What is Adrenal PCOS? Root Causes, Symptoms and Treatment

Adrenal PCOS Type/Root Cause

Adrenal PCOS, the second most prevalent type, is primarily caused by high levels of stress hormones. 


In previous posts, we discussed how excess insulin leads to increased testosterone production by the ovaries, which is the most common root cause of PCOS, affecting at least 80% of cases.


In the case of adrenal PCOS, the issue stems from the adrenal glands, not the ovaries. 


High stress prompts the brain to release adrenocorticotropic hormone (ACTH), which in turn stimulates the adrenal glands to produce cortisol, adrenaline, and dehydroepiandrosterone sulfate (DHEAS), aiding our response to stress or danger. 


Prolonged stress results in elevated levels of both cortisol and DHEAS, leading to Adrenal PCOS.


DHEAS, being part of the androgen family like testosterone, can cause similar symptoms such as acne, hair loss, and excessive hair growth. 


Studies indicate that 20-30% of women with PCOS have excess adrenal androgens. 


While research in this area is still developing, several studies suggest a possible genetic link in women with adrenal androgen excess, implying that some women might be more genetically predisposed to this type of PCOS.

"Adrenal PCOS is essentially an abnormal response to stress."

You might experience a similar amount of stress to your friend or partner, but find that while they can carry on relatively unscathed, your PCOS symptoms flare up like they’re

going out of fashion.

How does DHEAS cause PCOS symptoms?

DHEAS, like testosterone, plays a similar role in the body. 

When balanced, they both enhance sex drive, mood, and overall well-being. 

However, in excess, they can cause hair loss on the scalp, unwanted hair growth on the face, chest, and breasts, and acne on the face, chest, and back.

Both testosterone and DHEAS can convert to DHT (dihydrotestosterone), intensifying androgenic symptoms such as those mentioned above (as explained in chapter 2 for further details).

DHEAS also impacts the ovaries, affecting egg quality. 

It can interfere with the release of the luteinizing hormone (LH) from the brain, leading to disrupted or delayed ovulation, which explains long gaps between periods and potential fertility issues.

Interestingly, Adrenal PCOS doesn't typically lead to weight gain like insulin-resistant PCOS. 

So if weight gain isn't a symptom for you, Adrenal PCOS might be more likely, particularly in cases of lean PCOS. However, it's still possible to have Adrenal PCOS if you are overweight.

If you mainly struggle with acne and hair changes, don't have weight gain, and your testosterone levels are normal according to blood tests, it's likely you may have Adrenal PCOS.

DHEAS can cause symptoms similar to high testosterone but isn't often measured by doctors, despite its significance. 

I've seen many clients who exhibit all the signs of androgen excess but have been told their testosterone levels are normal or low. 

If this sounds like you, remember that other androgens like DHEAS could be causing these symptoms, even if they haven't been identified in your blood tests.

What causes high stress hormones?

When mentioning "stress," it often brings to mind images of an overburdened businesswoman swamped with emails and deadlines, or a frazzled mother navigating traffic with noisy kids in the backseat. 


But there are various "stressors" that can lead to increased cortisol and DHEAS production.


Psychological stress from scenarios like these is a common aspect of our modern lives and contributes to stress hormone production. 


However, there are other factors that might be influencing your PCOS symptoms, which include poor sleep, chronic infections, loneliness, restrictive diets, excessive exercise, autoimmune diseases, and high caffeine intake.


You might not always feel overtly "stressed out," but it's possible to be hypersensitive to normal levels of stress hormones. 


In my book, PCOS Repair Protocol, I go deep on a study indicated that stress experienced during puberty could lead to the development of PCOS later in life.


Enduring high stress levels during this critical developmental period can "hardwire" the brain to be overly sensitive to stress in later years.


This information could be relevant if you experienced a significant loss, trauma during adolescence, or if you were involved in extreme dieting or exercise during those years.

A Personal Story – Adrenal PCOS was my missing link

Discovering Adrenal PCOS was a game-changer for me, linking together all my symptoms after years of struggle.


Five years into dealing with PCOS, I was eating to manage insulin resistance, which greatly improved my sugar cravings, moods, and energy levels.


My skin was clearing up, yet my menstrual cycles were still irregular, occurring every 60-70 days.


Despite diligently working on my health while balancing two jobs, university, and a social life, the irregularities persisted. 


A doctor's visit led to testing my testosterone levels, which surprisingly came back normal, leaving the irregularity of my cycles unexplained.


Suspecting other androgens might be involved, I took a urine test for DHEAS and cortisol. 


The results were eye-opening: my DHEAS levels were extremely high, and my cortisol levels were off the charts, indicating I was more stressed than I had realized.


This realization led me to reassess the impact of stress on my PCOS. 


My routine included 5am HIIT workouts to improve insulin sensitivity, followed by a hectic schedule of work, night classes, and social activities. 


I was strictly adhering to a low-carb diet and pushing myself to excel in every aspect of life.


It wasn't until I eased up on my self-imposed expectations that my symptoms began to improve. 


I replaced some HIIT sessions with leisurely walks or swims, started my day with a ten-minute meditation to reduce stress hormones, and learned to say no to activities that didn't bring me joy. I also adopted an 80/20 approach to my diet.


After three months of this more balanced approach, my menstrual cycles regularized to 32 days, and my skin cleared up entirely. This holistic method was the key to healing my PCOS at its core.


While the HIIT workouts and strict diet were beneficial for my insulin, adhering to them rigidly was increasing my stress hormones and DHEAS levels. 


I needed to find a balance that managed both cortisol and insulin simultaneously.


In the following section of this chapter, we'll explore strategies for managing multiple root causes of PCOS concurrently.

Common signs and symptoms of Adrenal PCOS

Take the quiz below to rate the likelihood of high stress hormones being a root cause of your PCOS. 


Each time you answer yes, give yourself one point.

If you said yes to six or more of the points above, there’s a high chance stress hormones are a driving force behind your PCOS. 


If you aren’t sure or would like to confirm this with testing, see below for the best tests to confirm this.

Free 3 min Quiz 

PCOS? Which Type Do You Have?

What if I have high scores for Insulin Resistance and Adrenal PCOS?

A common form of PCOS is a combination of Insulin Resistance PCOS and Adrenal (type 1 + 2). 


This happens because high stress hormones can lead to increased insulin resistance, and insulin resistance, in turn, places more stress on the body, exacerbating adrenal PCOS. 


Essentially, each condition feeds into and worsens the other.


While this might seem daunting initially, it's actually beneficial because addressing either root cause first positively impacts the other. 


If you strongly identify with both types, I recommend beginning with the Insulin Resistance Core Treatment Protocol outlined here. 


Once you're comfortable with that, you can then incorporate the Adrenal Core Treatment Protocol, gradually integrating these strategies into your existing routine.


Alternatively, if you feel that stress is a more pressing issue for you at the moment, it's perfectly okay to start with the Adrenal PCOS treatment and then move on to the Insulin Resistance protocol. 


Both approaches are effective regardless of the order, and you'll notice several common elements between the two protocols.

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Testing to confirm Adrenal PCOS

To confirm Adrenal PCOS, the most effective test is a blood or urine test that measures DHEAS levels.

While blood cortisol can be tested, it's challenging to measure accurately in a standard blood test. 

If you're interested in a more detailed analysis, salivary or urinary cortisol and cortisone (a cortisol breakdown product) tests are more sensitive. They can detect earlier changes in hormone levels.

These hormones should ideally be tested multiple times throughout the day. 

This approach helps track the rise and fall of your stress hormones and DHEAS, offering valuable insights into Adrenal PCOS.

For these tests, it's best to consult a practitioner trained in ordering and interpreting the Dried Urine Test for Comprehensive Hormones (DUTCH). 

You can find a list of accredited practitioners in your area through specific directories.

It's important to note that while these tests provide useful information about how your body handles stress and a baseline for future comparison, they are not mandatory for starting the Adrenal PCOS Protocol. 

They mainly offer additional insight and help track progress after implementing changes.

Adrenal PCOS Core Treatment

The primary focus for managing Adrenal PCOS is to regulate your cortisol production. Under stress, the hormone ACTH not only prompts cortisol release from your adrenal glands but also triggers DHEA secretion. 

In Adrenal PCOS, adrenal androgens like DHEAS are often the main contributors to your symptoms.

To balance cortisol, it's crucial to enhance your stress management, establish a sustainable self-care routine, and improve your sleep. These lifestyle modifications are more critical than the dietary changes discussed in a previous post.

If you identify with Adrenal PCOS, you might, like myself, have a 'Type A' or perfectionist personality. 

While this trait can be associated with creativity and high achievement, in the context of PCOS, it may lead to an all-or-nothing approach, especially in health-related aspects of life. 

This intensity can make sustaining healthy habits challenging and potentially add more stress.

For all types of PCOS, especially Adrenal PCOS, finding a balance is key. 

It's about maintaining a healthy lifestyle without overexerting yourself. Discovering this balance may require some trial and error.

Incorporating regular downtime and relaxation is as essential as scheduling workouts or meal prepping. You might need to reassess your exercise routine or make minor adjustments to your diet to lessen stress.

Additionally, consider whether social commitments or your work schedule contribute significantly to your stress. Take a candid look at your life and identify the areas that are most stressful for you.

About The Author - Tamika Woods

Tamika Woods | PCOS Author | Nourished Natural Health
Tamika Woods, Clinical Nutritionist (B.HS; B.Ed), Bestselling Author

For a decade, Tamika battled chronic acne, irregular cycles, mood swings, hair loss, painful periods, severe digestive issues and Polycystic Ovary Syndrome (PCOS). You name it - she's been there!

Tam was finally able to clear her skin, regulate her cycle, be free of period pain and fall pregnant naturally with her daughter in 2020. It took Tam 10 years and tens of thousands of dollars in tertiary education to get the answers she needed to get better.

She didn’t want other women to suffer as long as she did which is why she has dedicated her life to helping women in the same position as she was.

Tam helps women interpret what their bodies are trying to communicate through frustrating symptoms, and then develop a step-by-step roadmap to find balance again. She's here to help you get on track!

Tamika Woods is the author of the Amazon best seller PCOS Repair Protocol. She holds a Bachelor of Health Science degree (Nutritional Medicine) as well as a Bachelor of Education, graduating with Honours in both.

She is a certified Fertility Awareness Method (FAM) Educator and a certified member of the Australian Natural Therapists Association (ANTA).

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References used for this article

Yildiz BO, Azziz R. The adrenal and polycystic ovary syndrome. Rev Endocr
Metab Disord. 2007;8(4):331-342.

Christodoulaki C, Trakakis E, Pergialiotis V, et al. Dehydroepiandrosterone-
Sulfate, Insulin Resistance and Ovarian Volume Estimation in Patients With Polycystic Ovarian Syndrome. J Family Reprod Health. 2017;11(1):24-29.

Deng Y, Zhang Y, Li S, et al. Steroid hormone profiling in obese and nonobese
women with polycystic ovary syndrome. Sci Rep. 2017;7(1):14156-14156.

SPOTLIGHT: Hayley’s story with Adrenal PCOS

Hayley*, who had been battling PCOS for three years, came to me for help. Unlike many with Adrenal PCOS, she didn't have irregular menstrual cycles. 

Her primary concerns were acne, hair thinning, and stubborn belly weight.

To tackle her PCOS and lose weight, Hayley had joined a gym, training with a personal trainer five mornings a week. 

Her regimen included 45-minute high-intensity workouts at the gym and lengthy weekend runs. She also adhered to a strict low-carb diet as recommended by her trainer, eating the same meals daily and feeling uneasy whenever she strayed from her routine.

Working as a secretary in a high-pressure law firm, Hayley felt burdened by constantly managing others' expectations. 

When she consulted me, she was at her wit's end – exhausted, stressed, and unsure what more she could do, as she felt unable to exercise harder or eat less.

We adjusted Hayley’s workout routine, replacing three of her intense gym sessions with gentle morning walks or yoga. Her diet was also modified to include more gentle starches like potatoes, oats, rice, and whole fruits for snacks.

Initially, Hayley feared these changes might lead to weight gain, as she was eating more and exercising less, but she committed to the new plan for six months. She also started a morning breathing exercise to reduce cortisol levels.

Within three months, Hayley's skin cleared, her hair loss stopped, and she felt more energetic and clear-headed, better able to handle work stress. Although her weight remained the same, she felt much happier and healthier overall.

Remarkably, around the six-month mark, Hayley experienced a sudden drop in weight, losing the stubborn belly fat.

Hayley's experience underscores that the simple calories in, calories out approach is ineffective for PCOS. Addressing and healing the root cause is essential; otherwise, the body, feeling unsafe, will conserve energy and store weight as protection. 

By focusing on the root cause, weight loss can occur more naturally and with less effort than typically expected.

*Name changed for privacy.

Core Treatment #1: Empty Your Stress Bucket

Grab a pen and paper and start listing all the things that create pressure in your life, both the good and the bad. 

This includes concrete activities like going to the gym, eating healthily, socializing with friends, or meeting work deadlines, as well as more abstract pressures, such as self-imposed expectations to be the best mother, daughter, partner, or sister.

Dig deep and aim to get everything out onto the paper.

Once you've finished, take a moment to review your list. Are there items that seem more significant than others?

Now, honestly assess whether there are aspects on this list you could scale back on to benefit your hormonal health.

Some elements on your list might be fixed, but others could be more flexible. 

For instance, could you create more time for relaxation by turning down a couple of social plans on weekends? 

I personally follow a “maximum two events” rule for my weekends: after committing to two activities, no matter what comes up, my response is, “Thank you, but my weekend is already full. Let's plan for another time.”

Setting personal boundaries or establishing non-negotiables is crucial for managing stress and reducing cortisol production. 

It's also important to re-evaluate the expectations you place on yourself. If you tend to set high standards in certain areas, honestly consider whether these are genuinely beneficial for you. 

Ask yourself if letting go of some of these expectations could still lead to a fulfilling life.

Core Treatment #2: Create a Stress-Lowering Morning Ritual

Having created more space in your weekly schedule, the next step is to establish a morning ritual aimed at reducing stress hormones and setting the tone for a calmer day. 

The way you begin your day significantly influences how you handle stress as it arises.

Committing to this practice can lead to a noticeable decrease in overall stress levels in just a few days. 

Start by setting aside 10 to 15 minutes, preferably early in the morning.

The structure of this ritual is entirely up to you. The key is to choose activities that uplift you and that you eagerly anticipate, treating it as a precious gift to yourself to start the day positively.

Remember, your ritual doesn't need to be a formal meditation session. Below are some suggestions for morning rituals to inspire you. Choose two or three to start with, and feel free to modify them until you find what works best for you.

Consider marking the beginning of your ritual by lighting a candle, burning some incense, or playing calming music. I personally enjoy using a "Yoga and Meditation" playlist on Spotify for my morning routine.

Ideas for Morning Rituals:

Core Treatment #3: Make Time For Joy

Combatting excess stress hormones effectively can be as simple as engaging in activities that bring you joy. By 'joy', I mean doing things purely for pleasure, not for ticking off tasks on your to-do list. 

When you're immersed in an activity you love, life's urgency often fades away.

As adults, we sometimes forget to prioritize what brings us happiness because we're caught up in what we think we 'should' be doing. 

However, dedicating time to joyful activities can actually make you happier and more productive when it comes to essential tasks.

Take a moment to grab another piece of paper and jot down activities that used to bring you joy, even if they go back to your childhood. 

List as many as you can think of, no matter how trivial or child-like they might seem.

For instance, my client Emily, a mother of three, initially struggled with this task. She couldn't recall what she enjoyed before having children. 

A conversation with her mother reminded her that she loved coloring as a child. 

She bought an adult coloring book and now spends a few minutes each day coloring after her children are asleep. 

At first, she felt a bit silly, but it has become a cherished and relaxing part of her day, helping her unwind and reduce stress.

Now that you have your list of joyful activities, choose one. Plan where you can fit this activity into your week and make it a priority. It's a simple, yet effective way to bring down stress levels and enhance your overall well-being.

Core Treatment #4: Remove or Reduce Caffeine

In her book "Rushing Woman’s Syndrome," Dr. Libby Weaver discusses how our fast-paced, never-ending to-do list lifestyle is impacting our primitive biology. 

Despite technological advancements allowing us to do things quicker, our bodies haven't adapted at the same pace, leading to noticeable effects.

To keep up with life's demands, many of us rely on stimulants like caffeine. However, for women with PCOS and adrenal imbalances, excess caffeine can exacerbate issues by increasing cortisol and adrenaline production. 

This leads to more DHEAS, worsening PCOS symptoms.

I understand it might be unwelcome advice, but reducing or even temporarily eliminating caffeine could significantly benefit your PCOS. 

It's not necessary to quit caffeine abruptly, and it may not be a permanent change, but consider the amount of caffeine you consume and the possibility of taking a break for your hormonal health.

Sensitivity to caffeine varies among individuals. 

If you can't drink coffee after a certain time of day or feel anxious after consuming it, you might be more sensitive and could benefit from eliminating caffeine for three to six months to allow your adrenal glands to recover. 

If caffeine doesn't noticeably affect you, limiting yourself to one cup per day could be sufficient. Note that this means one espresso shot or a standard cup of coffee, not a triple shot or a large size.

To minimize caffeine withdrawal symptoms, taper off gradually. 

For instance, if you usually drink three cups a day, reduce to two for a week, substituting one with decaf coffee or green tea. In the second week, cut down to one weaker caffeinated cup. 

By the third week, switch entirely to decaf or just one cup of green tea. 

If this feels comfortable, you could even switch to decaf green tea to become completely caffeine-free while your adrenals recover.

If you significantly reduce caffeine for a few months and don't observe notable changes, you can try reintroducing a small amount and monitor your symptoms. 

As caffeine metabolism varies from person to person, finding your ideal balance might require some experimentation.

Core treatment #5: Assess Your Exercise Levels

Are you over-exercising? Whilst regular exercise has been shown to lower stress hormones, overdoing it can have the opposite effect. 

You will know that you are doing too much if you still feel tired 15 minutes after finishing your workout.

"Exercise Should Make you feel more energized soon afterward."

The 15-minute rule is a useful measure to determine how well your adrenals handled your recent workout. 

If you find yourself collapsing on the couch afterward, it's a sign that your exercise routine caused an overproduction of cortisol and adrenaline.

This is particularly concerning for those with Adrenal PCOS, as the impact of high-intensity exercise on hormones needs to be carefully managed.

For individuals with Adrenal PCOS, it's essential to evaluate whether a rigorous exercise regimen is beneficial or detrimental to your health. 

If your stress hormones are elevated, it might be wise to switch to slower, more restorative forms of exercise such as walking, yoga, gentle pilates, or slow-paced weight training. 

This adjustment may only be necessary temporarily, while you focus on reversing your root cause.

We've written a detailed guide on the best exercise for PCOS here.. 

For the moment, take an honest look at your current exercise habits and consider where you could ease up. 

The goal is for exercise to be energizing and stress-relieving rather than exhausting.

Core Treatment #6: Balance Your Melatonin and Cortisol

Quality sleep at consistent times each day is crucial for managing PCOS, especially for those with Adrenal PCOS.

Our "sleepy" hormone, melatonin, naturally increases as the evening approaches, preparing us for sleep. In contrast, with the sunrise, melatonin production decreases, and cortisol levels rise. 

Think of melatonin and cortisol as being on opposite ends of a seesaw: when one decreases, the other increases. In a healthy circadian rhythm, this pattern is balanced and aligns with the sun’s cycle.

While excessive cortisol can have negative effects, it's essential in appropriate levels and at the right times. Cortisol helps us feel awake and energized in the morning.

If you've been struggling with Adrenal PCOS, it's likely that your cortisol and melatonin levels are imbalanced. You may find it hard to wake up, rely on caffeine to start your day, and not feel fully alert until midday. 

Then, just as you're getting ready for bed, you might experience a burst of energy, making it difficult to sleep. This can lead to disturbed sleep and waking up feeling unrefreshed, perpetuating the cycle.

A key step in managing your cortisol levels is to realign your melatonin and cortisol rhythm. 

Yyou can start with these basic guidelines to enhance your sleep-wake cycle:

Core Treatment #7: Consider a Stress-Lowering Herbal Blend

Along with the principles we’ve covered in this chapter, adding one or two nutritional supplements to support your body’s ability to cope with stress can dramatically improve and speed up your results with Adrenal PCOS.

My favorite herbal medicine for stress relief is ashwagandha root. 

This herb has been clinically proven to reduce chronic stress, lower cortisol, and lower anxiety.

Ashwagandha is an adaptogen, meaning that it helps your body adapt to stress. 

While the principles we’ve covered so far will go a long way in reducing stress in your life, some level of stress in the modern world is inevitable. 

My clients and I have found profound benefits from taking an ashwagandha blend like Calm + Destress.

An eight-week study comparing ashwagandha root with a placebo found that perceived stress and anxiety scores significantly decreased in those participants taking the herbal medicine.78 

The participants taking ashwagandha also showed significant improvement in salivary cortisol and had greatly improved sleep quality compared with the placebo. 

Early research also suggests that ashwagandha may improve blood sugar control and diabetes,79 making it the perfect Adrenal PCOS tool. 

Read more about Calm + De-stress Ashwaghanda for PCOS here.

Core Treatment #8: Support Stable Blood Sugar

Keeping your blood sugar at a steady level throughout the day is important for managing cortisol, a stress hormone in your body.

When your blood sugar gets too low (usually when you haven't eaten for a while or had too many sugary foods), your body releases cortisol. 

This happens because low blood sugar is like a signal of stress, and cortisol helps you deal with it by making you want to find food.

To avoid this cycle, it's essential to keep your blood sugar from dropping dangerously low. You can do this by following the PCOS Plate Method. 

It may also help to have some healthy snacks between your main meals so you don't get super hungry when it's time to eat.

When you snack, try to pick something with protein or healthy fats to prevent big ups and downs in your blood sugar. 
For instance, you could have an apple with almond butter, a protein-packed smoothie, or veggies with hummus and guacamole.

In your lunch and dinner meals, make sure to include some gentle starch, like we talked about in chapter 12. 

Carbohydrates not only help with your cortisol levels but also support the good bacteria in your gut that make a calming neurotransmitter called GABA. We all could use a bit more calm!

SUMMARY: Core Treatments for Adrenal PCOS

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About The Author - Tamika Woods

Tamika Woods | PCOS Author | Nourished Natural Health
Tamika Woods, Clinical Nutritionist (B.HS; B.Ed), Bestselling Author

For a decade, Tamika battled chronic acne, irregular cycles, mood swings, hair loss, painful periods, severe digestive issues and Polycystic Ovary Syndrome (PCOS). You name it - she's been there!

Tam was finally able to clear her skin, regulate her cycle, be free of period pain and fall pregnant naturally with her daughter in 2020. It took Tam 10 years and tens of thousands of dollars in tertiary education to get the answers she needed to get better.

She didn’t want other women to suffer as long as she did which is why she has dedicated her life to helping women in the same position as she was.

Tam helps women interpret what their bodies are trying to communicate through frustrating symptoms, and then develop a step-by-step roadmap to find balance again. She's here to help you get on track!

Tamika Woods is the author of the Amazon best seller PCOS Repair Protocol. She holds a Bachelor of Health Science degree (Nutritional Medicine) as well as a Bachelor of Education, graduating with Honours in both.

She is a certified Fertility Awareness Method (FAM) Educator and a certified member of the Australian Natural Therapists Association (ANTA).

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Hormone Healing Recipes

References used for this article

Yildiz BO, Azziz R. The adrenal and polycystic ovary syndrome. Rev Endocr
Metab Disord. 2007;8(4):331-342.

Christodoulaki C, Trakakis E, Pergialiotis V, et al. Dehydroepiandrosterone-
Sulfate, Insulin Resistance and Ovarian Volume Estimation in Patients With Polycystic Ovarian Syndrome. J Family Reprod Health. 2017;11(1):24-29.

Deng Y, Zhang Y, Li S, et al. Steroid hormone profiling in obese and nonobese
women with polycystic ovary syndrome. Sci Rep. 2017;7(1):14156-14156.
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