Adrenal PCOS

Polycystic ovary syndrome, or PCOS, may affect up to 20 percent of all women, although an estimated 70 percent of women with PCOS may be undiagnosed (1). Most individuals with PCOS present with a primary cause of insulin resistance. However, a smaller group of women go undiagnosed likely because they present with a lesser known cause referred to as adrenal PCOS. 

In this article, we’ll explain adrenal PCOS, how to test for it, and how to treat adrenal PCOS with a root cause approach. 

You have two adrenal glands that sit on top of each kidney and produce stress hormones, like cortisol and adrenaline, and sex hormones like DHEA and testosterone. Stress, whether emotional or physical, causes your adrenal glands to release more cortisol, which inadvertently also increases DHEA-S levels. DHEA-S is an androgen, like testosterone, but is only produced by the adrenal glands. Between 20 to 30 percent of patients with PCOS have high DHEA-S levels (2). Cortisol and DHEA-S disrupt the balance of other hormones in your body that lead to PCOS symptoms like irregular periods, acne, and unwanted hair growth or hair loss.

Most women with PCOS have a root cause of insulin resistance and high testosterone levels. However, DHEA-S is often the only androgen found to be elevated on bloodwork in women with PCOS with an adrenal gland root cause. 

To evaluate for adrenal PCOS, we first remember the three diagnostic criteria for PCOS. Women must meet at least two of the following criteria for a definitive PCOS diagnosis: 

Once PCOS is suspected, we dive deeper into finding the root cause by ordering labs to evaluate insulin resistance (fasting glucose, fasting insulin, hemoglobin a1c) and androgens (total testosterone and DHEA-S). For ideal ranges of these labs, refer to our article on PCOS and insulin resistance. If your labs for insulin resistance and testosterone appear within normal limits, look at your DHEA-S levels. Oftentimes, women with adrenal PCOS only present with high DHEA-S levels. We order these labs on all of our Get to the Root members, and may order additional saliva cortisol testing if appropriate.

The main focus for treating adrenal PCOS is to balance cortisol and reduce DHEA-S levels to within normal limits and encourage healthy hormones and regular periods. Here are a few interventions we may recommend for someone with adrenal PCOS:

Sleep loss has significant health consequences, especially for individuals with adrenal PCOS. For example, poor sleep can increase cortisol levels (3). A simple yet profound intervention you can start today is to aim for seven to eight hours of sleep every night. Reduce sleep disruptors, like alcohol, close to bedtime and avoid drinking caffeine after 1pm. Try establishing a regular bedtime routine and avoiding electronic screens too close to bedtime. Supplementing with our magnesium glycinate helps many of our members achieve more restful sleep as well.

Stress is a normal reaction to everyday pressures. Yet, over time, chronic exposure to stress without relief negatively impacts adrenal PCOS by increasing cortisol and DHEA-S levels. Simply put, you cannot heal your adrenal PCOS without prioritizing stress management. While we know you can’t always eliminate the source of your stress, you can control how you react to stressful situations. Effective ways to manage stress and proven methods for lowering cortisol include yoga or tai chi, meditation, spending time in nature, therapy, journaling, and more. Try to incorporate at least one stress reducing activity into your routine each day.

Resveratrol is a plant compound, or polyphenol, that has antioxidant properties. Top food sources containing resveratrol include red wine, grapes, berries, and certain nuts. Some research suggests resveratrol may help lower DHEA-S levels in women with PCOS (4). In one study, the women given resveratrol supplements for three months experienced a 22 percent decrease in DHEA-S versus a 10 percent increase seen in the placebo group (5). Interestingly, resveratrol also decreased total testosterone by 23 percent and fasting insulin levels by 32 percent. A different PCOS study found resveratrol to lower levels of inflammation as well (6). Our adrenal PCOS supplement bundle includes resveratrol for the most effective results.

Ovasitol one scoop twice a day for egg quality and the calming effect of inositol.
Resveratrol Plus one capsule twice daily for antioxidants and lowering DHEAS.
Magnesium Glyincate 2-3 tablets at bedtime for sleep and relaxation.

The foods you eat are important in adrenal PCOS too. Aim to eat a colorful diet rich in fruits, vegetables, nuts, seeds, lean protein, and whole grains. Blood sugar fluctuations are a physical stressor that may increase cortisol levels. Prevent dramatic blood sugar fluctuations by increasing fiber in your diet, following “PFC” meal guidelines and including a protein, fat, and complex carbohydrate with each meal and snack. Learn more about planning PCOS meals.

Adrenal PCOS is a subtype of PCOS that is caused by high levels of DHEA-S and/or cortisol. Women with this type of PCOS may have normal testosterone and insulin resistance markers and only present with high DHEA-S levels.

Key interventions to treat adrenal PCOS include prioritizing healthy sleep and stress management, eating an anti-inflammatory diet (see our foundational food plan below), and considering supplements that may reduce DHEA-S, like resveratrol.
 
We treat Adrenal PCOS in our functional medicine membership program.