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pcos stress stefani ruper

Psychological stress and female hormones: a recipe for fertility disaster

While the title of this post may sound hyperbolic, it nonetheless is grounded in truth.  There are a wide variety of dietary and lifestyle factors that affect reproduction.  Stress may be one of the greatest of all.


Dozens of studies performed on cynomolgus monkeys, bonobos, chimps, and baboons have demonstrated that having low social status–even while maintaining the exact same diet at high social status individuals–induces impaired fertility in primates.

Human models, while approximations, do not differ.   In some, a simple progesterone-dampening effect occurs,  in others the levels decrease precipitously, in most cortisol levels skyrocket, but in general a wide spectrum of reproductive disorders- from hormone deficiency to full-blown long-term amenorrheic infertility- follow from psychological stress.

This is something about which I have written before, and it’s a serious problem, causing not just outright and obvious infertility but also sneakily impaired and sub-optimal fertility all across the country.


Pysychological stress wreaks all sorts of havoc on the body.  Most importantly, cortisol levels rise, and the body’s inflammatory and immune responses become impaired.  Blood sugar levels rise, and insulin levels rise, too.  When these things happen, healing cannot occur, and tissues become progressively damaged with time.  This applies to reproductive tissues as much as it does to the rest of them.   Hypercortisolemia is good for nobody.

Several hormone responses also occur.  Three of the primary ones are as follows:

1)  As I mentioned, due to elevated cortisol levels, insulin levels may rise, and testosterone levels rise right alongside it. This is because insulin directly stimulates testosterone production in the ovaries.  This is bad for reproduction because a proper balance between testosterone and female balance needs to be maintained in order for proper reproductive signalling and tissue development to occur.   One particularly potent way in which this imbalance often hurts women is in the hormone condition Poly Cystic Ovarian Syndrome.  It is not the only thing that contributes to PCOS– definitely not– but it can play a big time role in it. For more on stress and PCOS (and overcoming PCOS!), check out the book I wrote. 

2)  Moreover, another effect that may occur as a result of stress is an increase in production of DHEA-S, a hormone produced in the stress glands.   DHEA-S is, like all other hormones, an important and very healthful hormone in proper balance.  But if the stress glands are in overdrive, they might over-produce everything, including DHEA-S.  This is detrimental, because DHEA-S is also a classically male sex hormone, and it plays a role similar to testosterone in PCOS.  DHEA-S in excess blocks estrogen signaling, interferes with LH and FSH signaling, and also increases hormonal acne.  DHEA-S can play a role in both type I and type II PCOS.

3) Finally, the brain, via the hypothalamus, sometimes turns off pituitary activity in response to stress.  This often leads to a cessation of LH and FSH signaling–the two primary pituitary signalling molecules–which in turn decreases levels of estrogen and progesterone in the blood.  Recall that reduced progesterone levels are one of the primary markers of reproductive distress in primate studies.  Prolactin levels may also decrease.  These facts make it impossible both to ovulate and to menstruate.

*Graphic extracted from PCOS Unlocked: The Manual.


These three categories– testosterone elevation, DHEA-S elevation, and pituitary decreases may occur differently in all women.  And there are a wide variety of other, more subtle, hormonal responses that also occur, especially when considered in conjunction with all of the other bodily stress that follows from psychological woes.

All that being said, STRESS IS BAD.  We know some of the reasons why, as I’ve explained above.  Others likely exist.  Even if you don’t have infertility problems, you may have hormone imbalances or deficiencies, and those can be just as insidious.  Eat right, sleep right, live well, breath deeply.  Repeat.


Stress is a significant problem for women’s health, and particularly women’s hormonal health.  This is manifested in a wide array of problems, but also most predominantly these days in the condition PCOS, or Poly Cystic Ovarian Syndrome.

You can read more about stress and it’s interplay with cysts, as well as how to overcome it all,  in my guide, PCOS Unlocked: The Manual.  







So, just as a heads up - some links above may be my affiliate links, which means I get a small commission if you click on it and make a purchase. Doing so is no additional cost to you, but helps me tremendously. Your support is SO greatly appreciated, so thank you in advance if you choose to do so. Check out my entire disclosure to know exactly how things work.

Managing director of Paleo for Women and author of Sexy by Nature.


  1. What you’re describing is the “fight or flight” reponse, so these changes actually make perfect sense. When the stress response is triggered, even if from emotional or chemical stress, the body goes into a mode of protection which will completely alter hormone and chemical balance. The body does this on purpose since it thinks it is in a fight for survival. Since we are mostly in states of stress these days, physical, emotional, and chemical, these chemical states stay off balance and the body adapts to them. That’s bad news for health and longevity.

    • But of course. 🙂

  2. Pingback: Fertility: An Underrated Health Marker | Paleo Parents

  3. So what happens when one has low cortisol, low estrogen/progesterone/estradiol/DHEA and possibly low FSH (testing for that in two weeks).

    • I should also add that I have low T3 and I am menstruating fine.

    • That just means everything has shut down because it is so tired and stressed. Lots of calories, lots of carbs, lots of fat, lots of sleep … 🙂

  4. What if estradiol is low, TSH is low, but FSH and LH are normal (and as a result amenorrhea)? Could this be stress related? I’m just confused because with low estrogen I thought FSH and LH would be low too!

  5. Hello Stefani,

    I am thinking of buying your ebook or book but dont know whether you talk about my type of case, at leat in my reasearch on your website i saw nothing about DHT levels. I basically had very hight levels of DHT in my last exams (which makes sense since i lost a lot of hair and also thinning of hair). Also had a few cyst in my last image exam (dont know the name in english). But testosterone and the rest seems ok. Additionally I come from 3 years of weigh gain frustration, Im about 10-15kg overweight, reasonably active, history of binge eating disorder (in reasonable control since about 5 months), low carb since 2 years (with episodes os binge in the middle that keep me from losing the weigh i need), and generally very bad self steem with all the frustration of not losing the weight and being constantly thinking about how i hate my hair now and my body. I dont trust doctors anymore, so I just would really aprecciate if you could tell me which material you wrote I could benefit from more?! thanks so much

    • Hi Renata,
      Sorry for the late response and thanks for writing. I actually don’t talk about DHT in the book as its not all that common an issue – though activity, “overweight” binge eating disorder and low carb are all things I discuss at reasonable length. It’s possible you could really enjoy the program but then again perhaps not. The only thing I can say that may help for sure on the issue is that if you try it and don’t like it you just let me know and you get a complete refund, because of course. 🙂

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