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
- Irregular periods
- Possible symptoms of adrenal fatigue
- 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.
Support Your PCOS Management With Creatine
Research suggests creatine may help improve insulin sensitivity and support exercise performance—beneficial for both adrenal and ovarian PCOS types.
Learn more about creatine benefits →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
- Anti-inflammatory foods: Focus on adrenal health supportive foods
- Healthy fats: Consider replacing inflammatory oils like sunflower oil with walnut oil or soybean oil with almond oil
- Limit stimulants: Reduce or eliminate caffeine, especially after noon
- Consider salt intake: Adequate (but not excessive) salt can support adrenal function
Recipes that support adrenal health include anti-inflammatory collagen golden milk and hormone support collagen beauty water.
Supplements to Consider
Under healthcare provider guidance, these supplements may help adrenal PCOS:
- Adaptogenic herbs: Ashwagandha, Rhodiola, Holy Basil
- Vitamin C: Important for adrenal function
- B-complex vitamins: Support energy production and stress response
- Magnesium: Supports relaxation and stress reduction
- Phosphatidylserine: May help regulate cortisol levels
Medical Interventions
Working with a healthcare provider, these treatments may be considered:
- Low-dose cortisol support: In some cases of very low cortisol
- Anti-androgen medications: Like spironolactone, if symptoms are severe
- Adrenal support protocols: Custom protocols based on specific hormone patterns
Treatment Approaches for Ovarian PCOS
Ovarian PCOS management centers on addressing insulin resistance and lowering ovarian androgen production:
Lifestyle Modifications
- Exercise Recommendations:
- Both cardio and resistance training are beneficial
- Higher intensity exercise may be well-tolerated and beneficial
- Aim for 150+ minutes of moderate activity weekly
- Include strength training 2-3 times per week
- Weight Management: Even a modest 5-10% weight reduction can significantly improve symptoms
- Sleep Quality: Poor sleep worsens insulin resistance
Dietary Approaches
Nutrition for ovarian PCOS focuses on insulin management:
- Low glycemic index foods: To minimize blood sugar spikes
- Moderate carbohydrate intake: Often 100-150g daily, individualized
- Higher protein intake: Helps with satiety and blood sugar control
- Healthy fats: Replace inflammatory oils like corn oil with flaxseed oil or canola oil with avocado oil
- Anti-inflammatory foods: Berries, fatty fish, nuts, leafy greens
- Consider dairy alternatives: Some may benefit from switching from conventional dairy to ghee (butter vs. ghee) or regular cheese to vegan cheese alternatives
Insulin-friendly recipes include insulin-balancing buckwheat pancakes and gut-supporting kombu-infused quinoa.
Supplements to Consider
With healthcare provider guidance, these supplements may help ovarian PCOS:
- Inositol: Particularly myo-inositol and D-chiro-inositol in a 40:1 ratio
- Berberine: May help with insulin sensitivity
- N-Acetyl Cysteine (NAC): May improve insulin sensitivity and reduce testosterone
- Chromium: Can help with blood sugar regulation
- Zinc: May help reduce testosterone activity
- Magnesium: Supports insulin function
Medical Interventions
Working with a healthcare provider, these treatments may be recommended:
- Metformin: An insulin-sensitizing medication
- Birth control pills: To regulate cycles and reduce androgens
- Anti-androgen medications: Like spironolactone for hirsutism and acne
- GLP-1 agonists: Newer medications that may help with insulin resistance and weight management
Combined Type: When Both Adrenal and Ovarian Factors Are Present
Many women have features of both adrenal and ovarian PCOS. In these cases, a comprehensive approach addressing both types is needed:
Balanced Approach for Combined Type
- Prioritize both stress management and insulin sensitivity
- Moderate exercise: Finding the right intensity that doesn't overstress adrenals while improving insulin sensitivity
- Balanced nutrition: Focus on anti-inflammatory, blood-sugar stabilizing foods
- Consider both adrenal and ovarian support supplements
- Personalized medical interventions based on your specific hormone profile
Monitoring and Adjusting Treatment
Regardless of your PCOS type, ongoing monitoring helps track progress and adjust your approach:
What to Track
- Hormone levels: Periodic testing of DHEA-S, testosterone, and other relevant hormones
- Symptom changes: Keep a journal of physical and emotional symptoms
- Menstrual patterns: Track cycle length and regularity
- Energy levels and stress response: Particularly important for adrenal PCOS
- Metabolic markers: Blood sugar, insulin levels, cholesterol (especially for ovarian PCOS)
When to Adjust Your Approach
Consider modifying your treatment plan when:
- Symptoms aren't improving after 3-6 months
- New symptoms develop
- Hormonal test results show significant changes
- Your lifestyle undergoes major changes (new job, relocation, pregnancy planning)
The right food choices can make a significant difference—comparing foods like carrots vs. parsnips or steamed fish vs. grilled fish can help optimize your nutrition for your specific PCOS type.
Special Considerations
Fertility and Pregnancy Planning
Both PCOS types can affect fertility, but approaches may differ:
- Adrenal PCOS: Focus on stress reduction and adrenal support before conception
- Ovarian PCOS: Improving insulin sensitivity often helps restore ovulation
- For both types: Begin treatment at least 3-6 months before attempting conception
Age-Related Changes
PCOS symptoms and treatment needs can change with age:
- Adolescence: Focus on establishing healthy habits and preventing long-term complications
- Reproductive years: Treatment often centers on symptom management and fertility
- Perimenopause/Menopause: Shifting hormone levels may require adjustments to treatment
Other Health Conditions
Be aware of conditions that commonly co-occur with PCOS:
- Thyroid disorders: Can mimic or exacerbate PCOS symptoms
- Gallbladder issues: Women with PCOS have higher risk of gallbladder problems
- 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. 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. 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. 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. 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. Share on X
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See Also
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PCOS Friendly Juices: Complete Guide to Low-Sugar Beverages
Mediterranean Diet Adaptations for PCOS Management
Low Glycemic Index Foods: Ultimate Guide for PCOS
Osteopenia and PCOS: Understanding the Connection
Best Kitchen Scales for PCOS Portion Control
Low GI Bread Options: Which Breads Have the Lowest Glycemic Index
Insulin Index: Beyond Glycemic Response for PCOS Management
Low Glycemic Index Foods List PDF: Printable Guide
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