Have you noticed that your cycle has gone wayward in the past 12 months? Our global community has collectively been going through (and still is) one of the biggest crises since World War Two…COVID. It has touched each of our lives in unique ways; from metta tectonic change to confusion and fear to changes in our home and work lives and unable to see loved ones and the 1000s of iterations in between. It’s a lot!! And you’re not alone if your cycle and period have been shifting, lacking rhythm or finding a new one. One thing is for sure, big changes are registered as stress in the body.
One of the reasons I have a particular interest in the menstrual cycle as a clinician is that it’s so multi-faceted. I’m always amazed that within its cyclic rhythms, there are so many layers that unfold throughout our lives. Because I work with many people who are experiencing menstrual cycle challenges, I’ve come to see the profound relationship between our cycles and stress levels.
The literature widely documents this relationship, and I’d love to chat with you today about all the “good to knows” on how stress affects the menstrual cycle as a whole and fertility. I’m going into full-tilt science mode today, but as always, I promise I’ll make it as easy and fun as possible.
The Adrenal-Ovary Dialogue
All the hormonal glands are in close communication with one another. Like in all healthy communication, each hormone responds appropriately to the other depending on the message. When we’re in a state of stress, reproduction is de-prioritised because the message says there are more important things to take care of right now.
Understanding how stress impacts your body is fascinating. I wrote all about the nitty-gritty science on the stress response last week, so make sure you have a read of that article over here so that the rest of this article makes sense.
Stress Impacts all Levels of Reproduction
The ovaries also have a communication feedback system with the brain, which is called the HPO axis (hypothalamus-pituitary-ovarian axis).
The ovaries, uterus and placenta all have cortisol (stress hormone) receptors on them. When the adrenal glands release cortisol in higher amounts, the entire HPO axis is down-regulated. Higher levels of cortisol lead to inhibition to all the key players involved in ovulation:
- Follicle-stimulating hormone (FSH): which nurtures an egg-containing follicle to maturity.
- Luteinising hormone (LH): the hormone that triggers the release of the egg from the follicle.
- Estrogen: the hormone that works with FSH to mature the egg and build the lining of the womb (which is then later shed at menstruation).
What happens when you don’t have all the key players essential for ovulation?
Simply put: Ovulation cannot occur, OR it’s abnormal.
When there is abnormal ovulation or no ovulation, then our other very important hormone, progesterone, cannot be produced.
4 Ways Stress Affects Fertility
Nature is very talented at preventing reproduction when the conditions are not right.
Downregulation of the HPO axis has a manifold flow-on effect on our fertility:
1. Stress Leads to Lowered Egg Quality
The process of egg maturation is complex with many steps involved. Eggs (and for males, sperm) are unlike all the other cells in our body. They contain only half our genetic material and ten times the number of mitochondria, which are responsible for producing energy for the cell. In response to stress mitochondria become damaged and less able to produce energy, and without enough energy, egg and embryo development may go awry or stop altogether.
2. Stress Impacts the Quality of the Womb Lining
The lining of your womb needs a balanced cocktail of estrogen and progesterone to create an ideal, nurturing environment for a fertilised egg to implant. Because stress impacts both estrogen and progesterone, the flow-on effect is that the lining doesn’t receive the ingredients it needs. The hormonal change is why the colour, consistency and volume of your menstrual blood can provide a lot of useful information about your hormone status.
3. Stress Impacts the Quality of Corpus Luteum and Progesterone
There is a domino effect when a follicle and egg are not able to mature smoothly. The structure formed from the follicle, the corpus luteum, will function suboptimally. This structure is responsible for the production of progesterone, which is essential for maintaining a pregnancy.
4. Chronic Stress Increases Insulin Resistance
Insulin sensitivity is blunted in the presence of higher cortisol. This hormone is what allows our body to extract energy from carbohydrates and sugars. When stressed, the body tries to protect itself by encouraging the body to store energy instead of using it.
Stress will also increase testosterone which has an inhibitory effect on ovulation (this pattern is a hallmark feature of PCOS/Anovulatory Androgen Excess). All in all, we can have a 40% reduction in our chances of conception if stressed during our fertile window – which is significant!
How this All Shows Up in the Menstrual Cycle
Ovulation is what causes menstruation. Or in other words, without ovulation, you would not have a period.
It’s the process of ovulation that creates all the hormones needed for a smooth flowing menstrual cycle. So when the process of ovulation is compromised, there are many downflow effects. Most of these are due to the menstrual cycle’s star hormones, estrogen and progesterone, not being in the optimal quantities or ratios.
The Stress Pattern Cycle
The stress pattern cycle is the most common pattern I see in menstrual cycle charts. As you can see in the pattern of this chart, this body has made x3 attempts of ovulation, which is indicated by the lower columns signifying the presence of fertile mucus. The first two attempts were not successful because there was no corresponding rise in body temperature. In the third attempt, it was successful as there was a 14-day phase with very sticky mucus or none, followed by a period.
Multiple attempts of ovulation are one of the most common causes of long cycles (35 days or longer). While your lived experience is “my period is late”, actually it was a case of your ovulation being late.
Stress & Short Cycles
Stress can also cause shorter cycles (21 days or less). In this pattern, ovulation occurs without too many problems, but due to compromised quality, the corpus luteum is unable to establish itself properly which leads to a disrupted luteal phase, and thus shortens the cycle.
This pattern can also be seen commonly in perimenopause and low thyroid function. It’s essential to work with a qualified healthcare practitioner to work out what your root causes are. A healthy luteal phase is between 12-17 days long. Anything less than 11 days is a sign that there is a hormonal disruption of some kind.
This is an example of a 22-day cycle where the luteal phase in only 9 days.
This is an example of a 22-day cycle where the luteal phase in only 9 days.
Unusual Spotting & Breakthrough Bleeding
Spotting and breakthrough bleeding can occur due to a combination of the above factors: attempted ovulation, a disrupted luteal phase or both. In this example chart, you can see a lot of spotting accompanied by an anovulatory cycle (there is no temperature rise) – both signs of stress.
While the exact physiological mechanisms are still not fully understood in PMS and PMDD; it is well documented that stress is an exacerbating factor in both.
Estrogen has a stimulating effect on the neurotransmitter, serotonin, our happy brain chemical. And progesterone stimulates GABA, our calming neurotransmitter. The naturopathic community are moving more and more towards nervous system strengthening approaches when it comes to PMS and PMDD.
Studies have consistently found that people with PMS have a lower threshold to stressful stimuli, and the amygdala is involved in both the generation and maintenance of PMS. The amygdala, which is also more colloquially called “the lizard brain”, is a region in the brain and is the seat the instinct. It’s continuously assessing our environments for danger and potential harm. When it perceives a threat, it will flood our bodies with adrenaline and cortisol to activate “fight or flight mode”. It will also send signals to the hypothalamus and pituitary, thus strongly influencing the HPO axis.
Functional Hypothalamic Amenorrhea
Functional hypothalamic amenorrhea (FHA) is one of the most common causes of secondary amenorrhea. Stress-Related FHA results from the downregulation of the HPO axis. It’s very common to also see disturbances in the hypothalamic-pituitary-thyroid (HPT) axis in FHA.
There are three types: weight loss-related, stress-related, and exercise-related amenorrhea. Yet, sudden weight-loss and excessive exercise both place physical stress on the body; so it’s being mediated by the same hormone pathway, just a different cause.
If you’ve been without your period for over 6-months and you suspect you have FHA and you’re not in the perimenopausal season of your life, it’s crucial to work with your healthcare provider. Experiencing long stretched without cycling estrogen and progesterone significantly impact your bone strength, cardiovascular and mental health.
Your Menstrual Cycle Can be Your Stress Barometer
As you can see, your menstrual cycle can be used as a very sensitive and accurate stress detector. Learning how to chart your cycle in terms of mood, energy, focus and your fertile signs (cervical mucus and basal body temperature) can give you highly valuable insight into how well your body is coping with stress.
Having a cycle awareness practice is extraordinarily valuable in these pandemic times. It can provide you with a soothing anchor and frame of reference to understand how your body is processing this momentous moment in collective history. From my observations, many women are shouldering the burden of all this change in a big way. Work, home and family all possess new demands of our energy, but our cycling bodies are extraordinary maps that guide us in managing our energy.
It can be useful to know at what point in your cycle, listening to the news is likely to do more harm than good and how to plan your work-life routines to work with your flow. In Daoist healing philosophy, times such as these are seen as “being in the void”; where all there seems to be is an abundance of chaos juxtaposed to the need to stay close to home. Surrendering to the void is exactly what the menstrual cycle teaches us. There are times and seasons for everything, and learning to work with and nurture your cycle is a terrific training ground for this.
Ader, R., & Cohen, N. (1993). Psychoneuroimmunology: Conditioning and Stress. Annual Review of Psychology, 44(1), 53–85. https://doi.org/10.1146/annurev.ps.44.020193.000413
Akhter, S., Marcus, M., Kerber, R. A., Kong, M., & Taylor, K. C. (2016). The impact of periconceptional maternal stress on fecundability. Annals of Epidemiology, 26(10), 710-716.e7. https://doi.org/10.1016/j.annepidem.2016.07.015
An, Y., Sun, Z., Li, L., Zhang, Y., & Ji, H. (2013). Relationship between psychological stress and reproductive outcome in women undergoing in vitro fertilization treatment: Psychological and neurohormonal assessment. Journal of Assisted Reproduction and Genetics, 30(1), 35–41. https://doi.org/10.1007/s10815-012-9904-x
Babayev, E., & Seli, E. (2015). Oocyte mitochondrial function and reproduction. Current Opinion in Obstetrics & Gynecology, 27(3), 175–181. https://doi.org/10.1097/GCO.0000000000000164
Bae, J., Park, S., & Kwon, J.-W. (2018). Factors associated with menstrual cycle irregularity and menopause. BMC Women’s Health, 18(1), 36. https://doi.org/10.1186/s12905-018-0528-x
Barzilai-Pesach, V., Sheiner, E., Sheiner, E., Potashnik, G., & Shoham-Vardi, I. (2006). The Effect of Women’s Occupational Psychologic Stress on Outcome of Fertility Treatments. Journal of Occupational and Environmental Medicine, 48(1), 56–62. https://doi.org/10.1097/01.jom.0000183099.47127.e9
Ebbesen, S. M. S., Zachariae, R., Mehlsen, M. Y., Thomsen, D., Højgaard, A., Ottosen, L., … Ingerslev, H. J. (2009). Stressful life events are associated with a poor in-vitro fertilization (IVF) outcome: A prospective study. Human Reproduction, 24(9), 2173–2182. https://doi.org/10.1093/humrep/dep185
Joseph, D. N., & Whirledge, S. (2017). Stress and the HPA Axis: Balancing Homeostasis and Fertility. International Journal of Molecular Sciences, 18(10), 2224. https://doi.org/10.3390/ijms18102224
Kalantaridou, S. N., Makrigiannakis, A., Zoumakis, E., & Chrousos, G. P. (2004). Stress and the female reproductive system. Journal of Reproductive Immunology, 62(1), 61–68. https://doi.org/10.1016/j.jri.2003.09.004
Prasad, S., Tiwari, M., Pandey, A. N., Shrivastav, T. G., & Chaube, S. K. (2016). Impact of stress on oocyte quality and reproductive outcome. Journal of Biomedical Science, 23(1), 36. https://doi.org/10.1186/s12929-016-0253-4