Is stressing about your diet and exercise routine ruining your fertility and causing PCOS symptoms?
Believing that PCOS is solely genetic, due to excess weight, or simply caused by cystic ovaries, that can be treated using hormone replacement is a dangerous assumption that prevents many women from getting the help they need. While weight loss in women who are overweight may be beneficial, this recommendation isn’t useful for women with PCOS symptoms who aren’t overweight. Using the pill as a treatment for amenorrhea is often unnecessary and simply masks a deeper diet and lifestyle problem. It’s possible there may be a genetic component that increases one’s risk of PCOS, we need to understand this syndrome is significantly affected by lifestyle factors including diet, exercise, and stress. Now do I have your attention?
In this blog you’ll learn how excessive stress, your diet, exercise, and life in general might be driving the adrenal hormone changes that are causing your PCOS symptoms.
The two main androgenic hormones causing these symptoms in women are testosterone and androstenedione, while androgens include dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEA-S). The adrenal glands produce all of the DHEA sulfate (DHEA-S) and 80 percent of the DHEA in the body. The adrenals also produce 50 percent of androstenedione and 25 percent of circulating testosterone. When these hormones are elevated like in PCOS, symptoms of androgen excess begin to manifest as menstrual malfunction and fertility challenges, lack of ovulation, weight gain, male-pattern hair growth and acne.
While insulin resistance and elevated insulin often drive the ovarian production of testosterone, it is the hypothalamus-pituitary-adrenal (HPA) axis that stimulates the production of DHEA/DHEA-S and androstenedione. These hormones can be converted to testosterone by peripheral tissues in the body. This process can occur independently from the ovaries and any involvement with insulin. This means that a woman with PCOS symptoms could have normally functioning ovaries with no cysts and no insulin resistance, yet still fit the symptomatic profile of the syndrome; I know… just read that again!
There is some controversy over whether elevated androgens cause insulin resistance or if insulin resistance happens first. Most likely the answer is some women likely develop insulin resistance first, while others develop elevated androgens first. Regardless, not only is the brain heavily involved in the output of androgenic hormones, it’s clear the adrenals are also responsible for PCOS symptoms.
So how does stress impact your hormones?
The pituitary gland is stimulated by the brain via the hypothalamus and secretes adrenocorticotropic hormone (ACTH) in response to stress. ACTH then stimulates the adrenal glands to produce your stress hormones cortisol, adrenaline, and noradrenaline, ACTH also stimulates the production of adrenal androgen hormones, including DHEA, DHEA-S, and androstenedione, remember these are androgenic hormones.
Research shows women who are under extreme chronic stress situations have a markedly increased DHEA response to ACTH stimulation, as well as a higher ACTH response to stress and stimulation from the hypothalamic hormones. They also have higher levels of baseline DHEA compared to healthy controls these women.
Now let’s have a quick review:
-Elevated androgens like testosterone and androstenedione contribute to PCOS symptoms like menstrual dysfunction, unwanted hair growth, weight gain, acne, and mood disorders.
-The adrenal glands are responsible for at least 20 to 30 percent of the elevated androgens seen in PCOS. Chronic stress elevates ACTH, which stimulates androgen secretion, for which there is no negative feedback loop. Unfortunately chronic stress is everywhere these days; from long work weeks, poor sleep to new babies. Add constant social pressures to have all of your shit together all of the time, whilst chasing unattainable bodies and physical perfection, we as women are bombarded by stress from every direction!
Add traumatic events, acute illness, gut dysbiosis, and disrupted sleep and it’s little wonder so many women come to me with reproductive dysfunction or amenorrhea, weight loss resistance, blood sugar fluctuations, anxiety and depression, acne, chronic fatigue and other hormonal imbalances. The worst part is that the more stress drives up our androgenic hormones, the more our menstrual cycles become irregular, the more weight, skin, and hair growth is affected.
For some women, this drives them to restrict their diet further, diet harder, work out more often and more intensely, and push their bodies to the brink of exhaustion, it’s a vicious cycle. So if you’re killing yourself at CrossFit five to six days per week, finding yourself gaining weight, losing your menstrual cycle, developing adult acne, or simply feeling like a frickin truck hit you every morning you wake up, it may be chronic stress causing your physical symptoms and hormonal imbalance. Also remember this chronic stress is a major contributor to the development of PCOS symptoms, especially in normal or underweight women with non-cystic ovaries and normal insulin sensitivity.
Managing your stress is challenging AF and there’s no quick fix long-term. Our culture thrives on stress and perfectionism. The desire to live an envy-worthy life that looks amazing on Instagram, striving to look good naked, make more money and having more possessions is literally breaking us!
Here’s the takeaway, pardon the pun. Excessive chronic stress, your diet, exercise, and life in general very well could be driving the adrenal hormone changes that are causing your PCOS symptoms. We need to challenge and change our definitions of success as women. It’s not having your Instagram looking enviable, or a Kardashian ass. Its having a strong, hormonally balanced receptive body. It’s body literacy, it’s trusting your body, nurturing it with nutritious food and adequate rest. It’s gratitude, positive self image and friendship. Find people who inspire you to shift your focus to the positive things in your life, including what your body is capable of rather than what it looks like. Self-acceptance is a practice, so please start today, the rest will follow.
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