Hormones

Can Stress Cause Hormonal Imbalance?

Hello, I'm Dr. Pooja
I am a former pharmacist turned licensed dietitian-nutritionist, Institute for Functional Medicine Certified Practitioner, and the founder of Pooja Mahtani Wellness, a virtual functional nutrition practice specializing in
PCOS, Thyroid, and Fertility.
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Can stress cause hormonal imbalance?

Can stress cause hormonal imbalance? Unfortunately, yes! Stress can not only impact the way you think and feel, but chronic stress can also lead to a number of hormonal imbalances.

Your body was designed to handle acute bouts of stress but not chronic stress, which can lead to prolonged exposure to cortisol and epinephrine, our body’s stress hormones. In this article, you will learn in detail how stress affects your hormones, such as blood sugar hormones, thyroid hormones, and sex hormones.

How Stress Affects Women

It’s normal to experience stress. Tight deadlines, busy schedules, finances, lack of sleep, undereating, over exercising, caring for a loved one, and many other stressors can add pressure to our lives. Surprisingly, some stress can be good for you. Research shows that short-lived stress can actually improve alertness and memory. 

When you feel stressed, the hypothalamus in your brain sends signals to the adrenal glands to release stress hormones, including cortisol and epinephrine. This signal triggers the “fight-or-flight” response, which is how your body alerts you to a “threat.” 

Blood pressure and heart rate increase, digestion slows down, and pupils dilate, among other responses. After the threat is gone, these stress hormones return to normal levels. 

So what’s the problem? Unfortunately, our hectic and fast-paced lifestyles put chronic stress on our bodies every day, which in turn can cause a constant release of cortisol. Chronic cortisol exposure can increase our risk for weight gain, fatigue, depression, gut issues, hormone imbalances, autoimmune disease, and cancer.

Ultimately, chronic stress can have a profound effect on our health. In this article, we will focus on the cortisol driven mechanisms that can cause hormonal imbalances.

Symptoms of a Stress-Related Hormonal Imbalance 

Hormones work together to regulate many aspects of our physiology and function. When one hormone is out of balance, it often leads to imbalances in other hormones. 

In my practice, I work with “stressed out” women all the time. The biggest surprise is that these women generally have no idea their hormonal symptoms are a result of chronic stress.

In fact, chronic stress can trigger a number of hormonal symptoms such as:

  • Acne
  • Hair loss
  • Weight gain
  • Period problems
  • PMS & PMDD
  • Depression & anxiety
  • Brain fog
  • Fatigue
  • Infertility
  • Decreased sex drive
  • Headaches and migraines
  • Insomnia
  • GI symptoms like gas, bloating, diarrhea, constipation, and food sensitivities
  • Worsening of existing hormonal imbalances like PCOS, Hashimoto’s, and endometriosis
  • Development of a metabolic disease like type 2 diabetes
  • Development of an autoimmune disease like Hashimoto’s disease

How Stress Can Cause Hormonal Imbalances

HPA Axis Dysfunction

“HPA” refers to your hypothalamus, pituitary, and adrenal glands. These glands are all part of the endocrine system and communicate with each other through different feedback loops, known as the HPA axis.

When you’re under stress, your hypothalamus (located in the brain) releases corticotropin releasing hormone (CRH), which signals the pituitary (also found in the brain) to release adrenocorticotropic hormone (ACTH), which then triggers the adrenal glands to release epinephrine and cortisol, your body’s main stress hormones.

In an acutely stressful situation, the fight-or-flight response is activated. Epinephrine increases your heart rate and blood pressure, whereas cortisol signals the liver to dump glucose into the bloodstream. Most of this glucose will be delivered to the brain as fuel. 

This is important so that the brain can continue to operate during this stressful event. Cortisol will also turn off all “non-essential” functions during this time to conserve energy.

Over time, however, prolonged and long-term activation of this fight-or-flight response can wreak havoc on the body. Long-term exposure to cortisol can negatively impact your thyroid and reproductive system, digestive system, immune system, and other body systems, all of which can lead to chronic hormonal, digestive, and immune symptoms.

Chronic stress can also cause what is known as HPA axis dysfunction. You may know it by its more popular name, “adrenal fatigue.”

Although the symptoms are real, the term “adrenal fatigue” is not entirely accurate and is not recognized by most endocrinologists. The adrenal glands don’t “fatigue” but instead become desensitized to ACTH (a pituitary hormone) over time. 

The toll of chronic stress can take place over a period of several years. Here are the common stages of HPA axis dysfunction:

Stages of HPA Axis Dysfunction (“Adrenal Fatigue”)

Stage 1: Stress can lead to a temporary increase in cortisol output. This stage is also known as the “alarm” phase. Stage 1 symptoms include mild fatigue, anxiety, and brain fog.

Stage 2: The adrenal glands begin to get desensitized and ignore the brain signals that are instructing them to release cortisol after a stressful event. Cortisol output begins to diminish despite ongoing stress. Common stage 2 symptoms include fatigue, anxiety, irritability, an afternoon energy crash, and weight gain.

Stage 3: This phase is characterized by very low cortisol output. This phase is also known as the “burnout” or “crash” phase. An individual in this stage is chronically exhausted and is unable to perform routine daily activities. Typically, this degree of tiredness is not relieved by quality sleep. Other symptoms include anxiety, irritability, depression, and brain fog.

Blood Sugar Imbalances

Glucose is the body’s main energy source. It cannot enter cells without the help of insulin, a hormone that is secreted by the pancreas. Insulin helps escort glucose into the cells, which in turn gets converted into energy to help carry out different cellular functions. 

When the body experiences stress, the adrenal glands prepare for the fight-or-flight response by increasing the amount of glucose that is available in the bloodstream. The brain will then use this readily available glucose to defend itself against this stressful situation or threat. The body achieves a high glucose state in three ways: 

1. During a stressful event, the adrenal glands release cortisol and epinephrine, both of which cause muscle tissue to become less sensitive to insulin. Because of this, glucose does not get taken up by the cell and instead remains in the bloodstream for immediate use. 

2. Cortisol and epinephrine can also activate a process known as gluconeogenesis, or the generation of new glucose, in the liver. In this biochemical process, these stress hormones will instruct the liver to convert protein stores into readily available glucose.

3. These stress hormones can also induce another process known as glycogenolysis, or the breakdown of glycogen (a stored form of glucose in the liver) into glucose, which is then released into the bloodstream.

Ultimately, these stress triggered mechanisms can elevate blood sugar levels and decrease insulin sensitivity, which, if they persist for years, can lead to weight gain, type 2 diabetes, and more.

Thyroid Disorders

When a stressor triggers the fight-or-flight response, a cascade of stress hormones can shut down a number of functions in the body if they are not deemed absolutely essential for survival. 

Unfortunately, when you live with chronic stress, processes such as digestion, reproduction, immune system surveillance, and even thyroid hormone production are slowed down or put on hold. 

In fact, prolonged levels of high cortisol can interfere with thyroid hormones in several ways. When cortisol levels are elevated, it can signal the thyroid gland to stop producing adequate amounts of thyroid hormone. Cortisol can also interfere with the conversion of T4 (inactive thyroid hormone) to T3 (active thyroid hormone).

In turn, these stress induced mechanisms can lead to thyroid disorders like hypothyroidism, or a state of low thyroid function. Common symptoms of hypothyroidism include weight gain, hair loss, irritability, brain fog, depression, and constipation.

It’s also plausible that thyroid problems can make you more vulnerable to stress. In either case, it’s clear that stress and the thyroid gland have a bidirectional relationship.

Sex Hormone Imbalances 

Excess cortisol can also interfere with sex hormones like estrogen and progesterone. Since reproduction is not an essential function of the body, chronic stress can alter normal menstrual patterns and shut down ovulation, or the release of an egg from the ovary.

Studies also show evidence of this phenomenon. In women without any known reproductive disorders (i.e., PCOS or endometriosis), it appears that daily perceived stress can interfere with menstrual cycle function, induce anovulation (a state in which no ovulation takes place), and even cause delayed or missed periods in extreme cases.

In fact, researchers indicate that recent daily stress can lead to the inhibition of an LH (luteinizing hormone) surge. This surge is needed to initiate the start of ovulation and the production of progesterone during the second half of the menstrual cycle.

It seems that nature has designed this system quite brilliantly. Historically, when we experienced bouts of famine, drought, or other catastrophic events, nature knew it was not the right time to reproduce. 

The brain sensed this extreme stress and, in turn, shut down all reproductive function by disrupting the ovulation process, which ultimately led to an “infertile” state in women.

In our modern lives today, while we are not necessarily dealing with the same stressors as our ancestors once did, we are dealing with chronic stress nonetheless. In turn, many women today are dealing with infertility as a consequence.

Chronic stress can also cause women to experience other hormonal symptoms such as PMS, depression and anxiety, headaches and migraines, decreased sex drive, and poor sleep.

Digestive Disorders

Digestive disorders can be another consequence of chronic stress. To be clear, stress suppresses the digestive system in order to reroute key resources that your body may need for the fight-or-flight response. 

Your central nervous system shuts down digestion by slowing stomach muscle contractions and decreasing the release of digestive enzymes. If chronic stress persists, nutrient absorption gets compromised, indigestion (or reflux) often develops, and the gut lining becomes irritated and inflamed. 

Chronic disorders like irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) can also develop.

In fact, researchers found that the ability to handle stress is a pivotal factor in either the development or avoidance of IBS. It turns out that individuals with greater levels of perceived stress, anxiety, and negative beliefs are at greater risk for developing IBS.  

Furthermore, another study on GERD found that chronically anxious individuals are more likely to notice a worsening of their symptoms during a stressful event. 

At the same time, stress causes increased motor function in the large intestines, which is why you may have the urge to urinate or have a bowel movement during stressful times. 

Immune-Related Diseases

In addition to hormone and gut imbalances, chronic stress can also cause the immune system to go out of balance.

Normally, acute bursts of cortisol are anti-inflammatory and can help generate a robust immune response against the common cold, for example. However, chronically high levels of cortisol can alter the immune system and cause a heightened level of systemic inflammation instead. 

Systemic inflammation, in turn, is a direct result of an overworked immune system. Unfortunately, a “tired” and unregulated immune system can’t properly protect you and can cause a number of health problems, such as: 

  • Increased susceptibility to infections and colds
  • Increased risk of food allergies and food sensitivities
  • Increased risk of gut disorders (70-80% of the immune system resides in the gut)
  • Increased risk of autoimmune disease
  • Increased risk of cancer

As expected, managing stress levels can go a long way toward supporting the health of your immune system.

How to Test Your Cortisol Levels 

In my practice, if I am working with a woman that presents with a hormonal imbalance, I will always run the DUTCH Plus Test to help me understand the state of her adrenals and sex hormones.

The DUTCH Plus Test is a combination saliva and urine test that measures markers such as: 

  • Cortisol awakening response (CAR)
  • Free cortisol
  • Metabolized cortisol (which indicates total cortisol production)
  • Cortisone (inactive cortisol)
  • DHEA-S (another adrenal hormone)
  • Sex hormones (estrogen, progesterone, and testosterone)
  • Sex hormone metabolites (only available through urine analysis)

This test can help answer questions such as:

  1. Can stress cause hormonal imbalance?
  2. Why am I always tired?
  3. Why can’t I fall or stay asleep?
  4. Why do I crash in the afternoon?
  5. Why am I having difficulty getting pregnant?
  6. Why do I feel sad and anxious?
  7. Why can’t I lose weight?
  8. Why can’t I think clearly?
  9. Why do I get headaches every month?
  10. Why do I feel irritable and bloated during the second half of my cycle?
  11. Why do I have heavy (or light) periods?

By looking at the entire adrenal picture through DUTCH testing, you can get a much more comprehensive look at your cortisol pattern. This robust test can help us determine if chronic stress is affecting your other hormones and the exact next steps to take to help reverse your hormonal imbalance.

Work with a Functional Medicine Nutritionist 

Anxiety medications, birth control, and sleeping pills are overprescribed for women who are looking to fix their hormone imbalance. The problem with this band-aid approach is that it addresses the symptoms but not the root cause of the imbalance. 

On the other hand, a functional medicine approach to stress-related hormonal imbalances offers short-term tools to get relief and manage your symptoms while also addressing the root causes in the long run.

If you’re interested in naturally restoring hormone balance, consider applying to my one-on-one women’s health consultation program. This six-month program uses a detailed health history questionnaire and comprehensive functional lab testing like the DUTCH Plus Test to help uncover the root of your hormonal health concerns.

Rest assured, you will receive an action plan that outlines the exact diet, supplement, and lifestyle recommendations you need to achieve optimal hormone balance. 

Are you ready to heal your hormones? Apply to become a client today!

Apply to work with me
Hi there

I’m Dr. Pooja!

I am a pharmacist turned functional medicine clinical nutritionist. After years of struggling with PCOS, I finally uncovered the root cause of my hormone symptoms and found a solution that actually works long-term. Now I'm on a fierce mission to help other women achieve hormone healing!

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