Adrenal PCOS is the rarest type making up only 10% of the PCOS cases. It is also considered the trickiest and most difficult to treat naturally because it doesn’t have a definitive cause. With insulin resistant or inflammatory PCOS diet and general lifestyle changes have been proven to be beneficial. Adrenal PCOS though, doesn’t seem to be driven by anything diet-related. Finding the root cause is essential, by in this type of PCOS even that is usually unclear. So let’s see what adrenal PCOS is about and what you can do to treat it naturally.

Before we continue, I’d like to make something clear. If you’ve talked to doctors, and asked them what type of PCOS you have, they might’ve not given you an answer, or you might’ve been told there’s no such thing. While allopathic medicine doesn’t name the types of PCOS as we do, knowing that several types exist is the recognition that PCOS doesn’t present itself in the same form in everyone.

Some have high DHEA-S but perfectly normal testosterone, some are the exact opposite. Some are insulin resistant, some aren’t. And some have cysts while some don’t. Yet all these people are diagnosed with the same condition. This is where the types come in handy. They also come in handy when treating the condition naturally, because they focus on the root cause.

What is adrenal PCOS?

If we refer back to the four main types of PCOS as they derive from the root cause, adrenal PCOS is the type where you have elevated DHEA-S. That’s an androgen made by your adrenals (hence the name), unlike testosterone, which is made by the ovaries. High DHEA-S is more common though and can be found alongside insulin resistance in women with PCOS, making up a total of 20-30% of cases.

This article will discuss mostly the case where DHEA-S is the ONLY thing that’s out of whack, meaning no insulin resistance or inflammation are present. As I talked in another article, if insulin resistance is present, it will take prevalence and you should see yourself as the insulin-resistant PCOS type.

So, going back to the initial question, true adrenal PCOS is the one where only DHEA-S is elevated – you don’t have insulin resistance, and you don’t have markers of inflammation. If you do, you should treat those two causes first.

This type of PCOS seems to be more common in lean women. Why? Because lean PCOS is often the one without insulin resistance. However, as I’ve stated several times, you can be insulin resistant even if you’re lean. So please, be sure to test for insulin resistance regardless of your weight!

Symptoms of adrenal PCOS

Like with anything PCOS-related, symptoms vary from person to person. You may have one or more of the following:

  • acne
  • fatigue
  • poor tolerance to stress
  • anovulation
  • amenorrhea
  • irregular cycles
  • low progesterone
  • mood swings
  • depression
  • anxiety
  • weight gain
  • polycystic ovaries on ultrasound

… and more.

Because this type of PCOS makes it obvious the adrenals aren’t functioning quite right, I would suggest testing cortisol levels. While there is no research clearly stating high stress is related to adrenal PCOS, poor tolerance to stress is more common in this case. With that, higher levels of cortisol are more likely.

Please don’t forget that if stress is a big component in your life, whether physical or psychological, ruling out hypothalamic amenorrhea is important even when some androgens are high. Sadly, you can have both HA and PCOS.

When PCOS is the only issue, it might not be so much that you have a lot of stress in your life. It is more an issue that you perceive every small stressor as huge. The slightest thing that throws you off balance, things that would normally slightly annoy other people make you feel completely overwhelmed. That’s how poor tolerance to stress looks like and it can be quite common with adrenal PCOS (but not limited to this type).

Ways to treat adrenal PCOS naturally

Treating any type of PCOS naturally has three main pillars: diet, exercise, and stress management. Supplementation can also help and I will give you a quick outlook on the main supplements for your adrenals, but, as with all medication, natural or not, it is best to consult with a doctor (in this case, I’d suggest a naturopath or a functional doctor, as this is their specialty).


Common PCOS diets and why you should avoid them

The world of PCOS diets is filled with people who swear by low carb, keto, or intermittent fasting. Personally, I believe you shouldn’t start with ANY of those diets if you have adrenal PCOS and have NO insulin resistance. Why? Because they will put huge stress on your body. Healthy carbs are fuel for your brain AND your adrenals, and depriving them of any source of carbs will result in more stress and more adrenal androgens. Not exactly what you want.

Keto is low carb taken to the extreme. While I’m aware of its general health benefits, not everyone needs it. Especially with adrenal PCOS and especially if you don’t have insulin resistance.

Intermittent fasting is another hot topic and one I intend to dive into on my Patreon in the next few months. In short, I’ll say this. All the benefits you’ve heard of for intermittent fasting, those medically-proven benefits, are real. However, all those studies that prove them were done ONLY ON MEN. So yes, intermittent fasting has been proven to reduce inflammation, encourage metabolic flexibility, improve digestion, improve gut bacteria, and more, FOR MEN. For women? The truth is we don’t know. It might work, but it might not. Now let’s take a look at the potential side effects of intermittent fasting:

  • chronic undereating
  • low energy
  • insomnia
  • hair loss
  • feeling cold all the time
  • loss of menstrual cycle
  • low sex drive
  • irregular blood sugar
  • food cravings
  • impaired hunger signals

Intermittent fasting is also a HUGE NO if you’ve ever suffered from an eating disorder.

If you do decide to try IF, pay very close attention to what your body is telling you. One of the first symptoms that it isn’t good for you, is constantly feeling cold. Also, make sure you’re not overeating in your eating window. Otherwise, it is easy to turn IF into bulimia, where you overeat and then starve yourself to compensate. In the same way, continue paying attention to what you’re eating. Despite what some say, doing intermittent fasting doesn’t mean you can eat whatever you want without negative consequences for your body.

What to do instead:

  • Start by limiting processed foods – with that you’ll be cutting out sugar and a lot of other harmful ingredients without even realizing it.
  • Limit or cut out stimulants. This includes coffee and caffeinated beverages. They tell your body to make more cortisol and will reduce your tolerance to stress even more.
  • Don’t starve yourself. Whatever foods you decide to cut out, make sure your diet isn’t restrictive. In order for the reproductive organs to do their job, you need to get enough food. Otherwise, your reproductive function shuts down.
  • Pay attention to both macros and micros. Often when dieting we only talk about carbs, proteins, and fats. Vitamins and minerals are equally important for the correct functioning of the body.
  • Eat balanced meals, ideally 3 meals a day, all containing proteins, carbs, and healthy fats.
  • Speaking of fats: don’t run away from them! Yes, you may not need Keto, but healthy fats are essential for a woman’s health.

I know these may seem like very general rules, but, believe it or not, PCOS management doesn’t require extremes. What it requires is a healthy diet, full of nutrients, that keeps your blood sugar stable, and doesn’t add stress on your body.

Working out

While HIIT is often recommended to those with insulin resistance, I suggest taking a step back from that if you have adrenal PCOS. We already established we do not want to put more stress on the adrenals, do working out should be done carefully.

Yoga and mindfulness have been proven to reduce androgen levels in women with PCOS. While results for DHEA-S weren’t spectacular, the levels were visibly lower.

Other than that, you’ll need to perform a self-assessment to figure out the workout for you. You might discover HIIT is the way to go for you, or strength training, or swimming. Here’s what you need to know:

  • Leave you feeling energized, especially if you work out in the morning or afternoon. If you’re dead tired and all you want is to sit down for the rest of the day, it’s too much for your body.
  • Might make you feel a little sore, you’ll know the muscles you worked but you shouldn’t be in pain. The soreness should not affect normal day-to-day activities to the point you dread doing certain things.
  • The soreness should subside in 1-2 days. By the 3rd day, you should feel you’re able to work those same muscles again without any issues. Otherwise, the workout was too hard for your level.
  • Doing the workout should never feel like a chore. It shouldn’t make you constantly think “no pain, no gain”. Because too much pain = risk of injury and an unhealthy increase in cortisol. The workout should be challenging in a good way, one where you feel you are making an effort, you are slightly out of your comfort zone, but it’s enjoyable. If it makes you feel like you’re about to die, constantly out of breath, stop! It’s too much.

Don’t forget to switch your workout. Don’t do the same thing each day, or you’ll end up hitting a plateau and you’ll fatigue your muscles in an unhealthy way. If you do a single type of workout (only yoga, only strength training, etc), it’s ok, just make sure you switch the style or the muscles you work.

Stress management

Stress management for PCOS is important, regardless of the type you have. If your adrenal PCOS makes you struggle with poor tolerance for stress and constant fatigue, stress management needs to be your emphasis, maybe even more than diet and working out. Here are a few things that can help you:

  • Take naps
  • Respect your circadian rhythm as best as you can
  • Take walks in nature
  • Laugh
  • Make time for things that bring you joy – whether that’s reading, listening to music, spending time with friends, make sure to schedule such activities into your weekly program
  • Have orgasms – they decrease cortisol and allow your body to truly relax.

Supplements that could be helpful

This is only a list of supplements that might help. Please do not take all of them at the same time. Do your research on them, read medical studies before taking them, and if you can, talk to a naturopath to get a proper prescription.

  • Rhodiola
  • Ashwagandha
  • CBD oil
  • Melatonin
  • Magnesium


To summarize, when DHEA-S is the only thing out of whack, the best you can do is start managing stress. Make sure you eat a balanced diet and move your body in a way that leaves you energized and happy.

As with any form of PCOS, there’s no one-size-fits-all. You need to find your triggers, eliminate them, and find a sustainable lifestyle that you can maintain for the rest of your life.

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