The impact of psychological stress on the female reproductive system

Stress is one of the commonest and underappreciated causes of reproductive issue in women.  Between puberty and menopause, a woman’s reproductive life can be adversely affected by psychological stress affecting the menstrual cycle, increasing PMS/PMT symptoms and impaired reproduction leading to infertility

Stress is defined as a state of worry or mental tension caused by a difficult situation such as divorce, illness, death of a loved one, daily hassles, financial or relationship problems.

Stress is a natural human response that prompts us to address challenges and threats in our lives. Everyone experiences stress to some degree whether real or perceived. As individuals we will all respond differently.

Following the perception of an acute stressful event, there is a cascade of changes known as “fight or flight” in the nervous, cardiovascular, endocrine, and immune systems. These changes constitute the stress response and are generally adaptive, at least in the short term.

First - stress hormones are released to make energy stores available for the body’s immediate use.

Second - a new pattern of energy distribution emerges. Energy is diverted to the tissues that become more active during stress, primarily the skeletal muscles and the brain.

Cells of the immune system are also activated and migrate to “battle stations due to the perception that the body is going to be injured and less critical activities are suspended, such as digestion and the production of growth and gonadal hormones.

Simply put, during times of acute crisis, eating, growth, and sexual activity may be a detriment to physical integrity and even survival so the brain deactivates any body system integral to these functions.

Stress can be acute (short term) or chronic (long term) and chronic stress is the most damaging. In our attempt to cope with stress it can lead to poor health behaviours such as smoking, drinking alcohol, and excessive caloric consumption. Our ability to adapt and respond to stress is fundamental to life. How we respond to stress depends on the type of stressor, the timing and duration of stress, our genetic predisposition, personality characteristics, and our way of coping with stress. 

How does stress affect the reproductive system?

Reproduction is the biological process by which offspring are created by their parents.  

The main endocrine system of the human female reproductive system is the hypothalamic -pituitary -ovarian axis (HPO). The stress system activates different hormonal systems.

Stress hormones are produced by the sympathetic nervous system (SNS) and the hypothalamic- pituitary-adrenal (HPA) axis. These are closely related to the autonomic nervous system (ANS), the part of the nervous system responsible for unconscious body functions such as breathing, digestion and heartbeat.

The ANS comprises of sympathetic and parasympathetic nervous systems (SNS and PNS) plays a large role in both responding and recovery from stress depending on which half is activated.

The SNS increases the feelings of stress and is associated with the release of neurotransmitters adrenaline and noradrenaline and the parasympathetic nervous system (PNS) is associated with reducing the feelings of stress, by the release of the hormone oxytocin and the neurotransmitter acetylcholine slowing breathing, pulse and alertness.

The ANS is responsible for the communication between the hypothalamus, pituitary gland and the adrenal glands also known as the stress glands. In chronic stress HPA axis dysfunction can occur reducing our ability to cope with stress leading to a direct suppression action on the hypothalamic-pituitary-ovarian (HPO) axis

Acute and chronic stress impairs reproduction by impacting all levels of the production of sex hormones via the hypothalamic–pituitary–gonadal (HPG) axis and interferes with the release of reproductive hormones within the follicular phase of the menstrual cycle. 

The interaction between emotional stress and infertility has been investigated for many years. Many infertile couples show marked stress during infertility evaluation and treatment. Most of the investigations that were performed during the last two decades show that in the majority of cases stress is the result and not the cause of infertility.

The biological interaction between stress and infertility is the result of the action of stress hormones at the brain level, especially on the hypothalamus-pituitary and on the female reproductive organs. The stress hormones adrenalin, noradrenaline and dopamine and the HPA axis interact with hormones which are responsible for normal ovulatory cycles: i.e., gonadotropin releasing hormone (GnRH), prolactin, luteinising hormone (LH) and follicle stimulating hormone (FSH).

Our feel-good hormones (endorphins) and sleep hormone (melatonin) secretion are altered by stress and interfere with ovulation. Symptoms of HPA dysfunction include not waking refreshed even after a good night`s sleep and/or insomnia.

Stress is an important factor which affects fertility as well as the success rate of in vitro fertilization (IVF), however it is a vicious circle.

 The prevalence of infertility-related stress is reported to be high among couples undergoing infertility treatments and also higher among women as compared to their male partners.

 Women with infertility have been reported to have poor psychological status in terms of anxiety and depressive symptoms compared to women without infertility.

Infertility causes stress which is aggravated as time passes and the couple remains infertile.

Among the causes of stress are the couple's isolation, life with unrealized potential and unborn child, disruption of day-to-day life during infertility evaluation and treatment, and the couple's feeling that they do not have control of their own lives. The IVF program is considered by many as the final step for the evaluation of the couple’s fertility potential, hence, couples participating in an IVF program are highly stressed, especially after a failed IVF cycle.

How often have you heard of couples who successfully conceive after stopping trying to or their treatment?

Stress management techniques such as the following are key to successful reproduction and calm the SNS response by sending it signals of calm and safety:

Breathing exercises

Making your exhale longer than the inhale. Consciously slowing your breath and making long exhales activates the vagus nerve and calms the sympathetic (“fight or flight”) response. Use an app such as the breathing app or headspace.

Movement

Ideally walking outside in nature. Being outside tends to alter our perspective on a problem and particularly being in nature is found to be calming and the increased activity can improve sleep.

Spending time with friends and loved ones or pets.

Yoga

Yoga is a holistic lifestyle-based intervention which focuses on regulating the lifestyle through mind–body practices. Major components of Yoga-based lifestyle are physical postures, breathing techniques, meditation and mindfulness.

For more information on how diet and lifestyle interventions can support you please contact me using the link https://calendly.com/eatwell22/discovery-call