PCOS & Stress

When it comes to managing PCOS, lifestyle factors can play a strong role. One of these factors is stress, which has been shown to worsen PCOS severity and even be the main catalyst of symptoms.

At Pollie, we believe that the best form of symptom management is an agenda that feels authentic to you. Stress management is no exception. In this article, we’ll be exploring:

• Stress and our hormones: How does stress affect our hormones? What’s the difference between “good” stress and “bad” stress?
• Stress and PCOS: How does stress impact PCOS specifically? What are indicators that you should be vigilant about stress management?
• Stress management techniques: What are some tangible next steps for reigning in your stress?

Stress and our hormones: Meet cortisol

Our adrenal glands, located near our kidneys, are responsible for creating the stress hormone cortisol. Cortisol is known as our “fight or flight” hormone: it is responsible for our quick responses in stressful situations. Thousands of years ago it would kick in during life-or-death situations like running from a saber tooth tiger. Since most of us do not need to be running from tigers today, our body has adapted to treat everyday stressors like work deadlines, fighting with a partner, having a baby, and more.

You may have heard that cortisol is responsible for weight gain and chronic health issues. But cortisol is not all bad news – in fact, it is responsible for many essential functions.

• Key component of regulating our circadian rhythm
• Increasing your blood sugar
• Keeping inflammation levels down
• Regulating blood pressure
• Increasing energy levels in moments of stress when we need to think clearly or act quickly
• Being able to work out harder
• Improving focus and memory

So why have we given this hormone such a bad reputation?

The answer is simple: if we have too much cortisol circulating in our bloodstream for a long period of time without returning to homeostasis, we enter a state of chronic stress. While proper amounts of cortisol play a huge role in helping us deal with stressful situations effectively, having high amounts of constant stress in our lives is what’s damaging.

When our body goes into fight or flight mode, our sugar levels increase, our senses increase, our heart pumps blood faster to prepare our body for the fight or flight response, and in all of these functions, cortisol is being released into our blood stream to help us survive. Once the danger is over, cortisol levels will decrease, and our body goes back to normal.

But what happens when we are in a constant state of stress? Some issues associated with high chronic levels of stress are:

• Anxiety
• Depression
• Weight gain
• Lack of focus and loss of memory
• Lack of energy
• Digestive problems
• Trouble sleeping
• Headaches
• Heart disease
• Irregular or absent cycles

Some people argue that chronically-high cortisol is responsible for adrenal fatigue, but that’s not the case. What used to be called “adrenal fatigue” (which is not recognized in the medical field), is what’s now known as “HPA axis dysfunction” (1). HPA stands for hypothalamus, pituitary, and adrenal glands. These three parts of our body need to work together for our hormones to be in optimal levels. When there is dysfunction in our HPA axis, our hormones are not at optimal levels and this is when we experience fatigue, weight gain, and lack of sleep.

Stress and PCOS

Stress is known to worsen PCOS symptoms largely because of cortisol’s impact on androgens, or male hormones. Since high levels of androgens are characteristic of PCOS, if you are unable to properly manage the stressors in your life and struggle with consistent anxiety or always feeling strung out, it’s possible that you are inadvertently increasing your androgens even more and subsequently worsening your symptoms.

One common misconception with PCOS is that excess androgen levels only result from our ovaries overproducing these hormones. But, it is estimated that 20 - 30% of people with PCOS have androgen excess that is spurred from our adrenal glands (2). This is often referred to as “adrenal PCOS” and represents one of the four main types of PCOS manifestations. Note that you can fit into more than one type, e.g. you may have both adrenal and insulin-resistant PCOS.

If you have recently completed an androgen blood panel with Pollie or an external doctor, it’s time to turn to DHEA sulfate (DHEA-S) and DHEA markers. Our adrenals produce all of the DHEA-S in our body and roughly 80% of DHEA. Since DHEA-S is not produced by the ovaries at all, it is used as an indicator of adrenal androgen secretion along with 11-androstenedione, which is also produced only by our adrenal glands (3).

Stress management techniques

Getting stress under control is no easy feat, but being aware that you are ready to make a change is the very necessary first step. Below are several ideas for stress management:

• 1-1 therapy: If therapy is financially possible, we recommend exploring this as an option. Especially when it comes to stress, learning how to rewire the thought patterns in your brain through cognitive behavioral therapy (CBT) or another therapeutic technique can be truly life changing. Your care coordinator can help you find a therapist if you are unsure where to start.
• Group therapy: If 1-1 therapy is not realistic for you but you still are craving more structured counseling, we recommend you consider group sessions. This can be a wonderful way to learn from others and learn therapeutic frameworks, all while paying a lower price point. Your care coordinator can help you find different group therapy options if that would be helpful.
• Pollie support groups: For many of us, peer support is a powerful tool. Chronic stress can be isolating, and connecting with others with similar goals can be a great support mechanism and accountability tool.
• Meditation: Meditation has been shown time and time again to have a palpable impact on stress reduction. While anyone can meditate, there are a variety of ways to enter this habit ranging from reading a quick article about mindfulness meditation to enrolling in a course on transcendental meditation. Your care coordinator can point you to the proper resources if you are new to meditation and curious to give it a try.
• Mindfulness techniques: We know, we know, meditation just isn’t for all of us. That’s where mindfulness comes in. Using a blend of principles from both meditation and psychotherapy, mindfulness frameworks can be an easy thing to learn and start incorporating into your everyday life. Your care coordinator can help you learn more about what sort of mindfulness medium may work best for you, e.g. a mobile app, book, articles, and more.
• Routines that center you: Maybe a 30 minute walk can take your stress level from a 9 to a 3, or you know that if you take a bath after a long day you’ll re-enter the world a changed person. Whatever these activities may be - exercise, gentle movement, self care, cuddling with your dog - keep a list of them on your phone or near your desk so that you can easily pick something from the list when you are feeling overwhelmed. We recommend having ideas with a variety of times involved (e.g., full-day hike vs. a 5 minute stretching session) so that you can pick and choose according to your schedule.
• Medication: While many people are able to manage their anxiety sans-pharmaceuticals, there is no shame in turning to medication for the short, medium, or long-term if your mental health is taking a toll on your quality of life. While Pollie does not currently prescribe medication, please let your care team know if you think you want to pursue this route and we will do our best to streamline this process.

Keep in mind that it may take a bit of experimentation to see what works for you. We recommend you discuss this with your care team to pinpoint specific tactics you would like to try.

*Remember that if you are struggling with debilitating stress or anxiety, you are not alone. If these feelings ever become overwhelming and you need immediate support, please text HOME to 741741 for free, 24/7 crisis counseling.

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