The Link Between Stress And Periods

Overview

Now and then, everyone experiences stress, but for people assigned female at birth (AFAB), stress affects the menstrual cycle.

The menstrual cycle is initiated and regulated by hormones in the body. Stress also causes the release of certain hormones that interfere with the hormonal regulation of the menstrual cycle. The effects of stress on the menstrual cycle can cause worsened PMS (Premenstrual Syndrome) symptoms, delayed ovulation, prolonged periods, irregular periods, period pain (dysmenorrhoea), or no period (amenorrhea).

Managing stress is important for better menstrual health.

Understanding the menstrual cycle

What is the menstrual cycle?

The menstrual cycle is a normal physiological cycle in women. It describes the sequence of events that occur in your body as it prepares for the possibility of pregnancy each month and is initiated and regulated by certain hormones.

Menarche is the first menstruation and usually happens between ages 11 and 14 in people AFAB. Menopause is the end of monthly menstruation for 12 months. Natural menopause occurs between the ages of 45 and 55.

The average menstrual cycle takes 28 days but can take between 21 days and 35 days. The cycle starts from the first day of menstruation (bleeding) until the first day of the next menstruation, which is the last day of that menstrual cycle and the beginning of a new one. That’s why it's called a cycle.

What happens during a typical menstrual cycle?

Understanding what happens during a menstrual cycle can inform you about what’s going on in your body and how stress could affect your menstrual cycle. The main hormones involved in menstruation are FSH, LH, oestrogen, and progesterone.

The menstrual cycle is in 4 phases; the follicular phase, the ovulatory phase, the luteal phase, and the menstruation phase.

The first day of the menstrual cycle starts with menstrual bleeding (menstruation) through the vagina. Menstruation occurs in the absence of pregnancy.

The follicular phase

The follicular phase starts on the first day of menstruation (the first day of the menstrual cycle). During menstruation, there are low levels of the hormones oestrogen and progesterone. This sends a signal to the brain, and the brain then stimulates the pituitary gland (located at the base of your brain) to produce follicle-stimulating hormone (FSH).

The ovaries contain thousands of follicles. A follicle contains an egg known as an oocyte that can mature for fertilisation at the beginning of pregnancy. The FSH produced by the pituitary gland is sufficient to stimulate some follicles. These follicles begin to mature. While maturing, the follicles produce oestrogen. The presence of oestrogen in the bloodstream prepares the uterus (womb) for pregnancy by causing the thickness of the lining of the uterus (endometrium).

Oestrogen also activates the pituitary glands to produce large amounts of luteinising hormone (LH). It is the LH that stimulates ovulation. The follicular phase averagely lasts the first 14 days of the menstrual cycle.

The ovulatory phase (ovulation)

The ovulatory phase begins on day 14 of a 28-day menstrual cycle. The increased level of LH acts in the dominant follicle to release the egg (mature oocyte). The egg enters the fallopian tube, which transports it to the uterus. It is the release of the egg that begins ovulation. During this period, the body is the most fertile. If there is fertilisation by a sperm cell, it results in pregnancy.

The luteal phase

In the luteal phase, the release of the egg from the dominant follicle eventually causes the follicle to rupture. The rupture causes an elevated level of progesterone in the blood. Increased levels of progesterone further prepare the uterus for pregnancy by supporting the thick lining of the endometrium and enriching it for pregnancy. The luteal phase happens from day 15 to 28 of a 28-day cycle.

The menstruation phase

When the ruptured follicle (corpus luteum) breaks down, and there is no pregnancy, it leads to low levels of oestrogen and progesterone because of no hormonal production from the complete breakdown of the corpus luteum. The menstruation phase begins when these low levels of progesterone cause the shedding of the thick lining of the uterus because there is insufficient progesterone to maintain the lining. This shedding results in menstruation which begins a new menstrual cycle. The menstruation phase lasts 3 to 5 days.

The low levels of oestrogen and progesterone bring us back to the follicular phase, and the cycle starts again.

What is stress?

We feel stress when we have to turn in an assignment in due time, lose a loved one, or are worried about something.

Stress is your body’s response to the daily events that happen in your life. Stress can be acute or chronic. Acute stress refers to a recent, short-lived occurrence.¹ It usually happens during emergencies. An example is escaping from an immediate danger, or fighting.²

Chronic stress happens when an individual faces an ongoing difficulty that may or may not be a constant threat.¹ Chronic stress lasts long, and various internal and external negative factors stimulate it.³ An example of chronic stress is working multiple intense jobs for a long time.

Stress is also a state of worry or mental tension caused by a difficult situation. Everyone experiences stress now and then, which affects both the mind and the body. Some level of stress can be good because it challenges us and helps us perform better. There is evidence that low stress can improve the body in a way that exercise (which can be considered a form of stress) improves the body.⁴

On the other hand, stress can cause harm to your mind and body. Chronic stress can cause health problems such as gastrointestinal disorders, anxiety, depression, mental illness, cancer, and an increased risk of cardiovascular disease.²

The body's stress response (fight or flight)

When you experience stress, your brain activates the fight-or-flight response by activating the hypothalamic-pituitary-adrenal (HPA) axis. The HPA is the interaction between the hypothalamus and pituitary gland in the brain and the adrenal glands located on top of both your kidneys. During stress, the HPA axis causes a subsequent release of hormones such as cortisol and adrenaline.²

Cortisol increases blood sugar by triggering the release of glucose from your liver into the blood. Increased glucose keeps your energy up, giving your body enough energy to respond to the stressor. Cortisol also suppresses some body systems during stressful situations, such as the digestive and reproductive systems.

Adrenaline, also known as epinephrine, causes the heart to beat faster, which increases blood pressure. Increased blood pressure helps deliver oxygen quickly to your muscles, which allows you to perform physical activities like running in the face of danger. Adrenaline also keeps you alert while in danger.

Whenever you face stressful situations, the body tries its best to protect and get you out of it.

The impact of stress on the menstrual cycle

Some studies demonstrate the impact of stress on the menstrual cycle. These effects include irregular flow, premenstrual syndrome (PMS), light menstrual flow, menstrual pain (dysmenorrhea), and no menstrual flow (amenorrhea).^5,6-11 Both physical and psychological stress affects the menstrual cycle.^12,10

Stress affects the menstrual cycle in any of the following ways.⁶

• PMS becomes worse
• Postponement and delay in ovulation
• Longer menstrual cycle
• Cessation of the period (amenorrhea)

Hormonal changes during stress

Both stress response and the menstrual cycle function from hormonal actions. The hormones present when the body is stressed interfere with the pathway of the menstrual cycle.⁶

Your body produces cortisol and adrenaline to help the body cope with stress. An increase in cortisol triggers activities that lead to the reduction of LH and oestrogen in the follicular phase, which reduces the effect of these hormones on the menstrual cycle.^6,12

Stress may cause an increase in progesterone levels during the follicular phase and a decrease in progesterone during the luteal phase of the menstrual cycle. This in turn  eventually causes low LH levels in the follicular phase, and thereby  a delay in ovulation.¹² All of which affect the menstrual cycle and can affect menstruation.

It’s important to note that stress during a menstrual cycle may have little to no effect on that cycle but could affect the next menstrual cycle.¹² So, if you encounter stress now, it might not affect your current menstrual cycle, but it could impact your next menstrual cycle.

Effect of stress on reproductive functions

In addition to the effects of hormonal regulation during stress, the brain reserves energy and focuses on what’s necessary to get through the stress. As a result, the brain can delay reproductive functions when you go through stress, leading to no periods (amenorrhea) or short periods.¹³

Irregularities in the menstrual cycle can cause infertility in the long term.¹⁴

Although studies show evidence for the effect of stress on periods, other studies state that low to moderate stress levels on the menstrual cycle show no effect in healthy individuals.¹²

When it comes to finding the link between stress and periods, there are limitations to the research. One limitation is to measuring stress accurately in each participant.^5,8 Secondly, these studies don’t accurately account for individual factors such as environmental and genetic factors.¹⁰ There is room for more research without these limitations, but we know so far that stress negatively affects menstruation.

Managing stress for improved menstrual health

Although it’s almost impossible to avoid stress, there are ways to manage it.

You can manage stress by practising healthy self-care strategies for coping with stress. You could practise mindfulness and meditation, exercise, and relaxation techniques. You could also look out for yourself physically, emotionally, mentally, occupationally, socially and spiritually. These can improve your mind and body.

According to the Centers for Disease Control and Prevention (CDC), the following are other healthy ways to manage stress:

• Take breaks from watching, reading, or listening to news stories, including those on social media
• Take care of your body by exercising, eating healthy meals, and getting enough sleep
• Take care of yourself by taking care of your body and by giving yourself a break if you feel stressed out
• Make time to unwind
• Talk to others
• Connect with your community or faith-based organisations
• Avoid drugs and alcohol
• Recognise when you need more help and talk to a professional, e.g. a psychologist

Life can be overwhelming, but it’s okay to look for help. We all struggle or have struggled at one point in our lives. If you’re dealing with stress and it is overwhelming, please seek help from a professional, especially if it’s interfering with daily living, your health, and well-being. Professionals like psychologists and counsellors can help you as you navigate this stressful period. You’ll get through this!

Summary

The menstrual cycle is a physiological cycle in a person AFAB initiated and regulated by certain hormones in the body. Hormones involved in the menstrual cycle are the follicle-stimulating hormone (FSH), luteinising hormone (LH), oestrogen and progesterone.

In life, we all experience stress. Stress can be physical or psychological. It can be acute (short-term) or chronic (long-term). During stress, the body produces cortisol and adrenaline (epinephrine) hormones which affect the levels of oestrogen, progesterone, and LH. Varying levels of these hormones can result in worsened PMS symptoms, delayed ovulation, prolonged periods, irregular period, period pain, or no period. When the body goes through stressful situations, the brain also limits certain functions, including reproductive functions, which can cause delay or cessation in menstruation (amenorrhea).

Stress impacts menstrual health and general health and well-being. Practising healthy self-care strategies and seeking professional help can help you manage stress.