Which other factors affect the menstrual cycle?

    Last Updated: October 25, 2023

    The menstrual cycle is affected by numerous internal and external factors, all of which can alter the cycle’s length, regularity, and symptoms. Some of these factors are not modifiable, such as race/ethnicity, age, intrauterine exposures, family history, adverse childhood events, and genetics.[1][2] Other factors are related to the environment, like exposure to air pollution, endocrine-disrupting chemicals, and certain viruses and bacteria, as well as the geographic climate.[1][3] There are also important personal and lifestyle factors to consider, including mental health,[4][5], sleep health,[6][7] body mass index,[8][9][10] use of tobacco and cannabis,[11][8] lactation,[12][13] use of contraceptives (oral medications, intrauterine devices, ect.),[14][15] shift work,[2] and possibly even a history of concussions.[16]

    Of these factors, psychological stress is a common target for interventions aimed at restoring normal menses, reducing menstrual-related symptoms, and improving fertility. For example, acupuncture and acupressure may help some people with premenstrual syndrome or menstrual irregularity.[17][18] Psychosocial interventions, particularly cognitive behavioral therapy and mindfulness-based therapies, may increase pregnancy rates in people with infertility[19] and improve mood in people with premenstrual syndrome.[20][21]

    Adapted from Campbell et al., 2021[2]

    References

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    2. ^Campbell LR, Scalise AL, DiBenedictis BT, Mahalingaiah SMenstrual cycle length and modern living: a review.Curr Opin Endocrinol Diabetes Obes.(2021-Dec-01)
    3. ^Cherenack EM, Salazar AS, Nogueira NF, Raccamarich P, Rodriguez VJ, Mantero AM, Marsh A, Gerard S, Maddalon M, Jones DL, Klatt NR, Alcaide MLInfection with SARS-CoV-2 is associated with menstrual irregularities among women of reproductive age.PLoS One.(2022)
    4. ^Kappen M, Raeymakers S, Weyers S, Vanderhasselt MAStress and rumination in Premenstrual Syndrome (PMS): Identifying stable and menstrual cycle-related differences in PMS symptom severity.J Affect Disord.(2022-Dec-15)
    5. ^Green SA, Graham BMSymptom fluctuation over the menstrual cycle in anxiety disorders, PTSD, and OCD: a systematic review.Arch Womens Ment Health.(2022-Feb)
    6. ^Sihan Song, Hansol Choi, Yanghee Pang, Oksoo Kim, Hyun-Young ParkFactors associated with regularity and length of menstrual cycle: Korea Nurses' Health StudyBMC Womens Health.(2022 Sep 1)
    7. ^Kathryn E R Kennedy, Chidera Onyeonwu, Sara Nowakowski, Lauren Hale, Charles C Branas, William D S Killgore, Chloe C A Wills, Michael A GrandnerMenstrual regularity and bleeding is associated with sleep duration, sleep quality and fatigue in a community sampleJ Sleep Res.(2022 Feb)
    8. ^Risa Mitsuhashi, Akemi Sawai, Kosuke Kiyohara, Hitoshi Shiraki, Yoshio NakataFactors Associated with the Prevalence and Severity of Menstrual-Related Symptoms: A Systematic Review and Meta-AnalysisInt J Environ Res Public Health.(2022 Dec 29)
    9. ^Seif MW, Diamond K, Nickkho-Amiry MObesity and menstrual disorders.Best Pract Res Clin Obstet Gynaecol.(2015-May)
    10. ^McKinnon CJ, Hatch EE, Rothman KJ, Mikkelsen EM, Wesselink AK, Hahn KA, Wise LABody mass index, physical activity and fecundability in a North American preconception cohort study.Fertil Steril.(2016-Aug)
    11. ^Lammert S, Harrison K, Tosun N, Allen SMenstrual Cycle in Women Who Co-use Marijuana and Tobacco.J Addict Med.(2018)
    12. ^Calik-Ksepka A, Stradczuk M, Czarnecka K, Grymowicz M, Smolarczyk RLactational Amenorrhea: Neuroendocrine Pathways Controlling Fertility and Bone Turnover.Int J Mol Sci.(2022-Jan-31)
    13. ^Prosperi Porta R, Sangiuliano C, Cavalli A, Hirose Marques Pereira LC, Masciullo L, Piacenti I, Scaramuzzino S, Viscardi MF, Porpora MGEffects of Breastfeeding on Endometriosis-Related Pain: A Prospective Observational Study.Int J Environ Res Public Health.(2021-Oct-10)
    14. ^Dragoman MVThe combined oral contraceptive pill -- recent developments, risks and benefits.Best Pract Res Clin Obstet Gynaecol.(2014-Aug)
    15. ^Adeyemi-Fowode OA, Bercaw-Pratt JLIntrauterine Devices: Effective Contraception with Noncontraceptive Benefits for Adolescents.J Pediatr Adolesc Gynecol.(2019-Sep)
    16. ^Snook ML, Henry LC, Sanfilippo JS, Zeleznik AJ, Kontos APAssociation of Concussion With Abnormal Menstrual Patterns in Adolescent and Young Women.JAMA Pediatr.(2017-Sep-01)
    17. ^Lim CED, Ng RWC, Cheng NCL, Zhang GS, Chen HAcupuncture for polycystic ovarian syndrome.Cochrane Database Syst Rev.(2019-Jul-02)
    18. ^Mike Armour, Carolyn C Ee, Jie Hao, Tanya Marie Wilson, Sofia S Yao, Caroline A SmithAcupuncture and acupressure for premenstrual syndromeCochrane Database Syst Rev.(2018 Aug 14)
    19. ^Frederiksen Y, Farver-Vestergaard I, Skovgård NG, Ingerslev HJ, Zachariae REfficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis.BMJ Open.(2015-Jan-28)
    20. ^Faeze Panahi, Mahbobeh FaramarziThe Effects of Mindfulness-Based Cognitive Therapy on Depression and Anxiety in Women with Premenstrual SyndromeDepress Res Treat.(2016)
    21. ^Busse JW, Montori VM, Krasnik C, Patelis-Siotis I, Guyatt GHPsychological intervention for premenstrual syndrome: a meta-analysis of randomized controlled trials.Psychother Psychosom.(2009)