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How Does Cortisol Affect PCOS?

PCOS affects 4%-20% of women who are at a reproductive age worldwide. In India, it affects 3.7% to 22.5% (1.3-7.9 crore) of women. Research has shown that the cortisol hormone affects PCOS due to growing hypothalamic-pituitary-adrenal axis performance and high cortisol production. The enzyme that produces cortisol in peripheral fat deposits from corticosteroids is called 11beta-hydroxysteroid aminotransferase type 1.

Apart from irregular menstrual rhythms, elevated secretion of androgen enzymes and polycystic ovaries, there are a few other symptoms that women may experience if they have PCOS. Women with PCOS are also at a higher risk of developing depression, stress, anxiety, attention deficit disorder and borderline personality disorder. Almost 60% of PCOS women suffer from mental health disorders and this disorder is caused due to the cortisol hormone and its elevated secretion in PCOS. The adrenal gland is responsible for cortisol secretion and its imbalance can also cause digestive problems, sleep deprivation and weight gain, which are all symptoms of PCOS.

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What Is Cortisol?

Cortisol is essentially a type of steroid hormone that is synthesised from cholesterol. The ACTH or adrenocorticotropic hormone released from the anterior pituitary gland increases LDL receptors and increases the activity of cholesterol desmolase, this converts cholesterol to pregnenolone and is the rate-limiting step of cortisol synthesis. The glucocorticoids that finally transform into cortisol suppress inflammation in your bodily tissues and control the metabolism in your muscles, liver, fat and bones. An imbalance in cortisol production can affect your sleep cycle and your mental health.

What does it do in the body?

Not just one, cortisol has many functions in the human body, such as mediating the stress response, regulating metabolism, the inflammatory response and immune function. Cortisol also affects your nervous system, immune system, cardiovascular system, respiratory system, musculoskeletal system and reproductive system. Some of the mentionable effects are:

  • Response to Stress: When you are stressed your body releases adrenaline and then the cortisol hormone so that you can be alert and prepared for action. Cortisol also initiates the release of glucose from your liver so that your body gets instant energy during stress.
  • Metabolism: Cortisol also takes charge of the function when your body uses various nutrients for energy.
  • Controlling inflammation: Occasionally cortisol can also boost your immune system by controlling inflammation. But high levels of cortisol can do just the opposite.
  • Blood pressure regulation: Your blood pressure is directly proportional to the amount of cortisol secretion in your body. So make sure to have a balanced cortisol level.
  • Blood sugar: Normally cortisol is the hormone that counterbalances the effects of insulin in your body. This means if there is a rise in cortisol level it can cause hyperglycaemia.
  • Balancing sleep-wake cycle: Usually, during the evening or after sunset your body produces lower levels of cortisol which relaxes your body and helps you sleep. In the morning the cortisol levels are high which results in a more active feeling in your body. When sleep cycles are hampered it is because of the imbalance in cortisol levels.

What Are Normal Levels?

Ideally, if the blood test is performed early in the morning it is expected to show a normal cortisol level which is 5 to 25 mcg/dL or 140 to 690 nmol/L. But the important thing to remember is that a normal cortisol level depends on the time of day and the clinical context. Normal ranges may vary slightly among different laboratories. Some labs use different measurements or may test different specimens. Talk to your doctor about the meaning of your specific test results.

What Causes High or Low Levels?

High Cortisol Levels

High cortisol levels in the blood are usually caused by chronic stress or some genetic condition and some symptoms of high cortisol levels are anxiety, fatigue, depression, heart diseases, headache, gastrointestinal problems, irritation, weight gain, memory and concentration issues and reproductive problems.

High cortisol levels in your blood can also cause Cushing’s syndrome, this is a medical condition in which a benign tumour, that produces an excess amount of ACTH, grows on your adrenal glands, pituitary glands or anywhere in your body. Cushing's syndrome also has similar symptoms like rapid weight gain, mood swings and high blood pressure, but some of the rare symptoms are purple stretch marks, prone to bruising and an increase in thirst and frequency of urination.

Low Cortisol Symptoms

Just like high cortisol levels, low cortisol levels are also very harmful to you and can cause severe diseases. One of the most common diseases is the low cortisol level in Addison’s disease and its symptoms are weight loss, fatigue, nausea, loss of appetite, skin darkening, muscle weakness, low blood pressure and mood swings.

How To Naturally Decrease Cortisol in Women

80% of your battle with cortisol imbalances can be won by following a healthy lifestyle. An unhealthy diet filled with added sugars and processed foods will raise cortisol levels and put you at a greater risk for high blood pressure and diabetes.

  • Perform deep breathing exercises 4-5 times a day to keep yourself stress-free and lower your elevated cortisol levels.
  • Include supplements in your diet, supplements that contain magnesium are beneficial for regulating your cortisol levels. Apart from that, supplements that contain Vitamin B12, folic acid and vitamin C can also help support the metabolism of cortisol.
  • Reduce or eradicate caffeine intake from your diet, as caffeine can raise cortisol levels. Although people under stress often take refuge in drinking coffee to relieve them from stress it has an adverse effect on stress levels.
  • Make exercising a daily habit even if it is for 30 minutes a day. Exercising for hours one day and skipping any physical activity for the next few days is an unhealthy practice.
  • Maintain a fixed sleep cycle. Try to sleep and wake up at a fixed time every day unless your profession requires you to disrupt your sleep cycle.
  • Eat a balanced diet that does not contain any added sugars or canned and processed food items. Include foods like bananas, garlic and dark chocolate, these help in balancing cortisol levels. Foods that are high in vitamin C such as fruits and black or green tea, and probiotic foods such as yogurt and kimchi are also good for maintaining cortisol levels.

How To Measure Your Stress Levels

Various factors can be considered as signs of stress, like emotional responses, cognitions, behavioural changes and physiological responses. You can also measure stress by recording the variation in time between consecutive heartbeats; this method is called Heart Rate Variability (HRV) analysis. Researchers also suggest that brainwaves can be an accurate way to measure stress response, this process of measurement is called Electroencephalography (EEG)

In 1983 a questionnaire called The Perceived Stress Scale was developed to assess the amount of stress that you feel you’re under. Unlike the above-mentioned methods of measuring stress, this tool relies on your perception of your stress.

Diagnosis & Treatment

The method of diagnosis of high or low cortisol levels is similar to the diagnosis of Cushing's syndrome and they are as follows:

  • Urine and blood tests are often conducted for the diagnosis and these tests measure hormone levels and show if there is an excess in cortisol levels.
  • The cortisol levels in your body rise and fall multiple times throughout the day. Those who have high cortisol experience a significant drop in cortisol levels in the evening. So, ideally, if the saliva of the patient is collected during the night it can determine the cortisol imbalance.
  • If the above-mentioned tests are inconclusive a CT or MRI can be recommended by your doctor as it shows the image of your pituitary and adrenal glands that often get infected by tumours due to an imbalance in cortisol levels.


If it is a case of high cortisol levels or Cushing's syndrome, surgery is the ideal treatment followed by medical therapy. Fortunately, Addison’s disease can be effectively treated with medications, including dexamethasone, hydrocortisone or prednisone. If the surgeon can't completely remove a pituitary tumour, he or she will usually prescribe radiation therapy as well as surgery.


The most common medications that are used to treat high cortisol levels are adrenal enzyme inhibitors, adrenolytic agents and glucocorticoid-receptor antagonists. Other options include metyrapone and mitotane.

Hydrocortisone tablets are a type of medicine known as a steroid (or corticosteroid). These tablets work as a hormone replacement for a natural hormone called cortisol. You may take hydrocortisone tablets if your body does not make enough cortisol — for example, if you have Addison's disease or if you've had your adrenal glands taken out.


Cortisol Cream can be categorised as a steroid. It is usually used to treat various skin conditions such as dermatitis, eczema and allergies. It works by reducing swelling, redness and itchiness of the skin and prevents further irritation, all of which are very common symptoms of elevated cortisol levels in your blood.

Cortisol Cream is meant for external use and is to be used if prescribed by your doctor. Wash and dry the affected area before applying this cream and use a small amount. Avoid any contact with your eyes, nose or mouth. Let the irritated area breathe and don’t cover it with anything. It works by reducing the actions of chemicals in the body that cause inflammation of the skin. Cortisol Cream may be unsafe to use during pregnancy.


Vitamin D and calcium supplements are recommended for people receiving long-term corticosteroids. Vitamin D supplements may be useful in people with Cushing’s syndrome, as well as in Addison’s disease. Potassium levels are known to be low in individuals with Cushing’s syndrome, and low potassium levels are a significant determinant of cardiovascular complications in this population. Hence, potassium supplements could be useful in people with Cushing’s syndrome.

Apart from these, some herbal and ayurvedic ingredients can be used as supplements for treating cortisol imbalance. Ashwagandha (Withania somnifera) is a traditional Indian Ayurvedic herb that has been shown to lower cortisol by up to 30% when taken regularly for 30-60 days. Fish oil contains omega-3 fatty acids, which have been shown to lower elevated cortisol levels. Prebiotic and probiotic supplements in the form of fruits and vegetables help to maintain lower cortisol levels and reduce stress. Cordyceps is a traditional Chinese medicine herb that increases stamina and longevity and lowers cortisol levels. L-theanine is an amino acid found in black tea, green tea and some brands of dark chocolate which also keep your cortisol levels in balance.

Frequently Asked Questions

Here are some of the commonly asked questions about cortisol and its effects on health:

How to balance cortisol?

The most direct way to reduce stress is to avoid stressors where possible. People can do this by thinking about things in their life that cause stress and whether they are avoidable or unavoidable. People can speak with a therapist to learn how to identify anxious thoughts and gradually replace them with more balanced ones. A person trying to lower their cortisol levels should eat a balanced diet, paying particular attention to their sugar and caffeine intake. Being physically active is beneficial to health and can improve a person’s mood.

Does caffeine increase cortisol?

Excess production of cortisol stimulates your fat and carbohydrate metabolism, creating a surge of energy in your body. While this process is essential for fight-or-flight situations, it also increases your appetite. Elevated cortisol levels mainly cause cravings for sweet, fatty and salty foods and if you give in to those cravings you will gain weight.

Does caffeine increase cortisol?

Both caffeine and stress elevate cortisol levels and ironically we tend to drink coffee when in stress. High amounts of caffeine can lead to the negative health effects associated with prolonged elevated levels of cortisol.

Learn More with Veera

Unable to determine whether you have a cortisol imbalance or not? Veera’s online assessment is the quickest way to get started with your PCOS management journey today and avoid any potential chronic health complications in the future.