PCOS and Fatigue

Many women with PCOS struggle with fatigue and wonder if a relationship exists between fatigue and PCOS. As with many other characteristics of PCOS, the answer is "probably, but we are not sure!"

Fatigue can have many different causes in different people, and even multiple causes in the same person. PCOS and fatigue are both linked to imbalances of the endocrine system. Three common causes of fatigue in both the general population and specifically in women with PCOS are insulin resistance, stress, and hypothyroidism. Fatigue may have other causes as well, such as lack of sleep, anemia, chronic pain, and other underlying disorders.

Insulin Resistance

Insulin resistance is a condition that vastly reduces the insulin sensitivity of cells, which impairs the processing of glucose through the cell membrane for conversion to energy. As a result, glucose remains in the blood stream, signaling the pancreas to produce more and more insulin. When the pancreas can't keep up this causes elevated blood sugar which is sent to the liver. Once there the excess sugar is converted into fat and delivered via the blood stream for storage throughout the body. This process can lead to weight gain and obesity, key factors in influencing the onset and course of PCOS.

The simple fact that glucose is not able to enter the cells in insulin resistance can contribute to fatigue, because the cells are not receiving their energy source. Weight gain can impair mobility and flexibility thereby reducing the ability to exercise, which further contributes to fatigue.

Fatigue frequently causes sufferers to "treat" their low energy with carbohydrates and caffeine, which dumps more glucose into the blood in a never-ending spiral of weight gain and increasing insulin and glucose levels and more fatigue.

Excess Cortisol

As you might guess, stress is a powerful contributor to both fatigue and PCOS. Although the original purpose of the stress response was to provide a momentary burst of energy in order to fight or run away (the "fight or flight" response), stress has become a continual presence in our lives today. Cortisol, a hormone produced by the adrenal glands, mediates the stress response. Cortisol is vital to our functioning as long as it remains within appropriate amounts, but excess levels of cortisol cause resistance in adrenal receptors and contribute to insulin resistance as well as general unresponsiveness to other hormones.

According to Dr. David Zava, biochemist, researcher and author, "Excess cortisol keeps hormones from operating at optimal levels." (1) This would include sex hormones like estrogen, progesterone, and testosterone, which are produced by the adrenal glands as well as by the ovaries and testes. Over time, as a response to prolonged stress, the adrenal glands begin to function at suboptimal levels. Adrenal fatigue occurs after intense or chronic stress and also sometimes following acute or chronic infections. A primary symptom of adrenal fatigue is sluggishness that is not relieved by sleep.

Hypothyroidism and Fatigue

The thyroid gland, located in the neck, produces thyroid hormones T3 and T4 which have wide ranging effects throughout the body. Hypothyroidism, or low thyroid function, is a very common disorder. A classic symptom of hypothyroidism is fatigue.

According to Dr. Zava, cortisol makes thyroid hormone work more efficiently, and a narrow window of cortisol levels is necessary for optimal thyroid function. When adrenal function is too LOW, the thyroid gland becomes less efficient at performing its job. Moreover, too MUCH cortisol causes tissues to become resistant to the effects of thyroid hormone, thereby mimicking hypothyroidism even if thyroid hormone levels are normal. (2)

As you can see, the interrelationship among hormones in the endocrine system like insulin, cortisol, and thyroid hormone is very complex. Hormones have a profound effect on each other, and organs that are distant from each other in the body still manage to be closely connected. This article has touched only briefly on the relationships between insulin and cortisol, and between cortisol and thyroid hormones.

Maintaining the body's balance is important. But although the complexity seems overwhelming, the solution can be fairly simple. Regular exercise has repeatedly been shown to return the body to a more balanced state. In fact, exercise improves insulin resistance and increases energy levels generally within days of beginning a regular program. (3) Combined with a diet low in simple carbohydrates, exercise and a regimen of precisely formulated supplements can start to improve hormone activity and set you back on the road to better health.

Dr. Sari Cohen

References:
(1) Cortisol Levels, Thyroid Function and Aging: How Cortisol Levels Affect Thyroid Function and Aging, Interview with David Zava, PhD. Virgina Hopkins Health Watch
(2) ibid.
(3) The Ins and Outs of Insulin Resistance, International Food Information Council,Food Insight, May/June 2000