Your body is no stranger to stress—between our already fast-paced modern lifestyles and a pandemic, it can be hard to escape. Stress may seem like something that’s in your head, but don’t underestimate the pervasiveness of stress throughout every system of your body and the significant effect it can have on your hormones. When your hormones are not balanced, they may impose changes on your menstrual cycle, in some cases even causing your period to disappear for a length of time.
That doesn’t mean that every time you’re under a tight deadline for work or having an argument with a significant other that your period is necessarily going to show up late or not at all, or be more painful. Of course, it’s nearly impossible to avoid certain life stressors, and those stressful events for the most part won’t alter your menstrual health. It’s more chronic, long-term stress that can have a greater effect on your cycle, explains Jaclyn Tolentino, D.O., a provider at Parsley Health Los Angeles. “If our bodies don’t adapt to stress well, it keeps our bodies in ‘fight-or-flight’ mode, which impacts other hormonal mechanisms and becomes a ripple effect,” Dr. Tolentino says. Read on to better understand how stress affects the hormones that govern your menstrual cycle and how managing it may help your period stay on track.
Can stress delay your period?
Stress can hit the reproductive system by way of the brain: It interrupts the hypothalamus and pituitary gland from functioning properly. When the body is under stress, it exits “rest and digest” mode and enters into “fight-or-flight” response. “During stressful events, the hypothalamus activates the sympathetic nervous system, which signals the adrenal glands to release hormones like adrenaline, and triggering the physiological changes we associate with the ‘fight-or-flight’ response: increased pulse rate, blood pressure, rapid breathing,” Dr. Tolentino says.
Under prolonged stress, the body’s HPA (hypothalamic-pituitary-adrenal) axis continues to fuel the stress response by keeping the sympathetic nervous system (which produces that “fight-or-flight” feeling) activated. Then it’s a chain reaction of hormone release from the hypothalamus, the pituitary gland, and the adrenal gland, and that reaction releases the primary stress hormone, cortisol. With increased cortisol circulating, it suppresses the hormone GnRH in the reproductive system–that’s the hormone that stimulates the pituitary gland to produce LH and FSH, says Dr. Tolentino. The production of LH and FSH, both of which play a vital role in ovulation, support the production of estrogen and progesterone, the two key hormones in a menstrual cycle. And throughout this, the HPA axis continues to stay active. “The actions of the HPA axis maintain this “high alert” status in our body,” Dr. Tolentino says. Basically, you remain stressed until the body sends a signal that it’s okay to relax. If the HPA axis is functioning on high alert, the entire system will be off, triggering changes to the hormones and therefore the menstrual cycle.
The changes in your period that can be caused by stress
Studies have suggested that consistently high levels of stress could affect your period because the HPA-axis has been disrupted. This may result in periods that show up early, late, or are a different length each month. Also, keep an eye on your stress levels for their effect on the thyroid. “Non-adapted stress also has an impact on thyroid levels,” says Dr. Tolentino. “It impairs the conversion of the thyroid hormones T4 to T3, and thyroid issues independently of sex hormones can cause the menstrual cycle to become irregular. That also can impact fertility,” adds Dr. Tolentino.
2. Missed Periods
In addition to your period being irregular, it’s also common to skip a month here or there due to extreme stress. Again, the culprit could be the HPA-axis dysfunction indirectly throwing off the production of your sex hormones. That can result in delayed ovulation or no ovulation at all (anovulation), which can then cause you to miss your period altogether that month, says Dr. Tolentino.
If your period was previously regular but has stopped for at least three consecutive months (and there’s no chance of pregnancy), it could be a sign of secondary amenorrhea, which indicates a three-month or longer pause in menstruation, Dr. Tolentino says. Extreme stress is a known risk factor for amenorrhea, which is associated with higher cortisol levels in the blood. Secondary amenorrhea affects 3 to 4 percent of women, according to research. Or, the stress-induced pause of your period could be a more serious condition called Functional Hypothalamic Amenorrhea, or FHA, says Dr. Tolentino. It’s a complex process, but the HPA-axis’ stress response disturbs the HPO (hypothalamic-pituitary-ovarian) axis, which controls ovulation and can disrupt the entire menstrual cycle. “Other factors involved in FHA are extreme weight loss, and excessive exercise,” she adds. At Parsley, your provider would likely first test you for other medical conditions that may cause your period to stop before evaluating you for FHA.
Dysmenorrhea, the condition associated with painful periods or severe menstrual cramps, may also be connected to stress. Some research associates high levels of reported stress, anxiety, and depression, and high levels of menstrual pain and cramps. But there’s not enough research to fully explain why. Other research claims that dysmenorrhea might induce anxiety and stress, so they might feed off each other, Dr. Tolentino suggests. Another factor that might impact dysmenorrhea is the presence of prostaglandins, she explains. These are chemical signals that your body naturally generates during your period and may heighten your body’s perception of pain.
5. PMS symptoms
Similar to dysmenorrhea, there is evidence, like this small study published in the Journal of Obstetrics and Gynecology, that implies higher stress levels may correlate with more severe and painful PMS symptoms (the most common including cramps, mood swings, irritability, and back pain). Based on this research, there is a connection between stress and periods through PMS, but it’s unclear exactly why the connection exists, Dr. Tolentino says. “A cascade reaction of hormone regulation exists between our adrenals, thyroid, and our ovaries that is intimately connected to feedback from the brain.” And then, stress affects that connection, through the HPA-axis. “Chronic stress creates a cascade that triggers hormonal imbalances, contributing to PMS,” she adds.
How to know whether stress is causing your period issues
Whether you’re experiencing irregular periods, missed periods, increased period pain, or something more serious like FHA, it’s important to bring it up with your provider. Just because you’ve experienced a particularly stressful time at work or at home, “we wouldn’t assume stress alone is the primary factor in menstrual irregularity or absence,” says Dr. Tolentino. Major changes in your cycle would be a result of extreme stress, whether that’s a traumatic event or chronically high stress levels, she says.
Parsley physicians will look into any factors that affect your menstrual cycle through diagnostic and lab testing. Your Parsley doctor will pay specific attention to symptoms of missing periods (amenorrhea), or very irregular periods, because they can affect your bone density or cardiovascular health, for example, Dr. Tolentino says. Since the body’s systems, especially the hormones, are so interconnected, stress won’t be the only contributing factor in your menstrual cycle—your nutrition, exercise, sleep quality, and other physiological processes are also at play. “Stress is just one piece of a larger puzzle related to menstrual dysfunction,” says Dr. Tolentino.
Parsley-recommended ways to get your cycle back on track and regulate stress
If you do have concerns about regulating your cycle and minimizing stress that might be contributing to issues, Parsley Health’s providers and health coaches can formulate a health plan to help. These are some ways they help members cope with stress-related menstrual irregularity.
Know your stress triggers. Managing your stress and your periods starts with practicing body intuition, Dr. Tolentino says, and knowing your personal stress triggers and how you tend to react to them. Setting boundaries and saying ‘no’ to events and people who cause you stress are completely acceptable (especially in a pandemic).
Recognize dietary factors that add to stress. If there are certain foods that typically trigger digestive symptoms, which may be exacerbated by stress, eat or drink them in moderation. Caffeine can be a key trigger of stress, during PMS especially, says Dr. Tolentino, so don’t overload on it. Working with a health coach can also help you to identify what these foods may be for you.
Practice stress reduction techniques. Find the practices that give you joy and help keep you grounded, Dr. Tolentino advises. For some people, this looks like meditation, yoga, or any other mind-body practices. Other people may find that a long run or cardio session is a better stress reliever, particularly during or right before your period.
Make sure you have a support network. “Family and friend support, and social connection is a huge component of a healthy, adaptive response to stress,” says Dr. Tolentino. Having people to check in with, during all phases of your cycle, is important to maintain control over your stress levels, she adds. The Parsley Health team is always there to offer support, too.
Journal to process stress, and to record your cycles. Dr. Tolentino recommends journaling for an additional way of practicing body intuition. You can record your mental-health related response to the various phases in your cycle, along with your physical symptoms. “Look for links between periods of stress, painful or irregular cycles, and practices you may be adopting to cope with stress levels,” Dr. Tolentino says.