Can Stress Affect Your Period? - GoodRx

How Does Stress Affect Your Period?

Written by Joanna Jan, MD | Reviewed by Alicia Stevens, MD

Updated on April 29, 2024

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Key takeaways:

• Stress impacts the hormonal pathways in your body, and this can affect the hormones that control your menstrual cycle.

• Stress can lead to irregular or more painful periods — or even pause the menstrual cycle entirely. 

• Stress management techniques and coping mechanisms can help to alleviate the effects of stress on your menstrual cycle. 

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Stress can lead to many different changes in your body. It not only affects mental health, but also physical health. And it can also affect your monthly period. The stress hormone cortisol can interact with the hormonal pathways involved in the different phases of your menstrual cycle. 

Let’s take a closer look at the normal hormonal changes of the menstrual cycle and explore how stress can impact your period.

The hormonal changes in the menstrual cycle

The menstrual cycle is controlled by the repeated rise and fall of different hormones in the body. And stress has a pretty big impact on these hormone levels. Before diving into how stress affects menstruation, let's first review the hormonal changes that occur during the menstrual cycle. 

The key hormonal changes include:

• A rise in the follicle-stimulating hormone (FSH) tells the ovaries to start maturing eggs for ovulation.

• A spike in luteinizing hormone (LH) tells the ovary to release a mature egg.

• A rise in estrogen prepares the uterus to build its lining in the event of egg fertilization.

• A rise in progesterone tells the uterus to maintain its lining in case of egg implantation. 

• A natural fall in estrogen and progesterone at the end of the cycle — if an egg is not fertilized — allows for menstruation and the cycle to begin again.

All of these changes are controlled by a connection between the brain and ovaries. This is called the hypothalamic-pituitary-ovarian axis. The hypothalamus and pituitary gland are areas of the brain that trigger the release of FSH and LH. And these hormones are how the brain sends messages to the ovaries. The ovaries then make estrogen and progesterone, which also send important feedback back to the brain. 

But the brain is also in communication with the adrenal glands. These are small glands that are located near the kidneys and produce cortisol. Cortisol is a hormone that is released when we are stressed. When cortisol levels rise, it can interrupt the feedback loop between the brain and ovaries — and potentially affect the menstrual cycle.

How does stress affect the hormones that drive the menstrual cycle?

When we are in a stressful situation, cortisol is released by the adrenal glands. This adrenal response prepares the body for a “fight-or-flight” response. Cortisol shifts our bodies into “survival mode” in a number of different ways. For example, it increases your heart rate and breathing rate. And it directs blood flow to your muscles. But cortisol also impacts your hypothalamus and tells it to stop producing the hormones that initiate the menstrual cycle. This can lead to changes in your period. 

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What sort of menstrual changes can be caused by stress?

High levels of stress can affect cycle length and menstrual cycle symptoms. The menstrual cycle is regulated by a hormone in the brain called gonadotropin-releasing hormone (GnRH), which causes estrogen and progesterone levels to change. 

Stress increases cortisol levels, which can decrease GnRH production and cause period changes. With acute stress, progesterone increases with cortisol, while estrogen decreases. But repeated episodes of short-term stress can lead to chronic stress. With chronic stress, hormone levels can be unbalanced for some time.

Let’s take a closer look at how high stress levels can change your menstrual cycle.

Spotting

It’s common to have spotting when under stress because of fluctuating hormones. Decreasing estrogen levels leads to instability in the uterine lining. This will cause the lining to shed slightly between menstrual flows and lead to spotting between periods.

Painful periods

Painful periods may be a result of high stress. This link between stress and menstrual cramps may go unnoticed by some, but it’s the result of hormone changes. Progesterone, which causes the uterus muscle to contract, increases with stress, and leads to increased period cramps.

Premenstrual syndrome (PMS)

The exact cause of premenstrual syndrome is not fully understood, but cortisol plays a role. Cortisol impacts the release of neurotransmitters like serotonin, which affects mood. This can lead to mood swings, feelings of anxiety, or depression. Cortisol also causes increased cravings for sugary foods. This can lead to nausea, bloating, and weight changes seen with PMS.

Irregular periods

Stress can cause a drop in estrogen levels. The sudden decrease in estrogen can lead to irregular menstrual cycles. The type of menstrual cycle changes can vary. The decrease in estrogen can either shorten or lengthen your cycles — causing you to have more frequent periods or skipped periods.

Heavier bleeding

It’s not unusual to notice heavier bleeding or the passing of large clots in response to stress. As cortisol leads to an imbalance in estrogen and progesterone, the uterine lining can shed irregularly. This can lead to a heavier flow and the passing of clots.

Can stress delay your period?

Yes, shifts in hormone levels can disrupt the normal menstrual cycle and delay your period. Normally, your period starts after a rise and fall of estrogen and progesterone. But stress can disrupt this process and cause your period to come later than expected. 

Can stress cause a missed period?

High levels of stress can stop menstruation and cause you to skip your period altogether. This happens when spikes of cortisol during stress signal the brain to put the menstrual cycle on pause. This is called functional hypothalamic amenorrhea.

This condition prevents the surge in hormones that triggers the natural progression through the menstrual cycle. And it’s a protective mechanism for the body. In this way, your body is trying to protect itself during times when you may not be prepared to support a healthy pregnancy.

If you have missed your period, it’s best to seek medical attention to figure out why. There are many conditions that can cause you to miss your period. So, you’ll need the proper diagnosis for determining the next steps to take.

Ways to help manage stress effectively

Everyone experiences some level of stress at one point or another. And it’s not always possible or realistic to completely eliminate it. But there are steps you can take to change the way it affects you. Taking the time to intentionally relax and focus on yourself can help you better prepare for stressful situations. Some helpful strategies to manage stress include:

• Paying attention to your emotions and prioritizing your mental health

• Taking time for yourself to do the things that make you feel happy and fulfilled

• Connecting with others and building a social support network

• Practicing self-care by getting enough sleep, eating nutritious foods, and exercising regularly

• Practicing mindfulness and meditation techniques

• Seeking counseling if you feel overwhelmed or if the stress in your life feels unmanageable

Stress management techniques can help to decrease cortisol levels. This can have both noticeable and positive effects on your mental and physical health.

When to seek care about period changes

The menstrual cycle is considered a useful measure of your overall health. If you’re having changes in your period, it could be a sign of an underlying condition. You should seek medical attention if you notice any of the following period changes: 

• Absence of your period for 3 months

• Heavy menstrual flow that requires changing menstrual products every 2 hours

• Painful intercourse

• Weight gain or weight loss

• Facial hair growth

• Constipation

• Darkening of your skin color, either all over or specifically around the neck or armpits

The bottom line

Stress can take a toll on different body functions, including your menstrual cycle. Cortisol levels rise during times of stress and change the hormonal pathways that regulate your period. If you’re noticing changes in your period, let your primary care provider or gynecologist know. They can figure out if stress or an underlying medical condition is the cause and give you guidance for the next steps.

References

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Cable, J. K., et al. (2023). Physiology, progesterone. StatPearls.

Gudipally, P. R., et al. (2023). Premenstrual syndrome. StatPearls.

Liang, J., et al. (2023). Determinants and assessment of menstrual blood flow. Current Epidemiology Reports. 

Nagy, B., et al. (2021). Key to life: Physiological role and clinical implications of progesterone. International Journal of Molecular Sciences.

Roberts, R. E., et al. (2020). Current understanding of hypothalamic amenorrhoea. Therapeutic Advances in Endocrinology and Metabolism.

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