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Missed period: Is it menopause or are you stressed?

Nikki Withers
Article written by Nikki Withers

Date published 17 July 2019

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Sometimes it can be hard to determine whether a missed period is due to approaching menopause or a stressful lifestyle. We look at how both these factors influence the menstrual cycle and discuss what you should do if you are affected.

During the reproductive years there are a number of reasons that women experience irregular periods. The most common factors are anxiety, stress, fatigue, and over-exercising, all of which affect the balance of hormones in the body. But for middle-aged women, irregular periods can be one of the first signs they are approaching menopause, which in turn can trigger further stress, depression and anxiety. For these reasons it is often hard for women to determine whether a missed period is due to approaching menopause or various lifestyle factors.

The effect of hormones

The two key hormones involved in the menstrual cycle are oestrogen and progesterone. If levels of these hormones become imbalanced, it can result in irregular or unpredictable periods. Because oestrogen is responsible for regulating the thickening of the uterine lining, if levels become erratic the lining can shed sporadically and lead to heavy bleeding.

Similarly, fluctuations in the level of progesterone, the hormone which regulates when the uterine lining is shed and also controls the intensity and duration of bleeding, can lead to irregular periods and unpredictable bleeding.

Causes of irregular periods

There are a number of reasons that women experience irregular periods, one of these being stress. Many of life's demands, such as work, relationships and money, can cause stress and people have different ways of reacting to these situations. One thing that is out of our control, however, is how our body reacts to these stressors. When we are stressed the adrenal glands secrete a hormone known as cortisol. Elevated levels of cortisol in the body can have a direct impact on oestrogen and progesterone production, which can in turn result in irregular periods.

Irregular periods can also be a sign that a woman is entering perimenopause: the stage before the occurrence of menopause. During this time a woman's hormone levels become increasingly erratic as they start to decline, and can result in changes to the menstrual cycle. It is at this time that women can also start experiencing symptoms such as increased anxiety, mood swings, and trouble sleeping. "Perimenopause is the single most difficult time in a woman's life," says Dr Marion Gluck, a London-based GP who specialises in women's health. "It is arguably worse than menopause because your hormone levels can fluctuate wildly."

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Distinguishing between the two

According to author and psychologist Vivian Diller, it is often hard to distinguish between the stress caused by menopausal changes and life stresses during the menopausal phase. "Some women are dealing with an empty nest, caring for elderly parents and midlife job fatigue at this time, whereas many women can feel unsettled by the changes they see and feel as a result of menopause. Women often feel out of control and then they stress about that. But, the stress over losing control only makes women feel even more unsettled, so learning how to manage the adjustments that come with menopause is important in managing this transitional time."

Can stress cause early menopause?

Many people ask whether stress can bring on an early menopause. Generally, it is thought that high levels of stress can cause women to experience symptoms similar to menopause due to increased cortisol levels, but that it doesn't actually induce menopause. "Stress is a symptom of life, and often more so at this stage of life," says Dr Heather Currie, chair elect of the British Menopause Society and founder of Menopause Matters. "The difference with stress around the menopause, when hormone levels are changing, is how we deal with the stress and that the changes and symptoms of hormonal changes can then lead to stress".

Dr Currie advises women who are approaching menopause to learn as much as possible about the hormonal changes involved, as well as what impact they may have and what diet and lifestyle changes can help. "They should see it as a time to invest time in themselves and really look at exercise, relaxation or whatever they enjoy."

Vivian Diller agrees: "Menopause, like menstruation, is a time of change. It isn't easy to adjust to the changes but eventually our bodies and minds do. Hormones calm down and a new phase of life begins. Rather than see menopause as the beginning of the end, it's best to view it as a transition to a new beginning."

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Nikki Withers

About Nikki Withers

Nikki Withers is a freelance health and medical writer, personal trainer and fitness instructor and was previously editor of Drug Target Review and European Pharmaceutical Review.