Effects of Poor Mental Health and Environment on the Menstrual Cycle

The menstrual cycle refers to the cycles in which a woman's uterus grows and sheds a lining (the endometrium) which supports the development of a fertilised egg. It typically occurs in 28 day cycles. It includes the following phases-

1. The Menstrual phase- The shedding of endometrium occurs.

2. The Follicular phase-It is the growth or proliferative phase

3. The Ovulatory phase -It is the phase in which ovulation occurs. (usually mid of the cycle)

4. The Luteal phase-It is the post ovulatory phase in which various hormones are secreted.

Many environmental factors may affect characteristics of menstrual cycle including workplace, caffeine consumption, smoking, occupation, physical activity, diet, age, weight, exposure to organic solvents, medical conditions, and lifestyle factors. One of the major factors that affects the menstrual cycle is the perceived level of stress.

How does stress affect the menstrual cycle?

Stress is a normal psychological and physiological reaction to changes in someone’s environment, which could be emotional, physical, social or cultural.

Stress activates a hormonal pathway in the body called the hypothalamic-pituitary-adrenal (HPA) axis . Activation of the HPA axis is associated with increased levels of cortisol and corticotropin-releasing hormone (CRH). The HPA axis, cortisol, and CRH help control stress response in the body. CRH and cortisol release can suppress normal levels of reproductive hormones, potentially leading to abnormal ovulation, anovulation (i.e. no ovulation), or amenorrhea (i.e. absence of menstruation). Furthermore, abnormal levels of CRH in reproductive tissue have been associated with negative pregnancy outcomes, such as preterm birth.

Research on stress and the menstrual cycle-

Stress from extreme or traumatic events has been linked to dramatic changes in normal menstruation. War, separation from family and famine have been anecdotally linked to amenorrhea in physician and epidemiological reports. Although these studies and case reports are informative, they are not scientifically rigorous and cannot rule out other associated factors, such as malnutrition, that occur during war or other tragic events. Physical, emotional and sexual abuse have been associated with the development of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Post-traumatic stress disorder (PTSD) has also been associated with PMDD.

Menstrual pain has also been associated with stress-

Dysmenorrhea (i.e. painful menstruation) has been linked to working in jobs that are low control, are insecure and have low coworker support. Stress from the preceding month may also affect the frequency of dysmenorrhea, so someone might not experience painful menstruation as a result of stress until their period the following month. People with a history of dysmenorrhea may be more likely to experience this effect. Similarly, people experiencing stress earlier in their cycle were more likely to report severe symptoms during the time leading up to and during menstruation.

As mentioned, the different effects of stress may be, in part, due to timing. Higher reported stress during the follicular phase (i.e. from the first day of menstruation until ovulation) has been strongly associated with changes in normal reproductive function. In one recent study, those reporting pre-ovulatory stress (during the follicular phase) were less likely to become pregnant as compared to those not reporting stress during the same time. This suggests that stress may cause the body to delay or entirely suppress ovulation. This idea is supported by research examining menstrual cycle variation.

The length of the luteal phase (i.e. post-ovulation until menstruation) tends to be consistent across and within women, whereas the length of the follicular phase has a stronger association with the variation in the total length of the entire menstrual cycle. This means that the follicular phase, as opposed to the luteal phase, is more likely to change in length. Therefore, the effects of stress on ovulation may be one of the biggest factors related to changes in cycle length due to stress, though it is unclear how this would be related to other stress-related changes in the menstrual cycle, such as painful menstruation.

PCOS and It’s relation with Stress-

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy affecting a remarkable proportion of premenopausal women. Different studies have shown that stress is widely encountered in women with PCOS.

As PCOS is a multifaceted disorder, ‘stress’ incorporates different translations. Stress is believed to be an important component of PCOS. It encompasses different definitions that are all equivalent, like metabolic, inflammatory, oxidative and emotional stress. However, the type of stress that distinguishes PCOS is metabolic stress. It becomes evident early in life and constitutes the pathophysiological heart of the syndrome. Metabolic stress along with the other types of stress are the progenitors of severe long-term health implications, which further exacerbate the reproductive, metabolic and psychological derangements of the syndrome, leading to an endless cycle of chronic illness.

• Treatments available for PCOS

People who have PCOS and feel depressed or anxious, or notice changes in their mood, can talk to their healthcare provider about possible treatment options. There are many treatments that may help with depression and anxiety.

Lifestyle changes

The effect of diet and exercise on symptoms of depression and anxiety in people with PCOS has been researched. Low-calorie diets in combination with exercise do not appear to improve symptoms of anxiety, and may only improve depression short-term.

Leading an active lifestyle in general may help improve mental health. People with PCOS who reported exercising regularly had fewer symptoms of anxiety and depression, and those who said they did at least 150 minutes of moderate exercise each week were less likely to be depressed.

Medications and supplements

No studies have been done on antidepressants or anti-anxiety medication for treating people with PCOS specifically, but they may be prescribed in the same way they would be to people without PCOS. Medications that help the body use insulin such as metformin may improve symptoms of depression in people with PCOS. Metformin may also help with anxiety symptoms.

Taking omega-3 fatty acid from fish oil alone, or in combination with Vitamin D, may decrease symptoms of depression and anxiety in people with PCOS.

Complementary and alternative therapies

There may be improvement in depression and anxiety among people with PCOS who receive acupuncture and in people who practice mindfulness 30 minutes a day. Yoga practice that includes poses, guided relaxation, breathing exercises, and meditation may also improve symptoms of anxiety in people with PCOS.

Some people with PCOS may experience an increase in facial hair. Depending on the culture they live in, they may feel self-conscious about it. For people with PCOS who feel distressed about facial hair, receiving laser hair removal may improve symptoms of depression and anxiety.