Re: Your Cycle #3: How Stress Affects Your Menstrual Cycle
Can stress affect your period? Yes – and in some pretty weird ways.
TL/DR: We all know stress can affect our mental health, especially if it never lets up. But it can also affect your period, wreaking havoc on that delicate balance of hormones in charge of ovulation and the length of your cycle. In fact, stress can lead to irregular, more painful, or completely absent periods.
Stress is clearly having a moment. Hats off to you, 2020.
No, seriously. If you’re anything like us, you stopped signing off on emails with “hope all is well,” like, five months ago. And despite the fact that many of us are working from home, um, indefinitely, the lack of a commute doesn’t make the work week any less stressful. If anything, it means no more excuse to grab a latte at your favorite coffee shop every morning, which means weak Keurig coffee until… forever? We can’t even go there.
By now, most of us are pretty aware of the damaging effects stress can have on your mental health and its ability to impact physical well-being. (To all the essential workers still getting up at 6 a.m. every day: Thank you). But did you know that stress can impact your menstrual cycle, too? Yeah – turns out, working your ass off to pass that exam or get that promotion might make your period irregular, more painful, or even make it disappear altogether.
For part three of our “Re: Your Cycle” series, we wanted to take an in-depth look at the many ways in which stress affects the menstrual cycle. And - spoiler alert - even the tiniest fluctuations in hormone secretion can throw your entire system out of whack (did you know stress has pretty much everything to do with hormones?). Grab that mug of Keurig coffee and let’s jump in:
The Real Definition of Stress
You know what stress feels like, obviously. But do you know what happens in your body to create it? It’s actually a pretty complex process, involving a whole cast of endocrine and metabolic players that work together to keep your systems functioning and, ultimately, keep you alive (i.e. not mauled by a bear or dead from starvation).
At its most basic level, stress is just your body’s reaction to any perceived change in the environment, both physical and psychological (1). On any given day, your body reacts to such changes – whether it’s stepping outside to a freezing gust of wind or running into your least favorite coworker at the grocery store – with physical, mental, and emotional responses.
Believe it or not, stress can actually be a good thing. It keeps us alert, motivated, and ready to avoid danger: If you smell smoke coming from your bedroom, you don’t just stay planted on the couch with your bowl of popcorn. You get up, assess the scene, and grab a fire extinguisher to put out the flaming sheets.
When stress becomes not-so-beneficial is when it happens to us over and over – especially without getting a moment to relax in between stressors. And today, with our lives chronically overstimulated by mobile phones, social media, and non-stop work, many of us have wound up with cortisol levels that remain elevated 24/7.
Hold Up: What, Exactly, is Cortisol?
If you’re super stressed and feel like you’re running on fumes, well, those ‘fumes’ are probably cortisol: It’s the HBIC of steroid hormones and your body’s built-in alarm system. Produced by your adrenal glands, cortisol has the ability to influence your mood, your metabolism, and lots of other physiological processes (2):
- Cortisol increases the availability of sugars (glucose) in the bloodstream and enhances your brain's ability to use that glucose for energy and alertness, giving you a quick jolt of stamina
- Cortisol communicates with regions in the brain that control mood, fear, motivation, and even memory
- Cortisol slows down or temporarily halts processes that it considers nonessential in a fight-or-flight scenario, such as immune system responses, the normal functioning of the digestive system, the reproductive system, and others
Even in optimal health, your body needs a certain amount of cortisol in order to function. Problems only arise when those cortisol levels get way out of control, throwing off what’s called your HPA axis (the hypothalamic-pituitary-adrenal axis).
The HPA Axis
The HPA axis has three major players: the hypothalamus, which is a part of your brain around the base of the skull; the pituitary, which is the hypothalamus’ pea-sized friend; and the adrenals, which are two triangular glands that sit right on top of your kidneys. All three communicate with each other via hormones that course through your bloodstream.
During a stressful event, the hypothalamus is alerted that, Hey, your body may be in danger! It responds by releasing hormones that travel through your body and eventually wind up in the adrenals. Like a long game of telephone, when the adrenals finally get this message, they push out cortisol, cortisol, and more cortisol.
If this whole process keeps happening over and over again, your body can’t catch a break. A state of prolonged stress may result in a phenomenon known as dysregulation of the HPA axis – and it can lead to major burnout, amenorrhea, and menstrual cycle irregularities (3).
Stress and the Menstrual Cycle
So: How do elevated cortisol and a whacked out HPA axis create problems with the menstrual cycle? It has a lot to do with that fourth bullet point above.
Our bodies haven’t quite evolved to recognize the kind of stress we experience most often in modern life. Even though a looming deadline, a fight with your partner, or your friend suddenly requesting $527 from you on Venmo for Uber rides don’t necessarily qualify as life-threatening circumstances, our adrenal system still registers them as such.
When cortisol levels skyrocket, the body temporarily shuts down parts of “nonessential” systems (looking at you, ovaries) to conserve energy for outrunning that imaginary lion, tiger, or bear.
In the female reproductive system, high cortisol has an effect on two key hormones involved in the phases of your cycle leading up to ovulation: Follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH is responsible for stimulating the follicle growth; LH is responsible for prompting the release of the egg from the ovary. Stress impacts when and how these hormones (also known as gonadotropins) are produced (4).
When the HPA axis is activated, the delicate chain of hormonal processes needed to release gonadotropins may be disrupted. As a result, the follicle may not fully mature – or the maturation process is put on pause, delaying ovulation or preventing it altogether (4). Kinda makes sense, if you think about it: Your body doesn’t want to set itself up for pregnancy if it assumes you’re under some sort of attack.
Your body’s failure to ovulate, known as anovulation, is the one of the most common reasons why your menstrual cycle (and menstruation itself) might become irregular during times of increased stress (5).
Stress has been associated not only with anovulation, but also with variations in the length of your menstrual cycle (we’re talking whole-month-or-more cycle here, not just the duration of your period itself), the level of discomfort you experience during your period, and whether or not your period shows up at all (6).
Can Stress Cause Heavy Periods?
All those times you could’ve sworn the deities were making some cruel joke by bestowing upon you the WORST period ever – during exams, on the first day of school, or right before a big interview? Well, blame hormones, but you were right. Stress can make PMS and period pain worse than usual.
One study found that high levels of stress caused premenstrual symptoms and dysmenorrhea - think awful cramps, bloating, nausea, vomiting, low back pain, and fatigue - bad enough that participants had to resort to medication (7). And if you already tend to experience severe PMS symptoms, stress may make them worse than usual (all the more reason to take that mental health day off from work).
Interestingly, when you experience stress in relation to your cycle may impact the severity of pain you experience during menstruation: According to a different study, lifestyle stress in the first half of the menstrual cycle (the follicular phase) was more strongly associated with dysmenorrhea than stress experienced in the second half of the cycle (the luteal phase)(8).
However: Stress hasn’t technically been shown to directly cause menorrhagia (a fancy word for heavy bleeding)(9) – most of the studies out there are about correlation, not causation. That said, it’s probably safe to assume that being under stress isn’t making things any better – especially for individuals who already often deal with a heavy flow, such as those diagnosed with endometriosis or PCOS.
Can Stress Make Your Period Longer?
Research hasn’t shown that stress makes your period - a.k.a. the menstrual phase of your cycle - longer than usual. However, it has been proven to cause irregular periods and a longer (or shorter) overall menstrual cycle, usually due to the changes in FSH, LH, and other hormones that impact ovulation.
If you noticed that your cycle is lasting about 38 days (or 20 days, or even 50 days) instead of your usual 28, there’s a good chance it could be stress related. So maybe try some deep breathing, meditation, or go for a long walk with a travel mug full of wine, you know, for motivation.
However, if you keep experiencing very long or irregular cycles, missing periods, or having unusual levels of pain for more than a few months, make an appointment with your OB-GYN or primary care doctor: It’s a good idea to rule out anything potentially more serious.
- Stress: Signs, Symptoms, Management & Prevention. (n.d.). Cleveland Clinic. Retrieved from my.clevelandclinic.org/health/articles/11874-stress
- Chronic stress puts your health at risk. (2019, March 19). Mayo Clinic. Retrieved from mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037
- Biller, B. M. (1990, February 1). Abnormal cortisol secretion and responses to corticotropin-releasing hormone in women with hypothalamic amenorrhea. PubMed. Retrieved from pubmed.ncbi.nlm.nih.gov/2153693/
- Minkowicz, C. (2018). By What Mechanism Does Stress Affect Ovulation? The Science Journal of the Lander College of Arts and Sciences, 11(2). Retrieved from touroscholar.touro.edu/sjlcas/vol11/iss2/7
- Rebar, R. (2018, January 15). Evaluation of Amenorrhea, Anovulation, and Abnormal Bleeding. NCBI Bookshelf. Retrieved from ncbi.nlm.nih.gov/books/NBK279144/
- Laura Fenster, Kirsten Waller, John Chen, Alan E. Hubbard, Gayle C. Windham, Eric Elkin, Shanna Swan, Psychological Stress in the Workplace and Menstrual Function, American Journal of Epidemiology, Volume 149, Issue 2, 15 January 1999, Pages 127–134, https://doi.org/10.1093/oxfordjournals.aje.a009777
- R. Kollipaka, B. Arounassalame & S. Lakshminarayanan (2013) Does psychosocial stress influence menstrual abnormalities in medical students?, Journal of Obstetrics and Gynaecology, 33:5, 489-493, DOI: 10.3109/01443615.2013.782272
- Wang L, Wang X, Wang W, Chen C, Ronnennberg AG, Guang W, Huang A, Fang Z, Zang T, Wang L, Xu X. Stress and dysmenorrhoea: a population based prospective study. Occup Environ Med. 2004 Dec;61(12):1021-6. doi: 10.1136/oem.2003.012302. PMID: 15550609; PMCID: PMC1740691.
- Rafique, N. (2018, January 1). Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences. PubMed Central (PMC). Retrieved from ncbi.nlm.nih.gov/pmc/articles/PMC5885123/
Writer: Emily Fearey is a freelance writer, content marketer, and The FIXX Editor in Chief. Based in Boston, MA, she spends most of her spare time hiking, baking bread, and taking care of her equine and feline dependents. Find her online at cwriting.com.