Adrenal PCOS: Surprising Ways Stress Affects Your Hormones

By: Chris Kresser

Kidneys adrenal

It’s well known that stress can cause the disruption or total loss of menstrual function in women. (1) And menstrual dysfunction, along with the physical symptoms of hormone imbalance, has become increasingly common over the past few decades.


It’s now estimated that up to 10 percent of reproductive-age women in the US have polycystic ovarian syndrome (PCOS), a health condition that not only affects a woman’s fertility, but also causes frustrating changes to her physical appearance, including weight gain, male-pattern hair growth, acne, and water retention.

Women with PCOS also have higher rates of anxiety and depression, either caused or exacerbated by the embarrassing physical changes that often occur with the condition.

And while there certainly is a genetic component that increases one’s risk of the syndrome, PCOS is significantly affected—and possibly caused—by lifestyle factors including diet, exercise, and stress.

Unfortunately, in an age where high achievement and perfectionism are idolized and flat abs and “thigh gaps” are considered to be the standard of feminine physical beauty, there are thousands of women running their bodies and hormones into the ground in an attempt to lose weight and achieve this impossibly high cultural standard.

I’ve worked with dozens of women who were undereating, overtraining, and under constant stress and even fear related to their poor body image and a desire to be thinner and leaner by any means necessary.

Sadly, this extreme diet and exercise behavior can backfire when women start to develop “adrenal PCOS”: the elevation of androgenic hormones by the adrenal glands that causes symptoms similar to ovarian cyst-driven PCOS.


In this article, you’ll learn how excessive stress about your diet, exercise, and life in general might be driving the adrenal hormone changes that are causing your PCOS symptoms.

Related Article: Child Autism Spikes 59% When Mother Suffers From PCOS

Myths and truths about PCOS

There are many misconceptions about PCOS that cause confusion, misdiagnosis, and mistreatment in women who are experiencing the multitude of symptoms associated with the disorder.

Despite the name polycystic ovarian syndrome, having cystic ovaries isn’t a requirement to be diagnosed with PCOS.

In fact, the NIH has concluded that the name PCOS should be changed, as the name causes confusion and doesn’t reflect “the complex metabolic, hypothalamic, pituitary, ovarian, and adrenal interactions that characterize the syndrome.” (2, 3)

Many people, including healthcare professionals, also don’t even realize that being overweight is not a requirement of having PCOS. It’s estimated that one-third to one-half of women with PCOS are at normal weight or underweight and that being overweight or obese does not increase the risk of developing the condition.

While weight loss in women who are overweight may be beneficial, this recommendation isn’t useful for women with PCOS symptoms who aren’t overweight. And using birth control pills as a treatment for amenorrhea is often unnecessary and simply masks a deeper diet and lifestyle problem.

Believing that PCOS is solely genetic, due to excess weight, or simply caused by cystic ovaries that can be treated using hormone replacement is a dangerous assumption that prevents many women from getting the help they need.

Related Article: Signs That You Have Adrenal Fatigue And How To Overcome It

Elevated androgenic hormones: not just an ovarian problem

One of the primary diagnostic criteria of PCOS is elevated androgens, “male” sex hormones that cause unwanted hair growth, acne, and reproductive dysfunction.

The two main androgenic hormones causing these symptoms in women are testosterone and androstenedione. Other androgens include dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEA-S).

It’s normal for women to have some androgenic hormones in their system; in fact, low testosterone in women is associated with low sex drive, bone loss, chronic fatigue, weight gain, mood disorders, and cognitive issues. Calling them “male” sex hormones is a misnomer.

However, when these hormones are elevated, as is pervasive in PCOS, symptoms of androgen excess begin to manifest. For some women, this affects their menstrual function and fertility. For others, they continue to menstruate but struggle with physical changes like unwanted hair growth, acne, and weight gain.

And one of the primary confusions over PCOS is which organ these androgens come from. While the ovaries are typically blamed for elevated androgens in PCOS, it’s estimated that 20 to 30 percent of women with PCOS have adrenal androgen excess. (5)

The adrenal glands produce all of the DHEA sulfate (DHEA-S) and 80 percent of the DHEA in the body. The adrenals also produce 50 percent of androstenedione and 25 percent of circulating testosterone. Since DHEA-S and 11-androstenedione are not secreted by the ovaries, they are used as markers of adrenal androgen secretion. (6)

How your adrenals cause PCOS symptoms

The chart below shows how both the adrenal glands and the ovaries impact androgenic hormone production. It illustrates how the hypothalamus and pituitary gland, both located in your brain, release hormones that drive the cycle of high androgen output, insulin resistance, increased abdominal fat, and impaired glucose sensitivity. These systems are called the hypothalamus-pituitary-adrenal or -gonadal axes. (HPA/HPG.)

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