How stress can affect your menstrual cycle & PCOS symptoms

We all experience stress. Sometimes acutely, which is a normal beneficial adaptation, but often times persistent and chronically. Research shows that certain types and timing of stress can negatively impact our menstrual cycle. And for those with PCOS, certain types of stress can worsen PCOS symptoms or cause flare ups for those who have their PCOS in remission.

What is stress?

Stress is a normal physiological and psychological reaction to certain changes to our environment. It might be exercise, a work deadline, speaking in front of people. Acute stress activates the sympathetic nervous system, or "fight or flight" mode, releasing cortisol and adrenaline into the body.

The problem with stress is when it becomes chronic, causing over-activation of the sympathetic nervous system or "survival" system.  

Stress isn't just "feeling stressed" - our body doesn't know the difference between stressors. Stressors can include mental and emotional stress, repressed emotions, trauma, financial stress, relationship difficulties, loneliness, nutrient deficiencies, dysregulated blood sugar, under-eating, over-exercising, over-working, environmental toxins, lack of sunlight, infections, food intolerances, or worrying about a chronic health condition.

Relationship between stress and your hormones and menstrual cycle

When the body is under chronic stress, it impacts the HPA/O axis (hypothalamic pituitary adrenal ovary) - a communication pathway between the part of the brain that signals hormone production and secretion, thyroid, adrenal glands (which secrete cortisol and adrenaline), and the ovaries.

Chronic stress sends the message that it's not "safe" to reproduce. This slows metabolism, lowers hormone production and inhibits ovulation and progesterone production, causing menstrual cycle changes and infertility. It may show up as irregular or longer cycles (>35 days), no periods, difficulty conceiving, lighter periods, heavier periods, painful periods, spotting between periods, skin breakouts, weight gain.

Stress and PCOS

Chronic stress is one of the main drivers of PCOS symptoms. Not only will it interrupt ovulation and menstrual cycle regularity, but higher levels of cortisol also cause more androgen hormones to be produced. Androgens are the hormones that cause PCOS symptoms including irregular cycles or no periods, weight gain or difficulty losing weight, infertility, skin breakouts, thinning hair, and hirsutism. Stress needs to be addressed in all PCOS women to reverse PCOS symptoms.

Stress and painful heavy periods

Chronic stress can cause longer cycles and lighter periods due to suppression of hormones via the HPA/O axis. But for some women, it can do the opposite and cause more painful and/or heavier periods. This is because oestrogen and progesterone need to be in "balance" in the body. And when chronic stress lowers progesterone production or inhibits ovulation (which means no progesterone is being produced), oestrogen becomes too high in relation to progesterone. Oestrogen dominance causes heavier, often more painful periods as well as breast tenderness, bloating and fluid retention leading up to your period.

Stress and gut health

Under stress, the body is in fight or flight mode (sympathetic nervous system) and when this persists we get stuck in survival mode, not allowing time to be in "rest, digest and reproduce" mode (parasympathetic nervous system). This causes lowered secretion of digestive enzymes and stomach acid, meaning food isn't being broken down adequately for nutrients to be absorbed (its not just what you eat, but how you digest and absorb!). Studies show it also causes changes to the gut microbiome and can lead to dysbiosis, leaky gut and inflammation in the body.

There is a big link between gut health and hormonal balance, and PCOS, and when we work on healing hormones and symptoms of hormonal imbalance, the gut (and stress) must be addressed. 

Ways chronic stress can show up in the body:

• Irregular or missing periods
• Changes to menstrual cycle flow
• Difficulty sleeping &/or early rising
• Fatigue
• Brain fog / difficulty concentrating
• Skin breakouts
• Mood changes
• Digestive issues
• Recurrent sickness
• Aches & pains
• Worsening or reactivation/flare ups of PCOS symptoms or autoimmunity

Strategies for reducing stress for hormonal balance

Whilst we can't get rid of all stress, we can minimise stressors on the body and regulate our nervous system to improve hormonal balance and PCOS. My favourite ways to regulate the nervous system includes:

 - Eating for blood sugar balance

 - Eating to support your body's needs, lifestyle and goals (ensuring adequate protein, carbs, fats, fibre)

 - Incorporating gut supportive foods (prebiotic and probiotic foods)

 - Reviewing your current exercise regime 

 - Breathwork (I often get my clients to do box breathing before main meals to improve digestion and hormones)

 - Addressing trauma or emotional stress with a psychologist or coach

 - Supplementation to replenish nutrients depleted by stress: electrolytes and minerals (sodium, potassium, magnesium, zinc), B vitamins and vitamin C