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Stress and the menstrual cycle

Updated April 20, 2020

Everyone experiences stress, and for many it’s not an enjoyable experience. It isn’t inherently bad, although research suggests that depending on the type of stressor (i.e. the reason for stress) and the timing of the stressor, it can cause changes to a person’s menstrual cycle.

What is stress?

Stress is a normal psychological and physiological reaction to changes in someone’s environment, which could be emotional, physical, social or cultural (1,2).

Activities that intentionally promote acute levels of stress, such as exercise and willful participation in social activities, can actually have long term positive effects on a person’s health (3–6).

When most people talk about stress, however, they are usually referring to chronic and/or negative forms of stress, such as having too many demands at school/work or the death of a loved one (1, 7). People experiencing chronic stress may feel that they are unable to handle daily life tasks, have limited-to-no control over the direction of their life or more easily become angry or irritated (1). This type of chronic stress can negatively affect a person’s short-term and long-term health (7–9).


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Biological relationship between stress and the reproductive system

Stress activates a hormonal pathway in the body called the hypothalamic-pituitary-adrenal (HPA) axis (10). Activation of the HPA axis is associated with increased levels of cortisol and corticotropin-releasing hormone (CRH) (10). The HPA axis, cortisol, and CRH help control stress response in the body (10). 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) (11-13). Furthermore, abnormal levels of CRH in reproductive tissue have been associated with negative pregnancy outcomes, such as preterm birth (11).

Research on stress and the menstrual cycle

Stress from extreme or traumatic events has been linked to dramatic changes in normal menstruation (11). War, separation from family and famine have been anecdotally linked to amenorrhea in physician and epidemiological reports (14–16). 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) (17) and premenstrual dysphoric disorder (PMDD) (18). Post-traumatic stress disorder (PTSD) has also been associated with PMDD (19).

Daily life stress may also affect the length of your cycle.

One study of stress in female nurses found associations between high stress and both anovulation and longer cycles (20), though these findings may be in part due to rotating shift work (working nights), which is common for nurses (21). Conversely, high stress jobs have also been associated with shorter cycles (22). 

These studies may have found different results because the stress of study participants may not have been equal. Differences in the level and length of stress exposure could cause people’s bodies to respond in different ways. For example, in one study, perimenopausal (approaching menopause) people with high stress were no more likely to have altered cycles than low stress people after one year; however, high stress was linked to shorter menstrual cycles after two years (23), indicating that symptoms may not present immediately.

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 unsecure and have low coworker support (24). Stress from the preceding month may also affect the frequency of dysmenorrhea (25), 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 (25). Similarly, people experiencing stress earlier in their cycle were more likely to report severe symptoms during the time leading up to and during menstruation (26).

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 (25, 27). 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 (27). 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 (29), whereas the length of the follicular phase has a stronger association with the variation in the total length of the entire menstrual cycle (29). 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.

Some stress in life is unavoidable, but you can learn to manage your stress.

Exercising, getting restful sleep, having a healthy diet, confiding in friends and family and having healthy social activities can potentially reduce the effects of stress on your health (4–7, 30).

Stress that causes long-term changes in your mood or sleep or that causes chronic physical pain may be serious. If you are experiencing high levels of chronic stress, you may want to consider speaking to your healthcare provider.

Not sure whether stress is affecting your cycle? Clue can help you track your stress, energy, sleep, and exercise. The best way to take care of yourself is to know your body.

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