Stress and Your Menstrual Cycle: Is there a link?

Most of us recognise stress when it comes along. It can be triggered by an impending deadline or presentation. Maybe you are moving house next week or taking on extra shifts at work to afford a holiday this year. Either way, stress is a natural reaction to different life events. Often a very good motivator, it helps us work harder and achieve things, in small doses. But there is a difference between experiencing a one-off stressful event and consistently being under pressure, categorised as chronic stress.

Stress has always been a part of human life. The changes we feel when stressed are much akin to what our ancestors felt when they were running away from life-threatening predators. Except today, our predators now take on the shapes of board rooms, bosses, and bills – some of these are way harder to escape from and more complex to deal with.

For those of us who love to skim read… here are the highlights:

• Stress is a physiological reaction to elements of our everyday life – a little is good, but a lot of constant stress is not so good.
• Your body responds to stress by producing hormones called cortisol and corticotropin-releasing hormone. These can affect several processes throughout your body, including your menstrual cycle.
• By blocking the key hormones which control your menstrual cycle, your body’s response to stress can make your cycles longer or shorter and/or more painful. It can even make them stop altogether.
• Everyone deals with stress in different ways, but if you are worried about how stress may be affecting your periods, we have included some tips to help you figure it out.

How can stress affect your menstrual cycle?

Our body’s reaction to stress is coordinated by something called our hypothalamic-pituitary-adrenal axis (We know it’s a mouthful… let’s just go with the HPA axis). Our hypothalamus helps encourage the production of hormones like cortisol and corticotropin-releasing hormone (CRH) 2. These kickstart your body’s reaction and effectively divert your brain’s attention and energy away from things like growing or coordinating your reproductive system.

Interesting fact! Cortisol receptors are found all over the body. This means cortisol can affect much more than just menstruation. It is implicated in things like memory formation, metaboInteresting fact! Cortisol receptors are found all over the body. This means cortisol can affect much more than just menstruation. It is implicated in things like memory formation, metabolism, and your sleep-wake cycle.lism, and your sleep-wake cycle.

To understand how stress may affect your menstrual cycle, it’s important to understand the basics. We’ve written a whole article on this and could talk about it for days, but the facts are; 

• A ‘normal cycle’ can last anywhere from 21 to 35 days, a one-off longer or shorter cycle is alright, but if you find them be consistently irregular you should get it checked out because it could be linked to an underlying health condition such as PCOS 
• Your body’s response to stress and the regulation of your menstrual cycle are both coordinated by the hypothalamus (this is called the hypothalamic-pituitary-gonadal axis or HPG axis).
• The hypothalamus produces a hormone called gonadotropin-releasing hormone (GnRH), which encourages the brain to release for the release of other important hormones such as Follicle Stimulating Hormone (FSH), which is involved in helping your eggs mature and Luteinising hormone (LH), which coordinates ovulation. 
• These in turn, control the hormones made by the ovaries to – Oestrogen and Progesterone. 
  • Oestrogen plays an important role in helping your eggs grow and mature.
  • Progesterone is produced once ovulation and prepares the uterus for either a potential pregnancy

The menstrual cycle is coordinated by the same area of the brain as the stress response. Therefore, it makes sense that cortisol and CRH are able to affect the levels of the regulatory hormone, GnRH – affecting all the other hormones under the control of GnRH. 

Cortisol can effectively delay ovulation by blocking the release of LH,. This can interfere with  progesterone production making your cycles longer and potentially heavier. Conversely, high levels of stress are also associated with shorter cycles.

In situations of chronic stress, ovulation can stop for long periods of time (known as chronic anovulation). This can be due to psychological stress but also periods of intense, excessive exercise or eating disorders. This is known as functional hypothalamic amenorrhoea. 

In a nutshell, stress can make your periods longer or shorter, make them stop altogether or even make your PMS worse, all by interacting with the HPG axis. Stress can also affect periods in subsequent months, changing their duration and even how painful they may be. This means a stressful event a month or two ago could affect your period in subsequent months.

And another thing….Not only does stress affect the menstrual cycle, but it influences sexual desire and arousal. In fact, Hamilton and Meston showed women experiencing high levels of stress showed lower levels of sexual desire, linked to elevated cortisol levels.

But, what causes stress and how can we manage it?

Stress is classed as a state of ‘disharmony’, disrupting the carefully coordinated balance that our body is consistently fine-tuning. Usually, our body reacts in this way temporarily and is able to revert whatever changes occur.  However, it is increasingly common that we are exposed to prolonged periods of stress or several different, unresolved stressors, which we cannot adapt to. This can feel never-ending and all-encompassing, impacting both mental and physical health. This is the type of stress linked to depression , fertility issues  and other health problems.

It really is quite logical, from an evolutionary standpoint, why high levels of stress could affect reproductive processes within our bodies. I mean, it would be extremely inconvenient to get pregnant whilst on the run from the big bad wolf…so you could say our body is reacting appropriately to this situation.

Everyone deals with and experiences stress differently. This can be down to the situation, your life experience, the support network you have. There is no one correct way to deal with stress. Just like how every one of us reacts to stress in different ways, we respond differently to the various methods of alleviating stress. For some people, talking about their feelings with friends and family helps. For others, this can feel like added pressure to put how they are feeling into words. There are some great tips on the NHS website.

If you are worried about your periods and their irregularity, there are a few things you can do.

1. Chart your periods. How irregular are they? Are they painful? Do your PMS symptoms differ based on the type of stress? This is such a good tool to get to know your body and periods. It will also make it easier to recount your history if you need to see a healthcare professional.
   
2. Write down when you feel stressed, how does this correlate with your periods and PMS symptoms.
   
3. Look out for other signs of stress such as feeling burnt out and fatigued, difficulty relaxing or sleeping, experiencing digestive problems or constantly worrying about the future.
   
4. If you are under stress consistently, it may be difficult to pin down your irregular cycles to this. The best way to establish what is going on with your cycles is to look at your hormone health  – you can do this using our tailored at-home Hormone and Fertility Kits. Looking at hormones such as testosterone or thyroid-stimulating hormone, we can eliminate other things which can affect your cycle and ovulation such as PCOS or abnormal thyroid function

5. Speak to an expert – If you are experiencing stress or even just feeling like you may benefit from being able to talk to someone about your worries, we are here for you. Our trained Fertility Counsellors are here to give you support, at every step of your journey. Our counsellors are trained psychotherapists accredited with the BACP (British Association of Counsellors & Psychotherapists) and BICA (British Infertility Counselling Association). Book in for your session here.

 Trusted Resources:

1. Good Thinking UK.  Types of Stress [Online]. [Accessed 23 June 2021]. Available from: https://www.good-thinking.uk/types-stress/.
2. Kalantaridou, SN, Zoumakis, E, Makrigiannakis, A, Lavasidis, LG, Vrekoussis, T and Chrousos, GP. Corticotropin-releasing hormone, stress and human reproduction: an update. Journal of Reproductive Immunology. 2010;85(1):33-9.
3. Hamilton, LD and Meston, CM. Chronic stress and sexual function in women. The journal of sexual medicine. 2013;10(10):2443-54.
4. Barsom SH, Mansfield PK, Koch PB, Gierach G, West SG. Association between psychological stress and menstrual cycle characteristics in perimenopausal women. Womens Health Issues. 2004 Nov-Dec;14(6):235-41. doi: 10.1016/j.whi.2004.07.006. PMID: 15589774.
5. Wang, L, Wang, X, Wang, W, Chen, C, Ronnennberg, AG, Guang, W, Huang, A, Fang, Z, Zang, T, Wang, L and Xu, X. Stress and dysmenorrhoea: a population based prospective study. Occup Environ Med. 2004;61(12):1021-6
6. Valsamakis, G, Chrousos, G and Mastorakos, G. Stress, female reproduction and pregnancy. Psychoneuroendocrinology. 2019;100:48-57.
7. Tsigos, C, Kyrou, I, Kassi, E and Chrousos, GP. Stress: Endocrine Physiology and Pathophysiology. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Grossman A, Hershman JM, Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrere B, McGee EA, McLachlan R, Morley JE, New M, Purnell J, Sahay R, Singer F, Stratakis CA, Trence DL, Wilson DP, editors. Endotext. South Dartmouth (MA)2000