Abnormal menstrual patterns often result from dysregulation or immaturity of the hypothalamic-pituitary-ovarian (HPO) axis, a biological process influenced by stress and elevated cortisol levels. Prior work done in India demonstrated a link between elevated stress in teenagers and abnormal menses. Our study explores the relationship between psychological stress and irregular menstrual cycles in adolescent girls in the United States to establish baseline data to inform strategies for improving female teenage health.

The institution's IRB approved our study. We distributed an anonymous survey to new patients at our large university outpatient pediatric gynecology clinic. Eligible patients were non-pregnant, English or Spanish-speaking individuals under 21 years old, not on hormonal therapies, with no history of chemotherapy, radiation, uterine agenesis, or primary ovarian insufficiency. Consent from legal guardians and assent from participants was obtained as appropriate. Participants completed the survey, which included the Perceived Stress Scale (PSS), a questionnaire about their menstrual cycles, and basic demographic information. Data analysis included descriptive statistics. Categorical variables were analyzed using chi-square tests, with a p-value of < 0.05 considered statistically significant.

Of 100 participants, 64 met the criteria for abnormal menses, indicated by a frequency of menses more or less frequently than 1/month, a cycle lasting >7 days or < 4 days, or a heavy flow requiring 5+ changes of saturated sanitary pads/tampons daily. The majority (84%) of the population was Hispanic. Most participants reported moderate (62) to high (27) stress levels. Despite the high incidence of stress, it was not found to be a predictor of abnormal menses (p=0.71). Anxiety and depression were reported by 29 and 18 participants, respectively. These comorbidities were not predictive of stress either. Still, 74 participants reported experiencing mood changes either fairly or very often during their menstrual cycle.

The incidence of both irregular menses and elevated stress levels in our minority-majority population is notable. However, in this study, no statistically significant association was found between the two variables. Stress's impact on the HPO axis, and therefore menses, may not be as strong as previously thought, but the frequency of both variables indicates the need for a larger study. Our findings highlight the need for further research into adolescent stress to reduce these heightened levels in young girls and to better understand factors influencing menstrual abnormalities.