During times of crisis, stress and anxiety are running high. As a result, OB/GYNs may be seeing more patients presenting with stress-induced symptoms, ranging from missed menstrual periods to shortness of breath. Although your patients may not make the connection between their symptoms and increased stress, a comprehensive workup — including a thorough medical history and, in some cases, an ultrasound exam — can help rule out other causes and ease patients' minds.
Stress and Menstruation
Stress can cause or exacerbate a broad range of physical symptoms, and gynecological symptoms are no exception. Menstrual irregularities are some of the more common stress-induced symptoms you may encounter in your practice.
Increased stress has long been believed to affect the menstrual cycle; it appears to do so by triggering shifts in levels of the hormones that regulate menstruation. Research has linked high stress levels to an increased likelihood of menstrual irregularities. Stress can also cause spotting between periods.
Stress has been shown to increase the severity of premenstrual syndrome, or PMS. As with menstrual irregularities, a variation in hormone levels appears to be responsible. Women under acute or chronic stress may experience more severe emotional and physical symptoms of PMS, including increased irritability, fatigue, bloating and cramping.
Other Common Stress-Induced Symptoms
Patients under extreme stress may also bring complaints of low libido to the OB/GYN office. A heightened sense of stress can dampen a person's libido by affecting testosterone and other hormones involved in sexual desire and arousal.
High levels of stress also appear to affect fertility, according to research published in Dialogues in Clinical Neuroscience, making it more difficult to become pregnant. In turn, infertility can lead to increased stress, creating an ongoing problem.
Finally, stress can increase the chances of developing both tension headaches and migraines. Women may also contact you about symptoms such as chest pain or shortness of breath. Although patients may worry these indicate a heart attack or infection with COVID-19, they are also classic signs of anxiety and panic attacks.
Identifying Stress-Induced Symptoms: The Role of Ultrasound
With some symptoms, a careful physical exam and medical history can rule out factors other than stress. For example, weight changes, excessive exercise, hypo- and hyperthyroidism and disordered eating can all cause menstrual irregularities. Likewise, further testing can eliminate cardiovascular problems as a cause of chest pain.
For other patients, ultrasound can play an important role in ruling out or diagnosing other causes of symptoms. For instance, an ultrasound exam can help identify uterine fibroids, pelvic inflammatory disease and other conditions that are associated with missed or late periods. A normal pelvic ultrasound indicates that other factors, such as stress, may be responsible. Likewise, ultrasound can help identify physical causes of infertility and rule out pregnancy as a cause of menstrual irregularities.
In these uncertain times, we are all under increased stress. By helping identify stress as a cause of certain symptoms, OB/GYNs can help reassure patients and form treatment recommendations accordingly.
