Stress is one of the biggest causes of an irregular menstrual cycle. This is partly due to the wisdom of our bodies. When we are highly stressed our body says "Wait! This is not a good time to get pregnant! Let's prioritise other things instead (like survival!) and leave the ovulation till later." We won't have a true menstrual bleed until we do ovulate so this can cause the length of our menstrual cycle to vary. This is known a stress-patterned menstrual cycle (or irregular cycle). Irregular cycles are a common feature of PCOS and they are often driven partly by stress. To make matters worse, being diagnosed with and living with the symptoms PCOS is often very stressful in itself, creating a vicious cycle.
How does this happen?
For those of you that need to know how it all works: basically stress directly affects the menstrual cycle because the parts of our brain that are responsible for responding to stress are also responsible for signalling our reproductive organs. When we are stressed the hypothalamus in our brain sends a signal to the pituitary gland in our brain, which in turn sends a message to our adrenal glands to release stress hormones. This is known as the hypothalamic-pituitary-adrenal (HPA) axis. Similarly, we have a HPO (hypothalamic-pituitary-ovarian) axis, which governs the release of hormones from our ovaries. When the HPA axis is very active (in times of high or chronic stress) it suppresses the HPO axis. It can also make tissues, such as the lining of the uterus, unresponsive to ovarian hormones. Thus ovulation and menstruation may be halted.
Furthermore, the stress hormone cortisol is actually manufactured from the ovarian hormone progesterone. So when we have lots of stress, we have lots of cortisol production at the expense of progesterone. Progesterone is our relaxing, feel-good hormone so when we have less of it we are more sensitive to stressors, further exacerbating the problem. Additionally, the majority of progesterone is produced from the ovaries after ovulation, so if we don't ovulate that also means we feel stress more acutely.
Cortisol also mobilises sugar from tissues into the blood stream (think of the quick energy-burst needed for running away from a predator), which increases insulin and in turn stimulates the ovaries to produce androgens, contributing to PCOS symptoms. Furthermore, cortisol encourages glucose to be stored as fat and excess weight also exacerbates insulin resistance. The plot thickens. To further complicate the problem, in women with PCOS the breakdown of cortisol is accelerated. The brain detects this and responds by increasing adrenal-stimulating hormones from the pituitary gland. It is thought that this may result in increased adrenal androgen production in women with PCOS.
What can I do about it?
Reducing stress. We hear these words all the time. "Stress is bad." "Reduce your stress levels for better health." But how do we actually do this? It really starts with making a commitment to yourself. Do you feel worthy of living a blissful, low-stress life? Give yourself permission and then start with these steps:
Make a list of all of the things that stress you out, make you crazy or make you feel crappy
Brainstorm ideas of how you could change, reduce or solve these things. Are there some that you can't think of anything for? Ask yourself if you could accept them, or let them go (this could even mean letting go a job, relationship or living situation).
Pick at least 3 ideas and schedule them in to your diary to put into action. If they are big, break them down into smaller, achievable steps.
Make a list of all the things that make you feel good, at peace and relaxed
Schedule at least 3 of these things into your diary and MAKE THEM HAPPEN
*Warning: this exercise creates profound change in your life. Some people are not going to like it and it may shake things up. When challenges come up remind yourself that you are worthy of living a blissful life and gently remind people of this.
I know, you've heard it a million times. "Meditation is good for you", "Sit down and meditate every day". But it often doesn't feel as simple as just starting to meditate. Where do we find the time? The answer is to make it simple and make it part of your life AS YOU GO ABOUT YOUR DAILY ROUTINE. Little or no extra time required. And yes, it really does make a big difference in your life. Our nervous systems rarely have time to calm down a few notches and allow our body to have a break from high alert. So a little meditation = a big difference. Here's how to get started now:
1. Mindfulness/walking meditation
As you go about your daily life use your body as a link to the present moment as often as possible. For example, every time you wash your hands, become aware of the sensation of your hands moving over each other and the water running over your hands. Every time you eat be aware of the flavours, textures and sensations in your mouth as you chew. Every time you feel stressed, use that as your cue to become aware of the sensation of your feet against your shoes or the ground and how that sensation changes as you walk. If you want to take it a step further you could spend 5 minutes walking barefoot in the park on your lunch break or before/after work and be aware of the sensation on the soles of your feet as you walk. Every time you become aware that your mind has drifted away (which it will, 1000's of times!), bring your awareness back to the sensation of your feet. This is known as walking meditation and you can take it with you wherever you go. This book is a great starting place if you want to know more about mindfulness.
2. Smiling mind App
The Smiling Mind meditation app is an excellent free resource to guide you in mindfulness meditation exercises. It is simple, easy to follow and pleasant to listen to. Each session is between 5-10 minutes, with extended sessions of up to 45 minutes available if you wish to take it that far. But just doing even 5-10 minutes a day can make a meaningful difference to your life.
Herbal medicine is an excellent adjunct for treating and managing stress. It can help to correct nervous system imbalances and relieve the symptoms of stress. There are a wonderful class of herbs called Adaptogens that help the body cope with and respond to stress better (Rhodiola is an excellent example of this). There are also anti-anxiety herbs, nervines, mild sedatives and hypnotics (to help with sleep). Herbs for stress are gentle, yet powerful with little-no side effects. They can really help you to get your stress levels down to a manageable level so that you are better able to make the underlying changes to your life that address the cause of your stress. See your Naturopath or Herbalist for the correct prescription and dosage for you.
Oftentimes nutrient imbalances are behind our lack of ability to cope with stress. A nutrient-dense diet is essential for providing the nutrition required to coping with stress. But sometimes nutrient deficiencies or imbalances can go beyond what is fixable with diet. This may occur if we are severely depleted over a long period of time or if we have increased requirements (due to disease, genetics or life-stage). Addressing any deficiencies or imbalances can have profound effects on our stress levels. When lifestyle techniques and diet just don't seem to be cutting it, it's time to see your Naturopath for a nutritional assessment.
So you can see how stress and nutrition can be major factors in keeping your hormones happy and are key to beating PCOS. But what else can be done about those stressful parts of PCOS that are icky to live with? I'll be addressing one of the big ones in my next post - hirsutism: that unwanted hair and what to do about it.
Until then, all the best on your health journey,
For a comprehensive treatment solution and access to an exclusive support section, including email support from Josephine, get The PCOS Solution.
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