Stress & Our Cycles - Part 2

How Stress Can Show Up In Our Cycles

We have looked at how stress can interact with our hormones and our menstrual health but how do we spot these changes in our cycle? 

So what might we notice in our cycles?

Ultimately, stress delays or inhibits ovulation leading to cycles where there is an imbalance of oestrogen and progesterone, anovulatory cycles, or a complete loss of our menstrual cycle.

Disclaimer: I would strongly encourage anyone who is experiencing menstrual cycle disturbances to go and get your hormones tested. Stress is just one contribute to cycle changes and it is important to get an accurate picture of what is happening (PCOS, thyroid issues, pituitary issues, etc.). Similarly any unusual, prolonged or heavy bleeding should be tracked and reported to your GP straight away as this can be a sign of fibroid, uterine issues/cancer or cervical/ovarian cancer. Similarly prolonged presence of oestrogenic mucus (especially coupled with an unusual smell) may indicate an infection so please get this seen to.

1 | Hormone Imbalances & PMS: 

We may also notice that our cycles are longer. As stress delays ovulation, it pushes out our ovulation meaning that we have a much longer follicular phase. 

During this longer follicular phase, our body may try multiple times to develop and launch follicles. When this happens we can get bumps of oestrogen in an attempt to reach ovulation. We may notice recurrent presence of moist mucus over a number of days/weeks with no culmination in peak cervical mucus (like egg whites).

This process can result in weeks of elevated oestrogen that won’t be able to be balanced by progesterone levels. This in turn can worsen PMS, sleep & anxiety and could result in heavier bleeding in the next cycle. (Note: any prolonged and heavy bleeding should be investigated by your healthcare provider)

A recent study by Trinity College Dublin found that "increased anxiety was an independent risk factor for change from non-painful to painful periods and worsening of pre-menstrual symptoms during the pandemic” and noted that 64% of women noted a worsening in PMS.

2 | Short Luteal Phases

If you are tracking your cervical mucus, using LH test strips or tracking your BBT temperature you will be able to identify your approximate time of ovulation. This is obviously helpful if you are trying to conceive or avoid pregnancy, but it is also very informative about our luteal phase.

Look at the number of days between your approximate ovulation day and the start of your next cycle. This is your luteal phase. Our luteal phase should be between 10 and 18 days long and for many it will be approximately 12-14 days long.

If our luteal phase is short, especially if it is <10days long, this is known as luteal phase defect/deficiency. It indicates that your body is not producing enough progesterone. 

You may notice the presence of oestrogenic mucus in your luteal phase as progesterone struggles to maintain its dominance and you may also notice some spotting for a few days before your period or more pronounced PMS symptoms. These can all be indicators that progesterone is low. 

If you are trying to conceive this can have an impact on your ability to sustain a pregnancy. If you aren’t trying conceive you should still care about your levels of progesterone and your luteal phase length. Progesterone helps balance our oestrogen levels, it is important for maintaining bone mineral density, our thyroid health, our mental health and it promotes good sleep.

3 | Anovulatory Cycles

An anovulatory cycle is taken one step further. Our bodies attempt to ovulate but cannot produce enough FSH from the brain (thanks to our hypothalamus putting a big fat stop to that one) to allow for ovulation at all.

We may notice the similar characteristics, prolonged presence of oestrogenic mucus but now with no dryness following ovulation. This is because we do not ovulate and therefore we cannot produce progesterone. It is the progesterone that produces the dryness during our luteal phase.

If we do have a bleed this month, it is not a ‘true period’ but instead a break through bleed caused by the change in hormones. Progesterone is important for so many things, such as our thyroid health, mental health, bone health and of course for supporting a pregnancy.

4 | Hypothalamic Amenorrhea (HA) or Period Loss

Hypothalamic amenorrhea literally means ‘without menstrual flow’ due to the hypothalamus not signalling your pituitary glands and subsequently ovaries to produce enough hormones.

As we know, stress hormones are also linked to the hypothalamus and pituitary gland and therefore can have an impact on the menstrual cycle but, as noted above, it is important that we go speak to our health care provider to rule out other causes of period loss (eg. pregnancy, menopause, PCOS, thyroid issues, pituitary issues, etc.)

Often, HA is linked to underfuelling, overtraining/stress, low-body fat percentage or a combination of all three. I’ll be diving into the topic of low-energy-availability (LEA) and RED-S in a later post but needless to say many of us are underfuelling our bodies for the amount of activity in our lives (at least 45% of recreational athletes are thought to be at risk of LEA). Similarly our busy, hectic lives filled with HIIT classes, meetings, nights out and more jacks up our cortisol levels, impacting our cycles. According to Dr. Rinaldi of the incredible book ‘No Period? Now What?’ numerous studies “found that women with HA have elevated cortisol levels in their blood and spinal fluid”. 

A Final Note

In my next post I’ll be talking about 5 tips to help your mental & menstrual health, with a big emphasis on stress management and nourishing your body. 

Please do remember that this is an educational post and is not intended as a form of diagnosis (nor am I qualified to do so). Our hormones are incredibly complex and cannot be taken in isolation. As I mentioned, if you are suffering from menstrual cycle disturbances or unusual bleeding please go speak to your healthcare provider to rule out any other causes or issues. 

P.S. don’t forget your cervical screening! It is important we stay up to date on those important appointments.

Sources, Disclaimer & Further Reading

Much of this information is taken from my on-going FEMM (Fertility Education & Medical Management) Teacher Training course and my qualifications & experience as a Women’s Movement, Nutrition & Lifestyle Coach.

Please note that I am not fully qualified at the date of writing this post but soon will be. The content written in these articles is purely for educational and information purposes and should never replace the advice of your healthcare practitioner.

Sources:

• No Period. No What? by Nicola J. Rinaldi,

• Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S)British Journal of Sports Medicine (2014) ;48:491-497.

• Loucks AB, Thuma JR. Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. J Clin Endocrinol Metab. 2003;88(1):297‐311. doi:10.1210/jc.2002-020369

• Loucks AB, Verdun M, Heath EM. Low energy availability, not stress of exercise, alters LH pulsatility in exercising women. J Appl Physiol (1985). 1998;84(1):37–46. doi:10.1152/jappl.1998.84.1.37

• Anne B. Loucks, Bente Kiens & Hattie H. Wright (2011) Energy availability in athletes, Journal of Sports Sciences, 29:sup1, S7-S15, DOI: 10.1080/02640414.2011.588958

• James B. Brown, Types of ovarian activity in women and their significance: the continuum (a reinterpretation of early findings), Human Reproduction Update, Volume 17, Issue 2, March-April 2011, Pages 141–158, https://doi.org/10.1093/humupd/dmq040

• Maher et al, Reproductive health disturbance in the era of the COVID-19 pandemic Endocrine Abstracts (2021) 77 P234 | DOI: 10.1530/endoabs.77.P234

Further reading:

• I would highly recommend No Period. No What? by Nicola J. Rinaldi, especially for those who are trying to conceive and have lost their cycles

• Dr Stacy Sims, Roar book is another excellent resource for those who take their training very seriously

• Maisie Hill’s Period Power is a great book for those who are more geared towards holistic health & wellbeing