Top Signs of High Cortisol and Adrenal Dysfunction in PCOS
Wondering if you might have high cortisol or adrenal dysfunction with your pcos? This article will discuss the top signs of high cortisol and adrenal issues in PCOS.
My latest series has been about the Priority Pyramid and how your hormonal health is affected by deeper issues than just hormones alone. (See my first post in this series here and the podcast here)
One of those deeper issues that can cause PCOS symptoms is a stress hormone called cortisol and it’s activity in PCOS. Cortisol is produced from two glands called the adrenal glands and when we have issues with our cortisol and stress hormone production we call this adrenal dysfunction.
What are the adrenals?
The adrenals are glands that sit on top of the kidney and produce a hormone called cortisol. This hormone is a stress hormone but also an energy hormone. Ideally you will produce some of it (not too much or too little) according to a circadian rhythm. Healthy cortisol levels are higher in the morning and lower as bedtime approaches.
What is adrenal PCOS: Understanding DHEA
Many women with PCOS make too much of two distinct hormones that both come from the adrenals glands: cortisol and DHEA.
DHEA is an androgen (similar to testosterone) that is made from the adrenals. It’s important as a precursor to many hormones but too much can be problematic. Often with too high DHEA levels we will see similar symptoms to high testosterone in PCOS- things like excess facial hair or acne.
If DHEA is too high, we may also start making too much of something called DHEA-sulfate (on lab tests as DHEA-S). DHEA-S is the most inflammatory form of DHEA and can cause similar issues in PCOS as discussed above.
Some of us deal with both high cortisol and high DHEA. Commonly, however, it can also be one or the other wreaking havoc in different ways.
What is adrenal PCOS?
One phenotype of PCOS involves increased symptoms through androgens like DHEA produced from the adrenals. Whereas some women might mostly have issues due to insulin resistance or inflammation, in adrenal PCOS, most issues are driven by overactive adrenals.
This group is the smallest official group of those with PCOS, representing about 20% of those with PCOS and (in my opinion) the one who benefits least from major diet changes. Much of the work needed to heal adrenal dysfunction revolves around altering our lifestyle patterns like sleep, rest, and boundary setting, possibly even doing work in therapy.
However, just because you aren’t an adrenal PCOS type, doesn’t mean you don’t have adrenal issues like high cortisol. Most women with PCOS are dealing with issues from all three root cause categories and should implement strategies for each.
If you need help with that, you might check out my PCOS Foundations course which is designed to help make the process of working on all the PCOS root causes simple. You might also like a few of my other articles that dive into root causes like Functional Nutrition for PCOS andPCOS Self Assessment Quiz and Guide- PCOS diagnosis Quiz
Why does cortisol get high in PCOS?
Reasons for high cortisol can vary greatly. There’s some evidence that high cortisol exposure in the womb might change your hormones, childhood trauma can certainly play a role, and living with a lot of stress and anxiety can also be part. Raising children, working a stressful job, burning the candle at both ends, and chronic sleep deprivation are other reasons. Poorly managed blood sugar and chronic inflammation are both stressors on the body that contribute to stress hormone overload.
Sound familiar? Read below to learn more about the top signs of high cortisol and adrenal issues in PCOS. But it might be worth taking a stress rhythm test (like this one) to see what your unique rhythm looks like and get unique supplement recommendations. Many adrenal issues can be addressed with changes in lifestyle and supplementation.
Top Signs of High Cortisol and Adrenal Dysfunction in PCOS
You’re probably wondering what the top signs of high cortisol and adrenal dysfunction in PCOS are. To figure out if the adrenals and cortisol are a large part of the picture for someone with PCOS, I tend to ask questions about the signs below to see if they resonate. If many of these feel like I’m describing your life, you might want to look into more of my information on adrenals and cortisol. As I continue writing articles and creating podcasts, I’ll try to come back and add more links here. Feel free to search the blog for the words ‘cortisol’ or ‘adrenal’ and you might find some helpful gems.
Top Sign of high cortisol in PCOS number one: You’re Wired but tired
High cortisol levels have a distinct feeling in the body. To me, it feels like a the morning after a sleepover as a kid. You’re wired up, jumpy and on edge and might even feel energized, but you’re also deeply tired. Ironically, high cortisol issues can cause a second wind at night that makes it tough to get good sleep and could mean you actually are sleep deprived.
This feeling in the body is what I call ‘wired but tired’. It’s like you’re in a fight or flight state but can’t find your way out. It’s similar to that super productive feeling you might have experienced when coffee used to work for you!
Many of us get used to high cortisol levels and it can feel almost boring to withdraw from them, leading to depressed moods and extra fatigue. This makes it tempting to continue living in this stress state because for many stressed people it is their normal.
Top signs of adrenal issues in PCOS number two: You have blood sugar dips
Have you ever noticed how your blood sugar can sometimes dip too low when you’re stressed or surprised or even fasting?
Stressful experiences can cause our bodies to rapidly produce adrenaline and our blood sugar can dip in response. This may lead to feeling weak, shaky, extra hot, or fainty. When our blood sugar dips too low, our bodies will pump out some of the extra glucose (sugar) we store in our muscles to bring our blood sugar back up.
This is one way that high cortisol makes insulin resistance worse. When we are often producing cortisol and adrenaline, our bodies can spike our blood sugar and insulin much more often.
This is one reasons it’s a good idea to avoid fasting when dealing with adrenal issues- fasting can be stressful and cause those spikes we just discussed.
Tops signs of high cortisol in PCOS number three: You have Anxiety
Relatable, right? Who doesn’t have anxiety these days?? But if you deal with more sever anxiety, would describe yourself as an anxious person, or have a running nervous push towards self-imposed rules, order, or perfectionism, there’s a good chance it isn’t just in your mind.
Our brains and hormone responses are deeply connected and our brains are also very primal. Our mind can’t always distinguish between what is real and what is imagined and will produce stress hormones whether we are actually in trouble or danger or not.
This is one reason cognitive behavioral therapy and other forms of therapy (like somatic) have been found to be helpful in PCOS: when we turn down the anxious thoughts, we turn down the intensity of the cortisol.
If you are anxious, this work is key to improving cortisol levels. You can create the perfect list of diet and activity changes for PCOS but if not paired with mindset change, it often does little for the condition.
Strategies like mindfulness, guided meditations, acupuncture and even alternative therapies like Reiki can be very healing if this sounds like you.
Top signs of adrenal issues in PCOS number four: You live on coffee
This is the “classic” adrenal case- the woman, usually in her 40’s raising multiple children, exhausted, just trying to make it through each day, pushing through the exhaustion with a latte and a prayer.
The adrenal’s begin for us as an energy factory but overuse can create issues with the way our bodies perceive the signals from the adrenals, leading to symptoms of tiredness and fatigue. When that happens, the chronic fatigue and exhaustion that is experienced is sometimes called adrenal fatigue, but is better classified as adrenal dysfunction. Your adrenals can’t really “burn out” but we can have issues with properly using the hormones we create there.
This kind of adrenal dysfunction makes getting through the day without a nap (or multiple naps!) very difficult and can even make coffee and caffeine lose it’s effectiveness. If you feel like you need to drink coffee to get through the day, and yet it doesn’t seem to really be doing much (but used to!) this could be you.
Top signs of high cortisol in PCOS number five: You’re a Runner, Personal Trainer, (Ex) Athlete or Body Builder
This is a group I see more commonly than any other having adrenal issues. These individuals become especially worried because most of them had healthy lifestyles to begin with. For a period of time everything was under great control (these individuals often also have type A personalities) and worked just like expected. Then, something happens and what once worked just doesn’t work anymore.
Pushing through the exhaustion to perform ever more intense workouts, doing two a days, training multiple people in a day and actively participating, all of this puts extreme strain on the adrenals and makes it hard for them to keep up.
The body begins producing excessive cortisol in response to these workouts which raise levels of testosterone in the body contributing to weight gain and instability. Many people come to me when they realize they are doing more and more and only continuing to gain weight or are battling extreme fatigue.
I tend to see issues like these as well in ex-athletes.
If you feel you need to exercise to be calm, struggle with sitting still or calming yourself during meditations and find that you keep doing more and more with very little to show for it, you might have high cortisol.
Top signs of adrenal issues in PCOS number six: You wake up with a racing heart or have trouble falling asleep due to a “second wind”
Since cortisol ideally is produced along the circadian rhythm, most people have higher levels in the morning and lower levels as the evening comes. This helps make them sleepy and the levels raise before waking up to help them tackle the day.
Many people, however, develop imbalances in these adrenal rhythms, developing extra high cortisol in the morning (waking you up with a jolt) and giving you a second wind that keeps you from getting enough sleep. This cycle then feeds itself and creates more imbalances as time goes on.
Top signs of high cortisol in PCOS number seven: You eat healthy but you’re experiencing weight gain that you can’t get under control
One of the most difficult to determine issues with cortisol comes in the form of unexplained weight gain. Unexplained weight gain can happen for a multitude of reasons but my red flag radar goes up whenever I hear someone describe themselves as very active. It is usually these people, the ones who eat very healthy but exercise excessively (they almost never think what they are doing is excessive) who have the most issues with adrenal based weight gain.
Top signs of adrenal issues in PCOS number eight: You work nights or are sleep deprived
Do you currently or have you ever worked a job that included night shifts? Even just a few years of this kind of work can be very hard on the adrenals. Likewise, do you have small children who don’t let you get much rest?
Sleep deprivation is a major source of many health issues, including PCOS symptoms. Those who work nights and/or are sleep deprived tend to be more inflamed, more insulin resistant, and more stressed overall.
Lack of sleep can trigger overeating by increasing cravings and can make it hard for your body to find a balance with stress hormones.
There are many careers, of course, where nights must be worked. Someone has to do it, right? As a mom of a young child I also know that no matter how much rest I might try to get, my son has his own ideas about how much we really need!
The best advice I can give if you are in this situation is what the research on circadian rhythms has shown: sleep whenever you can, even if in short bursts. Naps can be hard to come by but if you get the chance, jump at it if at all possible. Likewise, try not to fall into revenge sleep deprivation where you end up staying up late to make up for your lack of personal time.
It does feel good in the moment (trust me, i know) but that extra hour of sleep will feel better tomorrow.
Top signs of cortisol issues in PCOS number nine: You work in a traditionally stressful career
Medicine, social work, teaching, even therapy- these careers all involve lots of emotionally demanding labor. These careers can be high stress, require a lot from you physically and require a level of dedication and self-sacrifice that many people do not have.
I admire and support those in these careers and deeply understand the need to put one’s own health on hold to further career or help others. These do tend to be career paths that create a lot of adrenal dysfunction, though.
Ironically, it seems to be clients with these careers who feel the least stressed. We can often develop a tolerance to a certain level of stress and feel almost empty without it. This can lead to pushing ourselves into adrenal issues if we aren’t careful.
Top signs of adrenal issues in PCOS number ten: You have a history of trauma
Those with PCOS often have elevated Adverse Childhood Event (ACE) scores. Trauma often leads to a lowered resiliency to stress. This means that you may experience the same events as someone else, but be more vulnerable to increased hormone spikes during those events.
What helps high cortisol in PCOS?
If you think adrenal issues are part of the puzzle, I’d suggest the following things to think about.
1. Be honest with yourself about your activity vs rest cycles
Do you spend at least one full day each week totally resting?
Those struggling with adrenal issues need this and sometimes more. No one needs or does well with exercise twice a day either. And if you’re a personal trainer, consider stepping back from how active you are in sessions to protect yourself from adrenal damage. It is also wise to think about limiting how often you wake up to do exercise before your body is ready (6 am or earlier) and how often you wake up with an alarm if you can help it.
2. Sleep as much as you can, ideally at least 8 hours
We all need to have at least 8 solid hours of sleep as well. Some working on adrenal issues will need even more.
Avoid sacrificing your sleep for physical activity, dedicate your efforts to your bedtime routine and sleep hygiene over everything else.
When we first start working on our adrenal issues in PCOS, we tend to have a pendulum effect. The years of not listening to our bodies cries for rest may now catch up with us.
This is why I believe many women experience adrenal fatigue when their children hit their teenage years- there’s finally some time for rest and the body is making up for lost time.
If you find that you are very sleepy when you start this work, just know this is normal. If you give in to rest and allow it, you will not be exhausted forever. Eventually an equilibrium will be reached.
3. Eat more protein
Protein helps with a range of things that support healthy adrenals. First, protein stabilizes blood sugar which prevents as many stress based sugar spikes. It also helps tide you over for those days when meal times are inconsistent. Protein has a very relaxing effect on the body and is supportive of mood and gut health balance.
A high protein breakfast like these is a fantastic way to start your day to support the adrenals. http://www.amberfischernutrition.com/easy-high-protein-breakfast-ideas-for-pcos-12-recipe-ideas
Need support getting more protein in a quick and efficient way? I’ve created the Ultimate Guide to Protein for PCOS to help you do just that. Learn your unique protein needs, how to cook, prepare, and prep proteins and recipe ideas to help make them tasty. Find that here.
4. Eat meals on time
When we are running on cortisol, we often forget to eat. Things get busy and before we know it, it’s 3 pm! One of the most supportive things you can do for your adrenals is to eat regular meals at regular times. This signals safety to your body.
Aim to eat your breakfast, lunch, and dinner about the same time each day. Add a snack mid-afternoon to help even more.
5. Work on controllable stresses
Not all stress is emotional. In fact, many of the stresses we experience come from biological stressors like diet. Eat an anti-inflammatory, balanced diet. Avoid intermittent fasting and restricted timing for eating as these will only increase stress.
Food sensitivities, allergies, autoimmunity and other gut health issues can contribute or mask adrenal issues. It is important to address these first.
Likewise, there are many things we say yes to in life where we really ought to say no. Can you work on setting appropriate boundaries for yourself that give you some extra space for you?
For example, maybe a relative takes the kids for a few hours once a week so you can relax. Maybe you turn your phone off during certain hours. Maybe you cut the dead weight of a few friendships you find more draining that fulfilling.
Supplements for high cortisol and adrenal issues in PCOS
Cortisol often requires supplementation to re-balance completely, but what is necessary depends on the issues at hand. It is best to work with a professional on this but here is some general supplemental advice.
You can try products like phosphatidylserine have been shown to help balance cortisol numbers and this is one of my favorites to use, especially when I don’t know current cortisol status. This is one I recommend. Supplementing with herbs like rhodiola has been shown to help balance cortisol levels in the body. These are two different supplements I like for balancing cortisol. (Find them here and here)
Conclusion
I hope this article helped you discover if you might have one or more of the top signs of high cortisol or adrenal issues with your PCOS. Balancing cortisol can be a key component in reducing PCOS symptoms. Starting with lifestyle changes like sleep and self-care is the first step toward making powerful change. I wish you the very best as you continue your PCOS hormone healing journey!
PCOS thoughts & Tips, every friday.
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MEdical Disclaimer
The information contained on amberfischernutrition.com is for informational and education purposes only and should not be construed as medical advice. As a nutrition professional, I draw upon evidence based practices and personal experience with myself and clients to form recommendations like the ones made in this guide. You are an individual with your own unique set of health goals and concerns. Ensure you discuss any changes to your diet with a qualified healthcare professional, like your doctor, to ensure these changes are right for you. This is especially important if you have any other underlying medical conditions. Do not consume foods you are allergic to. Results will be individual and will vary.
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