Stress and women’s health

A woman’s reproductive health is a complex and fragile system that quickly reacts to any adverse factors, which primarily include stress — both acute and chronic.

Alarm signals

The regulation of the menstrual cycle is a multi-stage “cascade”, the upper level of which is the cerebral cortex and the structures of the limbic system (hippocampus, amygdala). The main role in this process is played by neuropeptides (dopamine, norepinephrine, serotonin, kiss-peptin) and the hormone melatonin. Stressful situations directly affect the processes of synthesis and use of neurotransmitters and hormones, as a result of which the most important link in the regulation of the menstrual cycle is disrupted.

It is the limbic system that is responsible for our emotions – primarily for the reactions of fear and anger that we have to face in situations of threat to life and health.

Pronounced psychoemotional shocks have a negative impact on many aspects of women’s reproductive health.

The first alarm call is most often menstrual irregularities, which may manifest themselves in the near future after suffering stress:

• prolongation of the cycle – delay of menstruation for 10 days or more;
• shortening of the cycle — the beginning of menstruation 10 or more days earlier than usual;
• termination of menstruation in the absence of organic pathology – functional hypothalamic amenorrhea (obsolete terms – “wartime amenorrhea”, “hungry amenorrhea”, “stress amenorrhea”);
• profuse uterine bleeding (menorrhagia — during menstruation; metrorrhagia – non-menstrual bleeding). The occurrence of these problems is primarily due to a violation of the ovulatory nature of menstrual cycles, which leads to hyperestrogenism against the background of progesterone deficiency and, as a consequence, to hyperplastic processes of the endometrium.

Note: the normal duration of the menstrual cycle is 24-38 days; inter-cycle differences in duration are permissible within up to 10 days (FIGO criteria 2018)

Against the background of stressful conditions, violations of the biocenosis of the vagina often occur, mainly candidiasis colpitis. Scientific articles in the journal of the American Society of Microbiology Clinical and Vaccine Immunology confirm that psychological stress, especially chronic, suppresses the cellular component of the body’s immune defense and promotes excessive reproduction of Candida fungi. Acute stress, especially accompanied by sleep disorders and changes in diet (psychogenic overeating, predominance of carbohydrates in the diet), can also provoke manifestations of candidiasis.

Interestingly, researchers note the effectiveness of some antidepressants (in particular, selective serotonin reuptake inhibitors) in the treatment of resistant candidiasis associated with stress.

Sexual problems

Women’s sexual health is also negatively affected by stress, which directly depends on both the psychological state and the very neurotransmitters and hormones that are involved in the regulation of the menstrual cycle. The peculiarity of female libido is that it is characterized by a pronounced dependence on psychosocial factors.

Any intense experiences (fear, intense anxiety, anger) become dominant. When a woman does not feel safe, the instinct of reproduction fades into the background, because absolutely normal behavioral adaptation to stress is the activation of protection: you either have to look for a safe place or fight.

Stress negatively affects many aspects of sexual life, such as sexual desire, the ability to arouse and get an orgasm. In some cases, severe emotional experiences, especially those associated with physical and sexual violence, can cause dyspareunia (painful sensations during sexual intercourse) and vaginismus.

Stress-induced problems (nightmares, intrusive traumatic memories, insomnia) aggravate the situation, leading to emotional exhaustion.

Menstrual disorders directly affect libido and the ability to orgasm, as these processes are largely controlled by sex hormones.

Neoplasms

The growth of uterine fibroids can also be triggered by stressful situations.

By Chinese scientists T. Xia et al. in 2017, the results of an experimental study were published, which prove that stress can really accelerate the growth of uterine fibroids cells and lead to a rapid increase in tumor size. The mechanism is explained by the influence of norepinephrine and epinephrine through the AR-cAMP-PKA signaling pathway on the proliferation of leiomyomatous cells, expression of estrogen and progesterone receptors, synthesis of proangiogenic vascular endothelial growth factor and fibroblast growth factor.

According to a meta-analysis published in the journal Stress Health in 2019, chronic psychological stress increases the risk of developing uterine fibroids by 24%.

Premature ovarian depletion

Psychoemotional shocks may also be associated with premature ovarian depletion and premature/early menopause. Of course, the time of menopause depends on the ovarian reserve, which is determined by a number of factors, such as genetic predisposition, gynecological diseases (endometriosis, ovarian tumors), chemotherapy and radiation therapy, surgical interventions on the ovaries.

The International Journal of Clinical and Experimental Medicine (2015) published a large experimental study proving that stress-induced changes in neuroendocrine and immune responses lead to disruption of complex mechanisms of regulation of the hypothalamus—pituitary—ovary axis, which leads to premature ovarian insufficiency, premature or early menopause.

It is important to remember that menstruation may stop not as a result of premature depletion of the ovarian reserve, but because of functional hypothalamic amenorrhea: in this case, the ovarian reserve is preserved, which is confirmed by laboratory indicators  and ultrasound results.

Reduced fertility

Acute and chronic stress can cause a decrease in fertility – first of all, if the ovulatory nature of the menstrual cycle is disrupted or amenorrhea develops.

It is also important to remember that infertility can be closely related to the psychological state of a woman, especially if she has become a victim or witness of violence. Such cases require special attention and work with a specialist psychologist or psychotherapist.

Stress-associated growth of uterine fibroids, endometrial hyperplasia and decreased libido also have a pronounced negative effect on fertility.

According to a large study published in the journal Human Reproduction (2014), in women with high levels of alpha-amylase in saliva (a laboratory marker of stress), fertility was reduced by 29%, and the risk of infertility increased by 2 times.

Acute stress during pregnancy threatens extremely unfavorable consequences: according to an article in the journal Scientific Reports (2019), psychoemotional injuries during pregnancy increase the risk of spontaneous abortion by 42%; and the publication BMC Pregnancy and Childbirth (2016) states that stressful experiences in pregnant women increase the risk of premature birth by 2 times.

Recommendations for women facing gynecological problems after suffering stress:

• if the menstrual cycle has independently recovered and has become regular again after a single case of lengthening or shortening, no special examination is required, it is recommended to undergo a standard medical examination;
• if the menstrual cycle is disrupted and does not recover independently for two or more months (lengthening / shortening of the cycle, spotting spotting from the genital tract) – you should contact a gynecologist for examination, perform ultrasound of the pelvic organs, hormonal examination;
• if there are acute abdominal pains or abundant bloody discharge from the genital tract (especially with clots, and also if you have to change the pad / tampon every 2 hours and more often) – urgently contact a gynecological hospital;
• if there are moderate pulling pains in the lower abdomen, it is planned to consult a gynecologist for examination, conduct an ultrasound of the pelvic organs;
• if there is itching or burning in the vagina, “curd” or any other discharge with an unpleasant odor – contact a gynecologist, take a smear on the flora, optimally conduct a comprehensive study of the biocenosis of the vagina.