Stress, Hormones & The Liver: Why Stress Can Make PMS Worse

We all know that stress affects our mood, energy, and sleep. But, did you know it can also have a big impact on your menstrual cycle and period symptoms? Both Western medicine and Traditional Chinese Medicine (TCM) recognise that stress doesn’t just stay “in your head” it has a knock on effect impacting your hormones and your body’s natural rhythms.

The Stress–Hormone Connection

When you’re under stress, your body prioritises survival. The adrenal glands pump out as much cortisol (the “stress hormone”) as needed to help you cope. Now, this is a good thing! Cortisol isn’t bad, it’s essential. It’s what wakes us up in the morning and helps run as fast as we can from danger.

However, if our body is constantly under stress (physical or mental), the adrenal glands will keep pumping out more and more cortisol. Essentially, our body ends up confused and our hormone fluctuations are all over the place. We start to experience spikes in cortisol when it’s time to rest (e.g. feeling wired at bed time), and big dips when we need a little cortisol to get us going (e.g. feeling exhausted in the morning).

Key causes of Stress:

When I talk about stress, I’m not just talking about mental stress. Our body doesn’t actually know how to differentiate between a lion standing in front of us and work stress. To our bodies, it’s all the same.

So, what are key causes of stress that we might not realise?

Physical

• HIIT exercise or overexercising
• Lack of sleep or poor-quality sleep
• Illness, infection, or chronic health conditions
• Skipping meals, exercising on an empty stomach

Mental

• Work pressure, deadlines, or long hours
• Relationship difficulties or family conflict
• Financial worries
• Major life changes (moving, loss, pregnancy, new job)

How does Stress relate to your reproductive hormones?

Cortisol and your reproductive hormones share common building blocks. That means when your body is busy making stress hormones, it can “steal” resources away from your sex hormones (oestrogen and progesterone).

Think of it like this: your body has one pantry of ingredients. If you suddenly need to bake lots of “stress hormone cookies,” there aren’t enough ingredients left to make the “reproductive hormone cookies.” This is often called the “cortisol steal” or “pregnenolone steal.”

As a result:

• Progesterone levels may drop. This can lead to shorter cycles, spotting, or symptoms of oestrogen dominance (like heavy periods, PMS, and breast tenderness).
• Oestrogen can become imbalanced. Sometimes it dips too low (causing irregular cycles or missed periods), and sometimes it rises relative to progesterone, worsening PMS.
• Ovulation may be delayed or skipped. Chronic stress can suppress the luteinising hormone (LH) surge needed for ovulation.
• Libido often falls. Because reproduction is a “non-essential” function when your body is in fight-or-flight mode.

Over time, this stress–hormone imbalance can create cycles that feel unpredictable, heavier, or more symptomatic. It’s your body’s way of prioritising immediate survival over fertility and long-term health.

Stress & The Liver in Chinese Medicine

In Traditional Chinese Medicine (TCM), the Liver has the job of ensuring the smooth flow Blood throughout the body. The Liver stores the blood in TCM to be released at menstruation and flow smoothing through the uterus and then out. When life feels stressful, the Liver Qi becomes stagnant, like a traffic jam inside the body.

Just as cortisol can “steal” from reproductive hormones in Western medicine, Liver Qi stagnation in TCM can disrupt the flow of Blood and Qi to the uterus. A big red flag for us as TCM practitioners that points straight to Liver Qi stagnation is Premenstrual syndrome (PMS).

Common signs:

• Irregular cycles or painful, clotty periods
• Emotional stress symptoms like irritability, mood swings, and frustration
• Digestive upset such as bloating or alternating constipation/loose stools
• Tension (temple) headaches or breast tenderness before the period

Where Western medicine describes stress diverting raw materials into cortisol production, TCM describes stress as “jamming the traffic” of energy and blood. In both views, the result is the same: stress makes it harder for your reproductive system to function smoothly.

What can we do about it?

The good news? Both Western and Chinese medicine agree that stress management is key.

Supporting your nervous system, calming your mind, and keeping your Liver Qi flowing smoothly can reduce PMS and make your cycle feel easier.

Simple steps include:

• Mindfulness – Breath work, meditation, journalling, counselling – all of these tools are incredibly at reducing stress and releasing those pent up emotions
• Movement – walking, yoga, running, stretching – whatever makes you feel best! That means, when you’re finished the session, you walk away with a boost not feeling more exhausted. Strength training is amazing for female reproductive health from a muscle building perspective to help balance our hormones.
• Sleep hygiene – wind-down and screen-free time to support the body as it starts to switch off to get that quality sleep.
• Nutrition – don’t skip breakfast, have coffee after some food, restrict “naked carbs” to regulate blood-sugar levels (add protein to your carbs)

And of course, get some acupuncture and herbs!

• Acupuncture helps to regulate the nervous system, influencing cortisol levels and improving sleep.
• From a TCM perspective, it also moves stagnant Liver Qi and nourishes Blood — addressing both the stress and its impact on your menstrual cycle.
• Chinese Herbal Medicine can be tailored to your unique presentation. Whether stress shows up as anxiety, irritability, sleep disturbance, or painful periods.

Let’s finish on a good note…

As you can see, stress has a MASSIVE impact on our overall health, and our menstrual hormones are no exception. The good thing is, we have a monthly chance to check in with our bodies, and we have the ability to significantly influence our hormones by making lifestyle and dietary changes to reduce stress.

Small changes that you can gradually integrate that are sustainable and often free or inexpensive can be the answer to a lot of your symptoms.

How do you begin?

I would start by downloading a period tracking app and actively tracking your cycle and symptoms. Note how you feel across the whole month, not just the week of your period. This data is so valuable, not only for your health practitioner, but it’s vital for you to have. These signs our bodies are leaving us are little signals that can guide us on how to best support ourselves.

Your cycle doesn’t have to feel like a battle each month. With the right support, you can ease the impact of stress and restore harmony between your hormones and your Liver.

Written by Zoe Finger