Adrenal PCOS

The second most prevalent form of PCOS results from elevated levels of stress hormones, known as adrenal PCOS. In the previous section, we discovered that an excess of insulin stimulates the ovaries to produce higher quantities of testosterone. This is the primary cause of PCOS and accounts for at least 80% of PCOS cases. However, in adrenal PCOS, the issue does not lie within the ovaries but rather in the adrenal glands. Increased stress levels prompt the brain to release adrenocorticotropic hormone (ACTH). ACTH then stimulates the adrenal glands to secrete cortisol, adrenaline, and another hormone called dehydroepiandrosterone sulfate (DHEAS) to help us respond to stress or perceive danger. Prolonged stress leads to a continuous rise in both cortisol and DHEAS levels, ultimately resulting in adrenal PCOS. DHEAS, belonging to the androgen family like testosterone, triggers symptoms similar to acne, hair loss, and excessive hair growth. Research suggests that around 20-30% of women with PCOS experience excess adrenal androgens. Although studies in this area are still in their early stages, several findings propose a genetic connection between women with adrenal androgen excess, indicating that certain individuals are more predisposed to developing this type of PCOS.

DHEAS operates in a very similar manner to testosterone within the body. When present in appropriate levels, both testosterone and DHEAS enhance our libido, elevate our mood, and promote a sense of well-being. However, an excess of these hormones can infiltrate the follicles, leading to hair loss on the scalp, excessive hair growth on the face, chest, and breasts, as well as acne on the face, chest, and back. Similar to testosterone, DHEAS can be converted into DHT, intensifying the potency and severity of androgenic symptoms. DHEAS specifically affects the ovaries and can impact the quality of eggs. It may also interfere with the release of LH from the brain, resulting in halted or delayed ovulation. Consequently, this can lead to irregular menstrual cycles and difficulties conceiving. Interestingly, Adrenal PCOS, unlike insulin resistance, does not typically contribute to weight gain. Therefore, if weight gain is not a symptom, it is more probable that one is dealing with Adrenal PCOS. Nonetheless, Adrenal PCOS can still occur in individuals who are overweight, though it is more commonly observed in those with lean PCOS. If acne and changes in hair are the primary symptoms, weight gain is not experienced, and testosterone levels in blood tests appear normal, there is a strong likelihood that Adrenal PCOS is the underlying issue. Despite its prevalence, DHEAS is not commonly measured by doctors, even though it produces many of the same symptoms as high testosterone levels. It is not uncommon for individuals who exhibit all the signs of androgen excess to be informed by their physicians that their testosterone levels are within the normal range (or even low). If you find yourself in this situation, it is essential to remember that there are other androgens, such as DHEAS, that can cause identical symptoms as high testosterone levels and may not have been assessed in your blood tests.

When I mention the word "stress," I may have evoked an image in your mind of a busy businesswoman with an inbox full of tasks and approaching deadlines. Alternatively, perhaps you visualized an exhausted mother stuck in traffic, with children in the backseat screaming. The truth is, there are various stressors that can trigger the increased production of cortisol and DHEAS. While psychological stress, as described in the scenarios above, is a genuine aspect of our modern world and undoubtedly contributes to the production of stress hormones, there are other factors that you may not have considered which could also be contributing to your PCOS symptoms.

Some of these overlooked factors include poor sleep, chronic infections, feelings of loneliness, following restrictive diets, excessive exercise, autoimmune diseases, and overconsumption of stimulants such as caffeine. Even if you do not feel overwhelmed by stress, you may still be hypersensitive to the normal levels of stress hormones. In the opening chapter of this book, we explored an intriguing study that revealed how stress experienced during puberty can contribute to the development of PCOS later in life. Coping with higher levels of stress during this crucial period of development can effectively "hardwire" your brain to become excessively sensitive to the effects of stress in the future. This information may apply to you if you experienced a significant loss or traumatic event during adolescence, or if you engaged in extreme dieting or exercise during that time.

The most effective way to confirm the presence of Adrenal PCOS is through a blood or urine test that measures DHEAS levels. Although it is possible to test blood cortisol, it is challenging to obtain accurate results using a standard blood test. If you are curious, more sensitive tests such as salivary or urinary cortisol and cortisone (a byproduct of cortisol) can detect early changes. It is recommended to test these two hormones simultaneously and multiple times throughout the day for the most accurate assessment. By doing so, you can observe the fluctuations in your stress hormones and DHEAS, which provides valuable insight into Adrenal PCOS. To access these tests, it is advisable to consult a practitioner who is knowledgeable about the Dried Urine Test for Comprehensive Hormones (DUTCH) and can assist in ordering and interpreting the results. It is important to note that these tests are not mandatory to proceed with the implementation of the Adrenal PCOS Protocol. However, they offer interesting insight into how your body manages stress and serve as a reference point for comparison after making lifestyle changes.

The top priority when it comes to Adrenal PCOS is achieving a balance in cortisol production. When you experience stress, the hormone responsible for triggering cortisol release from your adrenal glands (ACTH) also triggers the release of DHEA. In Adrenal PCOS, the primary cause of symptoms lies in adrenal androgens like DHEAS. To restore cortisol balance, it is crucial to enhance your stress management skills, establish a sustainable self-care routine, and prioritize good sleep. These changes take precedence over any dietary adjustments discussed earlier. If you find yourself relating to the profile of Adrenal PCOS, it is likely that, like me, you exhibit characteristics of a 'Type A' or perfectionistic personality. This is not inherently negative as many highly creative and accomplished individuals share these traits. However, concerning PCOS, this personality type can lead us to devote excessive effort to improving our health. This all-or-nothing approach can make it challenging to maintain healthy habits without adding to our stress levels. For all types of PCOS, especially Adrenal PCOS, striking a balance between embracing a healthy lifestyle and avoiding excessive self-imposed pressure is key. Through trial and error, it is possible to find a happy medium. Allocating leisure time and relaxation is just as crucial as making time for exercise or meal planning. You may discover that your current exercise routine is not beneficial or that there are adjustments you can make to your eating patterns to reduce stress. Alternatively, it could be your social commitments or work schedule that contribute most to your stress levels. Take an honest assessment of your lifestyle and identify the areas that induce the most stress for you.

Happy hormones can be achieved, working together to complete a DUTCH test, and working on ways to eliminate stress in your life are all part of the packages provided.

Kate