Could stress be impacting your menstrual cycle?

 

Stress can have a huge impact on health, wellbeing, and yes, even your menstrual cycle. Our clinical lead Zoe dives into why, and how you can work to reduce your stress levels (goodbye, cortisol). 

Stress, don’t we all know it. It’s that pesky feeling that’s more than anxiety, it’s a feeling of not being able to cope or manage (1). Sound familiar? While small doses might be beneficial, experiencing excessive, or chronic stress can wreak havoc on our health and on our menstrual cycle. 

Have you noticed stress-induced changes in your cycle? There’s simply no single way that your period might respond to stress, as this will depend largely on the amount and exposure to the stressor and your coping abilities. The hormonal changes associated with stress, however, can certainly alter your cycle. Early research displays some associations between the COVID-19 pandemic and alterations to the menstrual cycle – with around half of Brits reporting changes (2). So, could stress be the culprit? 

Let’s take a look at how stress may manifest…

1. More Severe Premenstrual Syndrome (PMS)

You’ve probably heard of premenstrual syndrome (PMS) or maybe even the tagline, ‘I’m PMSing’. PMS is understood as a cluster of changes (that may be physical, emotional, or behavioural) in the time before menstruation that can have a profound impact on your quality of life (3). High stress has been shown to increase symptoms of premenstrual syndrome (4, 5). We know, it’s not good news… It can even make your PMS symptoms more severe and let’s face it, no one wants that (6, 7). One 2004 study found that individuals who were highly stressed were twice as likely to experience painful periods (8). Ouch! 

2. Absence or Delay of Menstruation 

Ever experienced a late period due to stress? Maybe your period even disappeared altogether? It can certainly feel worrying and even scary to miss a period. While this couldbe due to other factors (and you should speak with your doctor if your period is late or absent), if you have been experiencing high stress, this could be a likely culprit. Studies have shown that stress, particularly experienced during the follicular phase (which runs from the first day of your period through to ovulation), can result in absent or delayed ovulation (9-11). This means  you may not experience a period at all (12). 

Why? Basically, your body decides that it is going to prioritise its survival processes during stress and your reproductive functions don’t always make the cut!

3. Cycle irregularities

Stress can be a major cause of menstrual cycle irregularities (9-11). Longer or shorter periods? Heavier or lighter flow? Spotting between periods? Psst, check your stress levels! Studies have found that stress (amongst other factors) can contribute to these menstrual changes (11, 13, 14). Although it may feel alarming to experience these irregularities , the menstrual cycle relies on a delicate balance of hormones which stress can often impede (9).

Hold up, not all cycle irregularities are due to stress or something to be worried about.  While the menstrual cycle typically follows a 28-day pattern, fluctuations are normal, and a period can occur anywhere from every 21 to 35 days. Anything outside of this range, however, we generally consider irregular. 

Why does stress affect my period? 

The short answer is that these changes occur due to hormones. When you start to become stressed, a hormonal pathway known as the hypothalamic-pituitary-adrenal (HPA) axis becomes activated and releases stress hormones (15). I know, some long words – stay with me here. This increase in stress hormones results in shifts to the regular hormonal patterns that control the menstrual cycle, potentially leading to changes in ovulation and menstruation (16-18). Essentially: stress = shift in reproductive hormones = changes in your cycle. 

Know when to see a doctor: 

While stress may be one potential reason for changes in your cycle, there are certainly other possibilities and conditions which may result in menstrual changes (such as pregnancy and other underlying conditions such as uterine fibroids, polyps, or polycystic ovarian syndrome, ovarian cysts, and tumours). If you are feeling concerned, would more information or want to ensure that your cycle changes really are stress-related, it is best to speak with your doctor. 

Tips to lower your stress:

The good news is that it is possible to regain menstrual cycle regularity by lowering stress levels. One of the first steps to controlling stress is identifying your body’s specific response to stress. Then you identify early signs of life becoming a bit too hectic - and act. 

Suggestions: 

  • Cognitive Behavioural Therapy (CBT). Apps such as Bloom or Happify can help you better understand patterns of thoughts, emotions and behaviours that increase stress. 
  • Try keeping a stress journal – this can help identify triggers/causes 
  • Incorporate more self-care.
  • Mindfulness — yoga and meditation (even mindful masturbation) 
  • Meeting your physiological requirements: adequate sleep, regular exercise, and a balanced diet. 
  • Do something you enjoy every day – this can boost mood and relieve stress.
  • Connect with others and maintain a social support system.

 

Zoe Sever is Unfabled's Clinical Lead. Zoe brings a wealth of knowledge from her broad spanning background, having started her career in Nursing and transitioning to Sexology and Research. She holds a Master’s in Sexual and Reproductive Health and is currently pursuing a PhD in Women’s and Reproductive Health at Oxford University. On a mission to empower individuals with cycles to better understand their bodies, Zoe is helping us to banish shame, stigma and demystify reproductive health

 

References: 

  1. Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. Jama. 2007;298(14):1685-7.
  2. Pierce M, Hope H, Ford T, Hatch S, Hotopf M, John A, et al. Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. Lancet Psychiatry. 2020;7(10):883-92.
  3. Yonkers KA, O'Brien PMS, Eriksson E. Premenstrual syndrome. Lancet (London, England). 2008;371(9619):1200-10.
  4. Yamamoto K, Okazaki A, Sakamoto Y, Funatsu M. The relationship between premenstrual symptoms, menstrual pain, irregular menstrual cycles, and psychosocial stress among Japanese college students. J Physiol Anthropol. 2009;28(3):129-36.
  5. Singh R, Sharma R, Rajani H. Impact of stress on menstrual cycle: A comparison between medical and non medical students. Saudi J Health Sci. 2015;4:115-9.
  6. Mohib A, Zafar A, Najam A, Tanveer H, Rehman R. Premenstrual Syndrome: Existence, Knowledge, and Attitude Among Female University Students in Karachi. Cureus. 2018;10(3):e2290.
  7. Del Mar Fernández M, Regueira-Méndez C, Takkouche B. Psychological factors and premenstrual syndrome: A Spanish case-control study. PLoS One. 2019;14(3):e0212557.
  8. Wang L, Wang X, Wang W, Chen C, Ronnennberg AG, Guang W, et al. Stress and dysmenorrhoea: a population based prospective study. Occup Environ Med. 2004;61(12):1021-6.
  9. Rafique N, Al-Sheikh MH. Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences. Saudi Med J. 2018;39(1):67-73.
  10. Nillni YI, Wesselink AK, Hatch EE, Mikkelsen EM, Gradus JL, Rothman KJ, et al. Mental health, psychotropic medication use, and menstrual cycle characteristics. Clin Epidemiol. 2018;10:1073-82.
  11. Bae J, Park S, Kwon J-W. Factors associated with menstrual cycle irregularity and menopause. BMC Women's Health. 2018;18(1):36.
  12. Medicine PCotASfR. Current evaluation of amenorrhea. 2004 Sep.
  13. Kwak Y, Kim Y, Baek KA. Prevalence of irregular menstruation according to socioeconomic status: A population-based nationwide cross-sectional study. PloS one. 2019;14(3):e0214071-e.
  14. Ekpenyong CE, Davis KJ, Akpan UP, Daniel NE. Academic stress and menstrual disorders among female undergraduates in Uyo, South Eastern Nigeria - the need for health education. Niger J Physiol Sci. 2011;26(2):193-8.
  15. Smith SM, Vale WW. The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress. Dialogues in clinical neuroscience. 2006;8(4):383-95.
  16. Vitoratos N, Papatheodorou DC, Kalantaridou SN, Mastorakos G. Reproductive Corticotropin-Releasing Hormone. Annals of the New York Academy of Sciences. 2006;1092(1):310-8.
  17. Kalantaridou SN, Makrigiannakis A, Zoumakis E, Chrousos GP. Stress and the female reproductive system. Journal of Reproductive Immunology. 2004;62(1-2):61-8.
  18. Ding JH, Sheckter CB, Drinkwater BL, Soules MR, Bremner WJ. High serum cortisol levels in exercise-associated amenorrhea. Ann Intern Med. 1988;108(4):530-4.

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