Menstruation and Pandemic Stress: What you Need to Know

Have your periods become irregular during the COVID-19 pandemic? 

If you answered maybe or yes, you are not alone. You might be among the many teens and young women suffering from increased physiological and mental stress during this pandemic. Uncertainties about the future, feeling isolated from your loved ones, fear and anxiety about falling sick can be overwhelming and such level of stress can lead to irregularities in your menstrual cycle. 

How do stress alter your menstrual cycle?

Your menstrual cycle consists of three phases: the follicular phase, the ovulatory phase, and the luteal phase. Every month, your brain is the organ that initiates your menstrual cycle and coordinates these different phases by releasing a hormone called follicle stimulating hormone (FSH).  This hormone causes the ovary to signal your egg to mature. As the egg matures, your endocrine system releases several other hormones such as estrogen, luteinizing hormone, and progesterone to prepare your body for pregnancy.  If you don’t get pregnant, your progesterone levels fall, your uterine lining sheds off, and your body secretes the lining of your uterus, which results in your monthly menstrual cycle. 

When you suffer physical or emotional stress, your body senses danger, and it reacts by releasing the hormone cortisol. Cortisol then places your body in what is called ‘fight-or-flight mode’ to handle that stressful situation and to ensure your body’s survival. Cortisol can alter or shut down any body functions that are not considered critical to your survival. For instance it can wreak havoc on normal levels of estrogen, FSH and progesterone, which are all needed for you to maintain a regular menstrual cycle. 

Given the effects of cortisol on the hormonal balance, stress for an extended period of time, such the stress experienced by many women during the COVID-19 pandemic, may impact your menstrual cycle in a number of ways:

  •  Stress can cause you to skip ovulation, which results in you missing a period (amenorrhea)
  •  Stress can alter the length of your cycle. You may have longer or shorter menstrual period or longer intervals between menses
  • Stress leads to worsened premenstrual syndrome (PMS) symptoms like cramps, bloating, exhaustion, headaches and mood swings

Is stress the only cause of irregular periods?

If you have missed a period, you should not automatically assume that the cause is stress. There are many other conditions that may result in changes or delays in your menstrual cycle. The most common cause of a missed period in a reproductive-aged women is pregnancy. So, if you are in that age group and you miss a period, it will be essential for you to take a pregnancy test. Metabolic abnormalities, polycystic ovarian syndrome (PCOS), cardiovascular disease, an overactive thyroid, and uncontrolled type 2 diabetes can also be causes of menstrual irregularities. 

If you notice any changes or irregularities in your periods, it is important that you contact your OB/GYN specialist or a qualified health care provider to be seen for an evaluation. 

I hope this helps!

Stephanie C. Tardieu, MD

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