Why Stress Interferes with your PCOS Recovery
Stress’s relationship with PCOS (polycystic ovarian syndrome) is very much a doubled edge sword. The diagnosis of PCOS along with its devastating symptoms such as hair loss, acne, hirsutism (facial hair) and weight gain can be extremely to women. But the problem is that this stress could be the one thing blocking a women from recovering from PCOS both with a natural holistic or a conventional medical approach. If you or someone you know has been battling with PCOS, trying every remedy under the sun to no avail, then it is time to give a closer look at stress.
What triggers PCOS?
The actual cause of PCOS is still largely unknown amongst doctors. We really don't know what exactly causes PCOS. Because most women with PCOS have elevated androgens (male hormones) or symptoms of high androgens such as acne and hair loss, androgen excess or heighten response to androgens seems to be the common link. Male hormones include DHEA, androstenedione, testosterone and dihydrotestosterone (DHT). DHT which is the potent metabolite of testosterone is most responsible for symptoms of androgen excess. Androgens are produced in the adrenal glands and ovaries as well as by peripheral conversion of DHEA to testosterone. Genes, insulin resistance, and inflammation have all been linked to excess androgen production. Insulin resistance is the particular first target when addressing PCOS. But as the naturopathic doctor will detail shortly, addressing insulin resistance alone is rarely enough.
How does stress worsen PCOS?
Let’s face it life can be stressful! It is almost impossible to escape the demands of work and relationships as well as the unpredictable bumps along the way. When we refer to stress we are not as concerned with the stressors per se but how we handle the stress and what happens to our body as a result. When we become stressed our Hypothalamic Pituitary Adrenal Axis (HPA Axis) becomes activated triggering the classic “fight or flight” response. Our hypothalamus releases corticotrophin-releasing hormone (CRH) which tells our adrenal glands to pump out the stress hormone, cortisol. CRH also suppresses our Hypothalamic-Pituitary Gonadal axis (HPG-Axis) and inhibits the release of gonadotrophin-releasing hormone. Without gonadotrophin-releasing hormone, the release of luteinizing hormone (LH) from the pituitary becomes disrupted. This affects the production of estrogen preventing the LH surges which triggers ovulation. Anovulation is what leads to cysts, low progesterone and estrogen dominance, which are characteristic in PCOS. Progesterone is not just decreased because of lack of ovulation but also because of the stress hormone, cortisol. We actually use progesterone to make cortisol so progesterone can be rapidly decreased to meet cortisol demands. The last piece is that chronic stress increases adrenal androgens and blood sugar. DHEA is release from the adrenal glands and converted to testosterone and DHT in peripheral tissues. Elevated DHEA can also decrease insulin levels and why a woman with PCOS might have “normal” insulin levels despite having irregular cycles, hair loss and acne.
Managing stress in PCOS
Unless you are always as cool as cucumber will you never get over PCOS? Yes and no. Stressors are inevitable but there is so much women with PCOS can do to manage their stress response and support their adrenal glands. When not constantly under stress, the adrenal glands receive less stimulation and produce less androgens. By far I find breathing techniques like this one a great place to start. To help reduce cortisol and stress induced HPA axis activation, I will also often prescribe phosphatidylserine. I find it to be especially helpful when combined with L-theanine, a component of green tea. My patients like this combination as well because they sleep easier and deeper. Rhodiola is another great addition for lowering cortisol and tonifying the HPA axis. The unfortunate reality I have found in my naturopathic practice over the years is that the biggest sources of stress for PCOS patients are diet and the condition itself. There is far from a one size fits all diet for PCOS. Some dietary strategies like Keto and intermittent fasting which have been shown to help obese patients with PCOS, may actually increase physical (as well as psychological) stress on the body making PCOS worse in some patients. Moreover acne, hair loss and trying to get pregnant can be extremely frustrating especially when results seem to take forever. With PCOS, healing takes time. For most women with PCOS, it can take about 1-2 years for hormones to normalize and symptoms such as acne and hair loss to improve. It is important to remember while going through the healing process what my favorite yoga teacher use to say which is “slow is strong.”
Ready to get a handle on your PCOS? Then schedule a naturopathic appointment with Dr Ivy.
Find out how stress can increase hair loss in both patients with and without PCOS. Click here to get started on your PCOS recovery journey.