Photo by Franz Grünewald, Art direction by Marta Pucci
Can stress affect your period?
How stress might be impacting your menstrual cycle
Top things to know about stress and the menstrual cycle:
Stress can be acute or chronic, and can affect your physical and mental health.
Chronic stress may be associated with changes in the menstrual cycle, including irregular cycles, heavier flow, and painful periods. More research is needed to understand how different types of stress may affect different people.
Lifestyle changes such as exercise, sleep, and mindfulness may help reduce stress. It is important to talk to your healthcare provider if you find that your stress levels are affecting your work or social life.
Everyone experiences stress, and for many, it’s not an enjoyable experience. Stress isn’t always bad, but some research suggests that different types of stressors (reasons for stress) and the timing of them can cause changes to a person’s menstrual cycle.
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What is stress?
Stress is a psychological and physiological response to changes in your environment, which could be emotional, physical, social, or cultural (1,2).
Not all stress is negative. Activities of daily life that intentionally cause short-term stress, such as exercise, can actually have positive health effects (3,4).
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 or work, or the death of a loved one (1). Researchers refer to the health impacts of these life stressors, both from everyday experiences and sudden traumatic events, as the allostatic load (5). High levels of allostatic load have been linked to physical effects (such as heart disease, diabetes, and cancer) and mental effects (such as higher rates of depression, anxiety, and substance use) (5). People experiencing chronic stress may feel increased bodily tension, have more frequent mood swings, or have impaired social relationships (6).
Does stress affect the menstrual cycle?
Stress from extreme or traumatic situations has been linked to changes in the menstrual cycle. Adolescents exposed to war and forced migration may have higher rates of menstrual cycle disorders including painful periods, heavy periods, and amenorrhea (no periods) (7). Some research has found that early life exposure to famine may be related to premature ovarian failure and earlier age of menopause (8, 9). Physical, emotional, and sexual abuse have been associated with the development of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (10-12).
Recent research has investigated the impacts of perceived stress on menstrual cycles during the COVID-19 pandemic. Infrequent periods, irregular periods, and heavy or prolonged periods have all been explored in relation to the pandemic (13,14). However, more in-depth high-quality research is needed to determine the extent of these impacts (13,14).
Why does stress affect the menstrual cycle?
Stress activates a hormonal pathway in the body called the hypothalamic-pituitary-adrenal (HPA) axis (15). This activation can increase levels of cortisol and corticotropin-releasing hormone (CRH) (15). The HPA axis, cortisol, and CRH help control stress response in the body (15). CRH and cortisol release can decrease the production of reproductive hormones (16), potentially leading to abnormal ovulation, anovulation (i.e. no ovulation), or amenorrhea (17,18).
Can stress make your cycle less regular?
A recent systematic review found that higher levels of psychological stress were associated with irregular periods. However, there was not a consistent relationship between stress and cycle length. Higher levels of stress were linked to both shorter and longer menstrual cycles (19).
The studies may be conflicting because the stress of study participants may not have been equal. Furthermore, definitions of abnormal cycle lengths differ between the studies and rely heavily on self-reported data from participants, which can be more subjective. It’s also possible that different people respond to stress exposure in different ways.
Can stress make your period heavier?
High levels of stress may be linked to atypical period flow for some people (19). However, it may be that only certain types of stress affect menstrual flow. For example, stress associated with the COVID-19 pandemic has been linked to heavier period flows (20-22). One study of female athletes found that those with higher levels of perceived stress experienced more frequent heavy menstrual bleeding (23). However, academic stress does not seem to make periods heavier (19).
Once again, this conflicting data may reflect that there are many different types of stress, that each person’s body may respond differently, and that more research is needed in this area. Tracking your own experiences in the Clue app can help you identify your own unique trends.
Can stress make your period pain more intense?
High levels of stress might increase the perception of pain in general (24). Dysmenorrhea (painful periods) is more commonly reported among people with higher levels of self-reported stress (25). However, the intensity of period cramps may change depending on which type of stressor you experience. For example, exercise has a protective effect against dysmenorrhea (26). Some female athletes report less intense period cramps despite higher levels of stress (23).
Can stress impact ovulation?
The different effects of stress may be, in part, due to timing. Higher reported stress during the follicular phase (from the first day of menstruation until ovulation) has been associated with changes in typical reproductive function (27). 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 (27). This suggests that stress may cause the body to delay or entirely suppress ovulation (18).
When should you see a doctor?
You should see a doctor if (28-31):
You have not had a period in more than three months
You feel that your stress is impacting your physical or emotional health
You experience menstrual changes including irregular cycles, changes in menstrual flow, or increased pain with periods
You feel that you are unable to eat or sleep because of changes in your mood
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.
How can you manage stress during your period?
Stress may be a part of life, but there are things that you can do to help manage your symptoms during times of hormonal changes.
Exercise: Regular physical activity may have a protective effect against the negative impacts of stress and improve resilience against future stressors (4).
Sleep: Sleep deprivation is linked to changes in reproductive function (32). Adults need around seven hours of sleep per night for optimal health (33). Getting enough sleep can help reduce stress and improve physical and mental health (33).
Social engagement: People who report more social connectedness may have lower levels of chronic stress and experience fewer health consequences (34).
Mindfulness: Regular mindfulness practice may help to reduce a person’s reactivity to stressful situations (35).
Magnesium: People who are prone to anxiety may experience a reduction in stress by taking a magnesium supplement (36). However, more research is needed.
Relaxation exercises: Progressive muscle relaxation and deep breathing may promote relaxation and stress reduction (37,38). Note that more research is needed.
For some people, stress that fluctuates throughout the cycle may be a sign of something else going on. Premenstrual syndrome (PMS) is a pattern of physical and emotional changes in the days leading up to your period (39). Some symptoms include irritability, headaches, trouble sleeping, and digestive issues (39). Premenstrual dysphoric disorder (PMDD) is when severe PMS symptoms interfere with your daily life and relationships (39).
People who experience PMS or PMDD might benefit from interventions like cognitive behavioral therapy, hormone therapy, or antidepressant medications to help navigate cyclic mood changes (40-42).
Not sure whether stress is affecting your cycle?
Clue can help you track your stress, energy, sleep, and exercise. Clue also reminds you to check in on your feelings each day so you can better understand how your feelings change throughout the menstrual cycle. If you are subscribed to Clue Plus, you can find out when you most frequently experience each feeling in your menstrual cycle in the Analysis Tab. This will help you identify patterns and know what to expect, at each phase. You can also learn about what else you have tracked, together with these feelings to help identify influencing factors.
FAQs
Does stress affect the menstrual cycle?
Research has linked stress to changes in the menstrual cycle, including irregular cycles, heavy menstrual bleeding, and dysmenorrhea (19,20,23,25). More research is needed to determine why stress has these effects, but it is thought to be due to the interaction of stress and reproductive hormones in the body (16,18).
Is it normal to feel stressed on your period?
Many people report increased levels of stress just before the menstrual period (43). For many people, this stress can be managed with lifestyle changes (4,35,37). However, consistently high levels of cyclic stress may be a sign of something else going on, like PMS or PMDD (39). Tracking your experiences can help provide you with information about the timing, intensity, and impact of your stress levels as they relate to your cycle.
How can I relax while on my period?
Regular exercise, getting enough sleep, and social connection can be beneficial ways of caring for your mind and body to reduce stress (4,34,44). Some people find that incorporating mindfulness or relaxation exercises can help with overall well-being (35,37). Occasionally, supplements may be used to promote positive mood (36) and for people with mood disorders, medications may be helpful in managing symptoms (41).
