Does it ever feel like life just gets more stressful with time? We get a lot of things thrown at us all at once – work, family, bills, personal challenges, health crises, and more. Stress and anxiety can wreak havoc on your mental health, but they can also have some surprising effects on your physical body.
“Anxiety is a form of stress, and stress can interfere with the delicate hormonal balance mediated by the interplay between the brain, ovaries, and uterus,” explains Kecia Gaither, M.D., a board-certified OB/GYN and director of Perinatal Services at NYC Health+Hospitals/Lincoln in New York City. Translation: Anxiety and your menstrual cycle are not always a good mix. But here’s how they can co-exist.
Anxiety and Aunt Flo
Anxiety disorders are the most common mental illness in the United States, affecting 18.1% of the adult population. They develop for many reasons: genetic predisposition, brain chemistry, and external stressors, to name a few. And unfortunately, women are nearly twice as likely as men to be diagnosed with some type of anxiety disorder.
A 2018 study from BMC Women’s Health looked at the risk factors for irregular menstrual cycles. Researchers found that along with obesity and tobacco use, stress (which sometimes manifests as anxiety) has a major impact on your regular menstrual flow. That’s not to say there’s an immediate correlation between your anxious thoughts and your period. “Irregular cycles could be due to a number of issues inclusive of stress, lack of sleep, excessive exercise, and poor nutritional status due to not eating,” Dr. Gaither says.
In other words, if your period is late, irregular, or especially painful, there could be a variety of reasons for this. Early menopause, excessive exercise, disordered eating, thyroid dysfunction, endometriosis, and PCOS are all potential contributors to menstrual cycle abnormalities.
Lauren Streicher, M.D., a professor of obstetrics and gynecology at Northwestern University in Chicago, Illinois, reiterates this complexity. “The menstrual cycle is a fairly delicate balance, when you look at all the things that have to fall into place for things to work properly,” she explains. Stress plays a role, but not in the way you might think. “From a medical point of view, when we talk about stress, it’s anything that might stress the system,” she says. This could be anything from a vacation to a big move – things you might be excited about, but that still constitute a change in your routine. “That kind of stress, even if it’s good stress, can also throw things off [in the menstrual cycle],” Dr. Streicher notes.
If your period is late, though, you should always assume first that you might be pregnant. “The most common thing that causes a young woman of reproductive age to not get their period is pregnancy,” Dr. Streicher says. “Don’t chalk it up to stress.” Instead, she recommends, take a pregnancy test. If that’s negative, you can start looking at lifestyle factors like stress and diet to figure out what is going on.
The relationship between anxiety and your period goes two ways. High stress levels can cause an irregular menstrual cycle, or your menstrual cycle could be causing spikes in anxiety at certain times of the month – especially right before your period.
Pre-menstrual syndrome, or PMS, refers to the few days leading up to your period when you may feel extra moody, bloated, or sad. The cause of PMS is unknown, but it likely has something to do with fluctuating hormone levels causing a dip in serotonin. This brain chemical helps contribute to your overall mood and happiness, so when it’s lacking, you’re likely to feel pretty bleh.
If the anxiety is hitting you right before your period each month, it could have something to do with your PMS symptoms. “Certain women who have pre-menstrual symptoms sometimes can feel very anxious as part of that,” Dr. Streicher says. “That’s not going to have an impact on their cycle. That’s really more an impact of hormonal changes that may create a feeling of anxiety.” Talk to your doctor if you think your hormonal shifts may be making you anxious.
Dr. Gaither also cautions that your medications could be causing changes in menstrual bleeding. This includes birth control pills, hormonal medicine for chronic conditions, thyroid medications, cancer drugs, and even over-the-counter pills like Aspirin or ibuprofen. “There is always the possibility that an anti-anxiety medication may impact the menstrual cycle, and it is important for you to discuss with your health provider should it occur,” she says. While there isn’t a known connection between antidepressants or anti-anxiety meds and menstrual irregularities, everyone reacts to medication differently.
Getting Back on Track
To get your anxiety under control, Dr. Gaither recommends consulting your healthcare provider first to rule out any underlying health issues (like depressive disorders, pre-menstrual dysphoric disorder, or something else that needs clinical treatment). “Then look into mental health soothing remedies like bubble baths, aromatherapy, walking, exercise, [and] listening to music,” she suggests. A diet rich in whole, unprocessed fruits and vegetables, and low on sugar, has been shown to help reduce stress. Plus, when it comes to your overall health, mood, and productivity, getting adequate sleep is an absolute must. A licensed therapist can help you understand the roots of your anxiety and begin to make the necessary life changes.
Since the menstrual cycle is such a delicate and individualized topic, your best bet is to rely on experts to help you understand your body better. There’s no one-size-fits-all answer as to why you might be experiencing changes in your period. But if you’re extra anxious lately, know that this could be a connection worth exploring.