Stress & PCOS Causes, Management, & Treatment – From a TCM POV

Dr. Chloe A. Givens is a forward-thinking functional pharmacist and Certified CBD Expert. As a passionately curious science communicator, Dr. Chloe is teaching and inspiring others to utilize holistic modalities like herbal medicine to heal all aspects of their unique root causes of disease.

In Traditional Chinese Medicine (TCM), mid-August through September is referred to as late summer, or the fifth season. During this time of transition from peak yang energy to nurturing yin energy, our bodies naturally crave rest, balance, and nourishment. The month of September is also nationally recognized as PCOS Awareness month which is fitting since late summer can bring about a litany of hormonal changes for many women in our community. Because this time can elicit feelings of stress, worry, and pensiveness in those with imbalanced Spleen organ systems (more on this below), there couldn’t be a more perfect time to discuss the association between stress and PCOS. 

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a reproductive-endocrine-metabolic disease that, when left untreated, can lead to severe symptoms and infertility for many women. While this disease has unfortunately become more common over the years, the pathogenesis of disease manifestation is not totally clear. In TCM practice, this disorder is attributed to Liver, Kidney, and Spleen organ systems dysfunction, all of which will be discussed in this guide.2

TCM Perspective on What Causes PCOS

While the term "polycystic ovary syndrome" is not explicitly documented in TCM, the clinical presentations of this condition are often categorized by excessive menstruation, delayed menstruation, amenorrhea, and/or infertility.2 The ovaries of those with PCOS have even been described as resembling “nests,” formed from the gradual accumulation of blood stasis and phlegm dampness.3 Again, PCOS and the manifestation of symptoms will be unique for each individual. The exact pathogenesis is not completely understood, however, from a TCM perspective, we know that disease development and progression involves several patterns of hormonal and organ system imbalance (further discussed below). You can learn more about the specific patterns of imbalance that characterize PCOS from Elix TCM advisor, Dr. Liem Le, here: “Chinese Medicinal Food Therapy for PCOS.”

Spleen Qi Deficiency, Phlegm-Dampness, & Liver Qi Stagnation

As mentioned above, the Spleen organ system plays a crucial role in digestion and provides the essential components for the production of Qi (our vital energetic lifeforce) and Blood. While our Spleen organ system plays a crucial role in the production of Qi and Blood, our Liver organ system is in charge of smoothly moving that Qi and Blood throughout our body. When Liver Qi stagnates (stress is one cause of Liver Qi stagnation), our Qi and Blood stops flowing smoothly, and the Spleen organ system will naturally take the brunt of negative effects because it doesn’t have the Qi (or energy) it needs for effective digestion. Without the energy it needs for digestion, food sits instead of being digested and turns into phlegm-dampness, which can be thought of as an accumulation of internal mucus, almost like a cold type of inflammation. Over time, this can lead to the accumulation of phlegm and dampness within the uterine network.4 It is also very common for PCOS patients to struggle with hormonal weight gain and obesity. This is again attributed to Liver Qi stagnation and the accumulation of phlegm and dampness. This process is due to Spleen weakness and further emphasizes the connection between Spleen Qi deficiency and Liver Qi Stagnation as aspects of PCOS pathogenesis.5 You can learn more about hormonal weight gain and how to naturally and effectively manage it, here: “The Elix Guide to Hormonal Weight Gain.”

Some of the common symptoms associated with Spleen Qi deficiency and Liver Qi stagnation include:6

• Gastrointestinal Disruption (i.e. gas, bloating, loose stools, reflux disorder, poor digestion, etc.) 
• Sluggish Metabolism (i.e. insulin resistance)
• Low Energy & Fatigue
• Water Retention & Bloating
• Weight Gain
• Brittle Hair & Nails
• Dry Skin & Acne
• Changes in Mood (i.e. irritability, stress, anxiety, depression, etc.)
• Headaches
• Irregular periods (i.e. amenorrhea, dysmenorrhea, menorrhagia, and anovulation)

Several factors can play a role in PCOS development and symptom expression including chronic stress, insulin resistance, inflammation, and exposure to environmental toxins. Women can also be genetically predisposed to PCOS diagnosis which is why employing effective preventative strategies to mitigate disease is so important.

The Relationship Between Stress & PCOS

Receiving a PCOS diagnosis can mark the beginning of an uphill battle, both physically and mentally. For many women, the diagnosis alone can trigger a wide range of emotions including stress, anxiety, and depression.7 The added emotional toll is often an overlooked facet of the disorder and, if left unmanaged, can further exacerbate the condition.

While we know that some degree of stress is unavoidable, stress that disrupts your quality of daily living and worsens disease progression must be addressed. As we’ve discussed, PCOS is a complex disorder and it requires a holistic approach to healing. This can encompass making lifestyle changes related to diet and exercise, utilizing TCM modalities like medicinal herbs and acupuncture, and employing functional medicine approaches to stress management and self-care.8

When our bodies hold onto excess stress, the sympathetic nervous system (SNS) is sent into overdrive. This triggers what's referred to as the "fight or flight" response, during which the SNS communicates with the adrenal glands and prompts the release of hormones like adrenaline (epinephrine) and cortisol. The release of these hormones leads to several physiological changes including increased heart rate, increased respiration rate, blood vessel dilation, and glucose spikes. While this is a normal physiological response to stressful stimuli, chronic firing of the SNS can ultimately wreak havoc on our hormones.5

Stress & its Effect on Reproductive Diseases

Research has shown that chronic stress increases the likelihood of worsening symptoms related to herpes simplex virus and PCOS.9 This can further affect menstruation and oftentimes leads to infertility for many women.10

Stress & its Effect on the Menstrual Cycle 

High-stress levels and excess cortisol regularly cause absent or irregular menstrual cycles, alterations in cycle length, and even increased menstrual pain. 

Stress & its Effect on Premenstrual Syndrome (PMS)

Stress can also exacerbate premenstrual symptoms, making them more challenging to cope with. It’s common for symptoms such as cramping, bloating, and mood swings to intensify.1

Stress & its Effect on Sexual Desire

High cortisol levels and chronic stress can cause fatigue and decrease libido for many women with PCOS.11,12

Stress & its Effect on Pregnancy

In addition to its negative effects on menstruation, chronic stress can negatively impact a woman's ability to conceive, the overall health of her pregnancy, and her postpartum adjustment. It is also a leading factor in pregnancy-related depression and anxiety.7,10

Stress & its Effect on Menopause

The hormonal fluctuations associated with menopause can lead to anxiety, mood swings, and depression. Menopause itself can be a stressor, and emotional distress can exacerbate physical symptoms related to PCOS.

It is crucial to emphasize that women wrestling with chronic stress inherently face an elevated risk of encountering associated health challenges. These may include undesirable weight gain, elevated blood pressure, thyroid irregularities, heightened vulnerability to infections, persistent fatigue, sleep disturbances (insomnia), and susceptibility to conditions like depression, anxiety, and gastrointestinal discomfort.

For further insights into how stress affects your menstrual cycle, explore the following articles: “How Stress Affects Your Menstrual Cycle" & “The Many Manifestations of Stress & How Adaptogens Can Help.”

Stress Management for PCOS

While it may seem like managing chronic stress is an impossible feat alongside a PCOS diagnosis, rest assured that there are a plethora of lifestyle modifications that can be implemented to support your physical and mental well-being. Furthermore, the path to treatment for each woman on the PCOS spectrum is a uniquely individual journey. Every woman's experience with PCOS is distinct, and thus, so is her path to healing.

At Elix, we believe in empowering you to take control of your cycle and this includes recognizing those elements of your life that are contributing to the chronic activation of your SNS. Listed below are several avenues to self-care that you can begin integrating into even the smallest of your daily practices. You may find solace in enjoying a cup of warm herbal tea or committing to a consistent morning routine. Regardless of which activities you choose to prioritize, the goal is the same: learn to mitigate the stress in your life so your body can rest, recover, and heal. Continue reading below to explore effective approaches geared toward managing chronic stress.

Self-Care isn’t Selfish: Top Tips for Managing Stress-Induced PCOS

• Fuel Your Body Appropriately: A significant majority of women dealing with PCOS grapple with mental health issues such as anxiety, depression, and/or eating disorders. To address these concerns, try adopting a well-rounded diet that emphasizes whole fruits and vegetables, clean proteins, whole grains, and personalized herbal supplements, tailored to your specific needs. Incorporating fresh leafy greens like spinach, parsley, basil, sprouts, kale, and celery can be highly effective in countering the stagnation of Liver Qi, which is known to exacerbate stress and anxiety levels.8 If you find it challenging to integrate these leafy greens into your daily routine, try preparing a nourishing green smoothie where all your ingredients can simply be added to a blender together. You can even enhance your body's resilience to stress by complementing your dietary choices with an adaptogenic-rich formula like Elix Daily Harmony. We are currently transitioning into the fifth season which provides the perfect opportunity to begin incorporating more warming foods into your daily routine.

• Use Movement as Medicine: Engaging in normal physical activity will always be a top tip for reducing stress, improving mental and emotional well-being, and maintaining a healthy lifestyle overall. For those with PCOS, it may be beneficial to reduce excessive high-intensity cardio exercise and opt for a more low-intensity option like yoga, pilates weight training, swimming, or going on long walks outside.13

• Create Space to Prioritize Rest: This tip is self-explanatory as we all know that getting adequate rest improves a whole host of bodily functions.7 To learn more about how adequate sleep can improve your menstrual cycle, visit “Sleep Tips For An Easier Menstrual Cycle.”

• Self-Care Rituals: Incorporating activities like meditation, acupuncture, conscious breathwork, and committing to small daily routines can significantly reduce stress while improving mental and emotional well-being.6,14

• Surround Yourself with Support: Many women experience a profound improvement in their mental well-being after seeking out the expertise and guidance of a therapist or counselor. The emotional burden that frequently accompanies a PCOS diagnosis is unquestionably difficult, and how you choose to bear this weight can wield substantial influence over the trajectory of your journey with the condition. For numerous individuals, PCOS counseling evolves into an intrinsic aspect of their lives, and may even be the catalyst that jumpstarts their deep healing.

Final Takeaways

The path to managing PCOS can be long, and oftentimes there will be moments when maintaining your commitment to a healthier lifestyle feels like a formidable task. In those moments of self-doubt, remember that Elix is here to support you.

At Elix, we recognize the physical, emotional, and mental challenges PCOS can pose for the women in our community. We also understand that, while Western medicine and conventional approaches to therapy are effective for many women, holistic approaches for naturally managing PCOS are available, safe, and effective.

If you’ve been looking for sustainable ways to manage your PCOS while getting to the root cause of your symptoms, consider signing up for our 8-week program. Led by a team of trusted doctors,, TCM experts, and a dedicated support staff, this program offers you the opportunity to learn how to naturally manage your PCOS while having the support of an entire community of women. To learn more about how Elix can support you on your path to PCOS healing, follow the link here: “8-Week PCOS Wellness Immersion.” Because our goal is to provide each of you with personalized attention and support, limited spots are available. If you are ready to take the first step toward healing your PCOS, sign up here!

Sources

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2. Qing Yan, K. Luo, Rong Tang, Ge Wang, Fei Li. Research Progress of Traditional Chinese Medicine Therapy on PCOS. Acad J Med Amp Health Sci. Published online 2023. doi:10.25236/ajmhs.2023.040613

3. Tingwei WANG, Jie ZHONG, Lili ZONG. Correlates of Traditional Chinese Medicine Syndrome Types in Polycystic Ovary Syndrome. Med Res. 2022;4(2):26-30. doi:10.6913/mrhk.040204

4. 玉金 刘. Analysis on Pathogenesis of Polycystic Ovary Syndrome in Traditional Chinese Medicine. Tradit Chin Med. Published online 2022. doi:10.12677/tcm.2022.113064

5. Heng-xian S. Overview of the pathomechanism features of PCOS in each physiological stage in females. Glob Tradit Chin Med. Published online January 1, 2014.

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7. Chris Kite, Kite C, Atkinson L, et al. Sleep Disruption and Depression, Stress, and Anxiety Levels in Women With Polycystic Ovary Syndrome (PCOS) During the Lockdown Measures for COVID-19 in the UK. Front Glob Womens Health. 2021;2:649104. doi:10.3389/fgwh.2021.649104

8. Rimsha Shahid, Haq I ul, Mahnoor, et al. Diet and lifestyle modifications for effective management of polycystic ovarian syndrome (PCOS). J Food Biochem. Published online February 24, 2022. doi:10.1111/jfbc.14117

9. Ewa Rudnicka, Anna Maria Duszewska, Marek Kucharski, Paweł Tyczyński, Roman Smolarczyk. OXIDATIVE STRESS AND REPRODUCTIVE FUNCTION: Oxidative stress in polycystic ovary syndrome. Reproduction. 2022;164(6):F145-F154. doi:10.1530/rep-22-0152

10. Karsten MDA, Wekker V, Groen H, et al. The role of PCOS in mental health and sexual function in women with obesity and a history of infertility. Hum Reprod Open. Published online on October 22, 2021. doi:10.1093/hropen/hoab038

11. Sefik Gokce, Dilsad Herkiloglu. Increased clitoral artery pulsatility index and decreased sexual desire level in women with polycystic ovary syndrome. Ginekol Pol. Published online March 22, 2022. doi:10.5603/gp.a2021.0219

12. Donaldson N, Prescott M, Campbell R, Rebecca E. Campbell, Rebecca E. Campbell, Desroziers E. Prenatal Androgen Excess Impairs Sexual Behavior in Adult Female Mice: Perspective on Sexual Dysfunction in PCOS. J Endocr Soc. 2021;5. doi:10.1210/jendso/bvab048.1119

13. Patten RK, Pascoe MC, Moreno-Asso A, Boyle RA, Stepto NK, Parker AG. Effectiveness of exercise interventions on mental health and health-related quality of life in women with polycystic ovary syndrome: a systematic review. BMC Public Health. 2021;21(1). doi:10.1186/s12889-021-12280-9

14. Zheng MQ, Weng C, Hu W, Shen CQ, Tao Y, Pan ZW. Efficacy assessment of acupuncture in improving symptoms of uterine fibroids: A randomized controlled trial. Medicine (Baltimore). 2020;99(18). doi:10.1097/md.0000000000020016

This article was reviewed by Dr. Liem Le.

Dr. Liem Le is a Doctor of Chinese Medicine, Functional Medicine Practitioner, and Nutritionist Integrative Medicine Department at H. Lee Moffitt Cancer Center. He is a part of the teaching staff for the Masters program for the Functional Medicine and Human Nutrition program at University of Western States. Dr. Le is currently working on his fellowship in Integrative Medicine with the Academy of Integrative Health and Medicine via a scholarship from the White House to complete the initiative.