PCOS, Cortisol & Chaos: How to Calm the Hormonal Storm

If you’re one of the 5-25% of reproductive-aged women who have polycystic ovarian syndrome (PCOS) you may feel like you’re in a state of constant hormonal chaos. Symptoms like stubborn acne, pervasive fatigue, irregular menstrual cycles, and weight gain seem to appear one after another—or even at the same time—making you wonder if your body is actually working against you. 

If you’re searching for calm in the midst of the storm, you’re in the right place. 

While PCOS management usually focuses on insulin resistance and inflammation, what often gets overlooked is the impact of cortisol — your body’s primary stress hormone.

In this article, we’ll unpack the frustrating cycle of PCOS and cortisol. Most importantly, I’ll provide practical, powerful steps you can take to calm the chaos and bring balance to your body.

What is PCOS?

PCOS is a hormonal imbalance common among women of reproductive age worldwide. It’s a complex and multifactorial disorder, characterized by elevated levels of:

• Androgens (the hormones primarily responsible for male reproductive health)
• Antimullerian hormone
• Luteinizing hormone

Common symptoms of PCOS include:

• Irregular ovulation 
• Infertility
• Male-pattern baldness or hair thinning
• Hyperandrogenism, such as excess facial or body hair, acne, or alopecia
• Darkening of skin creases
• Weight gain, particularly around the abdomen (see also “lean PCOS”)
• Mood disorders
• Metabolic syndrome
• Difficulty sleeping

The cause of PCOS isn’t clear. However, experts estimate that up to one-third of women with PCOS have elevated DHEA (dehydroepiandrosterone) or DHEA-S (DHEA sulfate) levels. These hormones, primarily produced by your adrenal glands, are the precursors to androgens and estrogens. This means that when DHEA or DHEA-S levels are high, more androgens and estrogens are being produced, resulting in the symptoms often seen in PCOS.

Abnormal levels of DHEA and DHEA-S also indicate a degree of adrenal involvement.1 

How Stress Fuels Hormonal Chaos

Your stress response is governed by the hypothalamic-pituitary-adrenal (HPA) axis. When your brain perceives stress – whether it’s from a stressful job, a physical threat, or high insulin resistance in PCOS – your adrenal glands produce cortisol in response. 

Normally, this is an incredibly useful temporary response. But for many of us, the chronic stresses of modern life mean our cortisol level stays elevated. 

Women with PCOS are particularly sensitive to the disruptive effects of high cortisol. The reason behind this is that cortisol and DHEA(S) are interconnected.

While DHEA(S) isn’t a primary stress hormone, it plays a regulatory role by decreasing cortisol in times of acute stress. However, long-term stress triggers an overactive HPA axis, leading to elevated cortisol levels. In response, DHEA production may increase as part of the body’s attempt to maintain balance.2 This overproduction of DHEA (and androgens as a result) may be the key driver of the physical manifestations of PCOS. 

So is cortisol to blame for all of your PCOS symptoms like bloating and acne? Yes and no. Cortisol isn’t the sole cause, but it is a significant contributor to the chaos. 

So now, let’s dive into how you can begin to restore balance. 

A Multifaceted Approach to Restoring Balance

Calming the hormonal storm in PCOS requires a multifaceted approach that addresses lifestyle, mindset, exercise, diet, and targeted supplementation.

Exercise: Moving Beyond Gentle Workouts

The conventional advice for lowering high cortisol is to “take it easy” by prioritizing gentle workouts like walking and pilates. But for women with PCOS, this approach often falls short.

That’s because PCOS is often characterized by a storage metabolism. This simply means that the PCOS body is genetically adapted to environments of scarcity, with a tendency to store fat, particularly around the abdomen. 

It also means that this body type needs to be challenged in order to improve the core issue of insulin resistance. Here are my recommendations to accomplish this:

• Challenging workouts: Research shows that resistance training may help improve androgen levels in women with PCOS. You can combine resistance training with vigorous aerobic activity (like high-intensity interval training or HIIT) to improve insulin sensitivity.3 
• Zone 2 cardio: Zone 2 cardio exercises are those that slightly elevate your heart rate, which boosts fat burning and endurance without spiking cortisol. You should be able to talk comfortably while performing these exercises,but not sing. 

In short, exercise daily and make it challenging. Focus on zone 2 exercise most days of the week and include 2-3 strength training sessions every week. Most importantly, listen to your body and don’t overdo it. The goal is to feel tired—ready for deep, restorative sleep—and to enjoy the dopamine reward of a day well spent, not push yourself to exhaustion.

Lifestyle and Mindset 

• Nurture positive social connections: Limiting screen time helps boost your mood and mental well-being.4 Instead, spend more time with others in positive social relationships. Social connection triggers the release of oxytocin, which regulates cortisol secretion over time.5 In doing so, oxytocin helps regulate the stress response and activates the parasympathetic nervous system — your body’s natural “rest and digest” mode.
• Spend more time outdoors: Spending time outdoors in green spaces can be profoundly beneficial for lowering cortisol levels.6,7
• Focus on progress and goals: It’s easy to focus on symptoms when you’re not feeling your best. But it’s important to maintain a positive mindset when managing PCOS. Try to set achievable goals and track them so you can celebrate your progress, no matter how small they may seem. Engage in activities you genuinely enjoy — not as a way to fix your body, but to remind yourself that it’s a source of joy, strength, and connection.
• Embrace the PCOS advantage: Believe it or not, your PCOS may be a sign of genetic strength. Some evolutionary biologists believe that common PCOS traits – such as enhanced fat storage, insulin resistance, delayed menopause, and increased muscularity – offered survival and reproductive advantages in ancient times.8,9,10 This means that the issue isn’t your body; it’s the modern environment (sedentary lifestyle and high food availability). Embrace PCOS as a strength, not a disease or weakness. 

Diet Modifications for Blood Sugar Stability

Diet plays a huge role in managing PCOS. High blood sugar contributes to inflammation, which your body perceives as stress.11 In turn, your body activates your HPA axis, resulting in the release of cortisol. Chronically elevated cortisol can lead to worsening blood sugar control and further blunting of your HPA axis, trapping you in a vicious cycle.12

This is why diet modification should be the first step in managing PCOS. Studies show that diet can significantly improve pregnancy rate and menstrual regularity. It may also reduce symptoms of high androgen levels like excess facial or body hair.13 

For women with PCOS, I recommend avoiding a high-glycemic index diet. Instead, opt for a whole-food, low-glycemic index diet that emphasizes non-starchy vegetables, whole grains, fruits, legumes, meat, and fish. Research indicates that low-glycemic index diets can be successful at reducing inflammation and increasing insulin sensitivity for women with PCOS.14,15

Targeted Supplementation

Supplementation with herbs and nutrients can help support the HPA axis and insulin sensitivity. A few of my top recommendations are:

• Magnesium: As one of the most abundant minerals in the human body, magnesium plays a critical role as a cofactor in hundreds of important enzymatic reactions, including those that support sleep and a healthy nervous system. Magnesium also modulates the HPA axis, and research has shown that magnesium deficiency can increase your susceptibility to anxiety and stress.16,17 The recommended daily intake of magnesium for adult women is 320 mg, though there is some evidence that suggests women with PCOS may benefit from higher doses.18 
• Omegas (EPA/DHA): Omega-3 fatty acids are powerful anti-inflammatory agents, which may help calm the systemic inflammation driven by high cortisol and insulin resistance.19 Several clinical trials have also shown that omega-3 supplementation may improve metabolic markers (such as total cholesterol and triglycerides) in women with PCOS.20,21
• Ashwagandha: Also known as “Indian ginseng,” ashwagandha is an adaptogenic herb used in ayurvedic medicine to promote balanced energy levels, increase stamina, and improve sleep. But the most well-known benefit of ashwagandha may be its ability to alleviate stress and anxiety. This effect is mainly attributed to its positive effects on endocrine system functions, which includes regulating the HPA axis.22
• Activated B-vitamins: B-vitamins (specifically vitamin B12, folate, and vitamin B6) are responsible for metabolizing an amino acid called homocysteine. Deficiency in B-vitamins (a common finding in women with PCOS) can cause elevated homocysteine levels, which could lead to insulin resistance, androgen excess, and cardiovascular disease.23,24 I recommend activated forms of B-vitamins like methylfolate (vitamin B9) and P5P (vitamin B6).
• Inositol (Myo-inositol and D-chiro-inositol): Women with PCOS often have lower inositol levels than those without, and this deficiency can reduce insulin sensitivity and excess androgens.25 In one clinical trial, myo-inositol supplementation significantly reduced LH and testosterone levels and improved insulin sensitivity. Most notably, myo-inositol supplementation restored normal menstrual cycles in all the trial patients.26 

Getting Into Parasympathetic Mode

The key to effectively managing PCOS long-term is to shift your nervous system from a sympathetic (fight-or-flight) state to a parasympathetic (rest-and-digest) state. 

There are many techniques that can activate and strengthen your parasympathetic nervous system, leading to less stress and anxiety. Examples include:

• Mindful eating
• Deep, slow breathing
• Spending time in nature
• Getting a massage
• Deep abdominal breathing
• Humming
• Exercising
• Engaging in a hobby
• Meditating

Try adding 1-2 of these simple activities into your daily routine and notice how your sense of calm builds over time. 

Design a Roadmap to Healing with a Women’s Hormone Specialist in Boston

PCOS, cortisol dysregulation, and the hormonal shifts that follow can be challenging to navigate. But there is calm on the other side of the storm. As a naturopath specializing in hormone health, I help women all over the country identify the core drivers of their symptoms – whether it’s high androgens, insulin resistance, or HPA axis dysregulation – and build a personalized roadmap to healing. 

Ready to start addressing your hormonal issues at the source? Schedule a complimentary 15-minute consultation with me today. I look forward to hearing from you.