Cortisol is a hot topic on social media. It has become demonized by many PCOS influencers, and we’ve come to fear cortisol. You’re warned to avoid vigorous exercise and to stop drinking coffee because it causes cortisol “spikes”. The effects of cortisol in the body can be confusing – and much of what you read is not accurate. So, I teamed up with my fav PCOS doctor, Fiona McCulloch, ND to help take the mystery out of cortisol. We did the initial post on IG, but today’s blog post takes a deeper dive. Read on to learn if cortisol is worsening your PCOS.
What is cortisol?
Functions of cortisol in the body
Cortisol plays many important functions in the body, including:
- Regulating body’s immune system
- Suppressing inflammation
- Regulating blood pressure
- Regulating blood sugar
- Helps to regulate sleep-wake cycle
- Helps to control your metabolism
- Helps your body deal with stressThe bottom line is that optimal cortisol levels are necessary for health!
Stress and cortisol
Much of the fear of cortisol comes from its association with stress. Chronic stress leads to an increase of cortisol – which worsens PCOS symptoms and our overall health, so it’s natural to assume cortisol is “bad”. But it’s not quite so simple because as mentioned above, cortisol has many positive effects in the body. There is a difference between short term and long
Short term stress
When the body encounters an acute stress like having to give a public speech or having a heated argument, your body secretes hormones called catecholamines (example: adrenaline). This helps you to deal with the stress by helping you to focus (or run if you’re being chased by a dog!) Then more slowly, the body releases stress hormones, such as cortisol, which is controlled by the HPA axis. (hypothalamus, pituitary gland, adrenal glands). Catecholamines and stress hormones provide our body with energy and focus to handle the situation. Once the stressor has passed, the hormones go back to normal.
Chronic stress
Chronic stress worsens insulin resistance and inflammation, raises blood sugar, causes weight gain, especially in the belly area, disrupts sleep, causes gastro-intestinal problems, disrupts reproductive hormones, and negatively affects the thyroid and gut microbiome. This has a negative effect on your PCOS symptoms. In addition, it can increase the adrenal androgen, DHEA-S – so this is a double whammy!
PCOS and cortisol
So why all the talk about cortisol and PCOS? Do people with PCOS react differently to stress? Possibly. A 2021 meta-analysis of 41 different studies showed that women with PCOS had higher levels of cortisol. The exact reason is not clear. Perhaps having PCOS, along with all the symptoms, not getting adequate medical care, being gaslight, inadequate sleep, etc. can lead to chronically high levels of cortisol. Or it may be due a dysfunction in the HPA axis. As mentioned previously, the HPA axis controls the amount of cortisol that is released. The HPA axis and hypothalamus-pituitary-ovary(HPO) axis can be abnormal in PCOS patients. We need more research in this area to fully understand it, but in the meantime it makes sense to do what you can to manage stress.
Testing cortisol levels
You may have had your cortisol levels tested when first getting diagnosed with PCOS to rule out another medical conditions such as congenital adrenal hyperplasia (CAH) and Cushing’s syndrome. A very high or very low cortisol level can indicate a serious medical condition that is unrelated to PCOS.
Aside from that, it’s not common to get cortisol tested. But if you are concerned about your cortisol levels, check with your doctor about testing before taking supplements on your own. Chances are that your cortisol levels will show up as normal but you could still have disrupted patterns of cortisol secretions, such as too low in the am and too high in the evening.
Blood (take this in the morning): general screening, total cortisol
Saliva: cortisol awakening response and free cortisol pattern through the day.
Urine:
-dried urine: pattern through the day and how cortisol is broken down (metabolism)
-24 hour urine: total production in a day.
These last two tests are often done by functional medicine clinicians.
Ways to maintain healthy cortisol levels in PCOS
An important part of your PCOS plan is to manage stress. This is especially important if you feel you have chronic stress in your life – regardless if you’ve had your cortisol levels checked or not. The first place to start to manage stress and cortisol levels is with lifestyle. I find many people want to jump right into cortisol lowering supplements. Not only will this be ineffective if you haven’t managed your lifestyle first, but you may be choosing the wrong supplement which could make things worse!
Lifestyle
- Eat to balance blood sugar level by combining protein, fat and carbs at meals (and ideally snacks as well). And don’t too long without eating especially if this causes shakiness, headache or irritability. Low blood sugar causes a release of cortisol that lasts many hours.
- Make sleep a priority. Inadequate sleep can raise cortisol levels. This is a vicious cycle as high cortisol levels at night interfere with sleep. Tips to improve sleep: dim the lights in the evening, have a relaxing bedtime routine, a regular bed and wake time, get off screens at least 90 minutes before bed, and sleep in a cool temperature.
- Get outside in nature. Studies have shown this decreases stress and cortisol levels.
- Practice yoga
- Journal
- Limit caffeine. Pay attention to how it affects you, especially if you are feeling stressed. Caffeine causes a short-term increase in cortisol. This combined with the cortisol production from chronic stress may make you feel even more stressed. Some people feel better avoiding it all together, or at least have it after breakfast, whereas others feel perfectly fine having it first thing in morning before breakfast.
- Maintain healthy relationships
- Avoid overdoing social media (and unfollow those that cause stress)
- Regular exercise. See below for more info on vigorous exercise.
- Have fun and laugh
- Take care of a pet
- Aromatic oils, take a bath
- Practice mindfulness
Herbal/Botanical
Once you’ve mastered the lifestyle tips, you could consider some herbs/botanicals if you are still feeling off. But Dr. Fiona McCulloch warns that these should be taken under always be under the care of a physician, asindividual assessment is needed. Each has different properties, effects and side effects. For example, timing of supplements for the HPA axis is important.
- Ashwagandha
- Eleutherococcus
- Rhodiola
- Licorice
- Panax ginseng
- Holy basil
- Supplements
- Phosphatidylserine
- L-theanine
- Panthothenic acid (vitamin B5)
- Vitamin C
Do you need to avoid vigorous exercise with PCOS?
You’ve probably read on the internet that vigorous exercise spikes cortisol and therefore should be avoided with PCOS. As previously discussed, anything that acts as stressor can cause cortisol to be secreted. In this case, exercise can act as a beneficial stressor on the body. Cortisol is released during moderate to high intensity duration exercise to provide for muscle energy needs. It causes glucose to be released from the liver and fatty acids from the muscles, which are burned for energy. If your cortisol levels were too low, you’d be too tired to exercise! This is short term and cortisol levels are reduced approximately 30 minutes after exercising. Cortisol also helps the body recover from exercise.
Vigorous exercise may also help the body react better to stress in general. A study found that the adrenal glands may release less cortisol under a psychosocial stressor when adapted to regular vigorous exercise as compared to moderate/light activity.
On the other hand, too much vigorous exercise may have negative effects for some people. A study found trained endurance athletes had increases in long-term cortisol exposure. This may be especially true for those people with PCOS. So, while it’s normal to release cortisol during exercise, you should always listen to your body first. If vigorous exercise leaves you exhausted for hours, makes it more difficult to sleep, or causes weight gain, worsens hormones or makes your cycle more irregular, this type of exercise may not be best for you!
Other exercise tips
-If vigorous exercise or heavy weight lifting make you feel good, go for it. There are numerous health benefits for PCOS.
-Low-intensity/gentle movements like yoga may be best for certain patients depending on health and tolerance.
-When beginning, build up slowly – too much, too soon can be a stressor.
-We recommend a balanced exercise program that you tolerate well and enjoy, including recovery time.
Bottom line
Cortisol is a complicated hormone. But it’s the demon it’s made out to be on social media – on the contrary, but has many health benefits. And this includes the short term release of cortisol when exercising. But chronically elevated levels of cortisol can worsen your PCOS in many ways. And unfortunately most of us have chronic stress, too little sleep, irregular eating habits and no time to relax. This leads to chronically elevated levels of cortisol which worsen PCOS in many ways. Try to follow some of our lifestyle tips to help decrease chronic stress. And consult with a doctor if you feel you need more support for cortisol.
Want to learn more about cortisol and PCOS? Watch the IG live I did with Dr. Fiona HERE
