Dear Dr. Maslow,
With everything going on right now, I am so stressed! I’m worried all this stress will impact my ability to get pregnant, adversely affect a pregnancy or just my reproductive health in general. What do you think?
Dear Stressed Out,
First and foremost, it is absolutely normal to feel stressed in response to a traumatic or concerning event, particularly when the trauma is ongoing and therefore generating continued uncertainty and worry.. What has happened and is happening to our friends and family in Israel and the sentiment around the world is legitimately stressful to our minds and our bodies, even for those of us who are potentially removed from immediate harm.
Our bodies are programmed to respond to perceived threats with a response through our sympathetic nervous system, or the “fight or flight” response. These include increased heart rate, breathing rate, and a variety of other physiologic changes aimed to help us make a quick getaway or important decisions in the face of danger.
The hormones that regulate this response, like cortisol, typically revert to baseline levels after short periods of time. Prolonged exposure to stressors can keep levels of these hormones higher than typical for longer periods of time. However, by and large, the reproductive system is well protected from even significant stress exposures. While some data suggest that extreme and prolonged traumatic exposures in pregnancy, like those experienced by women in abusive relationships or experiencing homelessness, are associated with low birth weight and other pregnancy complications, you can be reassured that periods of even a few weeks of elevated stress is extremely unlikely to harm your fetus in any way.
Sadly, first-trimester miscarriages are relatively common and are almost always related to abnormalities present at the time of conception. That being said, having a miscarriage during a time of communal duress can make a difficult situation even more challenging. If you find yourself in this unfortunate situation, please give yourself some grace. Seek out support where you can and try to remind yourself that you did not cause this, no matter how stressed or anxious you were.
Stress alone, even severe stress, is rarely, if ever, the sole cause of infertility. Hence, the old adage to “just relax and it will happen” can be so maddening! Importantly, prolonged difficult circumstances can sometimes temporarily affect menstrual cycle schedules. This was seen with some frequency during the COVID-19 pandemic, where women found that they had delayed cycles, bleeding in between cycles, or occasionally even skipping several cycles in a row. There is some thought that menstrual cycle changes are less related to “stress” per se but may actually be associated with the changes that stressful situations induce in our lifestyles and routines.
Sleep, eating habits, and exposure to sunlight are all physiologic pathways that our bodies rely upon to maintain cyclicity. Lack of sleep, less exposure to sunlight, and changes in eating habits happened frequently during quarantine periods of the pandemic. It is also a common occurrence among young women going to college or seminary who often experience menstrual disturbances. In addition, young women, within 10 years of their first cycle, may be more sensitive to these types of changes. Thankfully, menstrual cycle disturbances rarely last more than a few cycles and generally do not have any long-term impact on fertility or overall health.
If you experience changes to your menstrual cycle or irregular bleeding patterns for more than two to three cycles, especially if you’re trying to conceive, I’d recommend you touch base with your OB/GYN to make sure there isn’t anything else that can or should be looked into.
The good news is that by doing your best to maintain a healthy routine—good sleep habits, getting fresh air and regular meal frequency—you can mitigate some of the impact that stressful situations have on our bodies. Obviously, this is easier said than done, especially in times of great duress or danger. Give yourself permission to feel stressed and scared about what is going on around you. When you can, do what you can to help support your mind and body through this time.
Hopes and prayers for happier and more peaceful times to come.
Dr. Bat-Sheva L. Maslow, MD, MSCR, is a reproductive endocrinologist and an expert on the intersection of reproductive medicine and Jewish life. To schedule an appointment with her at Reproductive Medical Associates (RMA) of New Jersey’s Englewood or the brand new Jersey City location, see www.rmanetwork.com/NJ. You can invite Dr. Maslow to speak in your community or learn more about her educational projects on her website www.batshevamaslow.com and @blmaslowmd on Instagram.