Polycystic Ovary Syndrome (PCOS) affects millions of women worldwide, impacting various aspects of health, including fertility and emotional well-being. With symptoms ranging from irregular menstrual cycles to potential risks of metabolic issues, PCOS presents significant challenges.
Cortisol, often referred to as the body's "stress hormone," can influence PCOS symptoms. By understanding and managing cortisol levels, individuals with PCOS may support their overall health and quality of life.
In this article, we will discuss the important 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 help the body manage perceived challenges (38).
Cortisol also plays a role in metabolism by influencing how our bodies use protein, fats, and carbohydrates for energy. Elevated cortisol levels are associated with weight gain because they are involved in maintaining blood sugar levels and may stimulate visceral fat cells (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 can be helpful in understanding an individual's stress response. For women with PCOS, cortisol measurements may assist healthcare providers in assessing contributing factors to the condition and formulating supportive strategies. The following are different methods for measuring cortisol:
Blood Tests:
A blood test can measure a patient’s cortisol level, however, it only provides a snapshot of the particular time in which blood was taken.
- Examples of Cortisol blood tests:
- 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.
- Examples of Cortisol saliva tests:
- Adrenocortex Stress Profile by Genova Diagnostics
- Diurnal Cortisol by Ayumetrix
Urine Tests:
The concentration of free circulating cortisol correlates with urinary cortisol levels, making urinary tests a sensitive method for examining cortisol throughout the day. This can be used to monitor cortisol and examine other hormone metabolites involved in the HPA axis (12).
- Examples of Cortisol urine tests:
- 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 with PCOS may experience menstrual irregularities and androgen excess, which can increase the risk of developing metabolic issues, weight management challenges, and other health concerns.
PCOS is characterized by higher levels of “male” androgens, which can disrupt the ovaries from releasing eggs (ovulation) and may lead to the formation of cysts on the ovaries (19).
Symptoms of PCOS
- Reproductive Symptoms: irregular periods, heavy menstrual bleeding, anovulation, fertility challenges
- Other signs of hormone imbalance: excessive hair growth on the face and body, acne, weight fluctuations, mood changes, and hair thinning (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 may become resistant to insulin, leading to an imbalance in hormones and increased production of testosterone. Insulin resistance can develop from various factors, including dietary choices, genetics, changes in the microbiome, and sleep patterns (19).
Risk Factors for Developing PCOS
- Obesity: Young girls and women who are obese may have a higher risk of developing insulin resistance, which can contribute to PCOS.
- Genetics: Research suggests that women with certain genetic factors may have an increased risk of developing PCOS (18).
- Chronic inflammation: In PCOS, chronic inflammation may contribute to insulin resistance and hormone imbalance (19).
The Connection Between Cortisol and PCOS
You may be wondering about the connection between cortisol levels and PCOS. In cases of PCOS, insulin resistance is a common metabolic theme. Higher levels of insulin can influence the HPA axis, which may lead to increased production of cortisol.
The release of cortisol signals the body to release glucose, which then requires more insulin production. As insulin levels increase, the body may respond by releasing more cortisol. This can lead to a cycle of elevated cortisol and insulin levels (22).
High cortisol levels can be associated with various effects. The following are common signs and symptoms of elevated cortisol (41):
- Development of insulin resistance
- Menstrual irregularity
- Fertility challenges
- Low estradiol levels
- Excessive androgen production: excessive hair growth, acne, weight gain, deepening of the voice
- Hair thinning
- Mood swings
Tips for Cortisol Management in PCOS
Several lifestyle and nutritional modifications may help in managing stress and supporting healthy 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 are several emerging pharmacological and complementary therapies aimed at supporting cortisol regulation in those with PCOS.
These therapies focus on supporting insulin signaling, lipid metabolism, or cortisol balance. It is important to seek the guidance of a healthcare provider for a personal assessment. Each supplement may have varying recommended doses and durations depending on individual health needs.
Below is a summary of some therapies that may aid in PCOS management (3,20):
- Vitamin D: may support glycemic index in women with PCOS
- Inositol: May help with fasting insulin levels, ovulation rates, and menstrual cycle regulation
- Folate: May support insulin and homocysteine levels; may improve lipid profiles
- Vitamin E: may help reduce oxidative stress in women with PCOS
- Alpha Lipoic Acid: may support lipid metabolism in the liver and kidney, potentially aiding in weight management and menstrual cycle improvement
- Chromium picolinate: may help with hirsutism and acne by supporting fasting insulin levels
- NAC: May be associated with increased ovulation frequency and improved insulin sensitivity
- Spearmint Tea: May help decrease androgen levels in those with PCOS, potentially reducing hirsutism
- Cinnamon extract: May support insulin sensitivity, which can aid in cortisol balance
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Key Takeaways
- PCOS is a common condition among women, affecting metabolic and reproductive health, and may be associated with various health challenges
- Insulin resistance in PCOS is closely linked with cortisol regulation
- Utilizing saliva and urine cortisol tests can provide insights into cortisol metabolism throughout the day
- A comprehensive approach that includes both insulin and cortisol support may offer the best outcomes
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