152. Is Chronic Stress Disrupting Your Hormones and Fertility?

Everyone has heard that stress impacts fertility. But stress does not just make you feel anxious — it activates a specific hormonal axis that can delay ovulation, shorten your luteal phase, and suppress fertility in measurable, identifiable ways. And most standard fertility workups almost never look for it.

In this episode of Cycle Wisdom, Dr. Monica Minjeur goes beyond the vague advice to just relax and explains exactly what chronic stress does to the hormonal cascade — from the HPA axis through cortisol steal, DHEA depletion, and suppressed progesterone production. Through Lauren's story, a 32-year-old small business owner who felt she was managing stress well but could not conceive, you will see how identifying and treating adrenal dysfunction can change outcomes in just a few cycles.

You will learn:

• How elevated cortisol directly delays or blocks ovulation — and why this can happen without any obvious cycle changes
• What “cortisol steal” means and how chronic stress diverts resources away from estrogen, progesterone, and testosterone production
• What a complete adrenal evaluation looks like — and why a single cortisol level does not tell the full story

If you have been told to just reduce your stress without any further evaluation or treatment — this episode will show you what a real clinical approach to this problem actually looks like. Learn more or schedule a free discovery call at radiantclinic.com.

Transcript

Speaker 4 0:00

Before we get into the episode, I would like to ask your help with something big. There is currently a rule at the federal level that is requesting input from the general public in regards to fertility benefits being able to be provided through employers independently. The comment period for this rule is only open until midnight Eastern Standard Time on July 13th, and I need your help. We are trying to get as many people as possible to write in and share your personal story about how your life or the lives of your loved ones have been improved or positively impacted by the availability of restorative reproductive medicine. For more information and the website to submit your story, please click on the link in our show notes to be directed to the International Institute for Restorative Reproductive Medicine, where you can read more about the proposed rule and get help with drafting your comments. If you have any further questions about this, feel free to send us an email at hello@radiantclinic.com. And now, on to today's episode

Speaker 1:09

I've heard it over and over again. Stress impacts fertility, and people say this like it's just a foregone conclusion. But stress doesn't just make you feel anxious, and it also isn't just about how you feel. Stress activates a specific hormonal axis that can delay ovulation, shorten your luteal phase, and suppress your fertility in measurable, identifiable ways. And most standard fertility workups almost never look for it. Today, we're talking about how we identify if stress is actually impacting your hormones, and more importantly, how we can work together to change the narrative and help your body heal. I'm Dr. Monica Minjeur, the host of Cycle Wisdom, where we help women and couples restore hormonal balance and reclaim their wellbeing through personalized healthcare grounded in clinical excellence. So let's start today with a patient story, and we'll call her Lauren. Now, Lauren came to me at 32 years old. She had a demanding career as a small business owner. She was also trying for a half-marathon and was trying to conceive. However, she described herself as healthy and managing her stress well. She didn't feel as though she had significant stress, and she exercised regularly, ate well, and got plenty of sleep at night. However, Lauren was frustrated that nothing seemed to be wrong, but at the same time, nothing was really working with helping her to conceive. She was quietly exhausted, but in a way that she kept dismissing as normal because on paper, from a health standpoint, everything looked fine. We started, as always, with getting Lauren started charting her cycles and started to notice a fairly consistent pattern. Her luteal phase, the time from ovulation until her period began, was only about eight to nine days. She also ovulated quite a bit later in her cycle, around cycle day 20 or 21, and so even though she was still having a period about every 29 days, we knew that something was driving this shift in ovulation and the shortened luteal phases. Our next steps was completing a full assessment of her labs, specifically looking at her adrenal function, things like cortisol, DHEA, testosterone levels, as well as looking at bigger picture things like progesterone levels and what was going on in her lifestyle. We specifically talked through how much she was training, what exercise looked like, what her caloric intake included, as well as sleep quantity and quality. Her labs and her charting showed the rest of the picture. She had low cortisol levels accompanied by low DHEA and low testosterone levels. Her mid-luteal phase progesterone levels were low, and we identified that she had issues with other lifestyle pieces, meaning she was not getting enough caloric intake to keep up with her exercise level. All of these pieces were driving this additional stress that was being placed on her body, and that was impacting the ongoing hormonal changes that we were observing. So we started with talking about what are the lifestyle pieces that we needed to change. We focused specifically for Lauren on making sure she had enough caloric intake to keep up with her exercise, and we also talked to her about dialing back on the amount of exercise she was doing while we were helping her adrenal glands to heal. We also added in DHEA supplementation specifically dosed for what she needed, as well as progesterone. Over the course of the next two cycles, we saw normalization of her hormone levels and her charting also improved, now showing that her ovulation was closer to day 13 to 16, and her luteal phase was now consistently around 11 or 12 days. Her cortisol levels still remained low, which can take years to correct, but over the course of the next three months with normalized cycles, Lauren was able to conceive with additional ongoing hormone and DHEA support. So let's break it down a bit, because a lot of people will talk about cortisol and the adrenal gland as if it is just a straightforward pathway, and it is actually incredibly complex. So the adrenal gland is one of a bunch of different organs that make up what we call your HPA axis. So this includes your hypothalamus and your pituitary gland, which are in your brain, as well as your adrenal glands, which sit just above your kidneys in the middle part of your back. Now, this axis all together is the body's master stress response system, and it's directly connected to the reproductive axis. So it's what helps your body when you go through a stressful time or a stressful situation to respond to those things by adjusting your heart rate, your breathing, your digestion, and when this has been going on chronically from things like over-exercise or under-eating or sleep deprivation or even psychological pressure, it prioritizes survival of your system over reproductive hormones. This is not a malfunction. This is not your body being broken. It's actually working exactly as it was designed. The problem is that many things within modern life keep that stress signal perpetually activated, and if we can never turn down the noise, the adrenal glands continue to fire so frequently that at some point in time they start to burn out Adrenal cycle disruption is common. We see it every day in our practice, and it's oftentimes dismissed as just stress. Now, many women come in knowing and understanding that they're under some level of stress, but they may not understand or see those changes or really be able to give a number to it until we can show them this is what's going on from your lab standpoint. On the flip side of things, sometimes I see individuals come in who say, "I'm under a ton of stress," but their labs look completely normal. This doesn't mean they don't have stress in their life, but it means that the adrenal glands, for now, are keeping up with that level of stress and not having that negative impact on the hormones. So this is why it's really important because it's incredibly difficult to give a subjective reading of where your stress level is and really incredibly important to understand what are the labs actually showing you. Now, some women have come in and said, "Well, I've heard that if stress was the problem, my cycles would just stop completely." And unfortunately, it doesn't happen so quickly. Oftentimes it can be delayed ovulation or maybe you miss ovulation one cycle. Sometimes it will start with a shortened luteal phase or lowering of hormone levels, but oftentimes by the time your cycles would stop altogether, the stress has already been there for quite some time. Another common thing that I hear from individuals is, "Well, I handle stress well, so it's probably not impacting my hormones." Or my other favorite, "I'm under stress all the time and I still have a period, so there's no problem here." Unfortunately, how we perceive stress and how we think that we manage stress does not determine how your body actually responds to stress. Some individuals, uh, are able to handle stress significantly better from a standpoint of their adrenal glands than others. For some women, even slight disruptions to their stress can make a significant impairment on their cycle, even for months to come. This is why we are incredibly careful to not ever tell women, "Well, just relax and then you'll get pregnant." That trivializes this real physiologic mechanism that happens behind the scenes with that hypothalamic pituitary and adrenal axis, and oftentimes undermines women's ability to actually get treatment and specific intervention. It doesn't mean that we want you to keep living in that stress, but it does mean that there are sometimes things that need to be done from a medical intervention standpoint in order to correct these things so that you can start feeling better more quickly. Yes, we always want to look at and evaluate what are the chronic stressors, where can we make some of those lifestyle changes, but we also have ways that we can help support what's going on in your adrenal glands in the meantime, and we'll get into that a little bit later in the episode. So in the world of restorative reproductive medicine, we are always asking why. So I wanna start with just a little bit about why this happens, why does ovulation get interrupted, and why do the hormones get interrupted, because that will help explain how do we fix this going forward. So your hypothalamus, again, an area of your brain, is responsible for releasing gonadotropin-releasing hormone. This hormone stimulates your pituitary gland, also in your brain, to release luteinizing hormone and follicle-stimulating hormone. Now, those are a little more self-explanatory. They stimulate your follicles in the ovaries in order to produce a follicle and then let ovulation occur Now, when we have chronic stress, that elevated cortisol response that happens actually suppresses in the level of your brain gonadotropin-releasing hormone, which then decreases your luteinizing hormone surge and either delays or completely blocks ovulation from happening. So it is a direct impact when we have those stressors. Again, for every woman, it's a little bit different. When is that cortisol going to make a difference? Is there a certain level, a certain amount of stress? And again, it can be incredibly different from cycle to cycle. And in many cases, we see that we just are delaying ovulation, whether that's for a couple of days or weeks, or sometimes it doesn't happen at all. And many times women will still have a regular period, so unless she is actually tracking that ovulation event, she may not even notice that anything has changed and furthermore may not notice or understand that stress is what caused it in the first place. And again, when we're talking about stress here, we're talking not just about emotional or psychological stress, like what you get from working too much or having a stressful relationship or having anxiety about the fertility process itself, but we're also talking about other things that happen in life. Things like lifetime transitions, an illness, switching into perimenopause or postpartum timeframe. All of these things can trigger this hypothalamic pituitary adrenal axis to go a bit haywire Other things that we definitely are always considering, do we have someone who is over-exercising? Specifically if you're doing any sort of endurance training like marathon training or a triathlete, if you don't have enough adequate caloric intake, oftentimes we'll see problems arise here. Under-eating can also cause this. If you don't have enough calories around, it signals scarcity. It tells your hypothalamus in your brain, "This is not a good time to get pregnant," and so it can delay or completely block ovulation. And then finally, and you've heard me talk about this a lot on this podcast, is sleep deprivation. If we don't have adequate sleep, if we don't have good quality sleep, it disrupts the normal cortisol rhythm, which then blunts that overnight hormone recovery. And so not getting adequate sleep, not getting consistent sleep can also trigger this response. The way that this happens is through something that we call cortisol steal. Sometimes in the medical literature it's also called pregnenolone steal, and we'll talk about why that is in a moment. But basically what this comes down to is your body will always preferentially channel its energy towards cortisol when you have stress. If there is a stressful situation, an illness, emotional stress, physical stress, something happens, your body will always say, "We need to produce enough cortisol to get through this situation." The problem is, is that cortisol also has a fine balance with what else is going on in your adrenal glands, specifically in the context of this conversation, hormone production So upstream of cortisol, we have pregnenolone, we have DHEA. And when we don't have enough resources in order to produce cortisol, all of the resources go towards that production of cortisol, thus stealing away DHEA. If we don't have enough DHEA, this leaves less available for ongoing production of estradiol and testosterone. If we don't have enough cortisol, it will also steal away pregnenolone, which is a precursor to progesterone. So again, think about this funnel where all of the resources for your adrenal glands are having to funnel into production of cortisol, thus taking away these vital molecules and proteins in order for the production of other hormones. So this is why it's so important that we are checking these other hormone levels to discern, "Hey, even if I've got a normal cortisol level, might I be seeing deficiencies in progesterone, DHEA, estradiol, testosterone?" And that's why when we are looking for all these pieces, we're casting a wide net, because most commonly what I find with women under chronic stress is actually that the cortisol level is low, meaning I have already depleted all of my stores and I am not producing enough cortisol to get what I need. We also oftentimes find that that DHEA level is low because, again, this declines under chronic stress, which then oftentimes is accompanied by low testosterone levels and low estrogen production. And so what this looks like from a symptom standpoint can be lighter menstrual cycles, um, absence of cervical mucus production, decreased libido, fatigue, energy troubles, and all of this is because of that chronic stress. So even if you've got normal cortisol or if you've got low cortisol, this doesn't mean you have no stress. It actually means the exact opposite. Likely you've had chronic stress that's playing a role in the long run here. And that's why it's so important that we're looking at not only those lab findings, but also what's going on with your charting. If we see a delayed ovulation, if it's happening later than cycle day 18 and there's no other identifiable cause like PCOS or other anovulatory conditions, then that's a sign that we say, "What else is going on? Why are we seeing that delayed ovulation?" In women who have a shortened luteal phase, so if that time from ovulation till the next period starts is less than 10 days, oftentimes that's going to be accompanied by a progesterone deficiency. But again, always digging deeper and saying, "Why is that progesterone deficient in the first place?" If you are somebody who is tracking your basal body temperatures as a part of your charting, we oftentimes will see erratic or slow rise on the basal body temperatures if the adrenal gland is not working well. This goes back to the fact that actually your hypothalamus is responsible for temperature regulation. So again, because your adrenals are connected to the hypothalamus and the pituitary gland through this HPA axis, it has a role altogether Now, when it comes to treatment, again, we're going to be looking at the long-term as well as short-term impacts that we can make a positive difference. So again, always talking about how are we going to remove those stressors if they exist, recalibrating how much exercise is appropriate with caloric support, prioritizing sleep, making sure that we're aiming for at least that seven to eight hours of high-quality sleep, ideally preceded by at least two hours without screen time, without anything else that's gonna increase the cortisol levels right before bedtime. We also talk about nutritional support, making sure that we have what's needed for adrenal function and cortisol metabolism to continue. So making sure that your diet is good and rich in magnesium and other B vitamins. We treat the physiology that's going on, not just the numbers. And so even though in Lauren's case we needed to utilize DHEA, that's not always the case for some of our patients. We do utilize DHEA where necessary and only if you need it because DHEA is like a building block that is created and it needs to go on in order to build together to make all of the rest of our hormones like testosterone and estrogen. So if an individual does not have enough DHEA, we start by giving them back DHEA within their supplement regimen in order to make sure they have the building blocks necessary to create enough testosterone and estradiol. Now, interestingly enough, pregnenolone is that precursor to progesterone, but we find that it's most effective to actually give progesterone supplementation when necessary. Unfortunately, giving pregnenolone doesn't seem to bring the levels up quickly enough. Your body needs lots of other precursors in order to make that transition happen. So typically, the quickest way that we see in order to help support the hormones is to give you progesterone if you're deficient in it. And then from a standpoint of helping to bring up the estradiol and the testosterone, give you DHEA in order to help boost those levels. I also would specifically recommend here against using any adaptogens. Now, adaptogens were created to try and help with adrenal function, but it's not a substitute for addressing the root causes, and it's not correcting any underlying pathophysiology. So again, this is where I say it's incredibly important to, first of all, know your numbers, and second of all, and most importantly, to work with a healthcare professional who understands the nuances of this so that they can help guide you as to what is the correct dosage. Make sure you have enough but not too much. Make sure that we're not wrecking something else in the long run. Because as is with all areas in the world of restorative reproductive medicine, there is not a one-size-fits-all approach when it comes to your unique hormone situation So let's wrap up here with a couple of questions that we get asked commonly when it comes to stress and your adrenal glands. The most common is, well, how do I know if this is actually stress or if it's something else? And again, oftentimes as was the case with Lauren's story today, the charting pattern is oftentimes the first clue, and then we back it up with that testing and the adrenal labs in order to confirm it. The evaluation that we do also helps to distinguish if it is just the adrenal glands or if there's another reason why your cycles are irregular, whether that's thyroid dysfunction, PCOS, or now called PMOS, or if there are other causes that may be playing a role Another common question and something we do see frequently is that a cortisol level can be normal. Can my adrenal axis still be the issue? And the answer is it's possible. A single cortisol measurement, even if it's done first thing in the morning, doesn't capture what's going on in the big picture. So looking at that big picture, specifically evaluating DHEA and the other downstream hormones, gives us a better indication as to what else might be going on with cortisol. Again, looking at the history, what else is going on from day to day within your lifestyle, those can be other things that can point us to the consideration that stress may be playing a role. Now, is this the same as adrenal fatigue? No. Adrenal fatigue is kind of a generalized term that we use when the adrenal glands aren't working great, but it's not a specific clinical diagnosis to have adrenal fatigue. Now, there is a medical diagnosis, adrenal insufficiency, but that's incredibly different. That means my adrenal glands are not working at all. These individuals need total replacement of everything that's regulated by the adrenal glands, and that's a very different story. So this does exist kind of on this spectrum where we say we can have problems as far as just adrenal dysfunction or chronic stress, but it's not the same as saying my adrenal glands don't work and they never will. And then final question that we oftentimes get is, well, what if I just change this one part? For example, if I just exercise well, uh, but not too much, or if I eat better, or maybe if I just would add in progesterone supplement, won't that be enough? And the reality here is that, yes, all of those things can help in the short term, but we always want to focus on what are the long-term things that we need to change so we're fixing this problem for the long haul. Again, giving you progesterone if your progesterone is deficient is appropriate and that is fine, but it doesn't change upstream that stress physiology that's happening, which can create ongoing long-term issues like increasing inflammation, as we talked about in last week's episode, which then leads to other chronic health conditions. So yes, we can address and improve what's happening now, but it is not a substitute and not able to ignore what's going on in the big picture. Imagine if stress was no longer just a vague explanation that led to nowhere, but a specific, measurable, and treatable driver of cycle dysfunction that your healthcare team actually knew what they were doing and could fix it. Your shortened luteal phases or delayed ovulation should prompt a real conversation about your adrenal axis, your sleep, your exercise, and your nutritional status. Imagine if every woman understood that you cannot fully restore fertility without respecting the stress physiology that governs it, and that addressing that physiology upstream is one of the most powerful and underutilized tools available to improve your health and promote fertility

Speaker 5 24:14

If you're ready to work with our elite team of healthcare professionals, go to our website radiantclinic.com to schedule a free discovery call and learn more about our package-based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa clinic or can arrange for a telehealth visit if you live in many different states across the US. Check out our website for current states that we can serve medical clients, and let us know if your state is not listed to see if we can still cover you there, as we are constantly expanding our reach. Please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom