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We all know that feeling stressed isn’t a particularly fun experience. But did you know that it can also impact your menstrual cycle and cause missed or irregular periods?1,2
A regular menstrual cycle indicates that your hormones are functioning as they should be.3 Stress, however, triggers a number of physical and hormonal changes in the body4 that can have a knock-on effect on premenstrual (PMS) symptoms, the regularity of your period and the severity of your symptoms.5
Here are just a few ways that stress can affect your menstrual cycle.
Stress can cause irregular menstrual cycles
Stress is a natural part of everyday life. However, our body hasn’t evolved to a point where it can recognise the difference between modern-day stress (an overflowing inbox of emails) and the threats it used to deal with back in prehistoric times (like a sabre tooth tiger attack).6
When you’re seriously stressed, your body triggers your fight-or-flight response, releasing stress hormones – like adrenaline and cortisol – to help you cope with the perceived threat.4
When this happens, it sets off a chain reaction that causes one part of your body, called the HPA axis, to become activated. This then stops another part of your body, called the HPG axis, from working properly – and this is where things can go wrong for your period.5,7
The HPG axis is important because it controls the hormones responsible for your reproductive health, like luteinising hormone (LH), follicle-stimulating hormone (FSH), oestrogen, progesterone and testosterone.8 However, when it isn't working correctly, it can mess up the regulation of your menstrual cycle and cause a variety of stress-related issues.9
Why your periods stop
When your HPA axis is constantly being triggered by stress, it can alter how your HPG axis works and play havoc with your sex hormones.5
Over time, this can lead to a condition called hypothalamic amenorrhoea (HA).10
HA is when a region in your brain called the hypothalamus stops working effectively.10 It can stop giving the correct signals to the rest of your body to produce the sex hormones needed for ovulation and also menstruation. This can then lead to a lack of menstruation, which is what’s known as HA.10
If you think about it, this response makes a lot of sense.
As mentioned, your body doesn’t know that you’re stressed because you have a deadline coming up, so it may respond to chronic stress as if you’re in a potentially life-threatening situation.6 And the last thing you need when you’re in a life-threatening situation is the ability to conceive. So, your body tries to prevent pregnancy by stopping ovulation, meaning you also don’t get your period.
Of course, if you’re trying for a baby, it’s a source of anxiety if your periods suddenly go missing or become less regular. Even if you’re not on a fertility journey, missing, late or early periods can also become a source of stress.
It’s important to note, however, that even if you don’t mind too much that your periods have disappeared, HA is a sign that the hormones in your body have become dysregulated. As a result, HA can have serious long-term consequences, including premature osteoporosis (thinning of the bones),11 so it’s important to consult your doctor if you think you have HA.
Stress and PMS symptoms
Chronic stress can also make PMS and period symptoms worse.5
In particular, research has found a link between stress and painful periods (dysmenorrhoea), the length and duration of the menstrual cycle and the amount of menstrual bleeding.5
So, if you start to notice changes to your periods, it’s worth considering whether this change may be related to your stress levels.
Again, this relationship between stress and PMS symptoms makes a lot of sense. Because stress increases levels of hormones like cortisol, which then causes a drop in your progesterone levels, this can all impact your cycle, as well as worsen PMS symptoms.12
Additionally, as we come to the end of our luteal phase, fluctuating hormone levels can impact our production of serotonin13 – one of the feel-good hormones. Chronic stress is known to affect serotonin transmission in the brain.14
So, you may find that your PMS symptoms, such as sadness or low mood, are worse when you feel stressed.15
Stress and lifestyle habits
Of course, it’s easy to fall into unhealthy lifestyle habits when we’re stressed. If we get busy with work, we might start skipping our workouts. If we’re feeling particularly anxious, we might find it hard to sleep. When stressed, we might drink more coffee or alcohol, or eat a less balanced or healthy diet.
Yet, all of these habits can contribute to more severe symptoms throughout menstruation.
Exercise, for instance, is a well-established remedy for PMS and period pain,16 whereas poor sleep quality has been linked to various PMS issues, including more severe menstrual pain and more frequent menstrual symptoms.17
How to reduce stress
Of course, it’s easy to say that stress is bad for you. But how can you actually reduce your stress level?
Here are a few of our top tips:
- practice mindfulness and meditation: taking some time out of your day to focus on your breath and clear your mind can do wonders for lowering your cortisol levels18
- get enough sleep: a severe lack of sleep is associated with increased cortisol levels, so try to get into a good bedtime routine and aim for at least seven to eight hours of quality sleep each night19
- exercise: when your heart rate increases, your body releases endorphins, which are great at combatting stress20
- eat a balanced diet: a balanced diet of fruit, vegetables and essential fatty acids (like the ones in oily fish) can help your body deal with stress.21 You may also want to cut out caffeine and alcohol
- try supplements: using certain PMS supplements may also offer a convenient way to keep up with your body’s nutritional needs.
- early research suggests that magnesium may be associated with improved sleep quality and potentially reduced menstrual cramps, but it's not yet recognised by the European Food Safety Authority (EFSA) for this specific use22
- vitamin B6 may help soothe PMS symptoms and potentially improve the low mood often associated with premenstrual syndrome23
- evening primrose oil (EPO) is thought to have anti-inflammatory properties that may help reduce the symptoms of PMS. However, more robust research is needed with evening primrose oil but some small studies suggest it may be beneficial24
The final say
Maintaining healthy lifestyle habits, practising mindfulness, ensuring you get enough sleep and exercise, and following a balanced diet can help you manage stress and support menstrual health.
And don’t struggle on your own. If you’re struggling with stress that’s affecting your menstrual cycle, it’s important to speak to your doctor or a healthcare professional for help too.
1. NHS inform. Irregular periods [Internet]. [Cited 2024 Feb 16]. Available from: https://www.nhsinform.scot/healthy-living/womens-health/girls-and-young-women-puberty-to-around-25/periods-and-menstrual-health/irregular-periods.
2. NHS. Period problems [Internet]. [Cited 2024 Feb 16]. Available from: https://www.nhs.uk/conditions/periods/period-problems/.
3. Nagma, S. ‘To Evaluate the Effect of Perceived Stress on Menstrual Function.’ Journal of Clinical and Diagnostic Research. 2015;9(3). Available from: https://doi.org/10.7860/jcdr/2015/6906.5611.
4. NHS. Get help with stress [Internet]. [Cited 2024 Feb 16]. Available from: https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/stress/.
5. Singh, R., et al. ‘Impact of stress on menstrual cycle: A comparison between medical and non medical students.’ Saudi Journal for Health Sciences. 2015;4(2):115. Available from: https://doi.org/10.4103/2278-0521.157886.
6. Katsampouris, E., et al. ‘Can ancient and modern stressors be distinguished? A mixed-methods exploration of psychosocial characteristics and health symptoms in young and older adults.’ Journal of Health Psychology. 2020;27(3):624–36. Available from: https://doi.org/10.1177/1359105320965654.
7. Yaribeygi, H., et al. ‘The impact of stress on body function: A review.’ EXCLI Journal. 2017;16(1):1057–72. Available from: https://doi.org/10.17179/excli2017-480.
8. Laisk, T., et al. ‘Large-scale meta-analysis highlights the hypothalamic–pituitary–gonadal axis in the genetic regulation of menstrual cycle length.’ Human Molecular Genetics. 2018. Available from: https://doi.org/10.1093/hmg/ddy317.
9. Reed, B., et al. ‘The Normal Menstrual Cycle and the Control of Ovulation’. National Library of Medicine. 2018. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279054/.
10. Podfigurna, A., et al. ‘Functional Hypothalamic Amenorrhea: A Stress-Based Disease.’ Endocrines. 2021;2(3):203–11. Available from: https://doi.org/10.3390/endocrines2030020.
11. Torbati, T., et al. ‘Hypothalamic Amenorrhea and the Long-Term Health Consequences’. Seminars in Reproductive Medicine. 2017;35(03):256–62. Available from: https://doi.org/10.1055/s-0037-1603581.
12. Hou, L. Premenstrual syndrome is associated with altered cortisol awakening response. Stress. 2019;22(6):640–646. doi: 10.1080/10253890.2019.1608943.
13. Gudipally, P., et al. ‘Premenstrual Syndrome’. National Library of Medicine. 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560698/.
14. Natarajan, R., et al. ‘Protracted effects of chronic stress on serotonin-dependent thermoregulation’. Stress. 2015;18(6):668–76. Available from: https://doi.org/10.3109/10253890.2015.1087502.
15. National Institutes of Health (NIH). Prior stress could worsen premenstrual symptoms, NIH study finds [Internet]. [Cited 2021 Jul 26]. Available from: https://www.nih.gov/news-events/news-releases/prior-stress-could-worsen-premenstrual-symptoms-nih-study-finds.
16. Yesildere Saglam, H., et al. ‘Effect of exercise on premenstrual symptoms: A systematic review.’ Complementary Therapies in Medicine. 2020;48:102272. Available from: https://doi.org/10.1016/j.ctim.2019.102272.
17. Jeong, D-K., et al. ‘Effects of sleep pattern, duration, and quality on premenstrual syndrome and primary dysmenorrhea in korean high school girls.’ BMC Women’s Health. 2023;23(1). Available from: https://doi.org/10.1186/s12905-023-02600-z.
18. Sanada, K., et al. ‘Effects of Mindfulness-Based Interventions on Salivary Cortisol in Healthy Adults: A Meta-Analytical Review.’ Frontiers in Physiology. 2016;7. Available from: https://doi.org/10.3389/fphys.2016.00471.
19. Nollet, M., et al. ‘Sleep deprivation and stress: a reciprocal relationship’. Interface Focus. 2020;10(3):20190092. Available from: https://doi.org/10.1098/rsfs.2019.0092.
20. Mikkelsen, K., et al. ‘Exercise and Mental Health’. Maturitas. 2017;106(106):48–56. Available from: https://doi.org/10.1016/j.maturitas.2017.09.003.
21. Gonzalez MJ, et al. ‘Diet and Stress’. Psychiatric Clinics of North America. 2014;37(4):579–89. Available from: https://doi.org/10.1016/j.psc.2014.08.004
22. Parazzini, F., et al. ‘Magnesium in the gynaecological practice: a literature review.’ Magnesium Research. 2017;1;30(1):1–7. Available from: https://pubmed.ncbi.nlm.nih.gov/28392498.
23. Ebrahimi, E. Effects of Magnesium and Vitamin B6 on the Severity of Premenstrual Syndrome Symptoms. J Caring Sci. 2012;1(4):183–189. doi: 10.5681/jcs.2012.026.
24. Mahboubi, M. Evening Primrose (Oenothera biennis) Oil in Management of Female Ailments. Journal of Menopausal Medicine. 2019;25(2):74. doi: 10.6118/jmm.18190.
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