Stress and infertility

Today, women cannot have conversations about starting a family or pursuing fertility interventions without discussing stress (like, ad nauseam). Throughout my infertility experience, I have tried nearly everything to manage and mitigate my chronic stress levels: from special fertility diets to completely overhauling my workout regimen; from developing a meditation practice to seeing an acupuncturist. And nearly everything in between.

So naturally, the question that I often get asked is:

What role does stress play in hormone imbalances?

That’s a big question to tackle, but I love big questions, and this is a great place to bust some myths.

Most people hear “stress” and immediately think “cortisol.” Usually in the context of, “my stress levels are high because I have so much cortisol,” or “if I could just lower my cortisol, I could dump this FUPA (aggressive acronym for belly fat) and get my stress in check.” Eh, that’s only partially correct.

Cortisol is a steroid hormone and it doesn’t cause stress. Rather, it responds to stress. It’s released to regulate stress levels and do a whole host of other herculean tasks to calm our asses down (control blood pressure, maintain blood sugar levels, reduce inflammation, just to name a few). So, cortisol is kind of an unsung hero of the endocrine system, but gets a super bad rep because of its association with stress. It’s essential to help our body get back to homeostasis from a stressed state.

*climbs off cortisol soapbox*

To directly answer the question: stress is a massive contributor to hormonal imbalances. The nature of stress can be emotional (related to work or relationships), dietary (due to eating like shit), or physical (resulting from trauma or infection). Both physical and emotional stress demand higher productions of cortisol from the adrenal glands in order to combat the stressor.

Pay attention, because this shit is about to get super nerdy.

When we think about chronic, long-lasting physical or emotional stress (e.g., very demanding job), there are three hormones at play — that is, three that we care about as it relates to reproduction.

1. Pregnenolone. The “mother hormone.” The hormone from which all others are derived.

2. Progesterone. Thickens up a woman’s uterine lining and gets it cozy af for a baby to be implanted.

3. Cortisol. Regulates a bunch of stuff.

These hormones are interrelated and in some cases, co-dependent. So if one is at a higher- or lower-than-normal level, there’s a domino effect.

When you are chronically stressed, your body produces higher amounts of cortisol as it tries to get back to homeostasis (normalcy and not feeling like you have to anxious-poop every hour).

When higher amounts of cortisol are produced, it becomes depleted quickly and your body needs to find other ways to generate this critical stress-management hormone. So the adrenal glands turn to progesterone because it’s a precursor to cortisol production, and it also becomes depleted.

A mental picture that is only semi-accurate and overly simplistic yet still helpful (to me anyway): imagine cortisol as a person, freaking out and trying to cope. Cortisol stress-eats an entire bag of Doritos in a futile attempt to feel better. In this case, progesterone is the bag of Doritos. There’s none left for anybody else who might have wanted some munchies, like your uterus.

(I fully acknowledge that shit just got weird with that analogy…)

But back to cortisol… now cortisol has no progesterone to help it deal with all the chaos in your body. So the adrenal glands need to go one hormone upstream to pregnenolone, and get the goods from it. Remember, pregnenolone is the mother of all hormones and is used to synthesize both sex and stress hormones. So in this chronic stress scenario, pregnenolone is diverted to synthesizing more cortisol instead of the sex hormones like progesterone.

Hence, you can’t get knocked up.

What options are available to women who are trying to restore balance? 

Every woman is different and so the path to restoring balance will depend on your circumstances and lifestyle. In my (unfortunately) deep experience with stress and hormones, I’ve found that it helps to nurture three areas in your quest for balance. 

FOOD

Eat to fuel your body and in a way that maximizes natural hormonal function. This was the foundation of my journey — I knew that I couldn’t be on drugs for life — hell, being on birth control for 20 years was a significant driver of my reproductive system failing to operate naturally on its own. Food is medicine and it doesn’t require a prescription.

FITNESS

Girl, move your body. I don’t care if you lift weights, go to Barre3, run, dance, walk with ankle weights on like my mom does — just make sure that you regularly move your body in a way that you will enjoy.

FREEDOM

I’m talking about the freedom to indulge in self care that makes you feel happy and empowered. For some, it’s diving into a good book. For me, it’s diving into the Bravo Network.

Think of these three areas as a little pyramid, with Food as the foundation. If your nutrition is out of whack, the measures you’re taking around fitness and freedom will only go so far in balancing your physical and emotional stress. So while Food is the foundation, I’ll also call out here that I’m a big believer in a philosophy of healthy eating, healthy treating.

If you’re on-track 70-80% of the time, that’s great! Or, if you only have capacity do one thing better than you did last week, like switching from Dannon Strawberry yogurt to plain greek yogurt with chocolate protein powder mixed in, that’s great too! Remember that you don’t have to be perfect all the time. Don’t beat yourself up when you’re not. Anticipate the stumbles. Have the donut. Enjoy the fuck out of that donut because you are a queen and you deserve it. Now move on.