Episode # 190: Why Women With PCOS Feel So Exhausted

Hi, and welcome back to the PCOS Repair Podcast.

If you’ve ever dragged yourself through a full day, completely exhausted, finally gotten into bed, and then couldn’t sleep, this episode is going to explain exactly what’s happening in your body. More importantly, it’s going to reframe something that a lot of women with PCOS quietly carry around—a belief that their exhaustion is somehow their fault.

It’s not.

Today we’re going to talk about how this all works and why.

Hi, I’m Ashlene, and I’m glad you’re here. If you’re new to this space in the podcast world, this is where we talk about PCOS and its new name, PMOS Health, in a way that actually makes sense and actually feels good to engage with. No shame. No impossible standards. Just honest, science-based conversations about what’s going on in your body and what genuinely helps your symptoms.

Today we’re talking about exhaustion—that real, bone-deep weariness where you feel heavy, like you’re dragging yourself through the day. The kind of exhaustion that makes you feel like you’re running on empty before the day has even really started.

We often feel at a bit of a loss as to how to deal with this kind of exhaustion, and sometimes we even start blaming ourselves for not managing our day well, for drinking caffeine too late, or for not saying no and having too much going on.

Today, though, I want to offer a completely different way of understanding what’s happening in your body and how to begin approaching it differently.

So first, let me describe something that may sound familiar.

You wake up tired—not just a little groggy or slow, but actually tired. You feel this heaviness in your chest. You’re dragging yourself through the morning. You’re awake, and you know that even if you laid back down, you probably wouldn’t actually fall asleep again. You’re just exhausted.

You get through your morning on sheer willpower and caffeine, and by early afternoon your energy crashes. Your brain feels foggy. Your patience is thin. Your cravings kick in hard. But you push through the rest of the day just trying to make it to the evening so you can finally go home and crash.

Now you finish your day feeling completely depleted, but when you finally lie down to sleep, your mind won’t stop. You feel wired and restless, like your body forgot how to switch off. You may eventually fall asleep, but it’s not deep, restful sleep. Then the alarm goes off, and the whole thing starts all over again.

That’s kind of the extreme version.

You may have a less extreme version going on, but if this is happening on occasion—or even just during certain times of the month—this is what we call the wired and tired experience of PCOS.

It’s one of the most common things women describe, especially those with Stress Response PCOS. But it can also happen in women whose primary root cause is something else.

Here’s what so many women do with this experience.

We blame our schedule.

We blame the way we’re handling things.

We tell ourselves we’re being lazy.

We tell ourselves we just need to get it together.

We’re not disciplined enough.

We’re not doing enough.

Instead of taking care of our nervous system, we push harder. We restrict more. We add more to our plate in an attempt to fix ourselves.

Sometimes that even comes in forms that sound healthy. Maybe we schedule a massage. Maybe we decide to exercise even more. Whatever it is, we’re trying to fix what we believe is the problem.

But exhaustion isn’t a character flaw.

It’s actually a signal from your body.

It’s a physiological signal.

Understanding that difference changes everything.

Before we get into the physiology, I want to acknowledge something that deserves to be said out loud.

There are so many things going on in our modern world that are stressful and overwhelming. The constant “go, go, go” culture that we live in is one of the reasons PCOS is becoming more common.

I don’t say that to be alarmist or negative. I say it because it’s important context for understanding why so many women are struggling.

We’re living in environments that create constant stimulation, constant information, constant demands on our attention, our energy, our time, and our emotional capacity.

Notifications are constantly popping up on our phones.

The news.

Social media.

Work pressures.

Family responsibilities.

Financial stress.

Relationship dynamics.

All running simultaneously and all requiring something from us.

With so many touchpoints, all of these demands have become more intense than they were 10, 15, or even 20 years ago.

Our nervous system—which was designed for a very different pace of life—is doing its best to cope.

Our bodies don’t adapt quickly.

We are incredibly resilient, but our deep, core physiology doesn’t rapidly evolve.

We’re still designed for a much simpler way of living.

We’re designed around sunrise and sunset.

Natural circadian rhythms.

Living season to season.

Eating foods that came from the land rather than packaged foods.

A much more primal way of living.

For women with PCOS, this matters enormously because the same stress response system that helps us navigate daily pressures also directly regulates our hormones.

When that system becomes chronically overloaded, the effects ripple through every aspect of our health.

One thing I’ve intentionally tried to create in my own life is a little corner where life isn’t always so stressful.

That impulse isn’t weakness.

It’s not hiding from the world.

It’s simply my way of creating an environment my body can retreat to.

And there’s wisdom in that.

When your body tells you what it needs, it’s okay to create a little bubble where it feels safe.

Now let’s talk about cortisol, because it’s one of the most important—and most misunderstood—hormones in the PCOS conversation.

Cortisol is your primary stress hormone.

It’s produced by your adrenal glands and released in response to stress.

That stress can be physical, emotional, psychological, or physiological.

Undereating counts.

Overdoing counts.

Poor sleep counts.

Emotional overwhelm counts.

Chronic low-grade anxiety counts.

All of these things slowly raise cortisol over time.

Cortisol itself is not bad.

In fact, it’s incredibly useful.

In short bursts, it sharpens focus.

It mobilizes energy.

It helps us respond to challenges.

The problem is that in today’s environment, we’re constantly stimulated by challenges requiring immediate attention.

That’s when cortisol becomes chronically elevated.

Chronically elevated cortisol disrupts our normal daily rhythm.

You’re designed to have higher cortisol in the morning.

It gradually tapers throughout the day, helping you feel alert when you wake up and naturally sleepy when it’s time for bed.

But when cortisol becomes chronically dysregulated, that rhythm flattens—or even reverses.

That’s when you feel flat and exhausted in the morning but wired at night.

The problem is that our daily schedule doesn’t match that rhythm.

Our body isn’t receiving the normal hormonal support that’s supposed to wake us up and help us wind down.

Chronically elevated cortisol also destabilizes blood sugar.

When cortisol rises, it raises blood sugar to provide quick energy for whatever threat your body believes it’s responding to.

Then blood sugar falls again.

When it does, your body starts screaming for fast fuel.

That’s when the cravings for sugar and simple carbohydrates show up.

This isn’t because you lack willpower.

It’s because your body associates those foods with quick energy.

This is cortisol doing exactly what it’s designed to do in a body that was never meant to live in constant stress mode.

Chronically elevated cortisol also affects your cycle.

It suppresses hormone communication between the brain and the ovaries because, from your body’s perspective, reproduction is not a priority during a time of perceived stress.

When the body senses a chronic threat, ovulation becomes a very low priority.

Ovulation can become irregular or absent.

Cycle quality suffers.

Progesterone, which requires ovulation to be produced, also drops.

What happens is that when we’re not ovulating, we don’t get that normal progesterone production. If you go several months without ovulating—or you’re only having one or two cycles a year—those progesterone levels become lower and lower over time. They don’t immediately bounce back after one ovulatory cycle. It takes many healthy ovulatory cycles to gradually rebuild those progesterone levels.

Stress and elevated cortisol also directly lower progesterone. So even if you’re having what I sometimes call a “shadow” of a cycle, or your body is attempting to ovulate, your progesterone levels may still remain quite low.

Low progesterone is also associated with an increased risk of miscarriage, which is one of the reasons progesterone becomes such an important conversation for women with PCOS who are trying to conceive.

Chronically elevated cortisol also drives inflammation.

That chronic inflammation amplifies many of the underlying drivers of PCOS, meaning these systems all become connected.

As we’ve been talking about, elevated cortisol also disrupts sleep—not just by making it harder to fall asleep, but by reducing the quality of your sleep.

Poor-quality sleep reduces your body’s ability to restore itself.

This is when hormone regulation, cellular repair, tissue healing, and recovery are supposed to happen.

Over time, your body changes.

Your behaviors change.

Your cravings change.

Your motivation changes.

Everything begins to feel overwhelming.

The frustrating part is that all of these symptoms can seem disconnected, making it difficult to understand what’s actually going on.

This is not a personal failure.

It’s your body doing exactly what it was designed to do in response to an environment that’s asking far too much of it.

Unfortunately, this isn’t something that’s often explained to women with PCOS.

That’s why something that seems so simple can actually be one of the biggest missing pieces of the PCOS puzzle.

Your nervous system directly influences your metabolic system.

When your nervous system remains chronically activated—in that constant sympathetic “fight-or-flight” state—your body diverts resources away from digestion, hormone production, immune regulation, and cellular repair, and instead directs those resources toward immediate survival.

That means you can be eating well, taking the right supplements, exercising appropriately, and doing everything “right.”

But if your nervous system is chronically overwhelmed, your body’s ability to actually utilize all of those wonderful things you’re doing becomes significantly compromised.

You really can be doing everything right on paper and still not feel well.

That doesn’t mean you’re failing.

It doesn’t mean everything else you’re are doing isn’t helping.

It simply means the foundation—creating safety within your nervous system—hasn’t yet been established.

Your nervous system influences your metabolic pathways in ways that go far beyond most of the PCOS advice you’ll find online.

You hear people talking about stress, cortisol, and nervous system regulation all the time, but it’s often oversimplified or dramatized.

In reality, it’s a fairly straightforward system.

Blood sugar regulation.

Insulin sensitivity.

Thyroid function.

Adrenal output.

Inflammation.

All of these are influenced by the state of your nervous system.

Often, online advice focuses on just one or two of these pieces.

But when you begin to see how they all work together as one beautiful symphony, everything starts making much more sense.

Your body is simply responding to the environment it’s living in.

And for many women with PCOS, that environment is one of chronic overstimulation, under-recovery, pressure to do more, push harder, and constantly keep going.

That’s simply the world many of us live in today.

I also don’t want to gloss over sleep because, specifically for women with PCOS, it’s often one of the first things that gets sacrificed.

When life becomes busy, sleep is usually one of the first things we shorten.

We tell ourselves we’ll just sleep an hour less tonight.

Or we’ll catch up later.

But sleep isn’t passive.

Sleep is one of the most active forms of recovery your body has.

And the quality of your sleep matters just as much as the quantity.

During deep sleep, your body regulates cortisol.

It repairs tissues.

It consolidates memories.

It balances blood sugar.

It produces key hormones, including growth hormone and progesterone.

When sleep becomes disturbed—even mildly—and especially when it’s disturbed consistently, the downstream effects on PCOS are significant.

Insulin sensitivity decreases.

Blood sugar regulation becomes more difficult.

Even after just a few nights of poor sleep, your body responds differently.

Have you ever noticed that after a poor night’s sleep your cravings are dramatically worse?

I want you to pay attention to that.

It’s something both my husband and I have noticed over the past several years, especially during the years when our children were little and sleep was interrupted.

Those days after poor sleep, we craved simple carbohydrates and sweets all day long.

We felt foggy.

And if we weren’t being intentional, the foods we naturally reached for weren’t the healthy ones.

That’s cortisol dysregulation at work.

Sleep disruption changes our hunger hormones in ways that drive cravings.

Appetite increases.

Inflammation increases.

Mood and motivation suffer.

And suddenly every healthy habit feels much harder to maintain.

Sleep disruption has been studied extensively, and we know it directly affects hormone signaling in measurable ways.

That’s why improving sleep is such an important part of managing stress and supporting PCOS.

If you’re caught in that cycle of poor sleep leading to worse symptoms, leading to more stress, leading to even poorer sleep, I want you to know that this is an incredibly common physiological pattern.

There is a way through it.

And it’s not about becoming more disciplined.

It’s about becoming more strategic in how you help your body relax so it finally feels safe enough to rest.

So what does recovery actually look like?

First of all, recovery is not a reward for doing enough.

It’s an active and essential part of supporting your hormones with PCOS.

I want to get really practical here because I think that sometimes when we talk about relaxation, we immediately picture taking a spa day, getting a massage, or having a whole “me day.”

Recovery for women with PCOS doesn’t require a dramatic lifestyle overhaul.

It doesn’t require changing your job or completely reorganizing your life.

Instead, it requires creating a few consistent, supportive anchors that your nervous system can begin to rely on.

One of those can be magnesium in the evening.

Magnesium helps support cortisol regulation, relaxes the nervous system, and can improve sleep quality. It’s also one of the most accessible tools we have.

Personally, I find that simply having a routine around it helps. After I’ve cleaned up the kitchen and I’m transitioning into quieter evening activities, grabbing a magnesium gummy becomes a cue that says, “Okay, we’re winding down now.”

It’s a reminder that I’m going to start making choices that support good sleep.

Sometimes it’s those little physical reminders that become really powerful habits.

Another helpful strategy is getting morning sunlight.

Even just 10 minutes of natural light exposure early in the day helps regulate your cortisol rhythm and reminds your body through your eyes that it’s morning. That helps reinforce your circadian rhythm.

Gentle movement is another wonderful tool.

A morning walk outside—not necessarily pushing yourself through a high-intensity workout—can do far more for cortisol regulation, blood sugar stability, and nervous system health than most people realize.

Now, I do want to clarify something when it comes to exercise.

I’m not necessarily saying you need to lower the intensity of your workouts.

Higher-intensity exercise absolutely has benefits for women with PCOS.

In fact, I generally prefer those more intense workouts to happen earlier in the day because we’re trying to encourage that healthy morning cortisol rise rather than stimulating cortisol later in the evening.

Hydration is another simple but incredibly important piece.

Dehydration is a physical stressor.

It raises cortisol.

It worsens fatigue.

It impairs cognitive function.

It even affects our mood.

Making hydration a priority—and adding electrolytes if you’re sweating heavily—is one of the simplest, highest-impact things you can do.

Another area to think about is reducing overstimulation.

Can you dim your screens in the evening?

Can you silence notifications during certain parts of the day?

Can you reduce the amount of news or social media you’re consuming?

Creating small windows of quiet allows your brain to slow down instead of constantly racing from one thing to the next.

Boundaries with your time and energy matter, too.

Knowing what you can realistically take on during a week—and recognizing which commitments consistently push you over the edge—can make an enormous difference.

Sometimes it’s saying no.

Sometimes it’s rearranging your schedule.

Sometimes it’s simply giving yourself more margin.

These small, supportive shifts create tremendous momentum over time.

And remember, this isn’t just about whether you feel stressed.

When we say, “I feel stressed,” what we’re often really describing is feeling overwhelmed.

But from your body’s perspective, stress is about whether it’s being overtaxed.

Sometimes you can actually feel energized while your body is under tremendous stress.

Maybe you’re excited about a project.

Maybe life is busy in a good way.

Maybe you’re rising to a challenge.

But at the same time, you’re sleeping less.

You’re eating differently.

You’re skipping meals.

You’re pushing through fatigue.

Your body may still interpret all of that as stress.

That’s why, in the cortisol world, we’re really talking about how your body perceives its environment—not simply how stressed you feel emotionally.

So before we wrap up today, if any of this sounds familiar, I encourage you to dive a little deeper by taking the PCOS Root Cause Quiz.

If today’s episode resonated with you, there’s a good chance you may have Stress Response PCOS, or perhaps another primary root cause with a significant stress component.

Either way, the best place to start understanding what’s happening inside your body is with the PCOS Root Cause Quiz.

It’s a free quiz that I created to help you begin connecting your environment to your symptoms and understanding what’s happening beneath the surface.

Because exhaustion…

Sleep disruption…

Feeling wired but tired…

Cycle changes…

These are all meaningful feedback signals from your body.

Your body is trying to communicate with you.

When you begin understanding how these systems fit together, you’ll be much better equipped to support your body and create an environment where it can truly thrive.

If you found today’s episode helpful, I hope you’ll hit that subscribe button and share this episode with someone who could benefit from hearing it.

Thank you so much for spending this time with me today.

Until next time, bye for now.