Can stress cause delayed menstrual periods?

From the Guidelines

Yes, stress can cause delayed menstrual periods. When you experience significant stress, your body activates the hypothalamic-pituitary-adrenal (HPA) axis, which can disrupt the normal functioning of the hypothalamic-pituitary-gonadal (HPG) axis that regulates your menstrual cycle, as suggested by a recent study 1. This disruption can lead to elevated cortisol levels, which may suppress reproductive hormones like estrogen and progesterone, potentially delaying ovulation and consequently your period.

Some key points to consider:

• Stress and stress sensitivity are commonly associated with functional hypothalamic amenorrhea (FHA), a condition characterized by chronic anovulation not due to identifiable organic causes 1.
• FHA is one of the most common underlying conditions causing secondary amenorrhea, affecting about 3-4% of women in the general population 1.
• Managing stress through techniques such as regular exercise, adequate sleep, mindfulness practices, and relaxation exercises can help regulate your cycle.
• If your period is more than a week late and you're sexually active, it's advisable to take a pregnancy test.
• For persistent menstrual irregularities lasting several months, regardless of stress levels, consult a healthcare provider to rule out other potential causes such as polycystic ovary syndrome (PCOS), thyroid disorders, or other hormonal imbalances.

It's worth noting that while other studies have discussed the relationship between stress and menstrual irregularities 1, the most recent and highest quality study 1 provides the strongest evidence for the impact of stress on menstrual cycles. Therefore, stress management is crucial for maintaining a regular menstrual cycle, and individuals experiencing persistent menstrual irregularities should consult a healthcare provider for personalized guidance.

From the Research

Stress and Menstrual Cycle

• Stress can cause delayed menstrual periods, as it disrupts the normal functioning of the hypothalamic-pituitary-adrenal (HPA) axis, which plays a crucial role in regulating the menstrual cycle 2.
• The activation of the HPA axis due to stress can lead to an increase in cortisol levels, which can interfere with the normal functioning of the reproductive system, causing menstrual irregularities 3.
• Studies have shown that stress can affect the menstrual cycle in various ways, including delaying or disrupting ovulation, altering menstrual flow, and changing the length of the menstrual cycle 4, 5.

Mechanisms of Stress-Induced Menstrual Irregularities

• The exact mechanisms by which stress affects the menstrual cycle are complex and involve the interplay of multiple hormonal and neural pathways 2, 3.
• Stress can activate the HPA axis, leading to the release of corticotropin-releasing hormone and vasopressin, which can inhibit the gonadotropin-releasing hormone pulse generator, disrupting ovulation and menstrual regularity 3.
• Additionally, stress can also affect the peripheral pathway, stimulating gonadotropin secretion and altering the normal functioning of the reproductive system 3.

Evidence from Studies

• A systematic review of 41 studies found that psychological stress is associated with menstrual dysfunction, including irregular menstruation and abnormal menstrual flow 5.
• Another study found that women who experienced stress during the COVID-19 pandemic reported changes in their menstrual cycles, including delayed or irregular periods, and that younger women were more susceptible to these changes 4.
• Animal studies have also shown that stress can disrupt the menstrual cycle, with one study finding that a 5-day endotoxin challenge during the luteal phase of the menstrual cycle delayed folliculogenesis and decreased luteal function in rhesus monkeys 6.