Does Stress Affect Your Period?

Not getting your period can be scary, especially if you do not know what’s causing it to not come back. The first thing that many doctors will tell you is “It is probably just stress.” Yet, they do not tell you how stress can show up in your body in different ways. Luckily, there are some easy connections that relate to your lifestyle that you may be able to use to guide your treatment plan. Amenorrhea is the umbrella term for not getting your period. There are two different forms of amenorrhea: primary and secondary. Our previous post “Why have I not gotten my period?” will help you identify which one you have, the most essential step to finding out a beneficial treatment method.

Why have I not gotten my period?

Many healthcare providers, unfortunately, misdiagnose the cause of secondary amenorrhea. There are multiple medical conditions associated with losing your period that have to be ruled out. It is not ok to just brush off secondary amenorrhea without making sure that all other related causes have been checked thoroughly. Therefore, before you or anyone concludes that you have secondary amenorrhea that’s only caused by lifestyle factors.

Do I have secondary amenorrhea?

If your provider has already ruled out other underlying medical conditions but you are still not getting your period, you may have functional hypothalamic amenorrhea. This may sound like a complicated term, so let us make it simpler. Functional means that your amenorrhea is not related to another disease. Hypothalamic refers to the hypothalamus, the part of your brain that controls the rest of the body. It changes its signals based on how stressed your body is. And as a reminder, amenorrhea is the umbrella term for not getting your period. So, functional hypothalamic amenorrhea is when you do not get your period because of improper signals from your hypothalamus. This type of amenorrhea is very common and affects 25-35% of women with secondary amenorrhea. Most of the causes relate to lifestyle factors like stress, exercise, sleep, and food.

How does the brain control the reproductive system?

Before we discuss what could be causing your amenorrhea, it is important to understand how the hypothalamus affects your periods. Imagine the body is like an orchestra. The hypothalamus is the conductor who signals to the rest of the body systems how strongly to play. It is responsible for sending hormone signals to different organs based on what the body needs at that moment. One of those signals from the brain triggers your menstrual cycle. For you to have a period, the hypothalamus sends a series of signals that eventually reach the ovaries and tell them to release estrogen and progesterone. The estrogen and progesterone help build the lining in your uterus that is eventually shed if you do not become pregnant. As long as this system is working properly, you should be getting a regular period. But, if the orchestra goes out of harmony, it can cause amenorrhea. There are a few different reasons why this could happen.

How does stress affect your period?

Stress is one of the main reasons why your brain may not be sending the right signals for you to have a period. Stress can be either physical, if you have to carry a heavy object, or psychological, if you have to carry heavy emotions. When you are stressed, your body releases a hormone called cortisol. Cortisol protects your body against any dangers. However, your body does not know the difference between the stress of running away from a hungry lion and having to take a calculus exam. Cortisol competes with the brain’s message for you to have a period. After all, would you want to be pregnant if a lion were chasing you? Researchers from India who were looking at whether stress was related to irregular periods asked women to rate their stress and if their periods were regular or not. They found that the women who were not getting their periods were significantly more stressed and had higher cortisol levels (2). In our own practice, we have seen many patients whose main reason for not getting their periods or getting pregnant was stress.

Can exercise affect your period?

Over-exercising can also cause amenorrhea. Female athletes in cycling, triathlon, and rhythmic gymnastics were most affected in a 2022 study (6). Over half of the cyclists had secondary amenorrhea. When you exercise, your body thinks that it is physically stressed and releases cortisol to compensate. Crossing the line between exercise and over-exercise can cause the body to go into panic. How much exercise is too much for a woman? If you feel too tired to do anything else that day, do not take any rest days, and push yourself to your limits regardless of how your body feels, you are likely overexercising. Your body will want to channel its energy to helping you get through the marathon you are running rather than try to nurture a baby or have a period.

Can a lack of sleep cause a delayed period?

A lack of sleep can also affect menstruation. Sleep is your body’s time to rest and rejuvenate. Making sure you are getting enough deep sleep is important for supporting both your brain and body as sleep and wellbeing are very interconnected. Sleeping more than 8 hours is associated with a lower risk of amenorrhea than sleeping less than 5 hours (8). A British study from 2018 showed that 61% of women with amenorrhea were not sleeping well (7). When you sleep, your body produces a hormone called melatonin. Think of your ovaries like a house being constructed. During the day, dust builds up in the house because of the work that is being done. Melatonin is like the vacuum cleaner that goes in and cleans up all the dust so that your egg cells can live longer and be healthier. Melatonin and cortisol are opposites: cortisol is high in the morning to give you energy during the day while melatonin is high in the evening to help you wind down. If you are more stressed and producing more cortisol, your body will not produce as much melatonin (i.e., less vacuum cleaning in your ovaries) which can then lead to your period becoming irregular.

Can dieting affect your period?

The final major cause of secondary amenorrhea is not eating enough food. You may be thinking, “I changed my diet, and my period is late.” Why? When you do not give your body enough nourishment, it has to be smart about where to use the energy that it has. It first provides fuel for processes that are essential to life, like your brain and heart, before distributing what is left for “nice to have” functions. Your period falls under the “nice to have” category. Restricting your food can also make the body feel like it is under stress and increase your cortisol levels, similar to the emotional stress mentioned above. Why is it important to eat a variety of foods? You want to make sure you are getting enough carbohydrates, fat, and protein. Each of these nutrients supports your hypothalamus in a different way. Many women who have functional hypothalamic amenorrhea tend to show disordered eating behaviors, including following fad diets or trying to eat the bare minimum in hopes of losing weight (5). Having a dietitian guide you towards a healthy eating plan is crucial for your amenorrhea recovery. Your body’s nutritional needs may be different than what you think, so it is good to talk to an expert and create an eating plan that will properly nourish you from the inside out.

Can amenorrhea have multiple causes?

Secondary amenorrhea may be due to a few different causes. In a study done in monkeys, the researchers found that diet, exercise, and stress on their own had minimal effects on how regular the monkeys were with their periods. When the three causes were combined, nearly 70% of the monkeys lost their periods (3). It is important to consider the body as a cohesive unit rather than individual components. Adjusting how much you eat, how often you exercise, and what time you sleep are very interconnected, and finding the optimal levels of these can lower your stress levels.

In summary, your period could be missing because of many lifestyle-related factors. Whether it be mental stress, over exercising, lack of sleep, or not eating enough nourishment, all of these cause your body to think that it is battling danger. Luckily, speaking to a professional like one of our team members can help you relax your body and get your period back on track.