There’s everyday stress, and then there’s period-skipping stress. What makes them different? What kind of stress causes your body to skip a period? And is it safe to go months without a period?
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Ob/gyn Swapna Kollikonda, MD, gives us the low-down on how stress might wage war on your menstrual cycle.
Stress impacts your menstrual cycle
The hypothalamus is the part of the brain that controls your period. It’s sensitive to external factors like exercise, sleep, stress or family drama. When working correctly, your hypothalamus releases chemicals that stimulate the pituitary gland, which then stimulate your ovary to release the period-inducing hormones estrogen and progesterone.
Enter cortisol, which is a hormone your body makes when you’re under stress. It can wreak havoc on the hypothalamus/pituitary/ovary interaction and result in irregular periods.
“When under stress, your body produces cortisol. Depending on how your body tolerates stress, the cortisol may lead to delayed or light periods — or no period at all (amenorrhea),” says Dr. Kollikonda. “If stress continues, you can go without a period for a long time.”
How much stress is too much?
There are many levels of stress ranging from a bad hair day to pandemics that shut you in your home for months. How stress affects your menstrual cycle is based on your unique brain and body.
“There’s a continuum. Lighter stress may have lesser impacts, and heavy stress may have more dramatic impacts that last longer,” says Dr. Kollikonda. “The higher your cortisol levels, the more likely you are to have missing or irregular periods.”
If you’re constantly stressed out, you may be more susceptible to problematic periods.
When to see your physician if you miss your period
If you’ve ruled out pregnancy as a cause, see a physician after three missed or dramatically different periods. Estrogen and progesterone have important roles beyond menstruation. They:
- Stabilize your mood.
- Promote bone health.
- Support heart health.
“Sometimes, thyroid issues might interfere with hypothalamus/pituitary/ovary interactions resulting in disturbance of the menstrual cycle. Those conditions are generally easy to fix,” says Dr. Kollikonda. “Polycystic ovary syndrome (PCOS) is another condition that can impact the menstrual cycle due to a hormonal imbalance. So the first step is to rule out conditions that could be causing the period changes.”
Treatments for stress-related amenorrhea
“If you continue to skip periods, your body will have a hormonal imbalance. Talk to your doctor,” says Dr. Kollikonda. “Your doctor may prescribe contraceptive hormones that include estrogen and progesterone to correct the imbalance and regulate your cycle.”
But before that, your doctor will likely recommend finding ways to de-stress and bring the cortisol levels down. You can crank down the stress level with:
- Good nutrition.
- Quality sleep.
Dr. Kollikonda noted how the adjustments made to work, activities and travel at the height of the pandemic had an impact on women’s stress levels — and their fertility.
“For more than half of my patients who dealt with infertility, the pandemic actually decreased the stress that was impacting their cycle and ability to get pregnant,” says Dr. Kollikonda. “Because these women weren’t traveling as much and had reduced work stress, they had more time to connect with their partner.”
Stress is personal — what’s cortisol-inducing to one woman may not be to another. “Tune in to your body to figure out what your stress triggers are, then work diligently to tamp them down,” says Dr. Kollikonda.