Dr. Susan Caldwell
Your Cycle & Stress: Your Body is Speaking to You...Charting is a Great Way to Practice Listening
When your cycles become confusing during stressful times, it can be a sign that your body is trying to get your attention in order to ask you for some help. There are predictable ways in which your cycle may reveal that there is something out of order on the inside. These signs can serve as invitations to become an expert in tuning in to yourself in order to take better care of yourself.
It is my experience as a primary care doctor that most of us do not regularly check in with ourselves but instead live most of our lives focused on things and people outside of ourselves while too often neglecting our own internal world. Our goal here is not to become obsessively self-centered but instead to build habits of checking in with ourselves on a regular basis. For women, charting our cycle is a wonderful way to build such a habit. Every time a woman who is charting visits the bathroom, she can pause to pay attention and observe her signs of fertility. Every evening she or her husband (or even better, together), makes a note on the chart (or on the app) of the most fertile sign of the day. Each evening she (or they) has another opportunity to pause, looking back at the cycle thus far, and to consider how she is doing.
Over months then years of charting, a woman knows her basic cycle pattern as well as she knows her own face. She begins to easily recognize problems or irregularities when they pop up. There will be times when she must deal with stress – physical, emotional or relational. These stressors, if intense or prolonged enough, will affect her in every part of her being, including her cycle. Women are fortunate to have a menstrual cycle which acts as an early warning system that something is out of order inside of her so that she can be alerted to take the appropriate action in order to get the care that she needs.
Basic physiology of a menstrual cycle:
Each cycle is divided into 2 basic segments with the point of change being ovulation (when the egg is released). The first segment is known as the preovulatory phase or pre-peak phase and the second is known as the postovulatory or post-peak phase. Generally, the pre-peak phase is highly variable for each woman (and even each cycle) because it is determined by the development of a particular follicle on the ovary which receives signals from the brain’s control center known as the hypothalamus. It is the hypothalamus that determines whether a woman is healthy and safe enough to ovulate each month based on the input from other vital organs. If all is healthy, the hypothalamus sends the signal to the pituitary gland and then to the ovaries to direct ovulation. This system of communication is called the “HPO axis"). If there is a problem (such as poor nutrition, little sleep, illness, or other stress) that would make pregnancy unsafe for the woman, then the hypothalamus withholds the hormones that would otherwise lead to ovulation. Because of the many factors that determine the timing of ovulation, this part of the cycle can vary widely in length and can make it difficult to predict the date of ovulation.
The second segment of the cycle is known as the post-peak phase because it is the part of the cycle that happens after ovulation. During this time, there is a structure on the ovary called the corpus luteum (formerly known as the ovarian follicle) that is busy making the hormones that prepare the lining of the uterus for either a healthy pregnancy or a healthy period. The length of this part of the cycle is very predictable for most women and lasts about 12-14 days. This part of the cycle is not usually affected by stress.
Now let’s explore some effects of stress on the cycle:
During stressful times, the brain is programmed to delay or prevent ovulation so as to avoid an unhealthy pregnancy as explained above. This can be perceived by a woman by a late peak day. For example, if her peak day is usually around day 15, she may notice that she began to see mucus as usual but then the mucus stops but reappears later around day 21 and she ovulates on day 22. She recognizes that her post-peak phase is the same as in the previous cycle, but the entire cycle is longer because of the delayed peak day. The cycle below is from a woman charting with the Creighton Model System.
When the hypothalamus detects unhealthy or stressful conditions, there may be no signal sent to the ovaries in order to prepare a follicle to ovulate. When a woman detects cervical mucus prior to ovulation, it is a signal that there is an ovarian follicle making estrogen as it is preparing to ovulate. When there is little or no mucus, it may be a sign that ovulation did not occur. Remember that ovulation is a sign of health and ideally should happen each and every month. Dry cycles should prompt an investigation of a possible underlying physical or emotional disorder. The cycle below is from a woman charting with the Creighton Model System.
The blood that is seen during a period is due to the shedding of the uterine lining that is built up over the past month in response to estrogen which is made by the ovaries throughout the cycle. Put simply: estrogen causes the lining to grow and progesterone causes the lining to undergo changes that prepare the uterus for pregnancy or to prepare for a healthy period. When there is too much estrogen relative to the amount of progesterone (aka "estrogen dominance"), there can be very heavy periods as a result. This is very common in the years leading up to menopause. (Note: this is only one of many causes of heavy periods).
IRREGULAR PERIODS IN TEENS/YOUNG WOMEN:
It can take up to 7-10 years after a woman’s first period for her cycles to finally become regular. Therefore, teen girls and young adults are much more likely to see the results of stress as irregular bleeding. This can present as continuous spotting between periods or very heavy periods or as absent periods for months on end. In these cases, young women are seeing the result of a disrupted HPO axis and need a bit of help restoring the function of this coordinated system of hormonal function. It is very important that we take a gentle approach to the treatment of irregular cycles in teens so as not to suppress the necessary maturity of the HPO axis by using treatments such as artificial hormones such as birth control pills. Possibly what is needed is better sleep habits, less exercise or a change in diet. When medication is needed, I have found it much more helpful to use prescription progesterone to support and restore normal function to the reproductive system.
These are just a few of the predictable effects that stress can have on a woman’s cycle. Let’s face it…stress happens. But when it does, a woman who is charting is much better prepared to understand and then to be able to take the appropriate action when she notices that her cycle has changed. Self-awareness leads to better self-care in the long run.