Could stress be the cause of your missing period?
While so many of us are struggling to cope with a ‘new normal’ in the past few weeks, stress and anxiety are on the rise.
Some signs and symptoms of stress are easy to pinpoint such as increased fatigue, rapid heartbeat, and shortness of breath or dizziness. However the female body can also show signs of increased stress through changes in the menstrual cycle, most notably longer menstrual cycles (over 35 days) or even completely missed cycles.
The Stress Response
When someone experiences physical or emotional stress, the production of stress hormones increases from an area of the brain called the hypothalamus. This leads to a cascade of further hormone production that eventually reaches the adrenal glands – two small glands that sit on top of the kidneys that are essential to the fight or flight response.
When signalled to do so by this hormonal cascade, the adrenal glands produce cortisol. Cortisol helps an individual ‘deal’ with that stress by increasing their heart rate, moving blood away from their digestion and towards their muscles, increasing their blood pressure and so on. This response is meant to manage acute intense stress and then go back to a prolonged period of relaxation.
Stress and the Menstrual Cycle
Chronically elevated levels of cortisol can send a signal to the brain to stop producing LH and FSH, two hormones that are essential for egg development and ovulation. When this happens women can experience very long cycles or can lose their period completely, which is known as hypothalamic amenorrhea.
In the case of hypothalamic amenorrhea, the body is experiencing a level of stress to the point where it has decided that reproduction is no longer safe and is essentially shutting down ovulation for self-preservation.
Stress can also worsen physical and emotional symptoms of PMS.
How do you know if stress is the cause of your long or missing period?
High stress is not the only cause of long cycles or missing cycles. Polycystic ovarian syndrome (PCOS) is another very common cause. It can be difficult to differentiate between PCOS and stress-induced cycle irregularities in some women.
If you are unsure if stress is impacting your cycles, running some basic blood work can point you in the right direction. I typically start by running three hormones on day 3 of a women’s menstrual cycle (or any day if she has no cycle); LH, FSH and estradiol.
Whirledge, S. and Cidlowski, J., 2010. Glucocorticoids, Stress, and Fertility. Minerva Endocrinol., [online] 35(2), pp.109-125. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547681/> [Accessed 14 April 2020].
Dr. Kelly Clinning, ND
Dr. Kelly Clinning is a licensed and registered Naturopathic Doctor (ND) with a passion for research and evidence-based care. Her clinical focus is in treating women’s health with a particular concentration on reproductive health, PCOS, endometriosis and thyroid health. Her goal is to help women connect with their bodies, understand their remarkable physiology, and maintain sustainable balance in their health and life.
Dr. Kelly has her naturopathic prescribing license and incorporates natural desiccated thyroid (NDT) and bio-identical hormone treatment into her practice. She also uses nutrition, botanical medicine, acupuncture, and clinical supplementation.
After graduating from Western University with a Bachelor of Science and an Honours specialization in Kinesiology, she completed a Doctor of Naturopathy (ND) degree from the Canadian College of Naturopathic Medicine in Toronto. She is a member of the Ontario Association of Naturopathic Doctors, the Canadian Association of Naturopathic Doctors, and the Endocrinology Association of Naturopathic Physicians and is in good standing with the College of Naturopaths of Ontario.