Cycle science: Stress and the menstrual cycle
By Maegan Boutot, Science Writer for Clue
Everyone experiences stress, and for many it’s not an enjoyable experience. It isn’t inherently bad, although research suggests that depending on the type of stressor (i.e. the reason for stress) and the timing of the stressor, it can cause changes to a person’s menstrual cycle.
What is stress?
Stress is a normal psychological and physiological reaction to changes in someone’s environment, which could be emotional, physical, social or cultural (1,2).
Activities that intentionally promote acute levels of stress, such as exercise and willful participation in social activities, can actually have long term positive effects on a person’s health (3–6).
When most people talk about stress, however, they are usually referring to chronic and/or negative forms of stress, such as having too many demands at school/work or the death of a loved one (1,7). People experiencing chronic stress may feel that they are unable to handle daily life tasks, have limited-to-no control over the direction of their life or more easily become angry or irritated (1). This type of chronic stress can negatively affect a person’s short-term and long-term health (7–9).
Biological relationship between stress and the reproductive system
Stress activates a hormonal pathway in the body called the hypothalamic-pituitary-adrenal (HPA) axis (10). Activation of HPA axis is associated with increased levels of cortisol and corticotropin-releasing hormone (CRH) (2, 10, 11). The HPA axis, cortisol, and CRH help control stress response in the body. CRH and cortisol release can suppress normal levels of reproductive hormones, potentially leading to abnormal ovulation, anovulation (i.e. no ovulation), or amenorrhea (i.e. absence of menstruation) (10–12). Furthermore, abnormal levels of CRH in reproductive tissue have been associated with negative pregnancy outcomes, such as pre-term birth (10).
Research on stress and the menstrual cycle
Stress from extreme or traumatic events has been linked to dramatic changes in normal menstruation. War, separation from family and famine have been anecdotally linked to amenorrhea in physician and epidemiological reports (13–15). Although these studies and case reports are informative, they are not scientifically rigorous and cannot rule out other associated factors, such as malnutrition, that occur during war or other tragic events. Physical, emotional and sexual abuse have been associated with the development of premenstrual syndrome (PMS) (16) and premenstrual dysphoric disorder (PMDD) (17). Post-traumatic stress disorder (PTSD) has also been associated with PMDD (18).
Daily life stress may also affect the length of your cycle.
One study of stress in female nurses found associations between high stress and anovulation as well as high stress and longer cycles (19), though these findings may be in part due to rotating shift work (working nights), which is common for nurses (20). Conversely, high stress but low control jobs, where the person has little control over their work tasks and other key decisions, have been associated with shorter cycles (21). These studies may have found different results because the stress of study participants may not have been equal. Differences in the level and length of stress exposure could cause people’s bodies to respond in different ways. For example, in one study, peri-menopausal (approaching menopause) people with high stress were no more likely to have altered cycles than low stress people after one year; however, high stress was linked to shorter menstrual cycles after two years (22), indicating that symptoms may not present immediately.
Menstrual pain has also been associated with stress.
Dysmenorrhea (i.e. painful menstruation) has been linked to working in jobs that are low control, are unsecure and have low coworker support (23). Stress from the preceding month may also affect the frequency of dysmenorrhea (24), so someone might not experience painful menstruation as a result of stress until their period the following month. People with a history of dysmenorrhea may be more likely to experience this effect (24). Similarly, people experiencing stress earlier in their cycle were more likely to report severe symptoms during the time leading up to and during menstruation (25).
As mentioned, the different effects of stress may be, in part, due to timing. Higher reported stress during the follicular phase (i.e. from the first day of menstruation until ovulation) has been strongly associated with changes in normal reproductive function (24, 26). In one recent study, those reporting pre-ovulatory stress (during the follicular phase) were less likely to become pregnant as compared to those not reporting stress during the same time (26). This suggests that stress may cause the body to delay or entirely suppress ovulation. This idea is supported by research examining menstrual cycle variation. The length of the luteal phase (i.e. post-ovulation until menstruation) tends to be consistent across and within women (27), whereas the length of the follicular phase has a stronger association with the variation in the total length of the entire menstrual cycle (28). This means that the follicular phase, as opposed to the luteal phase, is more likely to change in length. Therefore, the effects of stress on ovulation may be one of the biggest factors related to changes in cycle length due to stress, though it is unclear how this would be related to other stress-related changes in the menstrual cycle, such as painful menstruation.
Some stress in life is unavoidable, but you can learn to manage your stress. Exercising, getting restful sleep, having a healthy diet, confiding in friends and family and having healthy social activities can potentially reduce the effects of stress on your health (3–6, 29). Stress that causes long-term changes in your mood or sleep or that causes chronic physical pain may be serious. If you are experiencing high levels of chronic stress, you may want to consider speaking to your healthcare provider.
Clue can help you track your stress, energy, sleep, and exercise in the Mental, Energy, Sleep, and Exercise sections.
Not sure whether stress is affecting your cycle? The best way to take care of yourself is to know your body. Download Clue for iOS or Android today.
- Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 385–396.
- Henry, J. P. (1992). Biological basis of the stress response. Integrative Physiological and Behavioral Science, 27(1), 66–83.
- Zschucke, E., Renneberg, B., Dimeo, F., Wüstenberg, T., & Ströhle, A. (2015). The stress-buffering effect of acute exercise: evidence for HPA axis negative feedback. Psychoneuroendocrinology, 51, 414–425.
- Paluska, S. A., & Schwenk, T. L. (2000). Physical activity and mental health.Sports Medicine, 29(3), 167–180.
- Menec, V. H. (2003). The relation between everyday activities and successful aging: A 6-year longitudinal study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 58(2), S74-S82.
- Hillman, C. H., Erickson, K. I., & Kramer, A. F. (2008). Be smart, exercise your heart: exercise effects on brain and cognition. Nature Reviews Neuroscience, 9(1), 58–65.
- McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840(1), 33–44.
- Vyas, S., Rodrigues, A. J., Silva, J. M., Tronche, F., Almeida, O. F., Sousa, N., & Sotiropoulos, I. (2016). Chronic Stress and Glucocorticoids: From Neuronal Plasticity to Neurodegeneration. Neural Plasticity.
- Oliveira, B. S., Zunzunegui, M. V., Quinlan, J., Fahmi, H., Tu, M. T., & Guerra, R. O. (2016). Systematic review of the association between chronic social stress and telomere length: a life course perspective. Ageing Research Reviews, 26, 37–52.
- Vitoratos, N., Papatheodorou, D. C., Kalantaridou, S. N., & Mastorakos, G. (2006). “Reproductive” Corticotropin‐Releasing Hormone. Annals of the New York Academy of Sciences, 1092(1), 310–318.
- 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.
- Ding, J. H., Sheckter, C.B., Drinkwater, B.L.,, Soules, M.R., & Bremner, W. J. (1988). High serum cortisol levels in exercise-associated amenorrhea. Annals of Internal Medicine, 108(4), 530–534.
- Drew, F. L. (1961). The epidemiology of secondary amenorrhea. Journal of Chronic Diseases, 14(4), 396–407.
- Stukenbrock, K. (2008). Der Krieg in der Heimat: „Kriegsamenorrhoe” im Ersten Weltkrieg / The war at home: “war amenorrhea” in the First World War. Medizinhistorisches Journal, 43(3/4), 264–293. Retrieved from http://www.jstor.org/stable/25805461
- Ladurie, E. L. (1969). [Amenorrhea during the famines of the 17th-20th centuries]. Annales, 24(6), 1589–1601.
- Bertone-Johnson, E. R., Whitcomb, B. W., Missmer, S. A., Manson, J. E., Hankinson, S. E., & Rich-Edwards, J. W. (2014). Early life emotional, physical, and sexual abuse and the development of premenstrual syndrome: a longitudinal study. Journal of Women’s Health, 23(9), 729–739.
- Girdler, S. S., Leserman, J., Bunevicius, R., Klatzkin, R., Pedersen, C. A., & Light, K. C. (2007). Persistent alterations in biological profiles in women with abuse histories: influence of premenstrual dysphoric disorder. Health Psychology, 26(2), 201.
- Wittchen, H. U., Perkonigg, A., & Pfister, H. (2003). Trauma and PTSD–An overlooked pathogenic pathway for Premenstrual Dysphoric Disorder?.Archives of Women’s Mental Health, 6(4), 293–297.
- Hatch, M. C., Figa-Talamanca, I., & Salerno, S. (1999). Work stress and menstrual patterns among American and Italian nurses. Scandinavian Journal of Work, Environment & Health, 144–150.
- Lawson, C. C., Whelan, E. A., Hibert, E. N. L., Spiegelman, D., Schernhammer, E. S., & Rich-Edwards, J. W. (2011). Rotating shift work and menstrual cycle characteristics. Epidemiology, 22(3), 305–312.
- Fenster, L., Waller, K., Chen, J., Hubbard, A. E., Windham, G. C., Elkin, E., & Swan, S. (1999). Psychological stress in the workplace and menstrual function. American Journal of Epidemiology, 149(2), 127–134.
- Barsom, S. H., Mansfield, P. K., Koch, P. B., Gierach, G., & West, S. G. (2004). Association between psychological stress and menstrual cycle characteristics in perimenopausal women. Women’s Health Issues, 14(6), 235–241.
- László, K. D., GyŐrffy, Z., Ádám, S., Csoboth, C., & Kopp, M. S. (2008). Work-related stress factors and menstrual pain: a nation-wide representative survey. Journal of Psychosomatic Obstetrics & Gynecology, 29(2), 133–138.
- Wang, L., Wang, X., Wang, W., Chen, C., Ronnennberg, A. G., Guang, W., … & Xu, X. (2004). Stress and dysmenorrhoea: a population based prospective study. Occupational and Environmental Medicine, 61(12), 1021–1026.
- Gollenberg, A. L., Hediger, M. L., Mumford, S. L., Whitcomb, B. W., Hovey, K. M., Wactawski-Wende, J., & Schisterman, E. F. (2010). Perceived stress and severity of perimenstrual symptoms: the BioCycle Study. Journal of Women’s Health, 19(5), 959–967.
- Akhter, S., Marcus, M., Kerber, R. A., Kong, M., & Taylor, K. C. (2016). The impact of periconceptional maternal stress on fecundability. Annals of Epidemiology.
- Lenton, E. A., Landgren, B., & Sexton, L. (1984). Normal variation in the length of the luteal phase of the menstrual cycle: identification of the short luteal phase. BJOG: An International Journal of Obstetrics & Gynaecology,91(7), 685–689.
- Sherman, B. M., & Korenman, S. G. (1975). Hormonal characteristics of the human menstrual cycle throughout reproductive life. Journal of Clinical Investigation, 55(4), 699.
- Centers for Disease Control and Prevention. (2015). Coping with stress. Retrieved from http://www.cdc.gov/violenceprevention/pub/coping_with_stress_tips.html