Trauma and PCOS / PMOS: how stress and the nervous system may be connected

Why PCOS / PMOS may not be only about hormones

In recent years, awareness of PCOS / PMOS has been growing, with more research and strategies emerging to manage its symptoms. There is increasing recognition of the importance of lifestyle changes, healthy habits and the role of diet. Sleep quality and stress management are also gaining attention.

The causes of PCOS / PMOS are still not fully understood. Researchers point to genetic and environmental factors. There is also talk of different types, which categorise women based on the underlying drivers of their condition: insulin resistance, high androgen levels, inflammation in the body, or PCOS / PMOS that appears after stopping hormonal birth control. Many women don’t fit neatly into any single category, which is when we talk about a “mixed type”.

This categorisation can be helpful in managing symptoms. But does it explain why the body ended up there in the first place?

In my opinion, we need to dig even deeper, and I’m not alone in this belief. Many researchers have long observed the connection between emotions, the mind and the way they show up in the body. The mind and body are one. Exploring these connections is much more challenging than counting calories or measuring hormones, but it’s encouraging to see growing attention being paid to them.

What made me look further?

My own experience, and conversations with other women who had similar struggles. Despite following a healthy PCOS / PMOS-friendly diet, taking supplements, exercising, getting enough sleep and leading a generally healthy lifestyle, the results were disappointing. Whenever I relaxed my routine, even slightly, whether with diet or sleep, the symptoms would return. The same happened when I stopped taking birth control pills.

I didn’t want to live like that, so I kept searching for answers. Today I understand how essential it is to address chronic stress and to build a sense of inner safety. For me, this became a key part of supporting my hormones and feeling at home in my body.

Your nervous system in five minutes

Your autonomic nervous system works in the background, without your conscious control. It has two main modes:

• The “gas pedal” (sympathetic system): the stress response, also known as fight, flight or freeze. Your heart beats faster, your muscles tense, digestion slows down and your body releases stress hormones.
• The “brake” (parasympathetic system): rest, digestion and recovery. This is the mode in which the body repairs itself and feels safe.

In a healthy rhythm, we move between the two. We switch on when we need to and switch off when the danger is over. The problem begins when the gas pedal stays pressed for months or years, because of ongoing stress, pressure, lack of sleep, or experiences from the past that the body still treats as a threat.

How a stressed nervous system may affect hormones

The body’s main stress system is called the HPA axis (hypothalamus–pituitary–adrenal axis). The brain signals the adrenal glands, and they release cortisol. Here are some ways in which a chronically activated stress system could touch the processes involved in PCOS / PMOS:

• Ovulation. The hypothalamus also helps control the signals that trigger ovulation. This is one reason why long periods of stress can make cycles irregular, or stop them altogether.
• Androgens. The adrenal glands also produce androgens, and the stress system influences how much they release.
• Blood sugar and insulin. Chronic stress and high cortisol can make blood sugar harder to regulate and may worsen insulin resistance.
• Sleep and inflammation. Stress disturbs sleep, and poor sleep and chronic stress are both linked to higher inflammation.

Some studies in women with PCOS / PMOS report signs of an overactive stress response, such as higher activity of the sympathetic nervous system and lower heart rate variability. It is important to be honest here: research is still ongoing, and we don’t know yet whether stress is a cause, a consequence or both. Living with PCOS / PMOS symptoms is itself stressful, and stress can make the symptoms worse. What I can say is that the nervous system is a piece of the puzzle that deserves more attention than it gets.

Could chronic stress or trauma play a role?

First, let’s define trauma. Trauma is a person’s response to an event, not the event itself (such as an accident). It is an experience that overwhelms a person’s ability to cope and process the difficult emotions connected to that event.

There is also childhood trauma, which can occur when a child faces frequent and/or prolonged adversity or neglect without adequate support from adults. This can include physical, emotional or sexual abuse, such as assault, sexual harassment, bullying or humiliation by peers. Other experiences, like a turbulent parental divorce, constant family conflicts, severe illness, the sudden death of a caregiver, toxic family dynamics or substance abuse in the family, can also be sources of trauma.

Long-term exposure to stressful situations and unresolved trauma can promote a toxic stress response. A chronically dysregulated stress response, especially in early childhood, can negatively impact overall health. It can directly affect the HPA axis and disrupt the neuroendocrine-immune system, the network through which the nervous system, hormones and immune system talk to each other.

The link between childhood trauma and health

A groundbreaking study from the 1990s, known as the Adverse Childhood Experiences (ACE) study, found a strong connection between childhood trauma and various negative health outcomes in adulthood. These include a significantly higher risk of heart disease, addictions, depression, suicide and obesity. Experts such as psychiatrist Bessel van der Kolk, psychologist Peter Levine, physician Nadine Burke Harris and doctor Gabor Maté have all highlighted the connection between trauma and health problems.

In 2022, a study (PMID: 35985071) examined a sample of psychiatrically healthy women to see how different forms of abuse (emotional, physical, sexual) and neglect (emotional and physical) are related to PCOS / PMOS. It found that emotional abuse (31.6%) was the most common form of abuse and was significantly linked to PCOS / PMOS.

It’s worth remembering that this kind of research shows an association, not proof that trauma causes PCOS / PMOS. Still, it is a signal that we shouldn’t ignore.

“But my sister doesn’t have PCOS / PMOS, and we went through the same things”

Nothing in life is black and white. Each of us processes reality differently. We have unique tolerances for food, exercise and stress. We have different genetic predispositions, and, most importantly, different sensitivities.

Maybe your sister found a healthy outlet for her stress through sport or a hobby. Perhaps she expressed her emotions differently, found supportive people around her, or worked on her inner balance and sense of safety. As a result, her nervous system may have been able to leave the fight, flight or freeze mode.

That’s why it’s crucial to look deeper, not only at physical factors, but also at emotional ones, and to understand each woman’s individual story.

Notice your own patterns

Take a moment to reflect, without judging yourself:

• Do your PCOS / PMOS symptoms get worse in stressful times?
• Do you find it hard to switch off, even when you finally have time to rest?
• Is your sleep light, interrupted or unrefreshing?
• Do you often feel tense, on edge or exhausted at the same time?

These questions are not a diagnosis. They are simply a way to start listening to your body.

What can help calm the nervous system?

Good news: the nervous system is not fixed. It can learn to feel safer, and small, regular practices help most. These are ideas I use myself and with the women I work with:

• Slow breathing. A few minutes of breathing with a longer exhale than inhale signals to the body that it can slow down.
• Gentle movement and time outside. Walks in nature, stretching, yoga or dance that feels good rather than punishing. Movement can be a way to come back to your body.
• A sleep routine. A regular schedule and a calm evening ritual.
• Connection. Time with people who make you feel safe and heard.
• Professional support. If difficult experiences from your past feel heavy, a trauma-informed psychotherapist can help you process them at your own pace. You don’t have to do it alone. Please also tell your doctor about your stress levels, because medical care for PCOS / PMOS remains important.

Where to go from here

If you’d like a practical way to start, my ebook “PCOS Stress Reset” will help you:

• understand how your body works with PCOS / PMOS,
• learn how to support your hormones through small, realistic changes,
• discover how stress and emotions affect your health.

If you’d like to read the full overview, start with PCOS / PMOS: what it is, how it affects you and what helps. And if you’d like to start with movement, you are welcome to join me in the studio in Zurich or online: dance classes in Zurich.

You can find your balance and support your nervous system, one small step at a time.

Take care of yourself!

This article is for information only and does not replace medical or psychological advice. If you suspect PCOS / PMOS, or if you are struggling with difficult experiences or your mental health, please talk to a doctor or a qualified therapist. If you are in crisis, contact your local emergency services.