Is adrenal PCOS really a thing?

As a registered dietitian, I’m here to help you understand what is known about PCOS and how to manage your symptoms.

“Adrenal PCOS” is a term that is being thrown around as one of the four types of PCOS, but we don’t really have scientific evidence that it is an accurate way to talk about PCOS.

And while our understanding of PCOS continues to expand daily, as a dietitian, I base my client recommendations on what is known right now.

In this blog post, I’ll explain how PCOS is a condition that can show up pretty differently, but that at the moment, there isn’t evidence to support the “four types of PCOS” that some people talk about. I’ll also explain how you can take action to understand, and manage, your unique set of symptoms that PCOS is bringing you.

Let’s dive in with a quick recap of what PCOS is.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a medical condition that affects as many as 1 in 5 women of reproductive age (1). 

It  is often referred to as a hormonal disorder, but it has an impact on many systems of your body. In fact, PCOS has been linked with insulin resistance, chronic inflammation, high levels of androgens (excess male hormones), and other hormonal imbalances.

PCOS has also been linked to an increased risk of metabolic syndrome, cardiovascular disease, sleep apnea, and mental health concerns.

There are many different symptoms that can happen, and they can really affect how you feel on a daily basis.

Common symptoms of PCOS can include:

• Missed or irregular periods
• Painful periods
• Fertility issues
• Hirsutism (excess hair growth on the face and/or body)
• Hair loss
• Acne
• Fatigue
• Mood swings
• Carb cravings
• Weight gain

Because PCOS can present with such different symptoms, sometimes people divide PCOS into four different types of PCOS.

The Four Types of PCOS

If you’re following PCOS “experts” on social media, they might be talking about four types of PCOS:

• Insulin-Resistant PCOS
• Inflammatory PCOS
• Adrenal PCOS
• Post-Pill PCOS

I don’t love the idea of these four types of PCOS for a couple reasons. First, these categories of PCOS aren’t actually recognized by well-known health care organizations or experts. Second, it gives the illusion that you should fit into one “type” of PCOS and you can only have one root cause of your symptoms. In reality, we usually see a lot of overlap between these types of PCOS. 

Instead, the clinical guidelines for PCOS group women with PCOS into four different phenotypes: A, B, C, and D (2, 3). 

Your type of PCOS and whether we call your symptoms “adrenal PCOS” isn’t all that important to me; what matters to me is coming up with a plan to reduce those symptoms. 

Let’s talk about what people are struggling with when they say adrenal PCOS and then, even more importantly, what we can do about it to help you start feeling a whole lot better. Sound good? 

P.S. Fun fact: I have PCOS and am phenotype B. 

What is Adrenal PCOS?

As you may know, the adrenal glands are two small glands that sit on top of your kidneys. They produce hormones like cortisol and adrenaline that help your body respond to stress and regulate metabolism (4).

Your adrenal glands also produce some androgen hormones: dehydroepiandrosterone (DHEA) and its sulfate form (DHEA-S). One study found that one-third (or about 33%) of women with PCOS had elevated levels of DHEA-S, which was also associated with higher testosterone levels (5).

If you suspect that you have adrenal PCOS, your blood tests have likely shown elevated cortisol and/or DHEA-S levels. 

It is also important to note that the symptoms that you’re experiencing might be due to other reasons. There are a few conditions that you and your doctor may wish to rule out, such as Cushing’s syndrome and congenital adrenal hyperplasia. 

Symptoms of Adrenal PCOS

For women dealing with adrenal PCOS, fatigue is one of those most common complaints, but of course, symptoms can vary greatly from one person to the next. 

Symptoms of adrenal PCOS may include any of the typical PCOS symptoms, such as:

• Irregular periods
• Hair loss
• Hirsutism
• Difficulty sleeping
• Anxiety
• Depression
• Brain fog
• Weight gain (and struggling with weight loss)

Causes of Adrenal PCOS

Chronic stress is a huge culprit when it comes to adrenal dysfunction and adrenal PCOS. 

Cortisol is what we think of as the stress hormone; it is made by your adrenal glands and the levels go up when you are stressed out. Chronically high cortisol levels can lead to weight gain, inflammation, and insulin resistance. 

Dehydroepiandrosterone (DHEA) and its sulfate version (DHEA-S) are also made predominantly by the adrenal glands and are necessary for the production of additional hormones. Acute stress causes your adrenal cortex to increase production of DHEA, which impacts a lot of systems in your body, including your reproductive system, your hormone systems and your metabolism (6).

DHEA converts into DHEA-S, which is more stable and generally a more reliable blood test to evaluate you for high adrenal androgen levels.

DHEA and DHEA-S are ultimately converted into testosterone and DHT (7). High DHT and testosterone levels are responsible for many of the unpleasant physical symptoms that are seen with PCOS, such as hirsutism, hair loss, and acne. 

Interestingly, research shows that higher levels of DHEA-S are negatively correlated with insulin resistance. In other words, those with higher levels of DHEA-S are less likely to have high insulin levels, high blood sugar levels, or be insulin resistant. Women with adrenal PCOS are also more likely to have a lower body weight and BMI (8). 

Ways To Feel Better

No matter which type of PCOS you have, the most important thing to me is that we have a plan to help you to feel better. The good news is that a healthy diet and making appropriate lifestyle changes can make a huge difference in managing your hormone levels and improving how you feel. 

And while every woman is different, there are some core strategies that I recommend for most of my clients. Here are my top picks for you, today:

Eating Enough 

Because weight gain is a concern among women with PCOS, it is really common to have clients come to me who are eating far too little. This has surprised many of my past clients, that I am encouraging them to eat more, not less. 

Having Balanced Meals 

Having a balanced meal with protein, carbs, and fat, most of the time, helps to keep your blood sugar stable and improve your insulin sensitivity. Balanced meals that have the right nutrients also keep your mood more stable and your energy levels higher than before. 

If you’re struggling here, be sure to check out this 7 day PCOS Diet Plan PDF and this PCOS Grocery List.

Reducing Inflammation 

No matter what kind of PCOS you have, you are likely dealing with inflammation. What you have on the end of your fork matters. Kick inflammation to the curb with anti-inflammatory foods, such as these. 

Reducing Stress

Remember how we talked about how folks with PCOS might have higher levels of stress hormones? And how stress can lead to adrenal androgen excess? Finding ways to work through and reduce stress really matters. 

A few of my favorite strategies are journaling, doing relaxing activities such as walking and yoga and making space for hobbies that I enjoy. 

Improving Sleep

Being a night owl and a thriving person with PCOS do not mix. Getting to bed at a decent time and having high quality sleep really matter to support your hormone balance. 

It may not always feel like it, but not sleeping enough is stressful for your body.

Medications or Supplements

You may also find symptom relief with medications and/or the right supplements. Oral contraceptives, or birth control pills, are a commonly prescribed medication. Research has shown that it can lower DHEA-S levels. 

Supplements are also becoming increasingly popular as alternate treatment options. Finding the right supplement from a trusted brand (and in the right dose) can feel pretty tricky. 

Supplements that may help::

• Ashwaganda
• L-theanine
• Magnesium
• Zinc
• Vitamin D

Always talk to your healthcare provider before starting any supplements. 

How I can help

I’ve seen far too many people feel stuck and overwhelmed trying to fit their PCOS symptoms neatly into a box, including adrenal PCOS. The truth is that those PCOS “types” aren’t actually recognized in the medical field, nor do they accurately represent many women’s real experiences with this condition. 

Instead of trying to fit yourself into these categories, recognize them as a potential driving force of your PCOS and let’s transition into solution mode: what can we do to help to manage and minimize your symptoms and empower you to feel great? There are a LOT of strategies that I have used with clients and I’m confident that I can support you, too!

The PCOS Playbook outlines exactly how and what to eat for PCOS – it takes the confusion and overwhelm out of it. As a dietitian with PCOS, I’m here to provide you with information that you can trust, not just share things that are trendy. 

Disclaimer: This information is for educational purposes only and not intended to be substituted for medical advice for polycystic ovarian syndrome (PCOS) or any other health condition. Always consult with your healthcare provider for personalized medical care and recommendations.