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Aviva Romm, MD

Updated: 10/21/2021

Why always "running on empty" hurts your overall health.

As a woman, mid-wife, physician and mom of three daughters I am passionate about supporting women’s health. Our hormones significantly influence pretty much everything. Simply put: if your hormones aren’t happy, neither are you! The fact is, we’re in the midst of a hidden epidemic in which an extraordinary number of women of all ages and life stages — at least 80% of us — will struggle with a hormone or gynecologic problem in our lifetime that is significant enough to cause disruption in our life quality, career or overall health.

It’s the reason I wrote Hormone Intelligence: The Complete Guide to Calming Hormone Chaos and Restoring Your Body’s Natural Blueprint for Well-Being, which just became a New York Times bestseller! It's important to get off the hamster wheel of stress — to get out of survival mode — to protect your health and well-being.

What Is Stress, Really?

According to a 2016 study published in the Journal of Brain & Behavior, women are twice as likely to suffer from stress, including severe stress, and anxiety as men. It’s not just that we feel we’re under more stress, we are — and changes seen on MRIs comparing women’s responses to stress and men’s prove it. The American Psychological Association (APA) reports that women top the charts in all stress-related statistics, including having more physical symptoms such as headaches, irritable bowel syndrome and depression, for example.

Stress literally means a strain or pressure that causes something to bend out of shape. I know you feel me on that! But it’s more than an emotional state, it’s a series of physiologic responses, called the stress response, that occur as a result of any number of triggers, properly called stressors, that threaten your sense of security or safety — whether consciously, unconsciously or biologically. Let’s take a deeper look.

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Your Stress Response

The stress response is orchestrated by the hypothalamic-pituitary-adrenal (HPA) axis. It starts in two little almond-size regions of your brain called the amygdala, your own surveillance system. They pick up on even tiny triggers — sights, sounds, smells, feelings — and if any seem like a threat to your safety, they send an automatic relay to your “emergency response central” — your hypothalamus. So if you smell smoke, your brain will immediately get you to scan your environment for a fire. If you see an obvious, unthreatening source, your brain calms down, but if you can’t rule out a fire — or there is one — your brain goes into alarm mode and you spring into action, either fighting the fire with your handy fire extinguisher or running.

This chain of events begins when your hypothalamus detects danger and produces CRH (corticotropin-releasing hormone), which in turn alerts your pituitary gland that something’s up and help is needing to get mobilized. Consider it the 911 center of your brain dispatching emergency services, which happen to primarily hang out in your adrenals in the form of a hormone called cortisol and the neurotransmitter adrenaline (a.k.a. epinephrine). These are then dispatched much like the police, fire department and an ambulance — all at once — throughout your body to protect you from whatever the danger might be.

So imagine this. You’re watching a National Geographic special about African animals. Gazelles are comfortably drinking at a watering hole on a golden plain in Africa when along comes a pride of hungry lions and a chase begins. The gazelles go into survival mode and run. They’re pumping out adrenaline, the first responder in the stress response. Adrenaline fuels the “fight or flight” you’re familiar with: your back gets tight as if you’re ready to spring or run, your heart beats faster, your breathing changes, and you become hypervigilant to danger. In the process, your blood vessels constrict and your cardiac and respiratory rates increase.

"Modern living causes us to experience chronic activation of the stress response without enough time and relaxation for resolution."

After a few minutes, if the danger persists, cortisol kicks in, mobilizing blood sugar to your muscles to provide fuel so you can run from or fight the danger. Insulin production also revs up to deal with that extra blood sugar so it doesn’t linger when the danger’s over and cause inflammatory damage. Cortisol gets your immune system ready to protect your boundaries, like the National Guard, against infection that could occur if you got injured, and it changes the way your brain works so that you’re reacting on automatic pilot rather than using your willpower and higher thinking; you need to be instinctual during a crisis, not thinking about your taxes or to-do list! The lions pursue, and eventually catch one of the older, sicker or slower gazelles. But then what happens? The remaining gazelles go right back to the watering hole as if nothing happened. They go from red alert back down to it’s all okay. This is called stress resolution. And it all happened in a matter of minutes.

The ability to respond and adapt to stress and still stay healthy is known as allostasis, a term that means that we’re extremely resilient to stress. The stress response is ingeniously orchestrated, if you think about it. So why, if it works so well to protect us, does stress cause so many problems? The answer is that when the stress response is activated day in and day out, adrenaline and cortisol go from friends to overstaying houseguests — and your health and hormones pay the price. And for most women, chronically activated it is!

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Stuck in the “On” Position

The stress response is a beautiful thing. While cortisol has gotten a bad reputation as the “stress hormone,” it should be called the survival hormone because we can’t live without it. It keeps our blood pressure, blood sugar, inflammation and energy balanced and plays a major role in maintaining healthy immunity, willpower, focus and memory. It is the music that keeps almost every cell in your body hummin’ in time to the right beat.

Cortisol gives us serious survival advantages: a little bit of stress keeps you on your toes should danger present, and it stimulates problem solving, focus and immunity. It makes us feel excited and alive, and it helps us to grow. But the stress response was meant to be a short-lived response. You get away from danger and the response calms right down in a matter of minutes — hours at the most. It was never meant to be stuck in the “On” position. But for most of us, that’s the situation. And that’s where our hormone problems get started.

Modern living causes us to get too much of a good thing and so we experience chronic activation of the stress response without enough time and relaxation for resolution, to the point that we get stuck in survival mode. The very system designed to protect us backfires and leads to a host of consequences, sometimes small symptoms, sometimes diagnosable conditions.

The Wear and Tear of It

At the heart of our modern hormone epidemic is a modern problem called allostatic load, the physical wear and tear that happens as a result of repeated or chronic stress. A sustained high cortisol level wears at muscle and bone; slows healing time; impairs digestion, metabolism and cognitive function; interferes with healthy endocrine function and impairs immunity. It can disrupt your sleep, digestion and microbiome and blood sugar; can cause you to have food cravings (especially for fat/sugar/salt/carbs) and to gain or have trouble losing weight; and can result in that root of all root causes — inflammation.

Because all your endocrine system is interconnected to your nervous and immune systems, when the HPA axis is on alert, it puts the brakes on ovarian and thyroid function. Even relatively short stretches of stress can impact your sex hormones and cycles. And it doesn’t stop there: the latest research on stress shows powerful links to irregular periods, menstrual pain, PMS, endometriosis, fertility challenges, PCOS and more.

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The Impact on Your Reproductive Health

When your stress response gets activated, your body diverts energy away from what Stanford University evolutionary biologist Robert Sapolsky, author of Why Zebras Don’t Get Ulcers, politely calls “optimistic activities”— meaning sex and reproduction. Your body is actually trying to do you the favor of protecting you from getting pregnant when times are hard or resources are scarce.

Your brain is the link between what’s going on in your external world and your ovaries (and thyroid). But I want to be clear about something: talking about the impact of stress on your health, hormones, or any related hormone or gynecologic condition does not mean it’s in your head! I’m emphasizing this because the term hysteria, which is derived from the Greek word for “uterus,” hysterikos, was a medical diagnosis that was used for centuries, and well into the twentieth century, as a diagnosis to dismiss women who presented with almost any of the hormonal and gynecologic conditions in this book. Stress creates a very real physical impact on our health and hormones.

Gonadotropin-releasing hormone (GnRH) is a hormone produced by your hypothalamus that starts the relay of messages that stimulate ovulation and your cycles. High cortisol levels, as well as some other chemicals that your body ramps up when you’re stressed, suppress GnRH. But that’s not all cortisol does. In further attempts to prevent you from ovulating, it also inhibits pituitary FSH and LH production. But let’s say you do manage to produce enough FSH and LH to reach your ovaries. Cortisol has that covered, too, making your ovaries more resistant to these hormones, and also blocking maturation of your ovarian follicles.

RELATED: All About Endocrine Disruptors

And there’s still more: cortisol blocks your progesterone receptors, so even if you do ovulate, you don’t reap the benefits of progesterone throughout your brain and body. As a result of yet another domino effect in your endocrine system, your estrogen and progesterone levels decline, your menstrual cycles go all wonky, and you don’t ovulate regularly or at all. Out goes ovulation, regular cycles and your sex drive — all the functions that have to do with baby-making.

Chronic stress is now recognized as having such a big impact on our hormone health that it’s considered an endocrine disruptor, much like other environmental toxins. Subtle hormonal symptoms like irregular periods, increased cramps or breast tenderness — the kind we’re told are just normal so don’t pay them any mind — can be important early signs that you’re under too much stress.

Aviva Romm smiling on the cover of "Hormone Intelligence."

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