Why stress hits women harder—and what it does to the body

Forest bathing, mindful breathing, guided meditations, and even counting backwards... We would do anything to eliminate stress from our lives, especially when the numbers are counting upwards. A 2025 Sleepseeker’s report ranked Singapore first globally for fatigue, while back in 2024, the Employment Hero’s Wellness at Work Report indicated that 61 per cent of Singaporean employees were exhausted. What both reports don’t factor in, however, is the gap between how each gender experiences it.

According to Dr Lau Khai Ying, consultant psychiatrist at Resilienz Clinic, women’s stress response systems also tend to take longer to “switch off”, meaning cortisol lingers like a guest who has missed every social cue to leave.

“On top of that, the brain circuits involved in emotional processing stay more active under stress, which can make worries harder to shake”, she adds. She points out one more pressure that society places on women: the “double burden”, where full-time work is paired with the invisible labour of keeping a household functioning, and an invisible mental tab that never really closes.

“Together, these biological and social forces form a perfect storm – one that helps explain why women are more likely to feel chronically stressed and burnt out.”

Like most millennials in Singapore, 34-year-old community outreach manager Jessica* is, by her own admission, permanently stressed, joking that the “cortisol levels in my body rise at a level that should require me to evacuate wherever I am”. What she notices, however, is that the problems she faces – workplace drama, monetary woes, and the usual probing by in-laws – barely register for her husband. Is he more sanguine? Possibly. Is there a biological reason? Also possible.

Dr Lau notes that women tend to have a more nuanced and sustained physiological response to stress, with scientific studies showing that they remain in “fight or flight” mode for longer, which sounds evolutionarily impressive, until you realise it’s functionally exhausting.

Then there is the matter of hormones, which, according to Dr Lau, act like a “volume dial” on the stress response. Oestrogen, in particular, modulates serotonin, meaning hormonal shifts – especially during a woman’s reproductive years – can create windows where stress hits harder.

How stress shows up as physical symptoms

In her clinical practice, Dr Lau often sees women’s bodies keeping the score with physical symptoms such as persistent jaw pain (TMJ) from clenching, chronic pelvic pain, digestive issues, and dermatological flare-ups like eczema or hives. She also points to symptoms that are often overlooked or misattributed: “brain fog”, which impairs the brain’s ability to think and regulate, and extreme lethargy, where even ample sleep doesn’t allay exhaustion.

“These are frequently dismissed as mere ‘busyness’ or poor sleep, when they are actually signs of dysfunction caused by chronic stress,” she says. In other words, it’s not just a bad week.

Unsurprisingly, stress affects fertility too. As Dr Lau explains, stress sends signals to the body that it’s not an ideal time to reproduce. As a result, the brain may dial down the hormones that regulate ovulation, sometimes leading to irregular cycles or even temporary pauses in menstruation. In short, the body prioritises survival, not reproduction.

“The reassuring part is that this kind of reproductive suppression is often reversible. With time – and support through lifestyle changes, therapy, or stress management strategies – many women see their cycles regulate and their fertility potential improve.”

How stress affects your heart

After a particularly stressful quarter at work, Jessica noticed a slight tightening in her chest whenever she breathed, which prompted her to visit a cardiologist. Once again, stress rears its ugly head, revealing a rather cosy relationship with another part of the body – the heart.

Dr Carolyn Lam Su Ping, senior consultant cardiologist at the National Heart Centre Singapore and a tenured professor at Duke-National University of Singapore, puts it simply: Stress is associated with the release of cortisol and adrenaline, and when sustained over time, it overloads the heart and contributes to high blood pressure. “And of course, if there is not enough blood feeding the heart itself, that can manifest as a heart attack.”

The link between long-term stress and cardiovascular disease risk is strong in both women and men. Stress-related symptoms even can mimic real heart disease. And distinguishing between the two is not a matter of feminine intuition or wellness literacy, but of actual investigation through procedures like an angiogram, along with checks for underlying conditions such as diabetes or high blood pressure.

Complication, too, comes in presentation, because women are less likely than men to exhibit the classic symptoms, such as chest pain. “Women can experience more atypical symptoms, such as jaw pain, non-specific pain, or even gum pain,” notes Dr Lam, recalling a patient who initially believed she had a dental issue when it was, in fact, cardiac. “Throat tightness and backaches can also happen, with pain always radiating to the left arm and chest.”

“More typical chest symptoms would still include breathlessness, chest pain, or symptoms on exertion. A change in your effort tolerance is also important, for example, going up the stairs suddenly becoming too much for you to handle. Do not just think you are unfit or blame other issues; check if it could be heart disease.

“Feeling faint, and especially actually fainting, are also dangerous signs. The rhythm of the heart may be off, or the heart may be so weak that it cannot pump enough blood to reach the head. There can also be an autonomic reaction, where the patient will really know something is wrong, because the pain is so intense that they want to vomit.”

Interestingly, Dr Lam also mentions something about the heart-mind connections being stronger in women. She points to Takotsubo cardiomyopathy, a condition discovered in Japan almost three decades ago by Dr Hikaru Sato.

The condition, also often referred to as “broken heart syndrome”, derives its name from an octopus trap due to the shape that the distressed heart takes. The numbers, too, are striking: middle-aged and older women are diagnosed up to 10 times more often than younger women or men of any age. Dr Lam notes that experts are still unable to pinpoint why women are more affected, but the condition can present like a typical heart attack.

“It is only when we do an angiogram that we find there are actually no blockages”, she adds. The root cause is very high stress, with patients experiencing symptoms like vomiting, dizziness or breathlessness.

Is it stress, or something else?

So how do you tell if your symptoms are caused by illness, disease, or… stress?

“When someone comes to me with physical symptoms, I pay close attention to how those symptoms show up in their life,” says Dr Lau. “If things like palpitations or shortness of breath mainly appear during periods of high anxiety and ease when the anxiety settles, they may be linked to mental health rather than a physical illness.

“But while stress can cause many things, we must never assume a symptom is ‘just stress’, until we have cleared the person of structural heart issues or systemic illnesses through blood work and diagnostic imaging. I will immediately involve a GP or cardiologist if a person reports persistent chest pains, unexplained fainting, significant unintentional weight loss, or gastrointestinal bleeding.”

Dr Lam agrees that while not everything is in the mind, the mind is not nothing too. The idea here is that care is concurrent, because according to Dr Lam, some antidepressants can cause arrhythmia, while semaglutide medication, like GLP-1, has been associated with psychological problems like depression.

She adds: “If patients need psychological help, such as coaching or psychiatric assessment, we should not shy away from that. It is as real as any risk factor.”

*Name has been changed for privacy