Chronic Stress and Ovulatory Dysfunction: Implications in Times of COVID-19

Pilar Vigil; Jaime Meléndez; Hugo Soto; Grace Petkovic; Yanara A Bernal; Santiago Molina

doi:10.3389/fgwh.2022.866104

Reproductive Endocrinology · Neuroendocrinology

Chronic Stress and Ovulatory Dysfunction: Implications in Times of COVID-19

Vigil P, Meléndez J, Soto H, Petkovic G, Bernal YA, Molina S

Published June 10, 2022 Frontiers in Global Women's Health, 3, 866104

DOI 10.3389/fgwh.2022.866104 PMID 35677754 PMC PMC9168655

RRM Academy Synopsis

Chronic stress can disrupt ovulation through kisspeptin signaling

A 2022 mini-review describes how chronic stress can disrupt ovulation by changing the brain signals that drive the menstrual cycle. The authors also appraise studies of women during COVID-19 lockdowns. Several studies linked pandemic anxiety with menstrual irregularity, and the authors note that the pandemic affected women differently.

Key Findings

Under stress, cortisol, corticotropin-releasing hormone and gonadotropin-inhibitory hormone inhibit kisspeptin neurons and GnRH neurons, which the review links to altered GnRH pulses and ovulation.
Acute administration of kisspeptin to women with functional hypothalamic amenorrhea stimulated gonadotropin release and ultimately restored ovulation.
In 952 female healthcare workers in Turkey with regular cycles before the pandemic, 71% had regular and 23% irregular cycles during it; stress scale scores were higher in the irregular group.
In an observational survey of over 1,000 women, 46% reported a change in their menstrual cycle, and 53% reported worse premenstrual symptoms.
A study of more than 18,000 mobile app users found stress reported in nearly half of participants. Some recorded more cycles without ovulation and others fewer.

Interpretation

The authors propose how the body may respond to stress and summarize observed associations. They note that the pandemic studies relied on self-reported data, that pre-pandemic cycle information often came from memory, and that many women in some studies came from high socioeconomic groups. They also note that the studies had no lab data on stress hormones and that only one used basal body temperature to detect ovulation. Most ran at the start of the pandemic, and the authors call for study of later stages and the recovery period.

RRM Context

The review calls monitoring for ovulation itself key, since regular periods can be associated with anovulation. Cervical fluid and basal body temperature are direct signs, and fertility awareness-based methods chart them. The review lists stress, weight loss, weight gain and excessive exercise as triggers that can stop ovulation. Reversing that state includes restoring ovulation and fertility.

Our editorial summary of this paper, not the article's abstract.

Abstract

Stress is known to be associated with adverse health outcomes. The COVID-19 pandemic and its associated lockdowns are examples of chronic stressors. Lockdown measures inadvertently caused significant psychological distress and became a powerful source of anxiety/stress, sleep disturbances, nutritional changes and weight gain. Stress is known to impact women's health specifically, through hypothalamic-pituitary-gonadal (HPG) axis dysfunction and resultant ovulatory dysfunction. Such dysfunction may manifest in menstrual irregularities and/or infertility due to hypothalamic hypogonadism. Here, we review the key physiological mediators of stress and associated ovulatory dysfunction. The kisspeptinergic system is comprised of sets of neurons located in the hypothalamus, the rostral periventricular region of the third ventricle (RP3V) and the arcuate nucleus (ARC). This system links nutrition, reproductive signals and stress. It plays a key role in the function of the HPG axis. During chronic stress, the kisspeptinergic system affects the HPG axis, GnRH pulsatility, and, therefore, ovulation. Leptin, insulin and corticotrophin-releasing hormone (CRH) are thought to be additional key modulators in the behavioral responses to chronic stress and may contribute to stress-related ovulatory dysfunction. This mini-review also summarizes and appraises the available evidence on the negative impact of chronic stress as a result of the COVID-19 pandemic lockdowns. It proposes physiological mechanisms to explain the observed effects on women's reproductive health and well-being. The review suggests areas for future research.

Topics

Reproductive Endocrinology › Neuroendocrinology › Hypothalamic Amenorrhea · Lifestyle and Environment › Stress and Allostatic Load › Stress and Ovulation · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances

Pilar Vigil, Jaime Meléndez, Hugo Soto, Grace Petkovic, Yanara A Bernal, Santiago Molina

P Vigil, J Meléndez, H Soto, G Petkovic, Y Bernal, S Molina

PMID 35677754 35677754 DOI 10.3389/fgwh.2022.866104 10.3389/fgwh.2022.866104 Vigil et al. 2022, Vigil 2022

Chronic Stress and Ovulatory Dysfunction: Implications in Times of COVID-19

Chronic stress can disrupt ovulation through kisspeptin signaling

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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