Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder, but it is not a single condition; it is a spectrum of subtypes. Adrenal PCOS (APCOS) is a specific presentation where the excess androgens, or “male hormones,” primarily originate from the adrenal glands, rather than the ovaries or as a result of insulin resistance, which is typical of other types. The adrenal glands, located above the kidneys, produce androgens, particularly DHEA-S (dehydroepiandrosterone sulfate), which is often elevated in this subtype. This adrenal overproduction is frequently linked to a chronic stress response or a dysfunction in the communication pathway known as the Hypothalamic-Pituitary-Adrenal (HPA) axis. Managing Adrenal PCOS requires a comprehensive approach that targets this underlying stress-hormone connection.
Identifying High Adrenal Androgens
Distinguishing Adrenal PCOS from other PCOS subtypes depends almost entirely on identifying the source of androgen excess. In the more common forms of PCOS, testosterone and androstenedione, often driven by high insulin levels or ovarian activity, are the primary elevated androgens. However, in Adrenal PCOS, the most telling diagnostic marker is significantly elevated levels of dehydroepiandrosterone sulfate (DHEA-S) in the blood.
DHEA-S is produced almost exclusively by the adrenal glands, making it a reliable indicator of adrenal hyperandrogenism. Women with Adrenal PCOS may have high DHEA-S while their total testosterone and insulin levels remain within the normal range, a pattern that guides the specific treatment strategy.
Foundational Lifestyle Changes for Stress
Managing chronic stress and regulating the HPA axis is the most important element in treating Adrenal PCOS, as stress directly stimulates the adrenal glands to overproduce androgens. The HPA axis controls the body’s stress response by releasing the hormone ACTH, which in turn stimulates the adrenal glands to produce both cortisol and DHEA-S. Reducing chronic psychological and physical stress is therefore a direct way to dampen the signal driving DHEA-S production.
Specific stress management techniques are highly effective for modulating this response. Practices such as mindfulness, controlled breathing exercises, and yoga can help to activate the parasympathetic nervous system, promoting a state of calm. Regular meditation, even for a short duration daily, helps to lower circulating cortisol levels, which in turn reduces the stimulus for adrenal androgen release.
Optimizing sleep hygiene is also a component of HPA axis regulation. Poor sleep quality or insufficient duration can elevate cortisol levels, disrupting the natural circadian rhythm and increasing adrenal strain. Establishing a consistent bedtime routine and aiming for seven to nine hours of quality sleep helps to regulate the body’s natural cortisol decline in the evening. Magnesium supplementation can often be helpful in promoting more restful and uninterrupted sleep.
The type of physical activity is also important, as intense or prolonged high-intensity exercise can be perceived as a physical stressor by the adrenals. Instead of strenuous cardio like high-intensity interval training (HIIT), focus should be placed on lower-intensity movement that supports, rather than stresses, the body. Recommended activities include strength training, walking, swimming, or restorative practices like Pilates and yoga.
Targeted Dietary and Nutritional Support
Dietary choices and specific nutrients can significantly support adrenal function and help stabilize the hormonal environment. While insulin resistance may not be the primary driver in Adrenal PCOS, maintaining stable blood sugar is still beneficial, as large fluctuations can act as a physical stressor on the adrenal glands. This can be achieved by prioritizing meals that include adequate protein, healthy fats, and high-fiber carbohydrates, which slow glucose absorption and prevent energy crashes.
An anti-inflammatory diet rich in antioxidants helps combat the inflammation often associated with hormonal imbalances and chronic stress. Consuming a wide variety of colorful fruits, vegetables, and anti-inflammatory fats, such as those found in fish, can support overall metabolic health. It is also helpful to limit or avoid excessive intake of caffeine and refined sugars, as both can destabilize blood sugar and unnecessarily stimulate cortisol release.
Certain supplements can provide targeted support for adrenal health and androgen management, but they should be used under professional guidance. Adaptogens are a class of herbs that help the body adapt to stress, such as Ashwagandha and Rhodiola, which have been shown to support a healthy cortisol response. These herbs may help improve stress resilience and regulate the HPA axis.
B vitamins, particularly Pantothenic Acid (Vitamin B5), are necessary cofactors for healthy adrenal hormone production. Magnesium is another beneficial supplement, as it is involved in hundreds of bodily processes, including stress response and sleep regulation. Additionally, compounds like phosphatidylserine may help to dampen excessive cortisol production, especially when taken at night to support the natural nighttime decline of the stress hormone.
Prescription Management Strategies
While lifestyle and nutritional adjustments are the first line of defense, prescription medications may be necessary when adrenal androgen levels remain significantly elevated or symptoms are severe. The goal of medical management is to either suppress the production of adrenal androgens or to block their effects on the body. These treatments require careful monitoring by a healthcare provider due to potential side effects.
Low-dose glucocorticoids, such as dexamethasone (typically 0.25–0.5 mg taken at bedtime), are sometimes used specifically to suppress the excess DHEA-S production from the adrenal glands. This medication works by inhibiting the release of ACTH from the pituitary gland, thereby reducing the adrenal stimulation that causes androgen overproduction. Due to the potential for side effects like reduced insulin sensitivity and adrenal atrophy, this therapy is generally reserved for patients with marked adrenal hyperandrogenism and is not a long-term solution.
Anti-androgen medications, such as spironolactone, are another common prescription used to manage the symptoms of high androgens, like hirsutism (excess hair growth) and acne. While these drugs do not treat the root cause of the adrenal overproduction, they block the action of androgens at the receptor level in target tissues like the skin.