Stress and Periods

By Dr. Christina Matera

What is the connection between stress and periods? Among women, it’s very common to experience stress during the normal monthly cycling of ovulation. It is not uncommon and actually almost predictable to have subtle, and not-so-subtle fluctuations in menstruation.

It is well known in history that during famines and wartime, fertility rates drop. But such utter devastation is not at all necessary to cause menstrual changes. Many women notice erratic, unpredictable bleeding or a delay of menstruation when they encounter particularly difficult times such as deadlines at work or school, personal illness, or death of a loved one. Physical pressures, such as a continuous and strenuous exercise regime or excessive weight loss often interrupt the normal monthly cycling of a woman. Given an individual woman’s particular threshold, she may even cease to menstruate until stability and tranquility is again achieved. This is how stress and periods are interconnected.

This shutdown of the menstrual cycle makes perfect adaptive sense when you consider that the major role of the ovulatory cycle is reproduction. It is as if the body is saying, ""You have enough on your plate right now! You are not able to deal with the additional strain and energy drain of a pregnancy, much less caring for a newborn infant. This is a sensible adjustment to stress and prevents a woman’s body from being overwhelmed.

Although women intuitively know that their menstrual cycle is susceptible to change given the stresses that they may encounter in their lives, it may seem odd that the ovaries somehow respond to both emotional and physical struggles. It is not until you understand that the monthly ovarian cycle is driven by a well-tuned, tightly run system that actually originates outside the ovary, in a small region of the brain called the hypothalamus. This is the key area that receives input from many different parts of one’s body and also from the environment surrounding the body. It acts as a central station to receive and organize this bombarding information and respond with instructions to the body telling it how to react to all of these stimuli. The hypothalamus is compartmentalized into centers that control thirst, hunger, temperature, and perceptions of light and dark, pain, growth and reproduction. It also plays a role in influencing various forms of behavior in animals, and this is probably also true in people. The hypothalamus also functions as a translation service, helping to decipher the two major forms of communication in the body, the nervous system and the hormone (endocrine) system. Information in the form of electrical neural activity and circulating hormones are received in the hypothalamus, processed, and conveyed to other parts of the brain and body so that the body knows how to respond. The organization of the hypothalamus places reproduction in the midst of all internal and external stimuli. Thus, reproduction will be allowed if the information if the body is in a stable, safe and healthy environment. If there is a perception that a woman is not physically or emotionally capable to sustain a pregnancy and care for a dependent and demanding child, the hypothalamus will issue a shutdown of the ovulation cycle.

In a stable environment, this carefully designed system perpetuates and results in monthly cycles of menstruation. However, any stress can “shake up” this order. What a woman now perceives is an alteration in her monthly flow. The menstrual cycle may lengthen or shorten. There may be erratic, and sometimes continuous bleeding, either heavy or light. A woman may also completely stop menstruating. The dreaded premenstrual symptoms often disappear when ovulation is disrupted. Different women respond in different ways and it is typically unpredictable. To the same stress, one woman may not have a perceptible change and another woman may become totally amenorrheic (without menses). Why this is so is not completely understood, but it appears that all women have their own individual limits as to how much stress they can truly withstand. Fortunately, when the stress is removed, and everything returns to baseline, normal ovulatory function and fertility will return.

Other than the unpleasantness of unpredictable bleeding, the disturbance of the normal ovulatory system can result in anemia (if there is heavy bleeding) and infertility. If the system is so deranged that the ovary doesn’t even produce estrogen, and particularly if this continues for a long period of time, enough bone loss can occur that puts this woman at risk of osteoporosis. Thus, this adaptive process, which helps the body to redirect its focus and energies to issues that are more important at the time, can lead to other problems, if sustained.

Fortunately, an understanding of how the reproductive system works allows us to offer various treatments that may minimize some of the problems when the system goes awry. For example, birth control pills can regulate menstrual flow and reproduce the much-needed estrogen. This, of course, can be utilized as temporary treatment until situations become more stable. Modern medicine can also offer other modalities to help cope with stressful life events until the passage of time allows for healing. A greater understanding and appreciation of the usefulness of non-traditional medicine, such as meditation, massage, acupuncture, and botanicals, also grant alternatives to help cope with stress and to bring our lives and bodies back to a healthy balance.