Stress can appear in all manner of ways, be it from work, personal relationships, or juggling too many responsibilities. Although a little added pressure may help you meet that deadline, stress can often have a dark side. Becoming overwhelmed and anxious can result in a snowball effect of worry, leading to concerning symptoms of poor health. During the past few months of the COVID-19 (SARS-CoV-2) pandemic, unforeseen changes have forced us to adapt daily routines accordingly. Shifts in our mental and physical state have stemmed from a lack of certainty for what the future holds. Noticeable effects of the psychosocial transformations occurring around us have also correlated with changes to women’s menstrual cycles. This makes us wonder: what is the connection between menstrual cycles and stress?
A growing number of reports show women experiencing more intense cramps, longer or shorter cycles, or absent periods altogether. Exploring how our bodies are dealing with the “new normal” has inspired the inne team to question how stress and our environment can impact our hormones. Here, we take a closer look at what exactly happens when life gets on top of us, and how this can lead to changes in our menstrual health.
The connections between stress and menstrual cycle
The role and behaviour of stress hormones
Stress itself is the body’s way of responding to conditions or experiences that make us feel threatened, physically compromised, or psychologically distressed. Our appetite may decrease, symptoms of headaches, hair loss, and deteriorating vision may occur, as well as menstrual cycles swinging from short, to long, to nearly invisible (1). Understanding what happens within us, hormonally, when we feel stressed is something which requires us to dig deeper into the way our bodies communicate through hormonal pathways.
Hormones themselves are chemicals that carry messages from one cell to another, running throughout our bloodstream and supporting organ functions. In relation to the menstrual cycle, sex hormone signals are sent between the brain and the ovaries. This causes ovulation, and preparation for fertilisation with such as the changes in cervical fluids. During this time, if you’re not pregnant, the shedding of the uterus lining results in a menstrual bleed.
It is the hypothalamus and the pituitary gland (situated in a bony hollow behind the bridge of your nose) that work together with the adrenal glands (located on top of each kidney) to control the release of hormones around our bodies, including the ovaries (2). The messages they feed one another will regulate our body’s cycle. As well as help processes such as digestion, sexual desire, mood, and our response to high pressure situations. When the body starts to feel stressed, a hormonal pathway in our brain called the hypothalamic-pituitary-adrenal (HPA) axis becomes active. This influences the way these glands work and function (3).
The potential impact of stress on menstrual cycles
The HPA axis is our central stress response system. It combines psychosocial and physical pressures so as to help the body become regulated and optimise survival. It’s what spurs us into “fight or flight” mode and interferes with the communication between the brain and adrenal glands. It signals to the body a need to produce corticotropin-releasing hormone (CRH) (4) which in turn produces adrenocorticotropic hormone (ACTH). It is ACTH that provokes the secretion of stress hormones cortisol and glucocorticoids (5, 6).
Cortisol and glucocorticoids are important mediators between menstruation, ovulation, and fertility. Research shows that high levels of these hormones can result in preterm labour and miscarriage (7). Increased cortisol levels suppress reproductive hormones, namely oestrogen and progesterone, inadvertently telling the body it’s too stressed to be pregnant (8). Fluctuation of these hormones may cause painful menstruation (dysmenorrhoea), spotting or the absence of menstruation all together.
“Increased cortisol levels suppress reproductive hormones, namely oestrogen and progesterone, inadvertently telling the body it’s too stressed to be pregnant.”
Short and long term effects of stressful situations
External Pressures and Personal Stress
Studies show that traumatic events such as war, separation from family, and famine have resulted in women experiencing secondary amenorrhea. This is the absence of menses for three or more months depending on the regularity of your period (9). Furthermore, women experiencing post-traumatic stress disorder (PTSD) are found to have a higher level of cortisol released within the body. This suppresses the secretion of reproductive hormones, and inhibits sexual behaviour by lowering the libido (10, 11).
Work, financial concerns, or lifestyle choices can all put additional pressure on the body, encouraging the HPA axis to activate. Statistics show that female shift workers compared to non-shift workers are more likely to report menstrual irregularity and longer cycles (12). Such reports also show that inconsistent sleep patterns and circadian rhythms disrupt the body’s production of cortisol and melatonin. The latter hormone helps to regulate your sleep-wake cycle, and is necessary for the body to rest. Meanwhile, changes in diet and vigorous sporting activities can noticeably affect the regularity of the menstrual cycle (6, 13). Check out our article about Hormones and Appetite to learn more about the intricacies of this topic.
Menstrual cycles in the context of COVID-19
Over the past few months, reports of women experiencing heavier bleeds, more painful ovulation, or absent periods are slowly gathering. Although there currently is little data, material is starting to help us understand the impact COVID-19 is having (14). We know that fever and inflammation has a noticeable effect on our bodies health, presenting another reason for our hormones to shift. So be it a case of COVID-19, worries for the future, or present day concerns, it’s safe to presume the pandemic is having a toll on us in one way or another.
Recognising Stress and Tracking Symtoms
The ways we deal with stress are undeniably different and personal. Therefore, recognising symptoms such as changes in mood, energy levels, increased acne or hair loss can be our body’s way of telling us something isn’t quite right. Linking this to your menstrual health allows for a fuller picture to appear. We suggest tracking your hormonal patterns and logging the start and end dates of your cycle via the inne app. Noticing when your progesterone levels fluctuate or differences to the length of your menstrual cycle can help to determine the root cause of any changes (15).
As always, if you have cause for concern, we suggest you seek expert advice. In the meantime, we advise putting aside an hour each day to focus on your mental wellbeing. Keeping those stress levels in check and adopting a self-care routine can help strengthen or develop a healthier, happier you in the long run.
This article was reviewed by Gianluca Adornetto, Lead Scientist at inne.
- Nachiappan, Vasanthi; Muthukumar, Kannan (December 2010). “Cadmium-induced oxidative stress in Saccharomyces cerevisiae”. Indian Journal of Biochemistry and Biophysics, 2010, available from: https://bit.ly/34HqJKU
- Daniel, P M. “Anatomy of the hypothalamus and pituitary gland.” Journal of clinical pathology, Supplement (Association of Clinical Pathologists) vol. 7, 1976, available from: https://bit.ly/34EYxYU
- Smith, Sean M, and Wylie W Vale. “The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress, Dialogues in clinical neuroscience, 2006 vol. 8,4, pages 383-95
- Vitoratos, N., Papatheodorou, D. C., Kalantaridou, S. N., & Mastorakos, G. “Reproductive” Corticotropin‐Releasing Hormone, Annals of the New York Academy of Sciences, 2006, pages 310–318.
- Stephens MA, Wand G. Stress and the HPA axis: role of glucocorticoids in alcohol dependence. Alcohol Res. 2012;34(4):pages 468-483.
- Bae J, Park S, Kwon JW, Factors associated with menstrual cycle irregularity and menopause. BMC Womens Health. 2018; page 36.
- Damti OB, Sarid O, Sheiner E, Zilberstein T, Cwikel J. Harefuah. Stress and distress in infertility among women, 2008;147(3): pages 256-276.
- University of California – Berkeley, Stress Puts Double Whammy On Reproductive System, Fertility. ScienceDaily. 2009, Online Article consulted August 2020. Available from: https://bit.ly/32wKD8G
- Amenorrhea – Symptoms and Causes, Mayo Clinic, Online Article Consulted August 2020. Available from: https://mayocl.in/34B3li2
- Ralph, C., Lehman, M., Goodman, R., & Tilbrook, A, Impact of psychosocial stress on gonadotropins and sexual behaviour in females: role for cortisol? Reproduction, 2016, 152(1)
- Elzinga, B., Schmahl, C., Vermetten, E. et al. Higher Cortisol Levels Following Exposure to Traumatic Reminders in Abuse-Related PTSD. Neuropsychopharmacol 28, 2003, Pages 1656–1665
- Baker FC, Driver HS. Circadian rhythms, sleep, and the menstrual cycle. Sleep Med. 2007, ;8(6): Pages 613-622
- Berz K, Mccambridge T, Amenorrhea in the female athlete: What to do and when to worry, Pediatr Ann, 2016. Available from: https://bit.ly/2EFpyAv
- Hua Zheng, Juan Tan, Ke Ma et al. Changes in RT-PCR test results and symptoms during the menstrual cycle of a female individual infected with SARS-CoV-2: a case report, 27 April 2020. Available from: https://bit.ly/3jnRlok
- Herrera, Alexandra Ycaza et al. “Stress-induced increases in progesterone and cortisol in naturally cycling women.” Neurobiology of stress 2016, vol. 3 96-104