Your Comprehensive guide to training with PCOS (Part 4)

PCOS and Cortisol 

The final piece of the exercise puzzle here relates to cortisol. Cortisol is an oft-demonized hormone, but high levels fundamentally reflect a body that is too stressed. And when this happens, you might start to lose some of the benefits of exercise. Managing your stress, and your corresponding levels of cortisol, should be a priority.

Now, there is real debate in the research on whether women with PCOS have higher levels of cortisol. One meta-analysis found this to be the case; they looked at 41 studies that showed levels of cortisol to be significantly higher in women with PCOS. However, a more recent study completed in 2023 questioned this finding. The authors of the 2023 study found that the vast majority of studies in the previously cited meta-analysis found no difference in cortisol levels in women with or without PCOS, the overall results having been driven by only a few studies. They questioned the methodology of those studies, as cortisol levels were measured via a blood draw rather than saliva testing, the former being much more likely to give inaccurate readings. Their study measured cortisol levels between women with PCOS and women without, measured via a saliva test, and compared that with scores of questionnaire, the Perceived Stress Scale, that measured their perception of stress. They found no difference in hormones, but much higher scores on the PSS, indicating much higher stress levels. 

So what are the implications of this study? For me, practically speaking, not much. We know that women with PCOS are at a higher risk of anxiety and depression and whether their cortisol scores are higher or lower is ultimately a distinction without a difference. Embarking on any new exercise or nutrition plan requires being honest with ourselves and how we are feeling on any given day so that we can adjust our workouts accordingly. This program should be able to react properly to fluctuations in energy levels or mood, it should not be set in stone. That is why at Woven our exercise programs are flexible; our system allows us to make changes each day or week to account for how you are feeling. 

What I would say, however, is that we should not assume women with PCOS cannot benefit from higher intensity exercise. Many women are scared away from doing this type of training for fear of ‘spiking’ their cortisol. While certainly a valid fear, we can avoid such overuse by effectively listening and reacting to our bodies. There are some tell-tale signs of overtraining in this context. If our performance suffers or we start to dread our workouts these are good indicators that we are doing too much. But if you can’t stick to the plan written by your coach it’s often not your fault. More often than not it indicates that the plan is too much and has not been adequately tailored to your life in a sustainable way. Not every workout needs to be super intense and lower intensity activities like yoga or pilates should absolutely be a part of your routine. But we should not be afraid of doing the type of training that they women with PCOS will benefit from the most.