Adrenal PCOS: Causes, Symptoms, And Treatment Options

Stress is an inevitable part of life that arises from various factors. Stress is common to everyone, whether it is handling the pressures of daily life, dealing with a demanding career, or navigating difficult life situations.

In women, stress can affect their hormones to the point of disrupting or causing the disappearance of their menstrual cycle. In fact, stress in women has been linked to the origin of numerous medical conditions, including polycystic ovarian syndrome (PCOS), a prevalent endocrinological condition that affects the female reproductive system.¹

What is PCOS?

PCOS is a hormonal illness that affects women in their reproductive years. PCOS affects up to 20% of women, with 50%–75% not even knowing they have it. A recent study revealed that 70% of women with PCOS are undiagnosed.² ³ ⁴

As its name suggests, PCOS affects a woman’s ovaries. One of the primary roles of these reproductive organs is to produce estrogen and progesterone. Ovaries also produce a small number of androgens and release eggs during ovulation, which the male sperm fertilizes.

The pituitary gland produces the luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which regulate menses and ovulation. FSH induces ovarian follicles to mature and produce estrogen, which then, in turn, causes the proliferation of the uterine endometrium. 

This mature follicle also contains an ovum that can be fertilized after ovulation. This estrogen then increases the pituitary production of LH and FSH, which induces ovulation.

The exact pathophysiology underlying PCOS has yet to be fully understood. However, there appears to be altered LH action and an abnormal selection of a follicle for ovulation due to insufficient FSH stimulation and local inhibition of FSH action. 

Production of excess androgen also referred to as hyperandrogenism, is a crucial feature of adrenal PCOS and significantly affects the function of the ovaries. About 60%–80% of women with PCOS have exhibited biochemical evidence of hyperandrogenism, with dehydroepiandrosterone-sulfate (DHEA-S) and dehydroepiandrosterone (DHEA) having the highest concentrations. 

High concentrations of these androgens promote hormonal dysregulation and endometrial dysfunction, which often results in pregnancy complications. 

Adrenal glands in the context of PCOS

In the context of PCOS, the most common secondary endocrinopathies are insulin androgen-related. However, some studies have also demonstrated an association between DHEA and adrenal PCOS. It indicates the possible effect of stress on the pathophysiology of PCOS.

DHEA is made by adrenal glands in response to acute stress. Upon experiencing acute psychosocial stress, the body increases cortisol production in response to the increased levels of the adrenocorticotropic hormone (ACTH). 

Dehydroepiandrosterone (DHEA) and its sulfate version (DHEA-S) are both generated by the adrenal glands in reaction to ACTH. Therefore, it makes sense that the DHEA levels would rise as a response to stress.

However, long-term psychosocial stress reduces levels of DHEA as well as its sulfate variant, which is unfortunate because DHEA is essential for resilience and effective adaptation to severe acute stress.

Acute stress causes increased production of DHEA levels into the blood system, which impacts ovarian, endocrine, and metabolic processes. 

Symptoms of adrenal PCOS

Most women begin noticing adrenal PCOS symptoms when they first start menstruating in adolescence or when they plan to conceive.

Common signs and symptoms of PCOS include:

• Weight gain

• Hair loss/growth

• Acne

• Irregular or missed menstrual cycle

Causes of adrenal PCOS

The human body has two adrenal glands on top of its kidneys. These glands mainly produce steroids (glucocorticoids and mineralocorticoids) as well as epinephrine and norepinephrine. Among other things, most of the hormones secreted by the adrenal glands take part in stress response. 

Once confronted with stressful emotional or physical situations, the pituitary releases ACTH, which tells the adrenal glands to release cortisol and DHEA.

What is DHEA?

DHEA refers to a hormone produced in the adrenal glands of each kidney. It is a precursor for producing other hormones, including estrogen in women and testosterone in men. 

As a young adult, your natural DHEA levels are at their peak. As you age, these levels drop. Doctors perform a DHEA-S test to determine the adrenal glands’ efficiency and DHEA-S levels in your blood.

While high levels of DHEA in males has little effect, it can cause symptoms like irregular or skipped periods, acne, hair loss or gain, fertility issues, or even frank virilization in women. In younger children, high DHEA levels can lead to premature adrenarche (the awakening of the adrenal gland).

How is stress related to DHEA?

Generally, stress causes a series of events in the human body as it tries to cope with the situation. This process usually involves several parts of the body, including the brain and hormones from the adrenal glands. In particular, the adrenal glands produce cortisol, the primary stress hormone, and DHEA to deal with stress in the body.

The prolonged stimulation of the body’s stress response system and the excessive exposure to DHEA, cortisol, and other stress hormones can affect the body’s normal functions.

Treatment for PCOS

Treatment for adrenal PCOS usually starts with lifestyle intervention. For instance, research shows that losing up to 10% of your body weight can help regulate the menstrual cycle and alleviate common PCOS symptoms. This is possible through eating a well-balanced and healthy diet.⁵

In addition, exercising at least three days per week can positively contribute to your weight loss journey. Following AHA/CDC guidelines for physical activity is advisable for optimum results. 

According to these physical activity guidelines, adults should engage in 75–150 minutes of strenuous aerobic exercise each week or 150–300 minutes of moderate aerobic exercise per week.⁶

There are also several effective medical treatments for adrenal PCOS, depending on whether the woman wants to get pregnant. Common medical treatments include:

• Taking birth control pills

• Taking metformin to improve insulin function and improve hirsutism

• Clomiphene for increasing fertility in women who are trying to get pregnant

• Ovarian drilling, which is a surgical procedure that aids in restoring regular ovulation in women

Ways to deal with stress to managing adrenal PCOS 

Effective treatment of adrenal PCOS involves restoring appropriate menstrual function, ovary function, and insulin metabolism. All these can be supported by finding healthy ways of dealing with stress. These can include the following:

Get quality sleep

Losing sleep seriously affects your health. In fact, studies show that insufficient sleep might raise cortisol and DHEA levels. Thus, aiming for seven to eight hours of sleep each night is a simple yet substantial intervention you can do right away.⁷

You should keep electronics far from your sleeping area for quality and undisrupted rest. It is also advisable to avoid consuming alcohol, tobacco, and caffeine at least an hour before bed. 

Meditate regularly

In addition to proper nutrition, women with adrenal PCOS may benefit from meditating daily to manage their stress levels. Not only does it help ease your body muscles, but it also improves the quality of your sleep by quieting your mind and allowing you to focus on your thoughts.

Practicing proper deep breathing techniques is among the most crucial aspects of meditation practice. 

Exercise

Gentle and restorative exercise routines can go a long way in dealing with everyday stress. Exercise, especially endurance exercise, can also help restore insulin sensitivity and appropriate reproductive function.

Practice self-care

Taking a few moments for yourself is among the most effective methods to unwind and manage stress. A decent self-care regimen should include everything that improves your mental well-being and makes you feel at ease. 

However, this does not only refer to candles and long baths. Other self-care routines include reading a book, spending time in nature, watching a movie, hanging out with friends or family, or even starting a new hobby. 

Join a support group

Another effective method of managing stress is confiding in a close friend who can support you during stressful situations. Even though it may be tough to feel social during trying times, creating and keeping commitments to activities with family and friends can improve your mental health. 

Alternatively, you can connect with other women walking the same path as you through various online or offline support groups.

The lowdown

Adrenal PCOS can interfere with a woman’s hormones and make it more challenging to conceive. This condition also produces high quantities of male hormones, which can cause undesirable symptoms, such as unsightly body and facial hair development.

Luckily, the first step in treating PCOS is making lifestyle modifications, such as eating a nutritional diet, exercising regularly, and finding healthy ways to manage stress. Several medical treatment options, such as birth control, clomiphene, metformin, and surgery, can help alleviate the symptoms of adrenal PCOS.