Do you ever feel too exhausted to workout? Do you beat yourself up over not sticking with a consistent workout routine?
Well, believe it or not, your hormones may be the true culprit!
Most people know that they should be exercising regularly to maintain their health - and, if you suffer from health conditions such as Polycystic Ovary Syndrome (PCOS), this is especially important. Exercise is not only essential to your cardiovascular health and longevity but, for women with PCOS, it can ease stress, boost endorphins and support healthy weight maintenance (1,2).
PCOS as a hormonal condition is often characterized by two key factors; elevated androgens or male hormones and insulin resistance (3). However, with as many as 1 in 10 women now affected (4), some of the most common symptoms experienced include absent, irregular or heavy periods, excess body and/or facial hair, acne, infertility and excess weight (5)(6).
As PCOS is idiopathic, meaning that the cause is still unknown, a diagnosis can often leave women experiencing heightened stress and anxiety over which treatment options are best and, how to manage the associated symptoms.
There is plenty of available research demonstrating the beneficial and also the detrimental outcomes when it comes to PCOS support. However, one of the recommendations which is often underestimated is the simple act of of exercise.
As so many women with PCOS can struggle with weight loss, the initial thought is often to get to the gym and start sweating on the treadmill. While this high intensity training can be helpful for the metabolic aspects of PCOS, it can be a problem if it leaves you feeling drained and exhausted. For this reason, it is important that you support all aspects of PCOS by balancing your more intense activities with ones which stimulate the parasympathetic or restorative part of your nervous system.
Your parasympathetic nervous system is responsible for rest, recovery and rejuvenation, which is vital for reducing stress and promoting hormonal balance (7). Activities such as swimming, walking and gentle yoga are just a few methods of exercise which fall into this category.
More recently, researchers have discovered that yoga, in particular, may hold benefits for PCOS beyond its stress-relieving and rejuvenating properties…
How yoga can support PCOS?
In recent decades, yoga has seen a steady increase in global popularity; with the perceived benefits sparking initial intrigue in the scientific community as far back as the 20th Century (8). This ancient practice originated from the Indus-Sarasvati civilization in Northern India over 5,000 years ago and, is believed to act positively on the body by working to establish homeostasis or balance within the organism (8)(9). More recently, yoga has gained popularity for its complimentary support of a number of health conditions, especially hormonal or stress related conditions such as PCOS (10–12).
Let’s look to some of these benefits that have been investigated in research:
In a study published in the International Journal of Gynaecology and Obstetrics, the effects of a 12-week yoga programme on glucose metabolism and blood lipid levels was investigated in girls with PCOS. After practising a combination of pranayama, asana and suryanamaskara yoga, as well as meditation for one hour each day; the girls displayed significant improvements in their fasting insulin, blood glucose, cholesterol and insulin resistance levels (11).
As such, researchers concluded that yoga was more effective at reducing glucose, blood lipids and insulin values than the control group, which participated in conventional physical exercise.
Hormonal balance, irregular periods and body weight
Yoga may also be more effective than conventional exercise at managing hormones involved in PCOS symptoms such as testosterone, luteinizing hormone (LH), prolactin and follicle-stimulating hormone (FSH).
In a study of 90 girls with PCOS, subjects were divided into two groups, either practicing one hour of holistic yoga or following a conventional exercise programme for a 12-week period. At the end of the 12-weeks, those who had followed the yoga programme saw a significant drop in their testosterone and LH levels compared with the conventional exercise group. Furthermore, the yoga group also demonstrated reductions in their hirsutism (or excess body hair) score, as well as noticing improvements in menstrual frequency and slight changes in body weight, FSH and prolactin levels (12).
Increased anxiety is a common symptom in women suffering from PCOS (13) and, can often leave women feeling overwhelmed in their condition.
In a recent study, subjects with PCOS were divided into two groups, either practicing yoga or performing conventional exercise over a 12-week period. The holistic yoga programme included pranayama, Vasishtha and Patanjali sutras. At the end of the study, girls in the yoga group displayed significant reductions in the frequency of their anxiety compared to their conventional exercise counterparts (12).
Why Yoga may be better than intense exercise for PCOS
While intensity and fast-paced living are often advertised as the pinnacle of vitality and success, this is not always the case when it comes to maintaining hormonal balance.
For women suffering with PCOS, or those who are hormonally sensitive in general, intensive exercise can be physically and emotionally draining. In fact, when trying to achieve hormonal balance, intense exercise may actually be counterproductive. This is because intense workouts can promote the production of androgens such as DHEA and testosterone (14,15) which are already in excess for women suffering with PCOS (16).
Approximately 20-30% of women who suffer with PCOS are believed to have excess adrenal androgens or male hormones (16). These adrenal hormones are primarily produced in the adrenal glands and the ovaries. For this reason, high stress in particular can wreak havoc on your androgen balance.
Additionally, when you are experiencing high levels of stress, your cortisol or stress hormone levels can become overexpressed. This imbalance occurs as part of the body’s natural ‘fight or flight’ response, which stimulates the action of your sympathetic nervous system.
This combination of stress and increased cortisol output can place the adrenal glands under extra pressure. While this mechanism was originally intended as a survival response to life-threatening events, such as being chased by a wild animal; nowadays, environments have quickly changed and evolution has yet to catch up. Therefore, this response can often be triggered by new types of stressors. This includes both physical and psychological stress, such as worrying about an important work deadline or trying to manage too many tasks at once.
The reason that being in a constant state of stress, or ‘fight or flight’ mode, is an issue is because your body must shut down all ‘unnecessary’ bodily functions in order to preserve energy to escape the perceived threat.
First of all, cortisol increases your blood sugar (17) which, when occurring regularly, can lead to increased insulin in the blood. This increase is especially negative when you are already experiencing blood sugar imbalances as part of your PCOS. Furthermore, reproductive functioning is shut down, which can affect your fertility levels overtime.
Additionally, stress can stimulate the adrenal glands to not only produce excess cortisol, but also other important hormones such as adrenaline and norepinephrine, along with the androgen hormones: testosterone, DHEA and androstenedione (18). While this may be great for survival under threat, it can elevate androgen levels even more and thus exacerbate your PCOS symptoms. For example, researchers discovered that excess DHEA in the body can actually be converted into Dihydrotestosterone (DHT) which can lead to hair thinning and hair loss in women (19).
As you can see, stress can raise the levels of androgen hormones being released, put a pause on fertility and reproduction (20), as well as promote insulin resistance through promoting a surge in blood sugar. Along with these effects, stress experienced over an extended period, known as chronic stress, can eventually lead to conditions such as adrenal fatigue or burnout syndrome (21) - issues which occur when the body becomes resistant to cortisol.
If your adrenal glands are pumping out cortisol at a heightened rate over a long period, your body eventually becomes resistant to the effects of the hormone. This resistance usually encourages a significant drop in energy levels, which can make even day-to-day activities, let alone regular exercise appear daunting.
For this reason, if you are struggling with persistent fatigue; a common experience among women with PCOS, it is best to switch around your workouts and focus on those exercises which require less intensity. Researchers have found that working out above 80-90% of your VO2 max; the maximum amount of oxygen which your body can take in, deliver and use in one minute; can trigger increased cortisol secretion (22).
After understanding the link stress and hormonal conditions, along with the impact of exercise on stress hormones, it becomes understandable why balancing your physical activity routine is important for conditions such as PCOS.
So, while it may sound counterproductive, choosing a lower intensity workout such as yoga may actually benefit your mind, body and weight more than hitting the gym as hard as possible. By opting for yoga, you are allowing your body’s cortisol levels to decrease along with rebalancing hormonal levels and relaxing the mind. Activities such as yoga may not only help to reduce circulating cortisol levels (7), but inadvertently support weight loss by allowing the body to switch off from its ‘fight or flight’ mode and focus on more general, health-promoting functions (23).
What yoga styles are best?
As yoga is becoming increasingly popular, there are many types of yoga styles which are common and easily accessible. In general, the best type of yoga for you will be the one that makes you feel the most relaxed, energetic and balanced.
When it comes to PCOS, the more relaxing styles of yoga are usually recommended. Hatha and Yin yoga styles can be beneficial as they place a very minimal amount of stress on the body. These styles not only protect against influencing androgen release but, can also be valuable for supporting deeper relaxation and emotional connection.
Styles such as Bikram and Vinyasa can be more intensive forms of yoga and should only be incorporated as and when you feel energised enough to take them on. With that being said, because of the cortisol connection in PCOS, vigorous methods of yoga can be practiced less frequently, such as 1-2 times per week.
The most important thing is to listen to how your body is feeling and adjust as necessary to match your hormonal cycles. If you feel tired one day, focus on the more relaxing and rejuvenating yoga styles. While, if you feel energetic and ready-to-go, this is the time to try something more strenuous. It is vital that you follow your body’s natural rhythm rather than your predetermined schedule if you want to promote healing and support for your PCOS.
Good yoga poses for PCOS
When it comes to supporting PCOS with yoga, relaxation and breathing are key. In particular, there are a number of poses which are believed to be very beneficial (24,25):
Child’s pose: this pose focuses on calming the entire nervous system, while also supporting lower back tension and menstrual cramps.
Cat cow: this pose stimulates the nervous system, while also loosening the muscles around the spine. Due to the nature of the pose, it also engages the abdomen and reproductive organs.
Bharadvaja’s twist: this pose supports the calming of the nervous system and loosens the muscles around the base of the spine.
Cobra pose: this is a very gentle pose which applies light pressure to the stomach area, thus stimulating your reproductive functions.
The bottom line?
Too often women tend to beat themselves up over not being able to maintain a perfect workout routine or struggle with having too little energy to achieve everything in their schedule.
In this case, it is important to remember that PCOS can manifest differently in different women. If you have PCOS and are also struggling with persistent fatigue and adrenal stress, then pushing yourself to complete a regular intense workout might be doing more harm than good. While high intensity workouts are perceived as being the crown jewel when it comes to weight loss, if you’re feeling stressed out and exhausted, intense exercise might make it more difficult rather than easier to maintain a healthy weight.
The most important thing is to stay active and yoga is an excellent way to do that in a more restorative manner. Yoga can not only support your emotional wellbeing but, also, target key symptoms associated with PCOS such as insulin and hormonal balance, cycle irregularities and anxiety.
As you can see; it isn’t always down to willpower but, rather, respecting your hormones and choosing the right type of exercise for you.
Is yoga as part of your current exercise routine? Have you experienced some of the benefits discussed above? Head on over to our community forum and and share your experience!
This blog article was written by Anita Tee
1. Redman LM, Elkind-Hirsch K, Ravussin E. Aerobic exercise in women with polycystic ovary syndrome improves ovarian morphology independent of changes in body composition. Fertil Steril [Internet]. 2011 Jun 30 [cited 2018 Jun 27];95(8):2696–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21324452
2. Vina J, Sanchis-Gomar F, Martinez-Bello V, Gomez-Cabrera MC. Exercise acts as a drug; the pharmacological benefits of exercise. Br J Pharmacol [Internet]. 2012 Sep [cited 2018 Jun 27];167(1):1–12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22486393
3. Ali AT. Polycystic ovary syndrome and metabolic syndrome. Ces Gynekol [Internet]. 2015 Aug [cited 2018 Jun 13];80(4):279–89. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26265416
4. Polycystic ovary syndrome - NHS.UK [Internet]. [cited 2018 Jun 20]. Available from: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/
5. Carmina E. PCOS: metabolic impact and long-term management. Minerva Ginecol [Internet]. 2012 Dec [cited 2018 Jun 20];64(6):501–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23232534
6. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol [Internet]. 2013 Dec 18 [cited 2018 Jun 27];6:1–13. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24379699
7. Tsigos C, Kyrou I, Kassi E, Chrousos GP. Stress, Endocrine Physiology and Pathophysiology [Internet]. Endotext. MDText.com, Inc.; 2000 [cited 2018 Jun 27]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25905226
8. Gupta DS, Gupta DA. Significance of Pranayama in healing. Indian J Res [Internet]. 1997 [cited 2018 Jun 25]; Available from: https://www.worldwidejournals.com/paripex/recent_issues_pdf/2017/May/May_2017_1494600135__28.pdf
9. Burgin T. History of Yoga • Yoga Basics [Internet]. 2016 [cited 2018 Jun 25]. Available from: http://www.yogabasics.com/learn/history-of-yoga/
10. Chong CSM, Tsunaka M, Tsang HWH, Chan EP, Cheung WM. Effects of yoga on stress management in healthy adults: A systematic review. Altern Ther Health Med [Internet]. [cited 2018 Jun 27];17(1):32–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21614942
11. Nidhi R, Padmalatha V, Nagarathna R, Ram A. Effect of a yoga program on glucose metabolism and blood lipid levels in adolescent girls with polycystic ovary syndrome. Int J Gynecol Obstet [Internet]. 2012 Jul [cited 2018 Jun 25];118(1):37–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22507264
12. Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Effect of holistic yoga program on anxiety symptoms in adolescent girls with polycystic ovarian syndrome: A randomized control trial. Int J Yoga [Internet]. 2012 Jul [cited 2018 Jun 25];5(2):112–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22869994
13. Cooney LG, Dokras A. Depression and Anxiety in Polycystic Ovary Syndrome: Etiology and Treatment. Curr Psychiatry Rep [Internet]. 2017 Nov 20 [cited 2018 Jun 27];19(11):83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28929349
14. Heaney JLJ, Carroll D, Phillips AC. DHEA, DHEA-S and cortisol responses to acute exercise in older adults in relation to exercise training status and sex. Age (Dordr) [Internet]. 2013 Apr [cited 2018 Jun 27];35(2):395–405. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22105939
15. Hackney AC, Hosick KP, Myer A, Rubin DA, Battaglini CL. Testosterone responses to intensive interval versus steady-state endurance exercise. J Endocrinol Invest [Internet]. 2012 Dec 27 [cited 2018 Jun 27];35(11):947–50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23310924
16. Kumar A, Woods KS, Bartolucci AA, Azziz R. Prevalence of adrenal androgen excess in patients with the polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf) [Internet]. 2005 Jun [cited 2018 Jun 25];62(6):644–9. Available from: http://doi.wiley.com/10.1111/j.1365-2265.2005.02256.x
17. Marik PE, Bellomo R. Stress hyperglycemia: an essential survival response! Crit Care [Internet]. 2013 Mar 6 [cited 2018 Jun 27];17(2):305. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23470218
18. Nussey S, Whitehead S. The adrenal gland. 2001 [cited 2018 Jun 27]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK26/
19. Arlt W. Androgen therapy in women. Eur J Endocrinol [Internet]. 2006 Jan 1 [cited 2018 Jun 25];154(1):1–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16381985
20. Nepomnaschy PA, Welch K, McConnell D, Strassmann BI, England BG. Stress and female reproductive function: A study of daily variations in cortisol, gonadotrophins, and gonadal steroids in a rural Mayan population. Am J Hum Biol [Internet]. 2004 Sep [cited 2018 Jun 27];16(5):523–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15368600
21. Wilson JL. Clinical perspective on stress, cortisol and adrenal fatigue. Adv Integr Med. 2014;1(2):93–6.
22. Hill EE, Zack E, Battaglini C, Viru M, Viru A, Hackney AC. Exercise and circulating Cortisol levels: The intensity threshold effect. J Endocrinol Invest [Internet]. 2008 Jul 22 [cited 2018 Jun 25];31(7):587–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18787373
23. Bose M, Oliván B, Laferrère B. Stress and obesity: the role of the hypothalamic-pituitary-adrenal axis in metabolic disease. Curr Opin Endocrinol Diabetes Obes [Internet]. 2009 Oct [cited 2018 Jun 27];16(5):340–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19584720
24. Stephens I. Medical Yoga Therapy. Child (Basel, Switzerland) [Internet]. 2017 Feb 10 [cited 2018 Jun 26];4(2). Available from: http://www.ncbi.nlm.nih.gov/pubmed/28208599
25. Büssing A, Michalsen A, Khalsa SBS, Telles S, Sherman KJ. Effects of yoga on mental and physical health: a short summary of reviews. Evid Based Complement Alternat Med [Internet]. 2012 [cited 2018 Jun 26];2012:165410. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23008738