Adrenal PCOS Explained: Key Facts You Need to Know

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that affects approximately 5-10% of women of reproductive age. While many people are familiar with PCOS, the "adrenal type PCOS" is a subtype that might not be as widely known. Adrenal PCOS involves the adrenal glands—small organs located on top of the kidneys that produce hormones such as cortisol, testosterone, and other key steroids.

Unlike the more common PCOS types associated with insulin resistance, Adrenal PCOS primarily stems from imbalances in the adrenal glands, which produce hormones like cortisol, adrenaline, and DHEA (Dehydroepiandrosterone). In this form of PCOS, women typically don’t have excessively high testosterone levels. Instead, they experience elevated DHEAS (a type of DHEA) and other symptoms linked to adrenal dysfunction.

How Does Adrenal PCOS Differ from Other Types?

Adrenal PCOS is unique because it doesn’t present with the typical signs of high testosterone like hirsutism (excessive hair growth) or acne. Instead, the main hormone imbalance in adrenal PCOS is an elevated DHEAS, which can lead to different symptoms that set it apart from other PCOS types:

Sleep issues: Women with adrenal PCOS often struggle with sleep disturbances, ranging from difficulty falling asleep to frequent waking during the night. This is likely due to the dysregulation of adrenal hormones like cortisol, which can affect the body’s natural circadian rhythm.

Heart pounding or palpitations: Another common symptom of adrenal PCOS is experiencing a racing heart or feeling heart palpitations. This is linked to excess adrenaline and other stress hormones produced by the adrenal glands.

Fatigue and mood swings: Since the adrenal glands are also responsible for managing the body’s stress response, women with adrenal PCOS often feel more fatigued and stressed, even if they haven’t had a particularly taxing day. This can lead to irritability and mood fluctuations.

Weight management struggles: Unlike other types of PCOS, which often involve weight gain due to insulin resistance, women with adrenal PCOS don’t necessarily gain weight at the same rate. However, calorie counting and restrictive dieting are often ineffective for weight management in these cases. You might find yourself eating a healthy and balanced diet but still gaining weight. This is because the hormonal imbalances at play aren’t directly linked to calorie intake, but rather to how the body manages stress and energy. People can exprience weight gain related to a high cortisol level as your adrenal gland is working very hard. This type of weight gain usually associates with an increased belly fat and central adiposity.

Why Dieting Doesn’t Work for Adrenal PCOS

If you’ve been diagnosed with adrenal PCOS, you may have already noticed that traditional dieting methods, such as counting calories, don’t seem to yield the desired results. This is because the root issue isn’t about overeating or calorie consumption—it’s about how your body processes stress hormones (cortisol). When your adrenal glands are overactive, it affects everything from your metabolism to your sleep patterns. The increased belly fat or central adiposity related to a long term high cortisol level can make insulin resistance worse. So, in long term, you could also experience insulin resistance at the same time.

Instead of focusing on calorie restriction, it’s important to address the underlying adrenal imbalance and support your body’s ability to manage stress, balance hormones, and restore energy levels. Dieting won’t fix the hormone imbalance causing your symptoms. Intermittent fasting and working out with an empty stomach are also not recommended because they can elevate your cortisol level.

Practical Tips for Managing Adrenal PCOS

Limit caffeine: Since caffeine stimulates the adrenal glands and can increase levels of cortisol and adrenaline, cutting back on coffee and other caffeinated beverages can help reduce the stress on your adrenal system. Opting for herbal teas or decaffeinated drinks might be a good alternative.

Focus on stress management: Since adrenal PCOS is largely about adrenal function, finding effective ways to reduce stress—such as through meditation, yoga, deep breathing exercises, or spending time in nature—can be incredibly beneficial.

Prioritize sleep: Sleep is critical for adrenal health. Make sure you’re getting enough quality rest each night, and try to keep a consistent sleep schedule. Avoid caffeine in the late afternoon and evening to help your body wind down naturally.

Nutrient-dense foods: Rather than focusing on calorie restriction, aim for a nutrient-rich diet that supports adrenal health. Foods rich in vitamins B, C, and magnesium can help nourish the adrenal glands and regulate cortisol levels. Include plenty of vegetables, lean proteins, and healthy fats in your meals.

Gentle exercise: Intense workouts can sometimes stress the adrenal glands even further, especially if you're already experiencing fatigue. Instead, focus on gentle exercise like walking, swimming, or yoga to keep your body active without overwhelming it. DO NOT exercise with an empty stomach. Before you workout, especially if you are planning on greater than 30 minutes workout or high intensity workout, you should eat a proper meal 2-3 hours ahead or having a snack 30 -60 minites ahead.

Having regular meals: DO NOT practise intermittent fasting. 16:8 fasting is quite popular nowadays but this is not recommended for women with high stress levels. Skipping meals especially for breafkast can elevate your cortisol a lot in the morning. Fasting in the morning can put you in a starving state and tell your body that you are living in a crsis. Having regular breakfast after you getting up is very important to manage your stress hormones and regulate your metabolism throughout the day. Other fasting patterns are also not recommended as fasting is not a good weight loss strategies for women with PCOS.

New Research on Adrenal PCOS

A recent study, "The role of adrenal androgens in the pathogenesis of PCOS" , highlights the central role of elevated DHEAS in adrenal PCOS. It demonstrates that this form of PCOS does not always result from insulin resistance, and that adrenal dysfunction—often driven by stress and hormonal imbalance—can be the key driver of symptoms like fatigue, mood swings, and sleep disturbances.

Additionally the study explores the relationship between adrenal androgen excess and body mass index (BMI) in individuals with polycystic ovary syndrome (PCOS). It examines how increased levels of adrenal androgens, such as DHEAS (dehydroepiandrosterone sulfate), can contribute to the symptoms of PCOS, including hirsutism, acne, and menstrual irregularities. The study also investigates how BMI, a key indicator of obesity, may influence adrenal androgen production and exacerbate the clinical manifestations of PCOS. Findings suggest that higher BMI may be associated with greater adrenal androgen excess, which can impact the severity of PCOS symptoms and complicate its management.

Conclusion

Adrenal PCOS is often misunderstood because its symptoms don’t follow the typical patterns seen in other types of PCOS. Elevated DHEAS and stress-related issues like sleep disturbances and heart palpitations are more prominent than the hormonal imbalances seen in insulin-resistant PCOS. Rather than focusing on restrictive diets, it’s important to address the root cause—adrenal health—by managing stress, supporting sleep, and making thoughtful adjustments to your lifestyle.

If you suspect you may have adrenal PCOS, it’s crucial to work with a healthcare professional who understands the condition and can guide you toward the most effective treatments tailored to your needs.

As an Australia-based Certified Fertility and Pregnancy Dietitian and a fellow PCOS warrior, feel free to have a free pcos quiz and contact me for personalized dietary advice about adrenal PCOS, managing symptoms through balanced nutrition and lifestyle changes!

Stay Tuned!