Which factors can impact menstrual health?

• A. Physical activity
• B. Stress
• C. Hormonal imbalances
• D. All of the above

Answer: (D)

Menstrual health is shaped by how the body regulates hormones and responds to both lifestyle and physiological conditions. Physical activity influences this balance through energy availability and hormonal signaling; very high levels of exercise or insufficient calories can suppress the signals that drive ovulation, leading to irregular or absent periods. Stress can alter the hypothalamic-pituitary-adrenal axis, raising cortisol and other stress hormones, which can shift cycle timing or worsen symptoms. Hormonal imbalances from conditions like PCOS, thyroid disorders, or elevated prolactin directly change reproductive hormone levels, causing irregular, heavy, or absent menses. Since each of these factors can impact the cycle, all of the above can affect menstrual health.