PCOS and Stress: Understanding Cortisol Hormones

10 years ago, the American Psychological Association (APA) delivered unsurprising news: Americans were stressed, even more so than in years previous. The APA’s 2010 ‘Stress in America’ survey found, among 1100+ respondents, 76% cited money as a high source of stress, while work and the economy clocked in around 70% and 65%, respectively. So over a decade on: are we still stressed? The answer appears to be an unequivocal yes, but for different reasons: for the APA’s 2022 survey, the rise in price of everyday items, supply chain issues, and global uncertainty were all major sources of stress for over 80% of respondents. It goes without saying that, on an individual level, we can’t solve macro-economic problems, but we can use this report as a reminder to better take care of our personal mental health, as best as possible.

As a first step, that requires a look at what the most common stressors are for people. We’ll then explore the effects of stress on the body, and finish with some science-backed suggestions for reducing stress that cost nothing and are accessible. Let’s begin!

What kind of things provoke stress?

We can divide stress into multiple categories: there are personal life events that are outside of our control, but happen to us by chance, global events going on around us, and stressors that we can try to tackle (for example, by switching jobs or taking some commitments off of our plate). Any of the above things can snowball into what is often referred to as chronic stress: according to Yale Medicine, this is characterized as a “consistent sense of feeling pressured and overwhelmed for a long period of time.”

So let’s rewind for a second: how do you become chronically stressed? Because it certainly doesn’t happen overnight. And what kind of things are most likely to provoke stress?

Well, stressful situations can look different for different people. However, the most universal sources of high stress for individuals include:

• Divorce, or a deeply dysfunctional/unhealthy relationship
• Death of a loved one
• Loss of a job
• Chronic illness or injury
• Mental health problems (depression, anxiety, OCD, and so on)
• A traumatic event
• Taking care of an eldery family member
• Financial trouble

What all stressful events have in common

The above list is by no means exhaustive. For instance, if you are experiencing issues at work, but you can’t quit because you don’t have a backup job available, or you know it will take a significant period of time to transfer positions, this can also be a high stress event.

What characterizes most stressful events is the feeling of extreme negative emotion (such as sadness, shock, upset, or anger), combined with a feeling of powerlessness or hopelessness. In the above example we just gave, if you have a year’s worth of savings, then you may feel cushioned by the knowledge that you could theoretically quit today and remove this stressor from your life without too much financial upset. This gives breathing room, a sense of agency, and a source of hope: within a certain amount of time, if things don’t get better, you can leave. When you feel you don’t have options, that is when stress can seem never-ending, and compound onto itself and become chronic.

We give this example to reassure you that if you believe you have a source of significant stress in your life (or worse, multiple), but it doesn’t appear on this list, your stress is still entirely valid. If you feel that others may not understand because it’s not characterized as “bad enough” by arbitrary standards of what “should” upset you or not: we encourage you to not let this restrictive mindset shame you into hiding your stress. Give yourself the space to acknowledge your stress and the time to understand where it’s coming from.

The key to understanding stress

Anyone who tries to diminish your feelings, without properly listening, or telling you that ‘things could be worse’ is not helpful. Very few people become less stressed by being told to just not be stressed. So let’s talk about what your stress is trying to do for you, because – believe it or not – its intention is to be beneficial.

This information about stress’ intended function will prove immensely helpful later, when we discuss stress-reducing strategies: we will take stress signals and reverse-engineer them to trick our bodies into feeling less stressed. This intentional switch will target turning off the sympathetic nervous system (“fight or flight”) and turning on our parasympathetic nervous system (“rest and digest”). So let’s talk about stress and its impact on the body.

How stress affects you, physically and emotionally

You may already know that, in the short term, a small amount of stress is thought to be good for us. This is because our bodies are well-equipped to handle stress in small doses: it alerts us to the fact that something is wrong, we need to change something, or we need to take certain steps, in order to ultimately remove the cause of stress from our lives. The problem emerges when sources of stress never let up.

So let’s quickly go over what happens when your body experiences a stressful event, according to the APA:

1. Your muscles tense

The musculoskeletal system is first to be primed when we feel stressed. Our jaws tense, our hands might clench into fists, our backs turn stiff: this muscle tension is thought to be a “reflex reaction to stress. . . the body’s way of guarding against injury and pain.”  

2. Your breathing becomes shorter

Breathing is controlled by the respiratory center of the brain. However, when we become stressed, our breathing rate changes as part of a “fight or flight response.” Rapid breathing and taking shorter breaths that feel focused in your upper-chest are signals your mind is moving fast, you feel unsettled, or you are upset.

3. Your heart rate increases

Both the heart and your blood vessels play an important role in controlling the cardiovascular system, as well as coordinating your body’s response to a stressful situation. Acute stress (that which is short-lived) makes your heart beat faster and triggers stronger contractions of the heart muscle. Your blood vessels will direct blood to this part of your body as a result of the stress hormones adrenaline, noradrenaline, and cortisol, and increase your blood pressure.

Unfortunately, when this occurs over a prolonged period of time – such as when you experience chronic stress – the heart is put under more pressure. Elevated levels of stress hormones and increased blood pressure are linked to increased risk of hypertension, heart attack, and/or stroke.

4. Your hormones trigger a stress response

Commonly referred to as “the stress hormone,” you may already be familiar with cortisol. Through a succession of complex internal events, a hormone signals the adrenal glands in your body to increase the production of cortisol. This is intended to give us the energy needed to “mobilize glucose and fatty acids from the liver,” while also activating the immune system.  

When cortisol is in constant production, though, we run into a problem: a perpetual state of inflammation, and impaired communication between the immune system and the HPA axis. Enter increased chances of chronic fatigue, metabolic disorders, and depression.

5. Your gut changes

We often think of the gut and the brain as disconnected, or at the very least separate, but in actuality, the stomach has hundreds of millions of neurons which intimately communicate with the brain. During times of stress, people can find themselves bloated, experiencing stomach pain, acid reflux, diarrhea, constipation, or even vomiting. It’s worth noting that people with chronic bowel disorders, such as IBS (well known as a “stress-sensitive disorder”), can also find themselves experiencing worse symptoms, thanks to changes in gut microbiota, intestinal sensitivity, and even alterations in the central nervous system.

So now we have an idea of what’s going on behind the scenes when your body goes through a stressful event, let’s look at how this may manifest in physical symptoms as well as interpersonal interactions.

Physical symptoms of stress

Some of these you may be more familiar with, while others you may only realize you experience when you read this list, put together by the Cleveland Clinic:

• Headaches or migraines
• Muscle tension
• This can manifest in the form of jaw clenching or grinding your teeth at night
• General fatigue or exhaustion
• Sleep disturbances
• Chest pain or racing heart
• Digestive problems
• This can include diarrhea, stomach pain, and constipation
• Aching joints
• High blood pressure
• Weakened immune system
• If you notice yourself getting ill more easily with colds and the flu, your immune system may be under stress

Interpersonal relationships under stress

As we know, stress isn’t isolated to one area of the body or one area of your life. Sometimes this tension and worry we carry when we’re stressed can spill into our interactions with those we are closest with. Stress can also manifest in the following ways:

• You find yourself easily snapping
• This may feel in general you’re in a bad mood, or you have less patience than you used to
• You are withdrawing from others
• Losing interest in people and things you used to enjoy can be a red flag for depression – if you find yourself retreating into yourself and becoming more reserved, we highly urge you to reach out to both a doctor and a therapist, who can discuss the psychological and physiological effects stress may be exerting on your body.
• You feel anxious a lot of the time
• Stress can result in difficulty sleeping, a general sense of dread or being under threat, and worrying about things uncontrollably. Again, in this situation, we cannot emphasize enough the importance of reaching out to loved ones, and if possible, seeing a therapist to discuss how to control your anxiety.
• You feel bad about yourself
• Have you noticed more negative thoughts about yourself and lower confidence in completing tasks you used to do? Lower self esteem can also look like dressing differently, speaking less in conversations, and not taking part in activities you used to like.

Science-backed remedies for stress

Stress can seem stressful in and of itself, but we want to emphasize that there are techniques for reducing stress. The methods we’re about to describe certainly aren’t exhaustive, and if your stress is chronic or really bothering you, then it could be extremely beneficial to work with a mental health professional who can create a tailored treatment plan (one that is flexible and adaptable) suited to your ongoing needs.

Perhaps the best way to think of these things isn’t as another task to tick off on your already full to-do list, but instead as routine self care. They are things that can help manage everyday stress levels, while giving yourself time to focus on the present and think solely of what brings you joy.

With that being said, here are a few science-proven ways you can alleviate stress, for little to no cost.

1. Be in nature

A 2019 study found that just 20 minutes in nature a few days a week could reduce stress. This doesn’t have to be a national park or big hike, either: it can be any accessible outdoor space that allows you to have a little interaction with nature. Think patios (even large, open windows), greenways, public parks, lakes, the beach, to your own backyard, and so on. Results were demonstrated in lowered levels of cortisone taken from saliva samples before and after the nature outings. Another study carried out by psychiatric researchers found that being in nature lowered feelings of isolation, promoted feelings of calm, and lifted mood in patients.

And if nature isn’t really your thing? Try to get some cuteness in your life in the way of cat sitting, walking your friends’ dogs, or even getting your own pet. Animals are shown by research to reduce feelings of loneliness, lower cortisol levels in the blood, and boost your mood.

2. Volunteer and serve others

One of the worst things about stress is how it can make you feel a complete lack of control over important areas of your life, in addition to feeling isolated in your pain. To counteract this, volunteering at a community organization that is important to you can improve feelings of efficacy, while also generating feelings of gratitude and fostering community. Much more research is needed in this area (for instance, one key study focused solely at adults over 50 and how volunteering increased life expectancy), but initial results are promising. It also helps give you a sense of purpose and meaning – in addition to offering a welcome distraction – even when things in your life might be really challenging.

3. Exercise

We’ve talked about the multiple reasons exercise is good for you and your mental health, but it’s also helpful in relation to modest stress reduction. This same linked study also found there is evidence that exercise may help your “emotional resistance” to stress; in other words, correlational evidence suggests it reduces stress in general, while also making you more likely to experience reduced stress levels in response to life’s inevitable stressors. However, if you feel that exercise becomes excessive (you feel exhausted or sleepy after), obsessive, a “should,” or contributes to your stress in any other way; consider other stress management techniques.

4. Make connections

One systematic review looking at the impact of adolescent friendships on childhood adversity (CA) found that “a growing body of research demonstrates the positive impact of adolescent friendship support on mental well-being after CA.” Though they aren’t sure on the why behind friends’ stress-reduction influence, they conjecture “neurobiological models of social buffering suggest that social support can reduce perceptions, reactions, and physiological responses to and after stress.”

And while we may not all have adolescent friendships to lean on, a tentative takeaway of this review would indicate that friendships in general are helpful to reducing how stressed we feel during and after an event. In fact, whether it’s a trusted family member, a partner, or a friend, confiding in someone about your feelings and asking for support can be a great way to reduce feelings of isolation that  can crop up during times of stress.

Check out this TED talk for even more information on how the quality of our relationships help us live more fulfilled (and longer) lives.  

5. Pay attention to the breath

We’ve talked about healthy habits you can cultivate to be more mindful, but it’s worth focusing on a small thing you can do each day to increase feelings of mindfulness, and try to control your stress levels in certain situations at the same time. In a nutshell: slow, controlled breathing. Healthline outlines 10 different breathing techniques to try, but the diaphragmatic method (breathing slowly into your stomach, versus short breaths that are in your upper chest), and alternate nostril breathing (shown to lower heart rate) are great for slowing down and coming back to the present moment.

Allara provides personalized treatment that takes the guesswork out of managing PCOS, and offers a customized, holistic plan of attack that merges nutrition, medication. supplementation, and ongoing, expert support to begin healing your body.

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