study that shed a little light on the link between PCOS and anxiety. They were looking at rats, but they found that if the baby was born from a mother with high levels of testosterone late in the pregnancy, they were more likely demonstrate anxiety-like behaviors into adulthood compared to offspring that weren’t exposed to high doses of testosterone. I think that’s just another piece of information that you’re wired the way you are, and it has nothing to do with something you did wrong. You’re right.
Dr. Darou: No again, I can’t tell you how many people I’ve had in my office who just break down in tears when they actually understand. Sometimes, it could be anything, it’s just that they understand that there’s a reason that they feel like that they feel, and there are some tools that we can look at to deal with it better, and again that is empowering people to learn how to take care of their health for the long run. Rather than feeling out of control that hormones are out of balance and that I feel I’m moody all the time, and I don’t know when my period’s coming, and the anxiety, and the more understanding we have of the mechanisms which can go on so many different levels, the more we understand what we need to do to cope better. And we all have our own quirks, and nobody is immune to this.
Amy Medling: No you’re absolutely right, everybody has their own as my would say, “cross to bear.” But it’s really our attitude and the way that we approach it makes all the difference.
Dr. Darou: Yeah, definitely.
Amy Medling: So, you know thank you for taking the time to explain this stress connection with PCOS, and giving us some really nice takeaways we can apply to our lives, and hopefully get through the holidays without putting ourselves through adrenal fatigue, by January 1st.
Dr. Darou: The key is be proactive, and make sure you stay active. Take your breaks, take care of your own needs in the midst of it all, and maybe take some adaptogens to help.
Amy Medling: Yeah, tell us, Shawna if somebody wanted to work with you, I think I failed to mention that you’re in Toronto, but tell us more about what you offer on your website and how to reach you.
Dr. Darou: Sure. So, yeah I have a private practice in Toronto in Canada, so I see patients on a one-on-one basis there. In terms for people who are out of town, currently the best way to learn more about my work or to learn more from me would be to visit the website which is called darouwellness.com, and Darou is d-a-r-o-u, or follow my newsletters. I’m a very prolific writer, so there’s lots of blogging going on. We’re working on some online courses and seminars, so that will be more accessible to people out of town. They’re not quite up and running yet, but we do have lots of resources online at this point.
Amy Medling: Great, so I will definitely put that information below the podcast, and I’m going to check out your Facebook page and share that really great quote before we get out of the call, but thank you again for coming on and joining us. And thank you everyone for listening, and I’ll look forward to being with you again next time.