High DHEAS and PCOS

Often times we see high DHEAS levels in women with Polycystic Ovarian Syndrome. For some women, this is the only marker in their blood work that comes back abnormal. The goal of this article is to help explain what DHEAS is, why it is important when it comes to PCOS, and what you can do about reducing DHEAS.

What is DHEA? 

There are two types of DHEA:

1. DHEA: This form is primarily produced by the adrenal glands and a small amount is produced by the ovaries.
2. DHEA-S: DHEA-S is created by the adrenal gland from DHEA, high levels can indicate inflammation. The “S” refers to sulfate, so DHEAS is the sulfated form of DHEA.

DHEA is not a direct androgen, it gets converted into testosterone. Once it gets converted to testosterone that is when we will see the effects of high testosterone symptoms.

Why is DHEA important when it comes to PCOS? 

Since DHEA is a precursor to testosterone, it can impact many of the symptoms associated with PCOS such as irregular cycles and metabolic concerns.

When DHEAS levels are high in PCOS, we should also consider the Hypothalamic Pituitary Axis (HPA). In our brain, we will release Cortisol Releasing Hormone (CRH) from the hypothalamus which will direct the anterior pituitary gland to release Adrenocorticotropic Hormone (ACTH) which will then direct the adrenal glands to release cortisol. This is known as the HPA axis or hypothalamic-pituitary axis. Women with PCOS tend to produce higher amounts of cortisol in response to an environmental stressor, as cortisol rises so do adrenal androgens. Obesity and insulin resistance also can play a role in adrenal androgens.

What can you do about reducing DHEAS in PCOS? 

Lifestyle: 

First and foremost, reducing lifestyle stress via meditation and yoga can be very beneficial in the case of high DHEAS. A recent small study, with mindfulness yoga 3 times a week for 1 hour each in women with PCOS showed lowered free testosterone and DHEAS levels. (3)

Botanicals: 

Rhodiola – this herb is known for its ability to reduce mental stress, improve concentration, and reduce fatigue. It has been also helpful in mild depression. Rhodiola is known to be an adaptogen, meaning it helps us to adapt to stressful situations. It has also been known to reduce the cortisol response to awakening. This is the cortisol we produce 30-45 minutes after waking up in the morning. Cortisol levels tend to peak in the morning to help us get up and get going for the day, however, we do not want cortisol to be too high in the morning as well. Rhodiola can help to decrease this response. (4)

Lavender – as you may already know lavender is a very calming herb. It also has the ability to reduce cortisol levels in the blood and reduce feelings of anxiety. A study of open-heart surgery used lavender via inhalation and found a reduction in cortisol levels in the blood along with decreased anxiety in patients. (5)

Supplements: 

L-theanine – this is an amino acid that is found in green or black tea. L-theanine is unique as it can calm a busy mind (aka the nervous system) without causing drowsiness. Mice models have found that L-theanine can modulate the HPA axis by protecting the body again ACTH production. (6)

Melatonin – those deficient in melatonin may benefit from its ability to reduce ACTH production in the brain. Please note, this should only be taken at bedtime!

Resveratrol – this unique substance is an antioxidant that comes from the skin of a grape. Research shows that 1,500mg of resveratrol over 3 months can help to reduce DHEAS. The study also mentioned a decrease in testosterone and insulin. (1)

Ultimately, when it comes to high DHEAs in PCOS, you really want to be focusing on ways to reduce stress. This can be through lifestyle or supplementation support. Some additional suggestions include practicing self-care, whatever that may mean to you. Such as, drinking tea, listening to music, watching TV, doing something you love like a hobby, taking a bath, doing yoga, meditating, going for a walk, exercising, talking to a friend, etc.

Really try to tune into your body and become intuitive to how your body is responding to specific events in your day to day life. If work is stressful, find ways throughout the day to take a break, do some deep breathing etc. If you feel like you are running on adrenaline throughout the day and cannot sit still, try to find 3-5 minutes multiple times throughout the day to do some deep breathing. All of these may sound so easy and natural, but it really takes time and dedication to incorporate a consistent schedule.

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References:

1. Banaszewska, B., Wrotyńska-Barczyńska, J., Spaczynski, R. Z., Pawelczyk, L., & Duleba, A. J. (2016). Effects of resveratrol on polycystic ovary syndrome: A double-blind, randomized, placebo-controlled trial. Journal of Clinical Endocrinology and Metabolism, 101(11), 4322–4328. https://doi.org/10.1210/jc.2016-1858
2. Nidhi, R., Padmalatha, V., Nagarathna, R., & Ram, A. (2012). Effect of a yoga program on glucose metabolism and blood lipid levels in adolescent girls with polycystic ovary syndrome. International Journal of Gynecology and Obstetrics, 118(1), 37–41. https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1016/j.ijgo.2012.01.027
3. Patel, V., Menezes, H., Menezes, C., Bouwer, S., Bostick-Smith, C. A., & Speelman, D. L. (2020). Regular mindful yoga practice as a method to improve androgen levels in women with polycystic ovary syndrome: A randomized, controlled trial. Journal of the American Osteopathic Association, 120(5), 323–335. https://doi.org/10.7556/jaoa.2020.050
4. Olsson, E. M. G., Von Schéele, B., & Panossian, A. G. (2009). A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract SHR-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. Planta Medica, 75(2), 105–112. https://pubmed.ncbi.nlm.nih.gov/19016404/
5. Salamati, A., Mashouf, S., Sahbaei, F., & Mojab, F. (2014). Effects of Inhalation of Lavender Essential Oil on Open-heart Surgery Pain. Iranian Journal of Pharmaceutical Research : IJPR, 13(4), 1257–1261. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25587315
6. Unno, K., Iguchi, K., Tanida, N., Fujitani, K., Takamori, N., Yamamoto, H., … Hoshino, M. (2013). Ingestion of theanine, an amino acid in tea, suppresses psychosocial stress in mice. Experimental Physiology, 98(1), 290–303. https://physoc.onlinelibrary.wiley.com/doi/full/10.1113/expphysiol.2012.065532