Is Stress Driving Your PCOS Symptoms?
No matter who you are, you likely experience stress in your normal life. Whether it be a demanding job, difficult life circumstances, or managing a busy household, stress is everywhere.
Because stress is so common and often even normalized in our modern society, stress gets overlooked when it comes to health concerns. Stress impacts all systems in the body, and there is an important connection between stress and PCOS.
What exactly is stress?
When you think of stress, you probably think of its symptoms, such as feeling uptight, racing heartbeat, irritability, or even headaches. All of these things can occur as a result of a stress response, which involves something called the hypothalamus-pituitary-adrenal (HPA) axis or your body’s “stress response system”. This axis involves two different parts of your brain as well as your adrenal glands. It is the primary system that your body activates in times of stress.
When your brain senses something stressful, it activates a physiological response in your body, also known as “fight or flight” mode. This stimulates the production of stress hormones like cortisol from your adrenal glands. During this response, both blood pressure and blood sugar increase as a protective mechanism to keep you alive and to keep up with the demands of the brain. Once that stressor is removed, there’s a negative feedback loop that will turn off the production of these stress hormones and signal to the brain that you’re safe.
Keep in mind that stress comes in all shapes and sizes, and there are many different types of stressors. Most often we think about stress as being emotional, but stress can also be physical or even environmental. Here are some examples of each type of stressor:
Physical stressors-
Over-exercising or participating in high-intensity activities like HIIT workouts
Going on and off diets or frequently gaining and losing weight (aka “yo-yo” dieting)
Caloric restriction (undereating)
Fasting
Nutrient deficiencies
Excessive alcohol intake
Not getting enough sleep
Gut infections and imbalances
Illness or injury
Environmental Stressors-
Chemicals and other toxins
Heavy metal exposure
Pollutants like cigarette smoke
Emotional Stressors-
Parenting
Financial burdens
Long “to-do” lists and a feeling of a lack of time
Sitting in traffic and/or being late
Comparing yourself to others
Emotional trauma of any kind, both past, and present
Death of a loved one or pet
Not dealing with your emotions
Saying yes to everything, and having poor boundaries with both people and tasks
Pressure to “do it all”
Strained relationships
Mental health issues, like anxiety and depression
Loneliness
Etc.
*Note that even “healthy” behaviors like exercise or HIIT training are stressors. In the right context, these types of stressors can be health-promoting and adaptive. But in the wrong context (like over-exercising and undereating or HIIT training when the body is sleep-deprived) these things can put too much stress on the body.
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What happens when the body is exposed to long-term (chronic) stress?
Activation of the HPA axis is both necessary and helpful for your body during acute stress. A healthy stress response is one that activates the HPA Axis when needed and turns it off when it doesn’t. The way that our bodies have been hard-wired to deal with stress and respond to stress is very short-term.
Unfortunately, stress is everywhere in our modern society. This makes it easy for short-term (acute) stress to turn into long-term (chronic) stress. This can lead to excess cortisol production and can create many stress-related problems.
Basically, when your body is prioritizing survival via the “fight or flight” mode, it’s not focused on general maintenance and repair that it views as not essential. High cortisol levels suppress your immune and digestive systems. It also interferes with normal metabolism, thyroid function, reproductive functioning, and more. This can lead to things like weight gain, elevated blood sugar, mood, and gut disorders.
The relationship between PCOS, androgens, and stress
Elevated androgens are a common hormonal imbalance associated with PCOS that can drive many of the unpleasant symptoms women deal with. Oftentimes, there is a huge emphasis on the ovarian production of androgens – which is mostly stimulated by excess insulin.
But it’s also important to know that the adrenal glands produce a significant portion of androgen hormones! So when the adrenals are chronically being activated by different types of stressors, this can contribute to the overproduction of androgen hormones.
Both the ovaries and the adrenal glands can contribute to high androgen levels that drive PCOS symptoms. Some women have adrenal-dominant PCOS while other women have ovary-dominant PCOS, and many women have a combination of both.
Women with PCOS have also been found to produce more cortisol at baseline than women without PCOS. This means that women with PCOS may have more sensitive stress response systems.
In my experience working with hundreds of women with PCOS, this connection often gets overlooked. I see many women engaging in behaviors like over-exercising or being in a chronic caloric deficit that actually stresses their body out and makes PCOS symptoms significantly worse.
I love this quote from Laura Schoenfeld that sums this up super well:
Signs of high stress and adrenal factor PCOS
Here are some signs and symptoms to look for to help identify if stress is contributing to your PCOS:
High levels of perceived stress (physical, mental, and/or environmental)
Trouble falling or staying asleep
Anxiety and/or depression
Feeling irritable
Low energy levels, specifically in mid-afternoon, or chronic fatigue
Low libido
History of an eating disorder
Bad PMS symptoms
Symptoms of high androgens (facial hair growth, changes in skin pigmentation, etc, which you can read more about in this post)
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