Episode #88: The Stress Hormones Story: Cortisol and Polycystic Ovary Syndrome

This week’s episode is another journal article where we’re going to review a lot of the myths around PCOS, and particularly when it involves stress and the hormone cortisol and our PCOS root causes. This research article explores the role of the adrenal and the HPA axis in women with polycystic ovarian syndrome, and in particular, its relationship to our coping mechanisms and environmental stressors and so forth in our life. So without further ado, let’s dive in.

You’re listening to the PCOS Repair podcast, where we explore the ins and outs of PCOS and how to repair the imbalances in your hormones naturally with a little medical help sprinkled in. Hi, I’m Ashlene Korcek, and with many years of medical and personal experience with polycystic ovarian syndrome, it is my joy to watch women reverse their PCOS as they learn to nourish their body in a whole new way. With the power of our beliefs, our mindset, and our environment, and the understanding of our genetics, we can heal at the root cause.

Welcome back to the PCOS Repair podcast, where today we’re going to review a journal article that I really loved, and I know you’re going to, too. We spend a lot of time here on the podcast talking about root causes. In today’s episode, we’re going to dive a little bit deeper into the research of one avenue of root causes, in particular, cortisol. This article goes into some amazing content and discussion on how so many of our root causes and environmental factors and our genetics are all so intertwined, and it goes back and forth, where one will worsen or get better It has the same net effect back and forth on the other. You’re going to see that in our discussion today. While this article was a very intense read, and I have linked it in the show notes for your reading pleasure, should you choose to read the whole article, but I think you’ll find this review and conversation on today’s episode very helpful in having a better understanding of that connection and view into how root causes affect our hormone production and our hormone dysregulation and imbalances. While we are focusing on stress and cortisol today, the same goes for all the other root causes. This is how they work in our body. There isn’t a very simple linear progression of these root causes. They are very interconnected. You’ll see that in today’s episode. All right.

The full episode, like I said, is linked in the show notes. The title of this article for reference is Cortisol and the Polycystic Ovarian Syndrome. It is by Renato Pascale and Asandra Gabaneri. It was published in the Expert Review of Endocrinology and Metabolism Journal. A few scientific terms that I’m going to try to keep this really plain English because the journal article, if you want to read it, has plenty of very scientific terms but a few terms I just want to review and make sure that you are familiar with before we get started. Androgenic, these are our androgen hormones, and these are going to include our sex hormones. Particularly in this episode, when I say androgenic hormones, the main one we’re talking about is testosterone. Although your other reproductive hormones do get involved, testosterone is the driving one. Testosterone is the one that’s going to adjust or mess up your LH levels and so forth. The main one we’re talking about here is testosterone but that’s where we use the word androgenic. The HPA axis this is your hypothalamic pituitary adrenal axis. Basically, this is talking about how our hypothalamus and our pituitary, which are part of our hormone-regulating systems, and our adrenals that sit on top of our kidneys that produce hormones and androgens, cortisol has a very big role on the adrenal gland. This is where that triangle, that axis, is what we’re talking about with fat and how they get involved. Basically, it’s how our environment, our genetics, and responses all work together and why it affects our hormones. Then adipose tissue, which is just excess fat. Sometimes I like to use that term specifically because weight on a scale is not what we’re talking about here. We’re talking about excess fat tissue in regards to our cortisol and insulin pathways in the body because the excess weight on the scale could be excess muscle, dense bones, and so forth. What we’re really talking about here is, do we have excess fat tissue that is getting involved in these pathways. Then cortisol, this is our stress hormone, insulin is the hormone that is released by the pancreas after eating to tell our cells, our body cells, to take the glucose, the blood sugar, into the cells so that we can use it as energy but it also has many other side jobs in the body that we will be discussing here in this review.

In this article, it really emphasized the impact of these metabolic factors. The main metabolic factors that we’re talking about here include insulin. Our body composition, in particular, if we have excess adipose tissue, we don’t even have to necessarily be in a certain BMI category, but if we have that excess adipose tissue to whatever level our body is struggling, and I think this is something that is often misunderstood. If we are excessively overweight, it becomes obvious but what about people that are in the healthy to slightly overweight? Some of those women actually do struggle with a little bit extra adipose tissue as well, signaling to have a higher insulin response and signaling for more androgen response. This is where that sweet spot for you comes in. As we find our sweet spot in our weight management and in our body composition, we find that our body starts to really work with us. Those are the symptoms that we are looking for to find our sweet spot. Everyone has a different one. Some people can accommodate a lot more fat tissue than others.

That’s where it gets a little bit unique to each woman. Then we have the HPA axis that’s going to have all of these talking together. Then the other metabolic factor is cortisol. In PCOS, cortisol production may be completely normal but the adrenal androgens may be overproducing for some women with PCOS. This is something where perhaps it’s a genetic factor, perhaps this is where we need further research as why this is happening but we have seen in research that women with PCOS, a subset of women, somewhere between 20% to 30% of women with PCOS, seem to be producing normal levels of cortisol. If you did a cortisol test, their levels would be normal, but their adrenal androgens, so the androgens produced by the adrenal glands are being overproduced. So this could be due to higher levels of cortisol or just the cortisol in general. So it’s hard to say. When it comes to hormones, there is a range of normal and are we just more sensitive as women with PCOS? Are our bodies wanting a lower level? And so if we’re on the high end of normal, so these are all questions of where exactly is that excess or that response of excess, even though the cortisol levels are normal, but that metabolism is disrupting in our PCOS, and it continues to have this adrenal hyperandrogenic state in. Basically, our adrenals are producing too many androgens.

Even though we’re doing a lot of things well, our stress response is somehow telling our body to create too many hormones. Then another interesting point the article made is that, and they go way into this, I’m not going to go way into this because we’ve talked about eating and PCOS in other episodes, but they pose an interesting question. This is like a chicken or the egg type of question. Is the overactivity of the HPA axis in PCOS, it seems to be linked to a prevalence of eating disorders but is this because we have this hyperandrogen state and we’re trying to compensate for it and we’re using tactics that lead to eating disorders, or are we having eating disorders because our body is not handling the stress well? and so is the chronic stress exposure leading to a state of hormones that then is leading to eating disorders, such as cravings and things that we, as a society, have just deemed not good for us. Then on the back end, we’re trying to correct for that and create an eating disorder or is it that our hormones are making it difficult to get our body to function correctly through excess androgen production, and we’re trying to cope with it through means of eating that lead to eating disorders?

You can see, did we come from it from this angle or did we come from the other angle? Then what part of that in the psychology of all of this is our mindset and our ability to make food choices and be the one that’s dictating those food choices as compared to being pulled by our body, what to do, and not having a very active role in those choices. This is where we include that we have a pathology, so our PCOS pathology and how our body functions. There’s definitely a genetic component that we’ve seen in PCOS, and we’ll talk about how that plays into the HPA access later on in this episode but also then we have our lifestyle choices and the psychology and mindset portion of that. When all of those come together, it creates this link of one leads to another, worsens another, and then it just continues in this one thing worsened, spiral effect, or one thing gets better, spiral effect. We see this very interconnection between our environment, our body, our hormones and how all of it functions together for improvement or for worsening.

Another area is we see the metabolic abnormalities, these ones that we have just been talking about, such as insulin resistance, especially excess or obesity in women with PCOS. These are common things that we see in their own right, and we lump them in their own categories of, Oh, if you lost weight, your PCOS would get better, or, you have PCOS, you’re at risk of insulin resistance, or you have insulin resistance. Then we talk about, now in this episode, we’re talking about PCOS and stress but here’s the thing, they’re all interconnected. Now, we may have one, and this is where getting into your root causes is really important. We may have one that is a primary primary source, and we have things that are feeding into that primary source. This is where discovering which of these sources is really the driving factor for you is so important because they are all interconnected. They are a part of all of this for everyone but some of them are less of a key factor and less important to address than others for each individual woman. These metabolic factors play a huge role in the PCOS pathology that then leads our symptoms. A big one is that as insulin, which synergizes with the luteinizing hormone, LH, it amplifies the ovarian androgen production.

Now, not only do we have cortisol, increasing our adrenal androgen production but cortisol raises insulin levels, and insulin levels then, through LH, amplifies our ovarian androgen production. You can see how very quickly we have magnified the magnitude of androgen productions quite extensively through various pathways that are all talking together. In the evaluation of adrenal androgens for PCOS, we find that about 20 to 30% of women that have been diagnosed with PCOS in studies, again, this is in small cohorts of studies, so we don’t have a huge global estimation here, but it appears that somewhere between 20 and 30% of women with PCOS have this androgen aspect involved. It’s usually primarily detected by elevated dihydrotestosterone sulfate, this is your DHEAS levels. If those levels If you’re elevated, you may have some degree of adrenal dysfunction playing into your PCOS root causes. We briefly mentioned weight as a part of this puzzle. How does it impact PCOS, and in particular, the cortisol levels, this becomes a pivotal factor influencing the HPA axis and the activity in PCOS.

Investigations into the Diverse Obesity Phenotype. When you think about the phenotype, this is how do people carry their weight. Do you carry it around the midsection? Do you carry it more in the hips and thighs? Are you more all over, evenly distributed of excess weight? We all know, even if you’re currently at a healthy weight, we all tend to know where would we gain weight if we were gain weight. That’s your phenotype of obesity. Whether or not you are categorized as overweight or not, that would be your phenotype. This reveals some of the disruptions that we see. Usually, women that have more of an abdominal phenotype of obesity tend to have a higher secretion of cortisol. They tend to see this as a bigger player in their adrenal type PCOS or their adrenal component of their PCOS and their stress responses. Remember how we talked about, usually, cortisol levels with PCOS are normal. That’s not what we’re looking for, per se, when we’re looking at the stress involvement. We’re looking at that laboratory value of DHEAS but women that have excess weight or have the BMI that’s reaching the obesity range, they may have elevated cortisol on a 24-hour cortisol test. That’s something where we see even a higher indication of this a problem and wanting to dive into that stress management as a root cause of PCOS, because this is really going to almost take it like a side route, and it’s going to be making its own hormone dysfunction even besides the PCOS ones, and it’s going to amplify that response, but it’s actually a whole side story going on that we would want to get under control. It mimics PCOS, but this is where it’s really important to dive into those root causes because we actually have a whole side story going on that we want to clean up in order to start seeing the results that you want. Then we also have to look into what’s going on with the insulin, cortisol tends to raise insulin, insulin can be raised by the foods that we’re eating, our body composition, by our exercise or lack thereof, can all affect insulin. Insulin’s role is found that it will increase the ovarian androgen production. This is important because we’re looking at the overall levels of the that’s the tip of that pyramid or that iceberg, so to speak, of where our PCOS symptoms are coming from, the excess facial hair, the period problems, all of those things are coming from the androgens. When we’re diving back down into these root causes of what are causing these excess in androgens. The insulin tends to have an independent rate of production in its own pathway. Remember, there was the side story of what’s going on with obesity and cortisol. Now we have a side story of what is going with insulin and androgens.

This is where we want to, again, look at those root causes, and cortisol stress management can all be at the root of both of these side stories. One of the medications that this study mentioned is pioglitazone, and that is one that is particularly showing some improvement of managing the insulin levels, making things more insulin sensitive but again, if we’re just pouring out the insulin because of a stress response, it may or may not not be as helpful. This is where we’re seeing some mixed results in some of the diabetic medications that are supposed to make us more insulin sensitive and why, again, we need to look deeper into some of those root causes. Then metformin had mixed results. We have to question, is that because of what’s going on deeper in the root causes when it comes to cortisol, or is it because it’s not that effective of a medication? But this is why these medications are beginning to become more popular and being offered to women with PCOS. You have to make your own decision on whether or not you feel like that’s the right route for you but that’s why they’re becoming more and more prescribed, even if you do not meet the parameters in lab tests for insulin resistance or prediabetes.

Okay, so then we have the genetic role of all of this, what are the genetics of the HPA axis in regards to PCOS? This is where we have very limited research. When we’ve looked at the genetics of PCOS, we see lots of different areas of our genetics that can have involvement. We definitely have seen some that increase our tendency towards inflammation, and definitely a lot of areas in our genetics that show increased tendencies towards insulin dysregulation but the HPA axis has been a little more elusive, but studies are definitely suggesting that there is a genetic basis for the adrenal androgen excess observed in PCOS. The reason we think this is not so much because of specific genetics that they have found, but there are sibling correlations where adrenal excess has been seen in sisters and also other family members. When we’re looking at those, specifically for this study, they were looking at the adrenal component, so I’m guessing that they were looking at the lab work of DHEAS but definitely more research is needed to connect the dots and create the links on the genetic basis of the adrenal androgen production.

However, we do see that there is some indication there but when it comes to our PCOS, from a practical standpoint, our genetics can’t be altered. While interesting scientifically, I don’t get too hung up on the genetics because clearly our body is functioning a certain way. It’s the body we have, whether it was passed down or however we ended up with it. This is how our body is functioning, from a practical level, I don’t get too hung up on what the genetic component is, but it is interesting, and the research article did bring it up.

In closing, I want to point out a few things. This episode, we are talking about the research of cortisol of stress and PCOS but before I leave you today, I do want to include some of the episodes where we have talked about management of stress in a more practical and applicable point of view, because I want you to go back and listen to those if you’re feeling like this may be something that is ringing true for you. The purpose of these research articles is I want you to see that this isn’t something where it’s a bunch of theory, these are things that the research is finding. The problem is that they haven’t been applied to modern medicine in a treatment modality because so much of it comes into lifestyle treatment. That’s not something that our doctor’s offices are equipped to handle, walking you through dietary changes and exercise plans and so forth. But they do pull out where medications are helpful and can offer you those. This is why I work with women on the lifestyle aspect because the medical aspect has its limits. Be sure to check out the links for the other episodes regarding stress management so that you can also include a more practical approach for your PCOS health. Then additionally, I want to emphasize that cortisol as a factor here that we’re talking about in this episode, it is not just from feeling stressed. When we think about stress, we can think about getting in a car accident, having a family member that’s sick, or some family situation that has changed, something that’s dramatic and dramatic and big and stressful but the truth is that cortisol can be released by just being overly busy, not getting enough sleep, and feeling rushed or things that you may feel like you have completely handled. We talk about that in some of the other episodes regarding stress and cortisol but I do want to point out that cortisol and stress and your perceived notion of how stressed you are, aren’t always clear indicators of how much cortisol you’re pumping into your body. It could just be that you’re staying up too late, getting up too early, traveling, circadian rhythm, could be dieting too hard is causing your body stress. Anything that your body perceives as stressful, as scary, as non-conducive to it being able to do its job easily, it’s going to count as stress, and it’s going to have a hyper cortisol tendency in your body. So It may not release as much in some regards of that perceived stress as in others, but there’s definitely a disconnect between sometimes how we feel stress and how our body perceives stress. I do want to point that out.

I would love to hear your takeaways, your follow-up questions, because I know this one’s a very deeply scientific, very difficult to read article, honestly, but I found it so fascinating and I wanted to share it with you. But if you have follow-up questions, you know where to find me. I’m over on Instagram. Send me a DM @Nourishedtohealthy. I’d love to answer all of your follow-up questions over on Instagram. Until next time, bye for now.