Polycystic ovary syndrome (PCOS) can feel like a complex condition. There are many aspects to PCOS, one of which is high levels of androgens. But are symptoms of PCOS linked to adrenal fatigue and is there a type of PCOS known as adrenal PCOS? Let’s take a look at the evidence and sort fact from fiction.
What is PCOS?
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder common among people assigned female at birth of reproductive age. People with PCOS may have prolonged or irregular menstrual periods and elevated levels of the male hormones known as androgens. PCOS symptoms include hair loss on the head, mood swings, high insulin levels, irregular periods, rapid weight gain, fertility issues, excessive facial hair and body hair and more.
Although PCOS cannot be cured, there are many medications (such as metformin and oral contraceptives like birth control pills), supplements and lifestyle changes including nutrition tweaks that could be beneficial for symptom management.
What is adrenal fatigue?
Adrenal fatigue is a term used to describe a collection of nonspecific symptoms like body aches, fatigue, nervousness, sleep disturbances, and digestive problems. The term adrenal fatigue has been used to describe a condition supposedly caused by chronic exposure to stressful situations. According to this theory, this chronic stress leads to the “overuse” of the adrenal glands which supposedly leads to their failure.
It is important to note that adrenal fatigue isn’t an accepted medical diagnosis. Instead, adrenal insufficiency, a recognised medical condition, refers to inadequate hormone production due to underlying diseases or surgery.
Adrenal fatigue vs adrenal disorder
Adrenal disorders, unlike adrenal fatigue, are medically recognised conditions. They include diseases where the adrenal glands produce too much or too little hormone, which can be diagnosed through blood and special stimulation tests.
Before being diagnosed with PCOS exclusion of certain conditions like thyroid disease, hyperprolactinemia and non-classic congenital adrenal hyperplasia is recommended. Plus, those presenting with amenorrhea (lack of periods) and more severe clinical features should have adrenal disorders including adrenal gland tumours, Cushing’s Syndrome, pituitary tumours, Addison’s disease and more excluded before being diagnosed with PCOS.
Adrenal fatigue, on the other hand, is a theory that suggests chronic stress can lead to a mild form of adrenal insufficiency, which is not recognised in the medical community.
What about adrenal PCOS?
Now we have established that adrenal fatigue is not a real medical condition we can understand the so-called “adrenal PCOS”.
Within functional medicine, people with PCOS are sorted into four different types of PCOS, known as the “root cause” of PCOS. These types of PCOS include post-pill PCOS, inflammatory PCOS, insulin-resistant PCOS and adrenal PCOS. There is no scientific evidence to support the functional medicine approach to types of PCOS and PCOS management.
Most people with PCOS present with inflammation, insulin resistance and high DHEA levels (a hormone that makes androgens and oestrogen) – it is almost impossible to “sort” people into these categories.
The adrenal glands
The adrenal glands are small, triangular-shaped glands located on top of each kidney. They play a crucial role in the body’s stress response and are vital for maintaining homeostasis, which is the balance of internal conditions necessary for survival.
The adrenal glands are comprised of two distinct parts, each responsible for producing different hormones.
The adrenal cortex
The adrenal cortex is the outer part of the gland. It produces several types of steroid hormones including corticosteroids (including cortisol, one of our stress hormones), mineralocorticoids (including aldosterone) and sex hormones (including androgens and estrogens, “male hormones” and “female hormones” respectively).
The adrenal medulla
The adrenal medulla is the inner part of the gland that produces catecholamines including adrenaline and noradrenaline. These hormones work together to respond to stress as well as to maintain blood pressure under normal conditions.
How the adrenal glands impact PCOS
Although there is no type of PCOS specifically related to the adrenal glands, there is a link between PCOS and the adrenals. This includes adrenal overproduction, adrenal hyperactivity, insulin resistance and adrenal function as well as HPA axis dysregulation.
People with PCOS often have elevated levels of androgens. Although the primary source of androgen production in people assigned female at birth is the ovaries, the adrenal glands also contribute to androgen production.
Research has seen that people with PCOS may have a more active adrenal response to stress. When the body experiences a lot of stress, it releases DHEA into the bloodstream in response to adrenocorticotropic hormone (ACTH). DHEA (Dehydroepiandrosterone) and its sulphate form (DHEA-S) are hormones produced by the adrenal glands and a precursor to other hormones, including testosterone and estrogen.
Research has shown increased levels of DHEA in people with PCOS compared to controls. This hormone can impact how our body processes energy, our hormone systems, and how our ovaries work. Research done on rats has shown that when DHEA levels are artificially increased, it leads to inflammation and a harmful type of stress in the body called oxidative stress. This causes big cysts to form in the ovaries of the rats. These cysts are similar to what we see in human PCOS.
Insulin resistance and adrenal function
Many people with PCOS have insulin resistance. Insulin resistance is a condition where the body’s cells don’t respond effectively to insulin. Insulin resistance can stimulate the ovaries and potentially the adrenal glands to produce more androgens. Elevated insulin levels can also impact the production of other hormones, such as sex hormone-binding globulin (SHBG), which normally helps regulate androgen levels.
HPA axis dysregulation
PCOS may be associated with changes in the function of the HPA axis, the system that controls the body’s response to stress and includes the adrenal glands. Dysregulation of this axis can affect hormone production, including that of adrenal androgens.
How to manage stress with PCOS
Managing stress is crucial for individuals with PCOS, as it can exacerbate symptoms. Techniques like regular exercise, good sleep hygiene, mind-body practices (like yoga and meditation), and engaging in hobbies effectively reduce stress. Being aware of stress triggers and using natural stress-relief methods like herbal teas can also be beneficial.
Stress can also be exacerbated with poor sleep. Many people with PCOS suffer from “PCOS fatigue” and brain fog. Getting adequate sleep can be challenging but our article on PCOS and sleep may be helpful.
Key takeaways: PCOS adrenal fatigue and adrenal PCOS
- PCOS is a hormonal disorder characterised by irregular menstrual cycles and elevated androgen levels.
- Adrenal fatigue is a non-medical term describing a set of symptoms believed to be caused by prolonged stress, but it is important to note that it is not recognised in the medical community.
- PCOS adrenal fatigue is not a real medical condition but your symptoms are very much real.
- The adrenal glands play a role in PCOS and are linked to insulin resistance, excess androgen production and increased stress levels but there is no adrenal PCOS type.
- Stress management is key in managing PCOS symptoms, with lifestyle changes playing a significant role.
- You may want to work with healthcare professionals if you believe you are living with elevated stress levels that impact your PCOS symptoms.
Founder and Editor | Registered Associate Nutritionist
Founder of Be The Collective LTD [The PCOS Collective & The Endo Collective] Alex Okell ANutr is a London-based reproductive health nutritionist with experience in research, private practice and digital media. She holds a Master’s degree in Nutrition from King’s College London and has co-authored papers with the University of Cambridge, King’s College London, The Food Foundation and the Food Standards Agency. Alex offers 1:1 PCOS support in our virtual PCOS clinic.