Modern day teens don’t have it easy. Along with having to deal with numerous changes as the body adjusts to new hormones and physical development comes the pressure to perform academically, get into good schools, participate in extracurricular activities, socialize with peers among many others.  Its is no wonder why stress is a common experience for teenagers.

According to the American Psychological Association, over the past decade, studies have shown that around 30-40% of teens report high levels of stress (1). Another survey done by the National Survey of American Attitudes on Substance Abuse XV found that 63% of teens reported stress levels as “fairly” or “very” high (2).

It is important to understand that stress is a normal part of life and can be helpful in certain situations. However, when stress becomes chronic, it can have a negative impact on a teenager’s physical and mental health, especially during this critical period of development.

Unfortunately, stress can take its toll on the balance of key hormones in the teen’s body. Proper hormonal balance is essential for adolescent development as hormones play a crucial role in the physical, emotional, and behavioral changes that occur during puberty.

In particular, stress can have significant effects on the hormones of adolescent girls.  This disruption can lead to changes in the timing and progression of puberty (3) and can affect the development of physical characteristics in girls that are associated with puberty. Hormonal disruption in girls can also manifest in a range of physical symptoms such as changes in menstrual cycles, irregular periods, or missed periods, impaired immunity, as well as emotional symptoms such as anxiety, depression, and mood swings (4) which can also impact academic performance.

Alarmingly, studies have shown that stressful life events and related changes in female hormones during adolescence can even have long-lasting impacts like infertility and reproductive health problems later in life (5)

How stress impacts hormonal balance in teens

When a person is feeling psychological distress, the body triggers its fight or flight response as a means to deal with this stress.

The body does this by getting the adrenal glands to make and release stress hormones, like cortisol (Figure 1). Cortisol leads to physiological changes like increased heart rate, high blood pressure, higher blood sugar and sweating. The latter are all adjustments that help the body rapidly deal with acute bouts of stress and bring everything back to normal.

However, when a person is chronically stressed, cortisol levels remain high for a long period of time. This can have a negative impact on the balance of other hormones in the body, like:

• Decreased growth hormone which can affect physical development (6)

• Decreased thyroid hormones which can drop energy levels, cause lethargy and trigger weight gain (7)

• Increased insulin levels which can cause insulin resistance and type 2 diabetes (8)

• Impaired estrogen and progesterone in females which can affect the menstrual cycle and trigger emotional symptoms. Stress and elevated cortisol can also affect dopamine release in the brain which can affect mental wellbeing in adolescents (9)

The effect of Stress on Adolescent Female Hormones

During prolonged stressful situations, the body shuts down any system that isn’t necessary for survival. The reproductive system is one of the systems that the body shuts down, while prioritizing those that will help get through this period.

Chronic elevations in cortisol during prolonged stress signals the ovaries to decrease the release of the hormones estrogen and progesterone. These are both hormones that regulate the menstrual cycle and reproductive functions. That is why periods can be late or stop completely when a girl is stressed out for a long period of time.

Teens can also experience the following symptoms from being chronically overstressed as a result of cortisol being elevated for long:

• Changes in the timing of the onset of puberty.

One study published in the Journal of Adolescent Health (11) reported that high levels of perceived stress were associated with earlier onset of puberty in girls. This was particularly true for girls who had experienced stressful life events, such as abuse or neglect. Another study published in the journal Hormones and Behavior found that stress during childhood and adolescence can disrupt the timing of pubertal onset and alter the trajectory of hormonal development (12)

• Mood swings, bloating and weight gain.

A study published in the Journal of Adolescent Health in 2014 found that stress was a significant predictor of mood swings in adolescent girls, with alterations in estrogen levels being an underlying cause. According to the National Institute of Mental Health (2016), currently 20% of adolescent girls experience major depression compared with 6% of boys, pointing to stress-induced disruption in estrogen as a possible cause (13)

• Reduced fertility

Elevated cortisol levels during chronic stress can also impact fertility, and may make it more difficult for girls to become pregnant later in life. Research has shown that elevated cortisol levels can cause deteriorations in the quality of eggs (oocytes) which may cause infertility problems further down the line (9).

• Increased susceptibility to infections

Chronic high cortisol levels can compromise the immune system and increase susceptibility to infections (14). There is evidence that stressed adolescent girls have an increased risk of developing urinary tract infections (15). 

Can Stress Trigger or Worsen PMS Symptoms?

Stress can also affect the onset, severity and duration of premenstrual syndrome (PMS) symptoms.

PMS is a condition characterized by physical and emotional symptoms that occur during the luteal phase of the menstrual cycle, typically just before a woman’s period (16). Common symptoms include mood swings, cramps, bloating, and headaches. It can be challenging for girls to manage their physical and emotional symptoms during this time.

Stress can affect PMS by altering the levels of certain hormones, particularly cortisol and progesterone.

Progesterone levels are thought to play a role in PMS symptoms, as they tend to decrease just before a woman’s period. Stress-induced cortisol increases can further reduce progesterone levels,  and contribute to the severity of the following PMS symptoms:

• Worsening of physical symptoms: Stress can intensify physical symptoms of PMS, such as cramps, bloating, headaches, and fatigue.

• Aggravating mood symptoms: Stress can worsen mood symptoms of PMS, such as irritability, anxiety, and depression.

How Teens Can Manage Stress

There are several ways for teens to manage stress, including:

• Exercise: Physical activity can help reduce stress by releasing endorphins, which are natural mood boosters.

• Mindfulness and meditation: Practicing mindfulness, such as deep breathing and progressive muscle relaxation, can help calm the mind and reduce stress.

• Sleep: Getting adequate sleep is important for overall health and well-being, and can also help reduce stress.

• Eating a healthy diet: Eating a balanced diet that includes plenty of fruits, vegetables, and lean protein (like fish, turkey and chicken) can help reduce stress and provide energy.

• Time management: Planning ahead and prioritizing tasks can help reduce stress by reducing the feeling of being overwhelmed.

• Social support: Spending time with friends and family can help reduce stress and provide a support network.

• Limit caffeine and sugar: Caffeine and sugar can increase stress levels and make it harder to manage stress.

• Seek help from a professional: If stress becomes persistent and difficult to manage, it is recommended to speak to a professional to find ways to address the stress.