5 Adrenal PCOS Symptoms You Should Know About

pcos Feb 28, 2026

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When most people hear PCOS (Polycystic Ovary Syndrome), they think of ovarian cysts, irregular periods, and fertility challenges. However, knowing the difference between polycystic ovary syndrome subtypes is crucial, as adrenal PCOS symptoms stem from excess androgen production by the adrenal glands rather than the ovaries.

What Is Adrenal PCOS?

Adrenal PCOS is a subtype of polycystic ovary syndrome (PCOS) characterized by the overproduction of androgens, specifically from the adrenal glands rather than the ovaries. The adrenal glands, small organs located atop the kidneys, play a crucial role in the body's stress response by producing stress hormones such as cortisol and DHEA-S (dehydroepiandrosterone sulfate), a potent androgen primarily synthesized in the adrenal cortex.

Unlike classic PCOS symptoms, where the ovaries produce excess androgens leading to polycystic ovarian morphology and insulin resistance, adrenal PCOS involves elevated DHEA-S levels with or without increases in other androgens like testosterone and androstenedione. This distinction is essential for accurate PCOS diagnosis and to specifically target adrenal androgens in treatment.

Recent clinical and biochemical insights reveal that approximately 20-30% of women with polycystic ovary syndrome exhibit adrenal androgen excess, contributing to symptoms of adrenal PCOS such as acne, excess hair growth, and irregular periods. These women may not always present with typical polycystic ovarian morphology or insulin resistance, making adrenal disorders a critical consideration in differential diagnosis.

Understanding the role of the hypothalamic-pituitary-adrenal (HPA) axis and the impact of elevated cortisol, the primary stress hormone, is so important, as chronic stress and emotional stress can exacerbate adrenal androgen production. Managing stress levels and improving insulin sensitivity are key components in treating adrenal PCOS and restoring appropriate menstrual function.

Symptom #1: Irregular or Missing Menstrual Cycles

One of the most common adrenal PCOS symptoms is irregular or absent periods. In adrenal PCOS, this occurs due to disruption in the HPA (hypothalamic-pituitary-adrenal) axis caused by chronic stress, adrenal gland dysfunction, or hormonal imbalance.

Elevated DHEA-S, a key adrenal androgen, can suppress signals regulating the menstrual cycle, including luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This hormonal imbalance interferes with appropriate menstrual function, creating a feedback loop where ovulation becomes sporadic or absent, leading to:

Long menstrual cycles (35+ days)
Skipped periods for months (amenorrhea)
Light, heavy, or unpredictable bleeding

Many women with adrenal PCOS also experience post-pill amenorrhea after stopping birth control pills, which can mask adrenal PCOS symptoms for years.

Symptom #2: Acne and Oily Skin

Persistent acne beyond reproductive age (especially around the jawline, chin, or neck) is a hallmark adrenal PCOS symptom linked to excess androgen production by the adrenal glands.

High levels of DHEA-S and other adrenal androgens stimulate sebaceous glands, increasing oil (sebum) production that clogs pores and causes inflammation. This hormonal acne often resists conventional treatments like antibiotics and may flare in response to stress or elevated cortisol, the primary stress hormone.

Symptom #3: Hirsutism and Hair Loss

Hirsutism, or unwanted male-pattern hair growth on the face, chest, or back, is a stressful adrenal PCOS symptom that is caused by excess androgen levels acting on androgen receptors in hair follicles.

Simultaneously, women may experience scalp hair thinning or loss, especially at the crown or temples, due to androgen excess. This combination of excess hair growth and hair loss can significantly impact confidence and quality of life.

Symptom #4: Mood Symptoms Like Anxiety or Irritability

The adrenal glands regulate the body's stress response by producing cortisol, the primary stress hormone. In adrenal PCOS, chronic stress leads to HPA-axis dysregulation, causing symptoms like:

Heightened anxiety and panic attacks
Trouble falling or staying asleep
Low resilience to acute stress
Irritability and mood swings

This chronic stress and elevated cortisol disrupt insulin metabolism and progesterone production, worsening adrenal PCOS symptoms and hormonal imbalance.

Symptom #5: Infertility or Difficulty Ovulating

Adrenal PCOS is a leading cause of infertility due to excess adrenal androgen secretion interfering with the menstrual cycle and ovulation.

Elevated DHEA-S disrupts communication between the brain and ovaries, delaying or preventing ovulation. Studies link adrenal androgen excess to anovulation and luteal phase defects even when ovarian androgen levels are normal.

If you struggle to conceive and your labs show normal testosterone but elevated DHEA-S, adrenal PCOS may be an overlooked cause of infertility.

How Is Adrenal PCOS Diagnosed?

Adrenal PCOS isn’t officially recognized as a separate medical diagnosis, but it can be clinically distinguished through targeted hormone testing and a knowledgeable healthcare provider's assessment.

The key hormone to test is DHEA-S (dehydroepiandrosterone sulfate). Elevated DHEA-S levels alongside normal testosterone and androstenedione suggest adrenal androgen excess as the primary cause of your symptoms.

Additional lab tests that help in differentiating adrenal PCOS symptoms and adrenal involvement include:

24-hour cortisol measurement or DUTCH hormone panel to evaluate adrenal function and stress hormones
Prolactin, TSH, and estradiol levels to rule out other endocrine disorders
Insulin and glucose response testing to evaluate insulin resistance, which often coexists with adrenal PCOS
Pelvic ultrasound (optional), since not all women with adrenal PCOS present with polycystic ovarian morphology

Because adrenal PCOS involves adrenal gland dysfunction and excess androgen production, some practitioners may also assess circadian rhythm, micronutrient status, and other causes of adrenal dysfunction.

Natural Approaches to Adrenal PCOS Symptoms

If you’re dealing with adrenal PCOS symptoms, know that healing is possible with a root-cause approach. Here are a few natural strategies that may help support adrenal health, balance hormone levels, and manage excess androgen production:

1. Stress Reduction and Nervous System Support

Calming the HPA axis is critical in adrenal PCOS to reduce elevated cortisol and adrenal androgen secretion. Try:

Mindful breathwork, meditation, or restorative yoga to manage stress hormones
Cutting back on high-intensity workouts if you're constantly exhausted to support adrenal gland function
Getting 7–9 hours of quality sleep and waking with natural light to improve hormone balance

2. Blood Sugar Balance

Maintaining stable blood sugar supports insulin sensitivity and adrenal function, which helps regulate androgen levels and improve adrenal PCOS symptoms. Aim for:

Protein, healthy fats, and fiber at every meal to avoid blood sugar spikes
Avoiding skipping meals or fasting for long periods to prevent stress hormone imbalances
Limiting caffeine and refined sugars that can worsen insulin resistance and excess androgen production

3. Key Nutrients for Adrenal Support

Certain vitamins and minerals are essential for adrenal function and hormone metabolism, helping to reduce adrenal androgen excess and support overall adrenal health:

Vitamin C – vital for adrenal gland hormone production and antioxidant support
Magnesium – calms the stress response, improves sleep, and supports insulin sensitivity
Zinc – supports hormone metabolism, immune health, and may reduce symptoms like acne and hair loss
Vitamin D – important for hormone regulation and immune function; deficiency is common in women with PCOS and may worsen symptoms
Calcium – works synergistically with vitamin D and plays a role in hormone signaling
Selenium – supports antioxidant defense and thyroid function, which is closely linked to adrenal health
Iron – important for energy levels and overall metabolic function; low iron can contribute to fatigue often seen in adrenal dysfunction
Omega-3 fatty acids – help reduce inflammation and support hormone balance, contributing to overall adrenal and metabolic health

4. Botanical Support

Adaptogenic herbs may help modulate the body's stress response, lower excess adrenal androgen production, and alleviate symptoms of adrenal PCOS. Consider herbs such as:

Ashwagandha – supports cortisol regulation and adrenal gland function
Rhodiola – enhances stress resilience and balances hormone levels
Vitex (Chasteberry) – may improve menstrual cycle regularity and hormonal imbalance

These should be used under practitioner guidance to specifically target adrenal androgen secretion and support hormone balance naturally.

Final Thoughts

Adrenal PCOS is often overlooked or lumped in with other PCOS types, but identifying it can make all the difference. If you’re experiencing symptoms like acne, hair loss, anxiety, or irregular periods and your labs don’t show elevated testosterone, your adrenal glands may be playing a bigger role than you think.

At Naturopathic by Design™, we specialize in helping women uncover the root causes of their hormone symptoms. Through advanced testing and personalized treatment plans, we help you feel confident in your body again. If you’re ready to get to the root-cause of what you’re experiencing, I’d like to invite you to book a free 15-minute discovery call with me to discuss what treatment could look like.