What is adrenal PCOS?

Some women with polycystic ovarian syndrome (PCOS) don’t have high testosterone on their blood test, but instead have high dehyroepiandrosterone-sulphate (DHEAS). This mouthful-of-a-word stands for a hormone produced by our adrenal glands.

Both DHEAS and testosterone belong to the group of hormones collectively known as androgens, or ‘male-type hormones’: the hormones responsible for male-type characteristics such as facial hair growth and male-pattern balding. In women, a small amount of androgens is normal and beneficial, but a larger amount leads to PCOS and its related symptoms.

      What is the difference between adrenal PCOS and regular PCOS?

Most of us are more familiar with testosterone as being the bad guy in PCOS. Testosterone production from the ovaries is commonly up-regulated in women with PCOS as a result of a deeper hormonal imbalance driven by a combination of genetics and lifestyle factors (e.g. diet, exercise and weight).

It is closely linked with insulin resistance, which ultimately leads to the stimulation of testosterone production from the ovaries. However, sometimes it is the overproduction of the adrenal-androgen DHEAS that is responsible for PCOS symptoms. This is commonly referred to as ‘adrenal PCOS’.

     What does DHEAS do?

DHEAS itself is an inactive hormone. It acts more as a reservoir from which testosterone and oestrogen can be made via conversion in the body’s tissues. This increases testosterone directly in the tissues, not in the blood, so you can have high tissue levels of testosterone that is not picked up in blood tests.

High tissue levels of testosterone leads to symptoms like acne, oily skin, polycystic ovaries and lack of ovulation (causing infertility). It also worsens insulin resistance, which means your ovarian testosterone production is also stimulated.

     What causes elevated DHEAS in women with PCOS?

There are several causes of elevated DHEAS

  • Researchers think genetics play a role in excess androgen production.
  • High prolactin may be behind the overproduction of DHEAS. You can have this hormone tested in a blood test to see if it is high.
  • High stress during puberty may also play a role, as may current stress.
  • Remember, if you haven’t been diagnosed with PCOS, your elevated DHEAS may be due to other causes, such as congenital adrenal hyperplasia – make sure your options have been thoroughly investigated by your doctor.

     Natural treatments for adrenal-type PCOS

The main treatment is to reduce stress. When we are stressed, our brain sends out adrenocorticotropic hormone (ACTH), which stimulates cortisol production from our adrenal glands. Cortisol is the hormone that helps us cope with stress, but when ACTH acts on the adrenal glands, it also stimulates DHEAS production. This means that if we are chronically stressed, DHEAS is chronically stimulated.

     Reduce stress by:
  • Decreasing your exposure to stressful situations (this may mean changing your job, friends or living situation, cutting down work hours, getting more sleep and releasing negative thoughts – yes, this means that thing you have been avoiding dealing with).
  • Mindfulness meditation daily. The Smartphone app Smiling Mind is a good place to learn this. It only takes 5-10 minutes per day and has been demonstrated by science to reduce cortisol and adrenalin levels.
  • Enjoying moderate levels of gentle exercise such as 30-60 minutes of walking, yoga, dancing or Chi gong, 3-5 times per week. Many women who exercise strenuously or every day experience interruptions to their menstrual cycle because it causes stress on your body and may result in low body weight. Over-exercising is not it.
  • The herbal medicines rhodiola, withania, lemon balm (Melissa), and passionflower can be used alone or in a combination product to act directly on your stress response.

In a clinical trial, drinking two cups of marjoram tea per day has also been shown to lower DHEAS in women with PCOS. This was a preliminary pilot study and the women in the trial did not have DHEAS levels above the normal reference range, however this simple, safe strategy is worth a go. Use one heaped teaspoon of dried marjoram (preferably organic or home grown) in 250ml of boiling water, steep for 20 minutes with the lid on. Drink twice daily between meals for at least a month.

Finally, if your prolactin is high, this can be reduced by taking the herb Vitex agnus-castus (chaste tree). This should be taken every morning on an empty stomach, immediately after waking for 3-6 months. The recommended dose will be on the label, however you should investigate the strength of the product for therapeutic use in your situation.