An article in today’s New York Times SCIENCE TIMES section by RANDI HUTTER EPSTEIN, M.D. describes how chronic stress may reduce a woman’s fertility.   I guess that is why the message your mother or grandmother may have shared with you again and again when you were trying to get pregnant, “just relax, honey”, may really make good sense. According to the Science Times interview with the clinician and researcher, Dr. Sarah L. Berga, chronic stress may keep some women from ovulating and certain relaxation techniques may be a big help. We know that chronic stress alters brain signals to the hypothalamus, the tiny glandular powerhouse at the base of the brain that is the mastermind of hormone production in our thyroid, adrenals and ovaries (and testicles in men).  Apparently chronic stress leads to more of the cortisol hormone but a reduced amount of the hormones critical for ovulation each month. 

I write about how the hypothalamic pituitary axis in my book on the risks of body shape and describe how chronic stress leads to increased cortisol production and increased belly or visceral fat – and share with you below my version of how all that happens. Women who are naturally apple-shaped have an overactive response to chronic stress because of their higher belly fat.   On the other hand, even pear-shaped people with little belly fat can start packing on the dangerous fat with stress leading to a more apple-shape and all the problems that go with too much belly or visceral fat.   

Apple-shaped women also have more problems with ovulation – and therefore their fertility.  An apple-shape condition called PCOS (polycystic ovarian syndrome) is linked to reduced fertility and shrinking belly fat through exercise, diet (and sometimes the medication designed to improve insulin function, metformin) can be of help.

  So what can women do about this?  I talk about relaxation techniques in my book and suggest ways women can reduce stress.  Dr. Berga found that cognitive therapy to reduce stress can improve ovulation and fertility.  In a study of 16 women, Dr. Berga showed that ovulation was restored in 7 of 8 women who underwent cognitive behavioral therapy, compared with 2 of 8 who did not get therapy. She also reported that women who did not ovulate had excessive levels of cortisol in the brain. 

She also did another study in women who exercised a lot.  She found that if you are stressed when you start exercise, your body reacts differently than if you are not chronically stressed and begin to exercise.  According to Dr. Berga in the New York Times interview, “not only does it appear that exercise was more stressful for already stressed women, exercise did not help them lower their stress hormones, which is of course one reason people take up exercising”. I strongly believe that for most women, it is NEVER too late to begin an exercise program - which will do far more to reduce dangerous belly fat than almost anything else.  And I would add that for women who know they already have a heavy dose of chronic stress (over 60 % of women report chronic stress so that means most of us) – work on ways to reduce stress too.  Many research studies have already shown that simply reducing stress will lower the risk of heart disease, diabetes and maybe even some cancers – likely in part because of lower belly fat.  Now with this information on ovulation and fertility, we can say that reducing belly fat (by reducing chronic stress and cortisol) may also improve fertility.  

This is yet another reminder to women of the powerful role chronic stress plays in our lives.  Perhaps we could do far more to improve the health of the nation by working on stress before we try to tackle everything else.  If only it were easy!!

 I welcome your comments and questions, as always.  To your health! Dr. Marie

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