Polycystic Ovary Syndrome (PCOS) affects millions of women worldwide, impacting fertility, metabolic health, and emotional well-being. With symptoms ranging from irregular menstrual cycles to heightened risks of diabetes and cancer, PCOS presents significant challenges.
Known as the body's "stress hormone," cortisol can profoundly influence PCOS symptoms. By understanding and effectively managing cortisol levels, individuals with PCOS can potentially gain better control over their condition, offering hope for improved health and quality of life.
In this article, we will discuss the critical yet often overlooked aspect of PCOS management: cortisol levels.
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What is Cortisol?
Cortisol is a steroid hormone that acts as the body’s primary stress hormone. It has several functions throughout the body, such as mediating stress, regulating metabolism, immune function, and the inflammatory response.
During times of stress, the sympathetic nervous system responds to the stimuli and activates a flight or fight response, which results in the activation of the hypothalamic-pituitary axis (HPA). Cortisol is then released from the adrenal glands to allow the body to deal with the perceived threats (38).
Cortisol also regulates metabolism by controlling how our bodies use protein, fats, and carbohydrates for energy. Elevated cortisol levels are closely linked to weight gain because they are responsible for maintaining blood sugar levels and also stimulating visceral fat cells to proliferate (38).
In healthy individuals, a normal cortisol spike starts within 30 minutes of waking and progressively drops throughout the afternoon and evening. By nighttime, cortisol levels should be at their lowest to prepare the body for rest (25).
How to Measure Cortisol
Measuring cortisol levels throughout the day is vital in understanding your patient's stress response. For women with PCOS, cortisol measurements can help the practitioner assess the root causes of the condition and formulate appropriate treatment strategies. The following are different methods for measuring cortisol:
Blood Tests:
A blood test can measure a patient’s cortisol level, however, only provides a snapshot of the particular time in which blood was taken.some text
- Examples of Cortisol blood tests:some text
- Cortisol by Access Med Labs
- Cortisol by BostonHeart Diagnostics
- Cortisol (C) by ZRT Laboratory
Saliva Tests:
Saliva tests are used to measure cortisol levels throughout the day. These tests provide a more detailed picture of cortisol fluctuations.some text
- Examples of Cortisol saliva tests:some text
- Adrenocortex Stress Profile by Genova Diagnostics
- Diurnal Cortisol by Ayumetrix
Urine Tests:
The concentration of free circulating cortisol correlates with urinary cortisol levels, resulting in urinary tests being the most sensitive for examining cortisol throughout the day. This can be used to not only monitor cortisol but also examine other hormone metabolites involved in the HPA axis (12).some text
- Examples of Cortisol urine tests:some text
- Adrenal Corticoids Profile by Doctor’s Data
- DUTCH Adrenal (Dried Urine) by Precision Analytical (DUTCH)
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What is PCOS?
Polycystic Ovarian Syndrome (PCOS) affects many women worldwide. Women suffering from PCOS experience menstrual dysfunction and androgen excess resulting in an increased risk of developing diabetes, obesity, cardiovascular disease, infertility, and psychological disorders.
PCOS is characterized by abnormally high levels of “male” androgens which disrupt the ovaries from releasing eggs (ovulation) and in turn create cysts on the ovaries (19).
Symptoms of PCOS
- Reproductive Symptoms: irregular periods, heavy menstrual bleeding, anovulation, infertility
- Other signs of hormone imbalance: excessive hair growth on the face and body, acne, weight fluctuations, depression, and alopecia (10)
The Root Causes of PCOS
Insulin resistance: Insulin is an essential hormone that helps our bodies turn food into energy and manages blood sugar levels. In PCOS, the body becomes resistant to insulin leading to an imbalance in hormones and overproduction of testosterone. Insulin resistance can develop from poor dietary choices, genetics, changes in the microbiome, and disrupted sleep patterns (19).
Risk Factors for Developing PCOS
- Obesity: Young girls and women who are obese are at a significantly higher risk of developing insulin resistance leading to the development of PCOS.
- Genetics: Research suggests that women with certain genes have an increased risk of developing PCOS (18).
- Chronic inflammation: In PCOS, chronic inflammation results in insulin resistance and hormone imbalance (19).
The Connection Between Cortisol and PCOS
You may be wondering where the connection is between cortisol levels and PCOS. In cases of PCOS, we see insulin resistance as a common metabolic theme. Higher levels of insulin trigger the HPA axis which causes an increased production of cortisol.
The release of cortisol signals the body to release glucose which then requires more insulin production. As insulin levels keep increasing, the body responds to the perceived threat and releases more cortisol. This causes the body to get stuck in a vicious cycle leading to chronically high levels of cortisol and insulin resistance (22).
High cortisol levels can cause many undesired side effects. The following are common signs and symptoms of elevated cortisol (41):
- Development of insulin resistance
- Menstrual irregularity
- Infertility
- Low estradiol levels
- Excessive androgen production: excessive hair growth, acne, weight gain, deepening of the voice
- Alopecia
- Mood swings
Tips for Cortisol Management in PCOS
Several lifestyle and nutritional modifications can aid in reducing stress and cortisol levels (21,39):
Lifestyle Interventions
- Relaxation exercises: yoga and meditation
- Walking
- Finding joy and laughter
- Play soothing music
- Practicing positive self-talk
- Reach out for help when needed
- Include foods high in magnesium: legumes, nuts, seeds, and whole grains
- Increase omega-3 fatty acids through consumption of salmon or olive oil
- Boost antioxidant intake: fruits, vegetables, nuts, and beans
Medical and Therapeutic Approaches
In addition to lifestyle and nutritional modifications, there have been several emerging pharmacological and complementary therapies aimed at regulating cortisol regulation in those with PCOS.
These therapies are directed at regulating insulin signaling, and lipid metabolism or directly lowering cortisol production. It is important to seek the guidance of a trained physician for a personal assessment of your particular case. Each supplement will have varying recommended doses and durations depending on each patient’s unique medical history.
Below is a summary of the top therapies to aid in PCOS management (3,20):
- Vitamin D: improves glycemic index in women with PCOS
- Inositol: Reduces fasting insulin levels, improves ovulation rates, and regulates the menstrual cycle
- Folate: Reduces insulin and homocysteine levels; improves lipid profiles
- Vitamin E: reduces oxidative stress in women with PCOS
- Alpha Lipoic Acid: regulates lipid metabolism in the liver and kidney aiding in weight loss, decreased ovarian cyst production, and improved menstrual cycles
- Chromium picolinate: reduces hirsutism and acne by reducing fasting insulin levels
- NAC: Associated with an increase in ovulation frequency and improvement in insulin resistance
- Spearmint Tea: Decreases androgen levels in those with PCOS resulting in decreased hirsutism
- Cinnamon extract: Reduces insulin resistance thus aiding in cortisol regulation
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Key Takeaways
- PCOS is a prevalent condition amongst women affecting metabolic and reproductive health and can lead to cardiovascular disease, obesity, infertility, and psychological disorders
- Insulin resistance in PCOS is closely correlated with dysregulated cortisol production
- Utilizing saliva and urine cortisol tests helps gain insight into cortisol metabolism throughout the day
- Treatment should consist of both insulin and cortisol regulation for the best outcomes
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