The link between cortisol and PCOS

Polycystic ovary syndrome (PCOS) is one of the most common endocrine conditions affecting people of reproductive age. According to the Rotterdam criteria, two out of the three following criteria are required for diagnosis of the condition: anovulation or irregular menstrual cycles, excess androgen hormones and polycystic ovaries. Aside from the diagnostic criteria the condition can display as a multitude of symptoms, which will vary between individuals.

What is cortisol?

When we perceive something as a threat (aka the cause of stress), this will trigger a physiological response within our bodies, activating our sympathetic nervous system (SNS) and out hypothalamic-pituitary-adrenal (HPA) axis. The SNS responds first resulting in a variety of bodily responses including increased heart-beat, increased breathing rate, and an increase in blood glucose and the redirecting of blood to our muscles. This is essentially preparing us for what’s commonly referred to as the fight or flight response.

As the body continues to perceive stress as a threat, the HPA axis is activated by the brain. The HPA axis is a hormonal system that initiates a sequence of chemical events causing the release of the ‘stress hormonecortisol. Cortisol keeps the body in a state of high alert, whilst also; increasing blood glucose levels, suppressing insulin levels, reducing our immune response and wound healing, and also altering our appetite and mood.

There are increasing reports linking the role of stress in PCOS manifestation.

Stress, Cortisol and PCOS

Cortisol has been implicated as a sensitive biomarker for stress-related changes in the body, playing an essential role in metabolic homeostasis. It has been found that stress can have an impact on the cause and worsening of PCOS. In fact, a systematic review and meta-analysis specifically focused on cortisol and PCOS, found levels of cortisol were significantly higher in those with PCOS compared to a control group.

Additionally, a study with 100 people with PCOS found increased levels of salivary cortisol in those with PCOS. Also, finding there was a higher prevalence of stress in those with PCOS, which played a critical role in body composition.

Furthermore, as mentioned above, cortisol has been found to impact insulin sensitivity, impacting blood glucose levels, another associated factor in PCOS.


If you have been diagnosed with PCOS, you may be at a higher risk of experiencing stress, and therefore increased levels of cortisol and its effects on the body. As cortisol is a hormonal response to stress within the body, lifestyle changes such as stress management techniques may help. Techniques such as mindfulness and yoga have been found in research to improve psychological and physical aspects associated with stress.

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