Introduction:
Stress is a real or imaginary threat to homeostasis that challenges an organism's well-being. Stress triggers the activation of the endocrine, nervous, and immune systems in response to the threat while prioritizing survival over other functions, such as reproduction and growth. The primary mediator of the stress response is the hypothalamic-pituitary-adrenal (HPA) axis. This axis, when activated by stress, affects the female reproductive system.
How Is the Hypothalamic-Pituitary-Adrenal Axis Activated?
Activation of the HPA axis causes the release of corticotropin-releasing hormone (CRH) from the hypothalamus, increasing the production and secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary gland. Glucocorticosteroids such as cortisol, mineralocorticoids like aldosterone, and adrenal androgens are synthesized and secreted by ACTH. CRH inhibits the release of GnRH (gonadotropin-releasing hormone), which triggers the synthesis and release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland, which acts on the ovary to trigger oocyte maturation, ovulation, and steroidal hormone production.
CRH and its receptors are present in the female reproductive tissues like the ovary, uterus, and placenta. In addition, CRH is secreted in the peripheral inflammatory sites where it applies inflammatory actions. Reproductive CRH regulates the key for reproductive functions, such as ovulation, luteolysis, implantation, and parturition.
What Is the Impact of Stress Through the HPA Axis?
Increased levels of CRH result in negative effects on reproductive functions by decreasing endogenous levels of LH and FSH. The levels of LH and FSH get normalized once the CRH level returns to baseline. Stress can stop GnRH release, which results in many effects, such as reduced GnRH AND GnRH receptor synthesis, distraction in the pituitary release of LH, and enhanced functions of gonadotropin inhibitory hormones. These inhibit the release of LH, which is essential for healthy ovulation in females. In addition, increased secretion of FSH can be due to raised glucocorticoids and an increasing FSH:LH ratio; this high ratio of FSH: LH is known to affect follicular development and oocyte quality negatively.
What Are the Signs Seen Due to Dysfunction of the HPA Axis?
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Blood sugar imbalance.
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Disturbed sleep.
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Chronic fatigue.
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Depression or anxiety.
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Sugar and salty food carvings.
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Weight gain.
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Temperature tolerance.
What Are the Effects of Stress on the Female Reproductive Organ?
One of the common effects of stress is impaired oocyte competency. In addition, cortisol levels influence the fertilization of follicles, as women undergoing in vitro fertilization show a higher level of CRH in the follicular fluid of unfertilized follicles than in the fertilized follicles.
What Are the Effects of Stress on the Placenta and Parturition?
Pregnant women contain CRH concentrations 1,000 to 10,000 times more than non-pregnant women. Most of this is bound by CRH binding protein, making it inactive, but there is a surge during the third trimester, which is hypothesized to act as a placental clock that plays an important role in the duration of gestation. In addition, ACTH production can be stimulated due to CRH production in the placenta, resulting in enhanced production of glucocorticoids; this mechanism can lead to preterm labor.
What Are the Other Markers of Stress Response?
Salivary amylase is secreted as one of the stress responses. In a study, women with a high salivary amylase level showed a significant decrease in the fertility rate. Stress can decrease the probability of conception every day during the fertile window.
What Is the Impact of Stress on Fetal Programming?
Increased levels of glucocorticoid exposure can permanently cause many issues, such as,
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Affect tissue and organ functions.
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Decreased birth weight.
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Increased risk of cardiometabolic disease.
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Stress-related anxiety.
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HAP affective disorders.
These effects may accumulate for many generations. Developmental disorders such as temperament, cognition, language skills, and motor functioning can be caused due to maternal stress.
How Does Stress Impact Sex Differences?
There are evident studies suggesting that male and female infants differ in response to prenatal stress when in utero. The female placenta changes in response to the variations in the concentration of glucocorticoids with changes in cortisol metabolism, adrenal function and growth, and placental cytokine expression. This response includes adaptation which causes reduced growth to promote survival. The male placenta resists glucocorticoids as the pathway responsive to cortisol remains unaffected. The male response is associated with the risk of preterm delivery, intrauterine restricted growth, or death in utero.
Prenatal maternal stress impacts the outcome of each gender beyond the neonatal period. Female fetal exposure to stress results in high levels of childhood anxiety, impaired executive function, and amygdala enlargement. These changes are not noticed in males.
How Can Stress Be Reduced Healthily?
Stress management includes:
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Eating a healthy diet; an unhealthy diet with sugar and processed food will increase the cortisol level and may result in high blood pressure and diabetes.
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Getting regular exercise.
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Getting a good amount of sleep.
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Regular practice of relaxation techniques like yoga, breathing techniques, and meditation.
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Maintaining a journal and noting down thoughts and reasons a person feels grateful.
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Giving importance to hobbies like listening to music, reading books, or watching a favorite show or movie.
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Maintaining healthy friendships and interacting with friends and family.
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Try to include laughter by listening to jokes or watching funny videos.
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Organizing and planning things to be done at home and work, and avoiding unnecessary things.
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Seeking professional counseling or therapies that can be of great help.
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Intake of supplements should be combined with a healthy diet and monitored by the doctor. Magnesium, vitamins B12 and C, and folic acid help to reduce cortisol levels.
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Caffeine intake should be reduced, which helps while stressed but does not act on the root cause of stress.
Avoid unhealthy ways to manage stress, like excessive alcohol or tobacco intake, drugs, or stress eating.
Conclusion:
Stress has a major side effect on the female reproductive system. Glucocorticoids are important for fertility and fetal life, yet they can also have a negative impact. Increased HPA axis can cause changes in the function of the hypothalamus, pituitary, and gonads. An increase in stress hormones like cortisol cause a major impact on the female reproductive system. When the HPA axis is triggered by stress, it affects the female reproductive system.
