Elsevier

Women's Health Issues

Volume 14, Issue 6, November–December 2004, Pages 235-241
Women's Health Issues

Association between psychological stress and menstrual cycle characteristics in perimenopausal women

https://doi.org/10.1016/j.whi.2004.07.006Get rights and content

In previous studies of the relationship between stress and menstrual cycles, stress has been found to be associated with longer cycles, to be associated with shorter cycles, and to have no association with cycle length. Some of the menstrual cycle changes that have been attributed to stress are similar to those experienced by women during perimenopause. In an effort to see whether an association between psychological stress and menstrual cycle characteristics can be detected in women approaching menopause, this study examines this relationship in perimenopausal women who are participants in the Tremin Research Program on Women’s Health. The analyses used prospectively recorded bleeding data and retrospectively captured life-event data. A single-year cross-sectional analysis of data from 206 women shows no correlation between stress level, as measured by total number and severity of stressful life events, and cycle characteristics, including interval length, duration of bleed, and variability in both of these factors, nor are there significant differences in cycle characteristics between subgroups of women with different overall levels of stress. In analyzing stress levels and cycle characteristics across 2 years, however, women with marked increases in their level of stress (n = 30) are shown to have decreased length (−0.2 days/cycle) of menstrual cycle intervals and decreased duration of bleed (−0.1 day/cycle) compared with increases in these measures (+2.9 days/cycle for cycle interval; +0.3 days/cycle for duration of bleed) among women with no marked change in stress level (n = 103); t-tests indicate that these differences are significant (p < .05).

Introduction

Data from both animal (Kaplan et al. 1996) and human research (Fenster et al., 1999; Hatch, Figa-Talamanca & Salerno, 1999; Matteo, 1987) indicate that psychological stress is associated with altered menstrual function. However, most such studies exclude perimenopausal women, due to their irregular cycle characteristics; for this reason, it was not clear whether an association between stress and menstrual cycle characteristics could be detected in women approaching menopause. Although an association between stress and perimenstrual symptoms (such as mood swings, depression, fluid retention, etc.) has been described for women, including those over the age of 40 (Woods et al., 1997; Woods et al., 1998), the association between stress and measurable characteristics of the menstrual cycle is not clear. Therefore, the primary goal of this investigation was to describe the relationship, if any, between psychological stress and characteristics of the menstrual cycle in perimenopausal women.

Early studies documented the relationship between menstrual function and the severe stress experienced by women and girls during wartime in Europe; this type of extreme stress has long been associated with amenorrhea (Drew, 1961; Sydenham, 1946). In addition, research in nonhuman primates has consistently shown that social stressors (such as repeated change in housing conditions) can have substantial effects on menstrual cycles. For example, Kaplan and colleagues (1996) found that socially subordinate (and therefore stressed) female cynomolgus macaques are characterized by impaired ovarian function and low concentrations of circulating estrogen, in comparison with dominant females. However, in humans, the effects of less extreme stressors, such as those encountered in everyday life, are not as well documented.

A number of studies have examined the relationship between more common stressors (job strain, financial worries, daily hassles) and menstrual cycle characteristics, such as cycle length and quality of bleeding, as well as amenorrhea. The results of these studies are not always consistent with one another nor are they necessarily conclusive. High stress has been found to be associated with both longer menstrual cycles (Hatch et al., 1999; Matteo, 1987) and shorter than average menstrual cycles (Fenster et al., 1999), as well as with a higher incidence of anovulatory cycles (Hatch et al., 1999). Low stress was associated with a more regular pattern of cycling (Matteo, 1987). Other researchers (Clarvit, 1988; Nagata, Kato & Seki, 1986), however, found no significant association between perceived work-related stress and menstrual function. Pepitone-Arreola-Rockwell and colleagues (1981), for example, found that measures of job stress were not associated with symptoms of menstrual dysfunction, although they were associated with other nonmenstrual health symptoms.

Although a number of studies have assessed the relationship between stress and menstrual cycle characteristics or ovarian function in younger women, ages 18–40 (Harlow & Matanoski, 1991; Metcalf & Mackenzie, 1980; Tudiver, 1983), few studies have targeted perimenopausal women. One intriguing study (Ballinger, 1990) suggests that stress may play a major role in determining perimenopausal hormone concentrations. In that study, menopausal women reporting higher levels of negative affect had significantly lower levels of estrone and estradiol and significantly higher concentrations of cortisol, a primary hormone in the physiological response to stress.

The types of menstrual cycle disturbances associated with both stress and perimenopause are considered significant for a number of medical, economic, and social reasons. Abnormal bleeding may lead to significant blood loss. Unexplained alterations in bleeding may be symptomatic of an underlying pathology, such as endometrial cancer or uterine fibroids. Abnormal bleeding has long been considered indicative of the need for hysterectomy, though recent research (Mansfield & Voda, 1997; Voda, 1994) suggests that many such hysterectomies may be performed unnecessarily. Although anovulation and luteal insufficiency are by definition associated with infertility, their long-term health consequences are not known.

Understanding the factors associated with menstrual cyclicity is also important because women need to be able to distinguish normal, age-related changes from changes due to other influences. According to a National Ambulatory Care Survey, U.S. women aged 25–54 annually make 2.9 million office visits regarding menstrual disturbances; for women approaching menopause (35–44 years of age), the rate for visits concerning abnormal bleeding is 7.2 per 100 women (Harlow & Ephross, 1995). A more precise description of the relationship between stress and the menstrual cycle will enable women and their health care providers to make a more informed assessment of observed menstrual cycle changes and help them to distinguish between possibly incidental disturbances and underlying pathologies.

Menstrual cycle disturbances similar to those associated with stress are typically found in women approaching menopause; heavy bleeding, extremely short or extremely long cycles, greater variability in cycle length and flow rate, and a higher incidence of discomfort are commonly reported in perimenopausal women (Mansfield & Voda, 1997). Because these changes are presumed to be unavoidable in this group of women, most previous studies of stress and menstrual cycles excluded perimenopausal women; it is not known whether stress has a significant influence on cycle characteristics in this segment of the population.

One of the problems inherent in studying the psychosocial and health-related factors associated with changing menstrual cycles in perimenopausal women is the rigorous prospective data collection required to document menstrual cycle patterns and the psychosocial or health-related factors that may be related to reproductive function. The study reported here relies on prospectively reported menstrual bleeding data. We investigate the relationship between measures of stress, specifically the number and severity of stressful life events, and menstrual cycle characteristics, in a group of perimenopausal women, all of whom are participants in the Midlife Women’s Health Survey and the Tremin Research Program on Women’s Health, two longitudinal studies of women’s reproductive health.

Section snippets

Sample

The study population was drawn from participants of the Tremin Research Program on Women’s Health (Tremin), a predominantly white, well-educated group of women; 99.3% are white, 92.5% are college educated, and 81% are married (Mansfield & Voda, 1994). In 1990, a subgroup (n = 505) of these women, aged 35–55 and still menstruating, was invited to participate in a special survey focusing on midlife and menopause (Mansfield & Voda, 1994).

Our first sample population was comprised of the 206

Results

Our predictions about the effects of stressful life events on menstrual cycle characteristics were partially borne out by the data analysis. Although stress levels per se were not shown to be related to menstrual cycle characteristics, changing stress levels from 1 year to the next do appear to be related.

Discussion

Our results provide some evidence for a relationship between stress and menstrual cycles. The comparison of 1992 and 1993 stress scores and cycle characteristics demonstrated that there were significant differences from one year to the next. While average stress scores declined, cycle intervals increased and duration of bleed decreased slightly. Given that the change in stress scores and change in cycle interval length were not strongly correlated, and that increasing length of cycle intervals

Conclusions

The results of this investigation, like those of Nagata and colleagues (1986) and Clarvit (1988), suggest that, in the long term, stressful life events have little relationship to the length of menstrual cycle intervals and the duration of menstrual bleeding in perimenopausal women. Without data on the exact timing of stressful life events, however, these results are not conclusive. There is some indication that marked increases in the level of stress may be related to the length of cycle

Susannah Heyer Barsom, Ph.D. is a physical anthropologist whose research interests include human adaptability, reproductive ecology, human fertility and women’s reproductive health across the lifespan.

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    Susannah Heyer Barsom, Ph.D. is a physical anthropologist whose research interests include human adaptability, reproductive ecology, human fertility and women’s reproductive health across the lifespan.

    Phyllis Kernoff Mansfield, PhD, is a professor of Women’s Studies and Health Education, and senior scientist at the Population Research Institute at Penn State. Her research interests include women’s health, the reproductive concerns of midlife women, sexuality, and the psychology of health. She is the Director of the TREMIN Research Program on Women’s Health and co-director of the Midlife Women’s Health Survey and serves on the board of directors of the Society for Menstrual Cycle Research.

    Patricia Bartholow Koch, PhD is Associate Professor of Biobehavioral Health and Women’s Studies and Assistant Director of the TREMIN Research Program on Women’s Health at the Pennsylvania State University.

    Gretchen L. Gierach, MPH works in the Department of Epidemiology, University of Pittsburgh Graduate School of Public Health. Her research focuses on endogenous and exogenous reproductive hormone exposures as they relate to disease outcomes in women across the lifespan.

    Shelia G. West, PhD, is an assistant professor of biobehavioral health and director of the Vascular Health Laboratory at Pennsylvania State University.

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