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Adrenal PCOS vs Ovarian PCOS: Treatment Approaches
If you've been diagnosed with PCOS, you may not realize that there are different types of this condition. Understanding whether you have adrenal PCOS or ovarian PCOS can significantly impact your treatment plan and help you manage your symptoms more effectively.
This article examines the key differences between these two types of PCOS and provides targeted treatment approaches for each.
Understanding PCOS Types: Beyond a Single Diagnosis
Polycystic Ovary Syndrome (PCOS) affects approximately 8-13% of women of reproductive age, making it one of the most common hormonal disorders. However, it's not a one-size-fits-all condition.
Recent research suggests that there are distinct types of PCOS based on the primary source of elevated androgens (male hormones) in the body:
Adrenal PCOS: Where excess androgens are primarily produced by the adrenal glands
Ovarian PCOS: Where excess androgens are mainly produced by the ovaries
Some women may also have a combined type with both adrenal and ovarian androgen production. Understanding your specific type can lead to more targeted and effective treatment strategies.
Adrenal PCOS: Key Characteristics
Adrenal PCOS has several distinctive features that set it apart from ovarian PCOS:
Hormone Profile
Elevated DHEA-S: The primary marker of adrenal PCOS is high levels of Dehydroepiandrosterone sulfate (DHEA-S), an androgen produced mainly by the adrenal glands
Normal or slightly elevated testosterone: Testosterone levels may be normal or only mildly elevated
Possible cortisol imbalances: Many women with adrenal PCOS also have dysregulation of cortisol, the stress hormone
Common Symptoms
Women with adrenal PCOS often experience:
Significant stress sensitivity
Fatigue and energy fluctuations throughout the day
Hirsutism (excess hair growth) and acne, though sometimes less severe than in ovarian PCOS
Less likely to have insulin resistance compared to ovarian PCOS
May have normal weight or be underweight (though not always)
Potential Causes and Triggers
Adrenal PCOS is often associated with:
Chronic stress: Prolonged stress can disrupt adrenal hormone production
Genetic predisposition: Family history of adrenal disorders or PCOS
Inflammation: Chronic inflammation may affect adrenal function
Environmental factors: Certain toxins may disrupt adrenal hormone production
It's important to note that adrenal PCOS shares some features with Cushing's syndrome, though they are distinct conditions.
Ovarian PCOS: Key Characteristics
Ovarian PCOS is the more commonly recognized form of PCOS and has these distinguishing features:
Hormone Profile
Elevated testosterone: The primary marker is high levels of testosterone produced mainly by the ovaries
Normal or slightly elevated DHEA-S: DHEA-S levels may be normal or only mildly elevated
Often elevated LH/FSH ratio: Disruption in the ratio of luteinizing hormone to follicle-stimulating hormone
Common Symptoms
Women with ovarian PCOS typically experience:
More pronounced insulin resistance
Greater tendency toward weight gain, especially around the abdomen
More severe hirsutism and acne due to higher testosterone levels
Irregular or absent periods
Multiple small cysts on the ovaries (though not always present)
Possible skin tags, acanthosis nigricans (darkened skin patches)
Potential Causes and Triggers
Ovarian PCOS is often associated with:
Insulin resistance: A primary driver that stimulates ovarian androgen production
Genetic factors: Family history often plays a significant role
Metabolic dysfunction: Issues with energy metabolism and mitochondrial function
Environmental factors: Endocrine-disrupting chemicals may play a role
In some cases, women with significant insulin resistance may benefit from specialized approaches for lean PCOS, even if they don't fit the typical weight profile.
Diagnostic Approaches: Identifying Your PCOS Type
Determining whether you have adrenal or ovarian PCOS typically involves specific testing:
Key Tests for Differentiating PCOS Types
Hormone Panel: Testing for total and free testosterone, DHEA-S, androstenedione, cortisol
Adrenal Function Testing: Morning cortisol, 24-hour urinary or salivary cortisol rhythm tests
Glucose Metabolism Tests: Fasting glucose, insulin, and HbA1c; glucose tolerance test
Pelvic Ultrasound: To assess ovarian appearance and potential cysts
Interpreting Results
Generally, these patterns help distinguish between types:
Adrenal PCOS: DHEA-S will be elevated (often >200 μg/dL), while testosterone may be normal or only slightly elevated
Ovarian PCOS: Testosterone will be elevated, while DHEA-S may be normal or only slightly elevated
Combined type: Both DHEA-S and testosterone will be significantly elevated
Always work with a healthcare provider to interpret your results correctly, as other conditions can cause similar hormone patterns.
Treatment Approaches for Adrenal PCOS
Managing adrenal PCOS focuses on supporting adrenal health and reducing stress-related hormone disruption:
Lifestyle Modifications
Stress Management: Perhaps the most critical intervention for adrenal PCOS
Regular meditation or mindfulness practice
Adequate sleep (7-9 hours in a regular pattern)
Gentle exercise like yoga, walking, or swimming
Stress-reduction techniques such as deep breathing or progressive muscle relaxation
Exercise Considerations:
Avoid excessive high-intensity exercise, which can stress the adrenals
Focus on moderate activity with adequate recovery
Consider strength training 2-3 times per week
Include restorative activities like gentle yoga or tai chi
Sleep Optimization:
Establish a regular sleep schedule
Create a relaxing bedtime routine
Limit screen time before bed
Consider blackout curtains and cool room temperature
Dietary Approaches
Nutritional support for adrenal PCOS focuses on adrenal health and stress reduction:
Regular, balanced meals: Avoid skipping meals, which can stress the adrenals
Moderate, high-quality carbohydrates: Unlike ovarian PCOS, severe carb restriction may not be necessary
Blood sugar stabilization: Pairing carbohydrates with protein and healthy fats
Mood disorders: Depression and anxiety are common with both PCOS types
Autoimmune conditions: May be more common with adrenal PCOS
Conclusion: Personalized Treatment for Your PCOS Type
Understanding whether you have adrenal PCOS, ovarian PCOS, or a combined type is a crucial step in developing an effective treatment plan.
While the general principles of healthy eating, regular physical activity, and stress management benefit all types of PCOS, the specific approaches and emphasis may differ significantly.
Work with healthcare providers who recognize these distinctions and are willing to test appropriate hormones to determine your specific type. With the right targeted approach, you can effectively manage your symptoms and improve your overall health and quality of life.
Remember that PCOS treatment is not one-size-fits-all—your personal needs should guide your treatment strategy. By addressing the root causes specific to your PCOS type, you can achieve better results than with generic PCOS treatment approaches.
Extra Tip: Consider Testing at Different Times
Hormone levels can fluctuate throughout your menstrual cycle and in response to stress. If possible, consider testing your hormone levels at different times—both during a relatively low-stress period and during a more stressful time.
This can provide valuable insights, especially for those with suspected adrenal PCOS, as stress significantly impacts adrenal hormone production. Similarly, testing at different phases of your menstrual cycle (if you have regular cycles) can provide a more complete picture of your hormonal patterns.
How This Article Was Made
This article was created through comprehensive research of scientific literature, clinical studies, and endocrinology resources focused on PCOS subtypes. Information was gathered from peer-reviewed journals, clinical guidelines, and reputable medical resources including:
The Journal of Clinical Endocrinology & Metabolism
Endocrine Reviews
The Journal of the Endocrine Society
National Institutes of Health resources (nih.gov)
The American College of Obstetricians and Gynecologists (ACOG) clinical resources
Special attention was given to recent research on the different sources of androgen production in women with PCOS and the effectiveness of targeted treatment approaches based on these distinctions.
Frequently Asked Questions About Adrenal vs Ovarian PCOS
Can my PCOS type change over time?
Yes, your PCOS type can evolve throughout your life. The relative contribution of adrenal versus ovarian androgens may shift due to factors like aging, stress levels, weight changes, pregnancy, and other hormonal fluctuations.
For example, a woman might initially present with predominantly ovarian PCOS but develop more adrenal features during periods of chronic stress. Similarly, someone with adrenal PCOS might see a shift toward more ovarian symptoms if they develop insulin resistance.
This is why periodic reassessment of hormone levels is valuable, particularly if your symptoms change significantly or if treatments that previously worked become less effective.
Hormone testing every 1-2 years or after major life changes (significant weight change, pregnancy, new chronic illness, etc.) can help you and your healthcare provider adjust your treatment plan accordingly.
Stress, weight, aging and pregnancy can shift your hormones from adrenal to ovarian PCOS or vice versa.&url=https://app.pcosmealplanner.com/knowledge-articles/any/adrenal-pcos-vs-ovarian-pcos-treatment-approaches" target="_blank">Share on X
Is it possible to have normal-looking ovaries on ultrasound and still have ovarian PCOS?
Yes, it's entirely possible to have ovarian PCOS without polycystic-appearing ovaries on ultrasound.
According to the Rotterdam criteria, a PCOS diagnosis requires two of three features: irregular/absent periods, clinical or biochemical signs of hyperandrogenism, and polycystic ovaries on ultrasound.
This means you can have ovarian-type PCOS without the characteristic "string of pearls" appearance on ultrasound. The defining feature of ovarian PCOS is elevated testosterone produced primarily by the ovaries, rather than the physical appearance of the ovaries themselves.
Additionally, ultrasound findings can vary based on the technician's experience, equipment quality, and even the phase of your menstrual cycle. Some women also have intermittent polycystic ovarian morphology, where the ovaries appear polycystic at certain times but not others.
Blood hormone testing remains the most reliable way to determine if your elevated androgens are primarily of ovarian origin. You can have ovarian PCOS without cysts on your ovaries!
Blood tests showing elevated testosterone are more important than ultrasound for diagnosis.&url=https://app.pcosmealplanner.com/knowledge-articles/any/adrenal-pcos-vs-ovarian-pcos-treatment-approaches" target="_blank">Share on X
How do insulin-sensitizing supplements affect adrenal vs. ovarian PCOS differently?
Insulin-sensitizing supplements like inositol, berberine, and chromium affect adrenal and ovarian PCOS differently based on each type's underlying mechanisms.
For ovarian PCOS, which is strongly linked to insulin resistance, these supplements often provide significant benefits by directly addressing a primary driver of the condition.
Improving insulin sensitivity typically leads to reduced ovarian testosterone production, restored ovulation, and improved metabolic parameters. For adrenal PCOS, where insulin resistance may be less prominent, the direct benefits might be less dramatic.
However, these supplements can still be helpful because insulin and cortisol (the stress hormone) interact in complex ways. Improving insulin sensitivity can reduce the overall metabolic burden and potentially help normalize cortisol patterns over time.
The optimal dosing and combination may differ between types—women with ovarian PCOS often benefit from higher doses of inositol (particularly the 40:1 myo-inositol to D-chiro-inositol ratio), while those with adrenal PCOS might need lower doses combined with specific adrenal support supplements.
They're crucial for ovarian PCOS but may still help adrenal PCOS through stress hormone interactions.&url=https://app.pcosmealplanner.com/knowledge-articles/any/adrenal-pcos-vs-ovarian-pcos-treatment-approaches" target="_blank">Share on X
Does the type of PCOS affect pregnancy outcomes and risks?
The type of PCOS you have can influence pregnancy outcomes and associated risks. Ovarian PCOS, with its stronger association with insulin resistance, typically carries higher risks for gestational diabetes, pregnancy-induced hypertension, and preeclampsia.
Women with this type may also experience more difficulty achieving pregnancy initially due to chronic anovulation. Adrenal PCOS may present different challenges during pregnancy.
The HPA (hypothalamic-pituitary-adrenal) axis undergoes significant changes during pregnancy, and women with adrenal PCOS might experience fluctuations in their symptoms as cortisol levels naturally increase.
Some women with adrenal PCOS report either significant improvement or worsening of their symptoms during pregnancy.
Regardless of PCOS type, pregnancy outcomes improve with pre-conception optimization of health, including achieving better hormone balance, reducing inflammation, and addressing metabolic issues.
Close monitoring throughout pregnancy is recommended for all women with PCOS, with specific attention to blood sugar control for those with ovarian PCOS and stress management for those with adrenal PCOS.
Ovarian PCOS increases diabetes and preeclampsia risk, while adrenal PCOS can cause unpredictable symptom changes during pregnancy.&url=https://app.pcosmealplanner.com/knowledge-articles/any/adrenal-pcos-vs-ovarian-pcos-treatment-approaches" target="_blank">Share on X
What's the connection between childhood/adolescent stress and adrenal PCOS?
Emerging research suggests a potential connection between chronic stress during childhood or adolescence and the development of adrenal PCOS later in life.
The adrenal glands are particularly responsive to stress, and chronic activation of the HPA (hypothalamic-pituitary-adrenal) axis during developmental periods may lead to long-term alterations in adrenal function and hormone production.
Adverse childhood experiences (ACEs) and chronic stressors during puberty, when the endocrine system is undergoing significant development, may program the adrenal glands toward increased androgen production, particularly DHEA-S.
This doesn't mean that all childhood stress leads to adrenal PCOS, but it suggests that early life stress may be one contributing factor in some women.
The connection underscores the importance of stress management techniques and potential therapeutic interventions that help recalibrate the stress response system.
For those with adrenal PCOS who experienced significant childhood stress, trauma-informed approaches to treatment may be particularly beneficial alongside conventional hormonal and lifestyle interventions.
Early stress may program adrenal glands to overproduce androgens later in life.&url=https://app.pcosmealplanner.com/knowledge-articles/any/adrenal-pcos-vs-ovarian-pcos-treatment-approaches" target="_blank">Share on X
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