PCOS, stress, and how to reduce your cortisol levels
A very common story for many women with PCOS is that they might be eating well, exercising regularly, and doing everything "right”, yet their symptoms might actually get worse instead of better. Rather than seeing results, they find themselves stuck in a cycle of weight gain, anxiety, hirsutism, and a body that feels like it is “working against them”. It is a vicious cycle and for many, a hallmark of life with PCOS.
One of the most common reasons why this cycle takes place is due to high cortisol levels. Cortisol has become somewhat of a buzzword on social media and within wellness circles, but for women with PCOS it is foundational to understanding our hormones and why this occurs, thus empowering us with the tools to build a loving and supportive relationship with our bodies rather than one that feels like a constant battle.
Understanding cortisol and PCOS
Cortisol is a hormone produced by the adrenal glands that governs how your body responds to stress. It is responsible for key daily functions, including your sleep-wake cycle, energy levels, and how your nervous system responds to stress. Cortisol has become somewhat of a buzzword in wellness circles, but for women with PCOS, understanding cortisol is essential to understanding what is happening in our bodies and supporting the nervous system in returning to a state of balance.
When cortisol levels remain elevated for prolonged periods, the pancreas may respond by producing more insulin to help meet increased energy demands. Over time, this can eventually lead to insulin resistance or worsen existing insulin resistance. Insulin resistance occurs when the body's cells become less responsive to insulin, making it harder to regulate blood sugar levels. At the same time, the hormonal disruption of PCOS itself (such as irregular cycles, elevated androgens, metabolic stress, and rapid weight gain) can keep the nervous system in a low-grade state of alert, thereby keeping cortisol levels higher.
This complex hormonal interplay is actually one of the reasons why PCOS has now been renamed PMOS (Polyendocrine Metabolic Ovarian Syndrome), to reflect the very nature of the syndrome more accurately. Insulin, cortisol, and androgens are all deeply intertwined; when one is disrupted, the others follow. Anyone with PCOS (or PMOS) will tell you that it is far more complex than simply having cysts on your ovaries. Understanding cortisol can help us understand that our ongoing symptoms are not a sign that there is something wrong or broken with our bodies, but simply that our nervous system is stuck in a response state that we are trying to slowly and gently undo. While there are many things in life that are simply out of our control that will inevitably lead to stress, learning how to reduce cortisol levels can help us slowly but surely guide our bodies and our nervous system to a state of equilibrium, making it more resilient to stress.
How to reduce cortisol levels
1. Breathe (slowly and gently)
The most direct tool we have for shifting the nervous system is the breath. Slow, extended exhalations, in particular, activate the vagus nerve and shift us from fight-or-flight (sympathetic) to rest-and-digest (parasympathetic) mode. Lengthening the exhale stimulates branches of the vagus nerve, which slows heart rate and signals to the brain that the body is safe. When the brain perceives safety, cortisol production gradually begins to decrease.
Just a few simple breaths can be enough to feel the difference. Here are a few easy and simple techniques to start with:
Double inhale, slow exhale
Inhale fully, take a second inhale on top of it, then release slowly and completely.
4-6-8 breathing
Inhale for 4 counts, hold for 6, exhale for 8.
Box breathing (4-4-4-4)
Inhale, hold, exhale, hold, each for 4 counts.
All of these breathwork exercises activate the parasympathetic nervous system almost immediately. I recommend starting with a timer for 3 minutes once a day, 3 minutes is easy to start with and it’s enough for you to feel a difference. Then you can move on to 3 minutes in the morning and 3 minutes before bed. Over time, you may naturally gravitate towards breathwork as a method of reducing and relieving stress.
2. Slow daily stretching
When we're chronically stressed, muscles tend to hold tension without us even noticing, such as tight hips, a clenched jaw, and rounded shoulders. Gentle stretching, especially slow, intuitive movement, reduces stress and tension in the body and signals safety to the nervous system. This helps us return to being present in our bodies, if even for a moment. Like breathwork, stretching activates the parasympathetic nervous system and helps ease tension in the mind and body, improving mind-body connection. Stretching also helps improve circulation, increasing blood flow to the muscles, and this helps ease physical tension stored in the body.
Stretching every day does not necessarily mean having to do yoga every day, in fact, studies have shown that just ten minutes in the morning or before bed is enough to make a difference over time.
3. Play, create, and explore
Our hobbies and creative outlets put us back in touch with play, joy, and simply doing things for fun.
When the body is in an elevated state of stress, chronic cortisol elevation can keep us in execution mode — moving from one task to the next and in a permanent state of always mentally checking our endless to-do list, always thinking about what needs to be done next. When we finally sit down and relax, it is likely in the form of scrolling through social media, which keeps us in an activated state simply due to the amount of information we must process.
When we engage with or reconnect to our hobbies and creativity, we are reconnecting with the part of ourselves that wants more from life than simply to just do, and instead, we connect with the part that wants to be.
This is what it also means to shift the nervous system from fight-or-flight mode to rest-and-digest mode. Less doing, more being. When we are fully immersed in play and creativity, we enter what psychologists call a “flow state”; here, attention becomes fully absorbed in the present moment. This is what signals safety to the nervous system, still attuned to its hunter-gather state that has evolved little since the days of our long-gone ancestors - if we have time for play and creativity, then that must mean we are safe and okay!
Take out your sketchbook. Learn a new skill. Read a book about a topic that interests you. Go for a hike with friends. Whatever it was that once brought you joy and meaning in your life, make space for it again.
4. Supplement magnesium glycinate
Magnesium is one of the most important minerals for stress regulation, and one of the most commonly depleted. Studies have shown that magnesium glycinate can help reduce stress levels and reduce cortisol levels, especially if you struggle with sleep or regularly wake up in the middle of the night. Research suggests women with PCOS are at higher risk of magnesium deficiency because magnesium plays a direct role in controlling how much cortisol your body produces.
Magnesium also works on a neurological level by supporting GABA, the neurotransmitter responsible for calming the brain and nervous system. Low magnesium means less GABA activity, which can result in higher anxiety levels and higher cortisol over time. It is also excellent for supporting deeper and more restful sleep, which is essential for reducing cortisol levels.
5. Prioritise sleep
Sleep is one of the most important and overlooked aspects of regulating stress and cortisol levels. If the benefits of sleep could be sold and packaged in a neat little container, I am certain it would be endlessly overhyped and marketed to us on social media! High-quality, restful sleep is essential to regulating the HPA (hypothalamic-pituitary-adrenal) axis, the body’s primary stress response system, allowing the body to fully rest and repair and regulate its hormonal and endocrine systems.
When cortisol levels are chronically elevated, it can be harder for the body to fully rest during sleep, with women with PCOS often reporting poor, restless sleep that includes waking up in the middle of the night. The same goes for insulin resistance, which can worsen sleep quality due to unstable blood sugar levels, which can worsen sleep quality and thus worsen insulin resistance. Again, it's one of those unfortunate catch-22 PCOS cycles - high cortisol levels lead to poor sleep, and poor sleep leads to higher cortisol levels, insulin resistance makes quality sleep harder, thus making insulin resistance worse.
Valerian, chamomile, and lavender are herbs that help support deeper sleep. Combining these herbs alongside nighttime stretching, simple breathwork, and a magnesium supplement are all things that can help promote deeper sleep. Make sure to avoid eating anything that will spike blood sugar levels right before you go to sleep, as this can also lead to restless and disturbed sleep.
6. Keep blood sugar levels stable
Blood sugar, blood sugar, blood sugar… Unfortunately, there is no escaping it when it comes to PCOS. Keeping your blood sugar levels stable helps reduce cortisol since it means fewer blood sugar spikes. The link between blood sugar and stress has been very well documented. When blood sugar drops too low or rises too quickly, the body releases cortisol to help restore balance. Over time, these repeated spikes and crashes can keep the body's stress response activated, making it harder to improve insulin sensitivity and regulate hormones.
Replace refined carbohydrates with complex carbohydrates (e.g. brown rice instead of white), prioritise protein, fibre, and non-starchy vegetables, add fats to your meals (olive oil, avocado, oily fish), and minimise ultra-processed foods and refined sugar. This combination slows the absorption of glucose into the bloodstream, helping to reduce dramatic spikes in blood sugar and the subsequent cortisol response.
Avoid skipping meals, especially if you find yourself becoming shaky, anxious, or irritable when you're hungry. Eating regular, balanced meals gives your body a consistent source of energy and reduces the need for cortisol to step in and compensate for sudden drops in blood glucose.
7. Go for walks
Walking is gentle on the mind, body, and nervous system, and it is easy and accessible. Walking increases the production of endorphins that naturally elevate mood, while also lowering cortisol without spiking it the way intense exercise can. It also activates rest-and-digest mode as walking activates deeper rhythmic breathing that gently activates the parasympathetic nervous system and helps the body shift from fight-or-flight into rest-and-digest mode.
Studies have shown that a simple 20–30-minute walk outdoors helps reduce cortisol levels. Natural light, fresh air, and green spaces can further enhance these stress-reducing effects, but don't worry if you can't get outside, a walk on a treadmill can also make a meaningful difference. It’s all about just gently moving the body in the very simple way it is wired to.
Walking also helps improve insulin sensitivity, since insulin resistance and elevated cortisol often reinforce one another; making walking a daily habit can help support both metabolic and hormonal health without placing additional stress on the body.
8. Don't stress about your cortisol levels
If you are stressing out about doing breathwork or going for walks, it’s a bit counterintuitive; it just defeats the purpose! Stressing about your cortisol levels simply means giving your already stressed-out mind and body even more to stress about. The things on this list aren’t another thing to add to your endless “to-do” list; the purpose of doing these things is so you can shift from doing to being. It is not about self-optimisation; it is about self-love, building a gentler relationship with your mind and body, and just letting your body know that it is safe, thus helping your nervous system shift from fight-or-flight mode to rest-and-digest mode. This is what lowering cortisol levels means, and for women with PCOS, it simply means shifting the body back into its natural balance.
Conclusion
When you have PCOS it can be so easy to feel as though your body is working against you. But it is not, it is just trying to communicate with you that something is not entirely right. It is our job, and it is in our hands to have a two-way conversation with our bodies.
Lowering cortisol levels means less pressure on the adrenal glands, increased insulin sensitivity, and a body that slowly but surely shifts from panic mode into safety mode. Chronic stress amplifies almost every symptom of PCOS, from irregular cycles to weight gain to hair loss and mood shifts. This means that for many, addressing cortisol can be an integral aspect of regulating PCOS symptoms, and that lowering cortisol levels creates the conditions your body needs to actually heal.
Do three minutes of breathwork in the morning and at night, make some art or read the book you’ve been meaning to, drink some a nice herbal blend before bed, take some magnesium glycinate, and try to eat in a way that truly supports your body (without restricting). I hope that when you read this list, your body doesn’t contract into a state of panic or anxiety at having even more things to do, but instead, it sees it as a signal of the softness and gentleness that has been lacking in your life; the softness and gentleness that your body is so deeply craving.
It all starts with you being kinder to yourself and being gentler with your mind and body, because that is what your body is signalling it needs from you right now.
Citations
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