Stress: My overwhelming observation amongst my patients both with endometriosis and Diminished Ovarian Reserve (DOR) and patients with other stress based causes of lower estrogen levels exhibit far more PMS symptoms at younger ages to include mood changes, anxiety, depression, migraine headaches, bloating, sleep disturbance and many more. These are all typical low estrogen symptoms. The referenced study underscores this through a look at living conditions:

Women Who Live Around More Green Space Less Likely To Experience PMS Symptoms, Study Indicates

Many years ago, studies with female primate monkeys in cages, where they were studied in separate rooms, then closer and closer together in the same room, showed increasing ovulatory and reproductive problems caused by stress at the brain level. This would explain why fertility rates are better in people who live in the country compared to those in cities where the dwelling proximity is much closer. This study further lends support to this hypothesis. We would all describe the countryside and more natural beauty as stress relieving. Our current world with its increased technology, buzing and beeping constantly and more apartment and condominium type living is contributing to more stress, less estrogen and therefore, an explosion in the symptoms referenced in this study. I don’t know what it will take to reverse these trends but until we figure out significant stress reduction, fertility in our population will continue to decline as it has over the 30 years of my practice.


Michael D. Fox, MD
Jacksonville Center Reproductive Medicine
Advanced Reproductive Specialists

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