How chronic stress affects a woman's reproductive health – a specialist's answer

Irregular cycles and pronounced premenstrual syndrome are not the only consequences of chronic stress on the female body. Vasyl Beniuk, obstetrician-gynecologist, Doctor of Medical Sciences, professor, and head of the Department of Faculty Obstetrics and Gynecology at the Bogomolets National Medical University, spoke in an interview with UNN about how stress changes a woman's body and what the consequences are. 

Cortisol - a hormone capable of reducing fertility 

According to the doctor, chronic stress causes the body to effectively operate in a mode of constant adaptation. Such stress has neuroendocrine and somatic consequences. In response to stress, cortisol secretion increases; when cortisol levels are chronically elevated, the secretion of gonadotropin-releasing hormone in the hypothalamus is disrupted, which, in turn, affects the levels of follicle-stimulating and luteinizing hormones. 

The results are ovulation disorders, a shortened luteal phase, and oligo-ovulatory or anovulatory cycles. Clinically, this manifests as irregular menstruation, intensified premenstrual syndrome, dysmenorrhea, cycle disruptions, and even a temporary decrease in fertility 

In addition to the hormonal component, stress directly affects the central nervous system. 

Prolonged elevation of cortisol levels is associated with increased anxiety, emotional lability, sleep disturbances, and the exhaustion of adaptive mechanisms. A vicious circle is formed: stress worsens hormonal balance, and hormonal disruptions, in turn, exacerbate psycho-emotional symptoms. We also observe an increase in functional gynecological disorders specifically related to the stress factor. These include: menstrual cycle irregularities; severe PMS; dysmenorrhea; chronic pelvic pain syndrome; complaints of mucosal dryness and sexual discomfort; and the exacerbation of existing gynecological diseases 

It is important to understand that chronic stress does not only act through the nervous system, the doctor says. It is also accompanied by oxidative stress, changes in the immune response, microcirculation disorders, and metabolic changes. This creates conditions for systemic imbalance in the body.

Today, we increasingly talk about the need for a comprehensive approach to such patients. Hormonal therapy should not always be the first solution. In many cases, correcting deficiency states, normalizing sleep, maintaining magnesium balance, working with anxiety, nutraceutical support, psycho-emotional stabilization, and restoring the body's adaptive resources are effective. Our clinical observations also demonstrate that a comprehensive approach significantly reduces the manifestations of PMS and dysmenorrhea, normalizes the menstrual cycle, and improves the psycho-emotional state of patients 

Pregnancy and stress 

Pregnancy is a natural state, but at the same time, during this period, the female body has an increased sensitivity to stress. As explained in a comment to UNN by the head of the Department of Hospital Obstetrics and Gynecology and Postgraduate Education at the Bogomolets National Medical University, professor and honored doctor Dmytro Govseiev, during pregnancy, cortisol levels in the blood rise, changes occur in the cardiovascular system, and the need for oxygen increases. The body becomes more vulnerable, not only to stress but also, for example, to infections or hypoxia. Chronic stress triggers even greater changes, and cortisol affects not only the body of the pregnant woman but also the child, as this hormone is capable of crossing the placenta. 

This can provoke fetal growth restriction, increase the risk of preeclampsia (a sudden increase in blood pressure in a pregnant woman accompanied by protein in the urine or impaired kidney or liver function), and inflammatory reactions. 

Acute stress also affects pregnant women. 

And here, unfortunately, premature contractions, increased pressure, uterine hypertonicity, and even bleeding can occur. Dizziness, tachycardia, and loss of consciousness are possible. Overall, stress is one of the most powerful factors in premature labor 

In addition to stress under wartime conditions, many women face negative physical impact factors: hypothermia, hypoxia, lack of nutrients and vitamins, excessive physical exertion, and the risk of infection. Furthermore, there is the lack of timely medical assistance. 

A woman is in a vulnerable state. And while in peacetime and under normal conditions, this might manifest, for example, as sudden mood swings, under the influence of stress factors, it can have much more serious consequences 

Pregnant women, the doctor says, need to remember the importance of self-examination, pay attention to the slightest atypical symptoms, and not dismiss everything as ordinary fatigue, as drowsiness or "brain fog" can be precursors to serious disorders. 

Pregnant women should be among the priority categories for evacuation when we talk about frontline areas. We all understand the complexity of the situations women find themselves in; this is often accompanied by psychological pressure, the inability to move to a safer place, or to receive timely medical care. Every case is individual. In some cases, telemedicine and online consultations can help. It is important for a woman to feel supported. Where there is stable medical support, a woman should not lose contact with her doctor. Our task is to recognize even the smallest symptoms in time, to help, and to ensure safety