Stress can definitely affect your mental health. For instance, you might find you can’t stop worrying or that you’re less interested in seeing friends. Maybe you struggle with stress management or find that stress makes it harder to concentrate. But you might be less conscious of the ways in which stress affects your physical health.

Sometimes, stress is actually more than just stress. Many of the physical symptoms of anxiety overlap with those of stress. Here’s how to tell whether you may have an anxiety disorder or whether it’s just stress. But even if your stress is temporary and doesn’t interfere too much with your day-to-day life, it can still take its toll on your body.

When you get stressed, your body issues a number of hormonal responses. The most commonly talked about stress hormone is cortisol. Cortisol is one of the hormones involved in your “fight or flight” response and is actually pretty necessary for survival. But chronic overexposure to cortisol can result in some adverse health effects — many of which are on this list. Stress also affects other hormonal systems: your growth hormones, hormones that direct your reproductive system, thyroid hormones and even insulin, for example. According to research, chronic stress may even become a precipitating factor to some endocrine disorders.

An increased heart rate is a well-known physiological response to stress. When you get stressed out, one of the hormones released is adrenaline. Adrenaline causes a temporary spike in heart rate, which is your body’s way of increasing the circulation of blood through your body in case you need it to react to a dangerous situation. Many stressful situations we encounter aren’t physically dangerous — but your body reacts as if they are.

Stress triggers many physiological reactions, one of which is muscle tension. This tension isn’t exclusive to any one muscle group — it affects the muscles in your chest and surrounding your lungs, as well. It may feel hard to breathe or you may experience a sudden shortness of breath. A calming breathing exercise may help.

This probably isn’t surprising to hear, but stress can put you in a really bad mood. People who experience stress are likely to experience irritability as a symptom. Instead of snapping at your coworkers or being rude some other way, it might be worth trying some stress management techniques to see if you can help mediate the issue.

Stress and anxiety are not the same thing. But stress can worsen any existing anxiety condition you have. Anxiety is a psychological disorder that should be diagnosed by a mental health professional. Stress is a feeling that can result in similar symptoms to mild anxiety. According to the Anxiety and Depression Association of America, tempering stress levels can be an effective tool for managing symptoms of anxiety.

Research has shown links between stress and depression. Scientists posit that this may be due to stress hormones or certain neurological responses in the brain. No matter the mechanism, limiting your stress could help to lower your risk of the mental health disorder.

Stress can trigger something called a tension headache, which can vary in severity depending on the person and the intensity of the stress. Episodic tension headaches can happen after a single stressful event, but some people experience chronic tension headaches from long-term endurance of stress. The physiological cause of the headaches can vary, but often they are triggered from tensed muscles in the head and back of the neck.

Stress can literally keep you up at night. And sleep deprivation causes a domino effect that can trigger other health consequences. According to the National Sleep Foundation, people with higher levels of stress tend to have poorer sleep quality. Stress hormones are at their highest during the evening, which is when you want to be primed for sleep. Too many stress hormones can interfere. Lack of sleep then causes an increase in stress hormones, which causes a further detriment to sleep — you see how this could quickly spiral.

It doesn’t matter how many brain-boosting study snacks you eat. If you’re stressed about an upcoming test, it could interfere with your ability to remember what you’re studying. According to a review of research published in EXCLI Journal, stress can result in a weaker verbal memory, reduced spatial memory, trouble accessing and creating new memories and even long-term memory disorders.

The effect stress has on your blood pressure is twofold. There’s a short-term spike in blood pressure as well as a long-term detrimental effect. In the short term, stress hormones cause a temporary increase in blood pressure. This spike is due to an increase in heart rate and narrowing of blood vessels. As for the long term, there’s no direct cause-and-effect relationship between stress and hypertension, but studies show that repeated spikes in blood pressure in the short term can increase the likelihood of high blood pressure in the long term. Additionally, coping mechanisms that people turn to during times of stress cause an increased risk of hypertension. These include smoking cigarettes, drinking alcohol and neglecting sleep.

Stroke is a leading cause of death in the United States, and there are many things you can do to prevent it. Limiting your stress could be a good place to start. Research shows a significant association between emotional stress and stroke risk.

The phrase “You almost just gave me a heart attack!” might be crass, but there’s a reason it exists. There really is a relationship between your emotional stress and risk of a heart attack. According to the American Institute of Stress, coping mechanisms associated with stress are significant risk factors for heart attacks, and heart attack incidents tend to spike after particularly stressful events such as natural disasters.

One of the hormones affected by stress is insulin. Researchers hypothesize that this may explain how diabetes and stress are so closely related. In fact, according to the American Diabetes Association, the stress-induced “fight or flight” hormonal response may not work as well in patients with diabetes. A study presented at the American Heart Association’s Scientific Sessions conference in 2018 showed that stress could increase the risk of Type 2 diabetes in women twofold. This may also be due in part to the sudden release of glucose that happens during a “fight or flight” response. If stressful episodes happen frequently, your body may not be able to keep up with the frequent spikes in blood sugar.

Stress can cause some serious upset in your stomach. Intense emotions triggered by stress can disrupt the usual flow of your digestive system, resulting in nausea, diarrhea, constipation, vomiting or stomachaches.

Food isn’t the only trigger for acid reflux. According to the American Institute of Stress, the sudden release of hormones alongside the heart rate increase and other changes increases your susceptibility to digestive distress. Stomach acid is released and can cause heartburn. Ouch!

It’s important to note that stress does not directly cause ulcers. Most often, bacteria in the stomach called H. pylori is the cause. However, the acidity changes that happen during periods of stress can increase your risk of an ulcer — or upset an existing one.

When you experience a stressful situation, your muscles tense up in order to protect themselves from potential injury. If the stress is short-term, your muscles relax again and it’s no big deal. But chronic stress can cause chronic tension, and chronic tension can result in muscle pain. Rather than relying on pain medicine, it’s best if you can treat the stress at the source to deal with these aches.

It’s not uncommon for people under significant stress to experience a lower sex drive. Hormonal shifts associated with stress may occur, as well. In men, there is a short-term increase in testosterone when under stress. If the stress becomes chronic, testosterone levels begin to decrease. Low testosterone can be a biological cause of a lower sex drive.

According to the American Institute of Stress, chronic stress can increase the risk of infection in male reproductive organs like the prostate and testes.

For women, stress can cause disruptions in the menstrual cycle. This can show up as irregular periods, heavier or more painful periods, or missed periods. It is believed that the disruptive effect of stress on menstruation is in large part due to cortisol that’s released when you get stressed out. The extra cortisol triggers a chain reaction in your hormones, impacting some hormones that play a large role in the female reproductive cycle.

Research is inconclusive as to which trigger comes first, stress or the symptoms menopause. But science is pretty clear that each exacerbates the other. In order to reduce the severity of menopause symptoms, it can be effective to try a few techniques in stress management.

In the short term, stress actually boosts your immune system. The “fight or flight” response triggers the immune system to act faster to heal any potential wounds. However, long-term effects of stress are more caustic. People who are under chronic stress have weaker immunity and are more susceptible to infections from viruses, including everything from the common cold to a serious illness.

Dealing with stress can be taxing on your energy levels. Some people even find they experience tiredness so severe it turns into fatigue that affects the body as well as the mind. According to research, there is a correlation between people who are stressed and people who feel fatigued. Stress is just one of many lifestyle factors that can drain your energy. These common habits could be why you’re always tired.

More from The Active Times:

15 Ways to Tell If You’re Suffering From an Anxiety Disorder

Mindfulness Tricks for When You’re Too Busy to Meditate

10 Pros and 10 Cons to Taking a DNA Test

15 Things That Happen When You Don’t Get Enough Sleep

35 Ways to Live a More Peaceful Life