The Menstrual Cycle - Nutrition & Training

Introduction

Before I start this article I wanted to say that as a man, I have no idea what it feels like to go through the menstrual cycle. I see it as my responsibility as a man and male nutritionist and coach to learn, understand, support and empathise. This article is not meant to sound or come across as patronising and if any part does, I whole heartedly apologise.

Many women fear the onset of their cycle as it comes with discomfort, irritability, cramps, and cravings. A regular cycle is of course a sign that you are healthy, but if you’re a keen gym goer, it can make your training sessions much tougher to get through.

The constant fluctuations in hormone levels mean that everything from your energy levels and strength, to your appetite and mood, can change from one day to the next.

Being aware of how your cycle affects your endurance, strength and ability to tolerate exercise/training, allows you to take advantage of the many biological ‘windows of opportunity’ that are presented to you along the route of your monthly cycle. Knowing how to adapt your training sessions and nutrition can play an important role in fat loss, training/exercise performance and muscle building.

The menstrual cycle is something that ALL MEN should learn more about, especially male coaches who are coaching women, because then we can understand the unique challenges that women face during this month and not be dismissive of them.

The Menstrual Cycle

I wanted to start by giving an overview of the menstrual cycle. Now, it's very important to note that every woman is unique and what's considered a normal cycle one woman, will be very different for another therefore this is a very general overview of a typical 28 day cycle.

The Menstrual Cycle lies at the core of a woman's health and wellbeing. It is a cycle of hormonal fluctuations that occur roughly every month in women of reproductive age (from menarche to menopause) for the purpose of allowing reproduction.

Menstruation is a woman’s monthly bleeding, often called the “period.” When a woman menstruates, her body discards the monthly buildup of the lining of her uterus (womb). Menstrual blood and tissue flow from your uterus through the small opening in her cervix and pass out of your body through her vagina. During the monthly menstrual cycle, the uterus lining builds up to prepare for pregnancy. If she does not get pregnant, oestrogen and progesterone hormone levels begin falling. Very low levels of estrogen and progesterone tell your body to begin menstruation.

The Menstrual Cycle consists of three distinct phases, Follicular, Ovulation and Luteal and within those phases different hormones will fluctuate up and down, namely oestrogen, progesterone, testosterone and luteinising hormone.

From the above graph you can see how these hormones fluctuate during a typical 28 day cycle.

The Follicular Phase - Day 0-14

Menstrual bleeding begins during this phase and bleeding occurs because the egg that was released during the previous cycle was unfertilised and the lining of the uterus started to break down. Bleeding may occur for anything from 2-5 days.

During the early follicular phase, oestrogen and progesterone levels are both low, however the hypothalamic-pituitary axis (which acts as a control/messenger system) starts to signal an increase in follicle stimulating hormone (FSH). It does this to order the follicles of the ovaries to develop a mature egg in preparation of fertilisation. There is a steady increase in oestrogen from the ovaries – initially slowly, but production increases from day 7. It does this to help the lining of the uterus grow and thicken in anticipation of ovulation.

When oestrogen gets to a certain level, it triggers a sudden surge in another hypothalamic-pituitary hormone called luteinising hormone (LH). This sudden increase bursts the mature follicle, and in doing so it releases an egg for fertilisation.

Ovulation - Day 14

Between days 13-15 ovulation occurs. During this phase, the egg is transported towards the fallopian tube because of an increase in blood flow and connective tissue contraction. At this point, there is a small peak in oestrogen and at the same time progesterone begins to increase. Together, oestrogen and progesterone work to keep the lining of the uterus thick and healthy to maximise the chances of fertilisation. During the ovulatory phase, you’ll also find a small peak in testosterone, which can boost libido at the time when the potential for fertilisation of the egg is optimised.

The Luteal Phase - Day 15-28

This phase, otherwise referred to as premenstrual phase, or f**k the luteal phase (lol) is the gap between ovulation and bleeding. If the egg hasn’t been fertilised, the combined high levels of oestrogen and progesterone sends a message back to the hypothalamic-pituitary axis telling it to ease off. This means that no additional follicles mature and ovulate and the corpus luteum stops producing progesterone causing the lining of the uterus to ultimately degenerate, which results in bleeding.

How Your Menstrual Cycle Impacts Training

The female body changes a lot during the course of a cycle, where bodyweight fluctuations are common and body composition can look very different day to day and week to week.. It is important to stress that how each woman feels during their cycle will differ and understanding that is key as a woman, or a coach when it comes to programming in relation to training, making training adaptations and nutritional considerations. If you are a woman and reading this, you will know your body and how it impacts your training/exercise and you can make adaptations yourself if you don't have a coach.

Body Temperature

Changes in body temperature occur over the course of the 28 days. During the follicular phase, it tends to remain fairly stable. However post ovulation and with the increase in progesterone, body temperature rises and this can lead to feelings of being too hot, especially when training/exercising. This can be very evident in the luteal phase and you may also be more prone to dehydration due to increased sweating.

Some women find that they fatigue quicker than during the follicular phase, contrastingly some may find that they actually adapt well to the increased body temperature through decreased urination and increased perspiration. As you can see not every woman is the same.

Pain Tolerance

Women have excellent stamina and tend to have a muscle fibre distribution that favours endurance (higher amount of type I fibres and less type II). As a result of this you typically won't have the absolute strength of your male counterparts, but you can tolerate much higher sub maximal volume… and can recover much more efficiently between sets too.

Women are machine-like in their ability to tolerate pain, especially during the follicular phase. This can lead to favourable increases in strength and tolerance at high intensities. Ramping up total session volume and decreasing rest periods is a good way forward.

General Performance

Lots of research and from experience of coaching women throughout their cycle, the general consensus is that training is perceived to feel harder during the luteal phase, therefore it may be more challenging to maintain performance during the second half of the month.

How To Adapt & Optimise Performance

Firstly I think it is really important to stress that there is no blanket conclusive evidence that suggests that all women SHOULD do this, or all women should do that in regards to training alterations at different phases of their cycle.

However this doesn't mean that anecdotally some women may not have symptoms and experiences that mean that they might want to individually adjust their training during phases of their cycle. For example some women may struggle with creating intra abdominal pressure on the week of their period, therefore avoiding movements that require a lot of this would be prudent. Or some women may avoid heavy deadlifts after their period due to lower back pain.

The Follicular Phase

Some women may feel and perform better during the follicular phase as there is an increase in pain tolerance, normal body temperature, limited potential fatigue and the force-generating characteristics of your muscle fibres are at their highest. However you might find that your metabolic rate is slower here than in the post-ovulatory period, with some studies showing that your basal metabolic rate can be at its lowest around one week before ovulation.

During the late follicular phase, testosterone and oestrogen are both relatively high, whilst progesterone is still quite low. Testosterone, as we know, is an anabolic hormone that promotes strength. Oestrogen itself also has anti-catabolic properties that reduce muscle damage and promote recovery. Progesterone though is a catabolic hormone that can counteract the effects of both testosterone and oestrogen. This means you could be in a great place to really push yourself with strength work. The oestrogen to progesterone ratio is in your favour to make some excellent progress and you may feel strong.

Some research suggests that weight training in the follicular phase results in higher increases in muscle growth then in the luteal phase. This is more than likely due to higher circulating anabolic hormone levels.

The Luteal Phase

After ovulation you move into the luteal phase and your metabolic rate may increase, but strength will possibly begin to drop off, although there are one or two studies to suggest that it may remain high throughout the early luteal phase too.

In this phase, progesterone levels spike, meaning your response to strength training won’t be as high, but what you may lose in strength, you gain in endurance and your metabolic rate will be slightly higher than in the previous two weeks.

Body temperature begins to increase and pain tolerance isn’t as high, so you may not be hitting any PBs. You don’t have to stop strength training (and you shouldn’t), but just be aware that you might not feel as strong and your perception of how hard your sessions are will go up.

A good strategy here could be to reduce the intensity, not be so focused on beating your previous weeks numbers and introduce more lower-intensity weight training coupled with moderate-intensity cardio or circuit sessions. You could time it with a deload week or focus on endurance sessions with an emphasis on duration and not intensity.

Can I stress again that the above suggestions should be used as a skeleton upon which to adapt depending on how you, or the woman feels. You may feel stronger in certain phases or weeks during one monthly cycle and then it may be different the next time. Individual adaptation is key.

Impact Of the Menstrual Cycle on Nutrition

Introduction

I'm making an assumption here, but I strongly believe that most women know that their menstrual cycle changes the way they eat. They may crave very specific foods (oh hi chocolate) or just feel ravenous during certain weeks.

Many women recognise the change, but some experience a disconnect as to why their cycle changes their eating patterns and instead of seeing those eating changes as a normal part of their cycle, they may instead think of it as a personal shortcoming or lack of willpower. Maybe they feel it’s somehow their fault for not being disciplined enough, or maybe they feel guilty and beat themselves up for eating that extra piece of bread (or that whole Terry's chocolate orange).

However it is not that you or your women clients are weak or lack willpower. Hormones have a very real impact on how your bodies feel, what they crave, and how many calories you are eating. They change satiety levels which means that at times during your cycle, you will want and eat bigger meals.

As a woman it is important to understand that how you feel is completely normal and as a coach it is important to reinforce this with your clients and help her move away from the success/failure, good/bad and all or nothing narrative. It is a chance to help them understand why they are feeling as they are and empower them to make their own decisions without guilt or judgment.

Recommendations

Similar to how there are no blanket recommendations for training or training alterations, the same applies to nutrition. Research in this area is in its relative infancy and as always it's important for women to use anecdotal evidence as a basis for any changes they make as no two menstrual cycles are the same, both for one woman cycle to cycle and when comparing women.

Some research suggested that over the course of your cycle the body changes the way it uses stored energy, with carbs being the preferred energy source during the follicular phase and fats during the luteal phase, therefore matching carbs and fat requirements to those phases was suggested as a valid option. However much of this research is based on poor quality studies and is outdated.

What we do know is that at all times it is important to nourish your body in order to support good physical and mental health. This means eating wholesome and nutrient dense food (with some junk thrown in because it's tasty as fuck) as that will cover all your macro and micronutrient needs. Calorie and macronutrient needs will differ from woman to woman based on multiple factors, but the below is a general reccomendation

Calories needs - depends on you and your goals

Protein requirements - 1.2 to 2.2g/kg (0.6 to 1g/lb) of bodyweight

Fat requirements - 0.65* to 1g/kg (0.3* to 0.5g/lb)

Carb requirements - whatever is left from remaining calories

Fibre requirements - 30 to 40g per day

*this is the lowest I would take your dietary fats

Calories

You may be a woman who is currently in a fat loss phase and therefore you will be in a calorie deficit. This brings about an added challenge during your menstrual cycle. Due to the individual nature of how each woman feels on their cycle, you will be the best judge as to how to navigate this. Or you should communicate with your coach and come up with a plan of action. It could be that during the more challenging weeks energy wise, you or your coach bring your calories up to maintenance.

Women may actually need more calories during certain weeks regardless, due to an increase in metabolic rate.

Protein

Large, complex molecules made up of amino acids (AAS) of which there are 20 and like a car engine, play a vital role in how your body functions. They are important for antibody/enzyme formation, act as messengers coordinating biological processes, structure, function and regulation of tissues and organs. 9 of the 20 are essential and critical for health, which we must get from food. Foods that contain all 9 are known as complete protein and typically come from meat, eggs, poultry, fish, dairy, whey and tofu.

One of proteins prime functions is to repair damaged tissue, which occurs during the menstrual cycle. Consuming an adequate amount of protein during your cycle is important. Some research suggests that low protein intake (particularly H1F-1) can cause heavy menstrual bleeding as the web lining healing is impaired.

Complete protein is also important for consistent muscle protein synthesis and to ensure that you recover well from your training sessions. Protein is even more important if you are in a fat loss phase, as this will preserve muscle mass.

Carbohydrates

Carbs are the body and brains preferred source of energy. Don't fear carbs, they fuel your sessions and your sanity! Without a good amount of carbs training during your cycle will be more challenging. Anecdotally some women feel very strong at certain stages and that combined with carbs = strength gains and possible PBs.

It’s also important to honour your hunger and cravings at various points within your cycle, which may lead you to choose more carb based foods. As previously mentioned basal metabolic rate ramps up after ovulation and into the luteal phase and it is here where you may be having more cravings.

Fats

Dietary fats are equally as important, especially sources of omega 3 like salmon, mackerel, sardines, chia and flax seeds (more on omega 3 in particular in the supplement section)

Fat is as essential to your diet as protein and carbohydrates are in fueling your body with energy. Certain bodily functions also rely on the presence of fat. For example, some vitamins (A, D, E and K) require fat in order to dissolve into your bloodstream and provide nutrients.

Fat intake is vital for hormonal health, so you must ensure you are getting the minimum intake necessary for optimal health. Fat intake will aid in the production of cholesterol. Cholesterol (HDL) is the precursor to our sex hormones, testosterone, oestrogen and progesterone. If you are not receiving adequate fat and cholesterol (HDL) intake is low, you may experience hormonal imbalances impacting your health.

Fibre

Consuming an adequate amount of fibre is really important for digestive health. At times during your cycle you may feel like your digestion is not quite how it usually is, or you may be experiencing cramping or bloating. Again this is quite normal, but you can potentially aid this be making sure you are consuming enough fibre and include sources of natural pro and prebiotic foods such as kimchi, kefir, greek yoghurt, sauerkraut etc.

Overeating

If you are worried about overeating during your cycle, you could

- Eat slowly so that satiety has a chance to come into play. We have all been there on Xmas day when we have a massive plate of damn tasty food in front of us and wolf it down, but later feel over full. This is because we haven't given our body time to know when it's full.

- Try and sleep as much as you can as this will help with controlling your hunger hormones (leptin and ghrelin)

- Plan ahead and have wholesome snacks to hand - with this however it is important to know that if you do overeat it is absolutely fine and if you do want some junk food, EAT it.

These are just a few strategies that you can use to help with hunger and cravings.

If you body temperature is high, this is a sign that you may feel like eating more food. This is usually down to oestrogen dropping. Being aware of this will help you to understand why you may feel like eating more.

Weight Fluctuations During The Menstrual Cycle

Scale weight is going to fluctuate a lot during your cycle and a lot of this will be down to hormonal reasons and water retention. Water retention will impact women in different ways, but from working with women it tends to occur more frequently during the luteal phase when progesterone is high. However it can also occur pre ovulation too.

Water retention will obviously make you heavier on the scales (if you are regularly weighing yourself) This is nothing to be concerned about and usually once your period starts that water retention will go. It is important to not let higher scale readings impact you emotionally by remembering that that number is not just an indication of how much body fat you have. It is very common for men and women to base their self worth on that number, a number that measures your total mass including, muscle, fat, bone, organs, skin and water.

If you are currently in a fat loss phase then you may well be weighing in each day. A good strategy is to always use an average over 7 days rather than single figures in isolation as this gives you a more accurate representation of your progress, especially during a time when weight fluctuations are even more common place than usual. Any good coach will use this approach.

Another important strategy to use is not comparing a week on cycle to a week off cycle. Something I ask my female clients to do is highlight on the DHC daily tracker when their menstrual cycle is, then we we are assessing progress we compare week 1 of one cycle to week 1 of the following cycle.

Menstrual Irregularities

Dysmenorrhea

Dysmenorrhea, also known as painful periods or menstrual cramps, is pain during menstruation. It usually starts around the time that menstruation begins. Symptoms typically last less than three days, but can differ from woman to woman. The pain is usually in the pelvis and lower abdomen. Other symptoms may include back pain, diarrhoea or nausea.

Dysmenorrhea can occur without an underlying problem, but underlying issues that can cause dysmenorrhea include uterine fibroids, adenomyosis, and most commonly, endometriosis. It is more common among those with heavy periods, irregular periods and those who have a low body weight

Oligomenorrhea

Oligomenorrhea is a condition in which you have infrequent menstrual periods. It occurs in women of childbearing age. Some variation in menstruation is normal, but a woman who regularly goes more than 35 days without menstruating may be diagnosed with oligomenorrhea. Periods usually occur every 21 to 35 days. The diagnosis changes to oligomenorrhea after more than 90 days without a period.

Amenorrhea

Amenorrhea is the absence or cessation of your period. It is a very complicated hormonal disorder with a number of possible root causes. It is important that you are aware of this disorder as those that train regularly and intensely are at a much higher risk of their period stopping than non-trained women.

Primary amenorrhea refers to the absence of menarche – the first menstrual cycle. This means that periods don’t start by 16 years old, but normal maturation has developed.

Secondary amenorrhea refers to any woman that has experienced menarche but bleeding stops for three or more consecutive cycles.

Who's More Likely To Be At Risk?

Firstly, those that regularly participate in sports or exercise frequently are at a much higher risk of amenorrhea. Current statistics suggest that 69% of women athletes will experience a loss of cycle due to secondary amenorrhea at some point. This is in comparison to less than 5% for untrained women. Those that participate in sports that have an emphasis on low body fat/bodyweight such as physique, ballet, gymnastics and diving show highest incidences of all.

Rapid decreases in body weight and/or body fat seem to be the trigger for a loss of menstrual cycle. A low body mass index, in particular, seems to be a big risk factor and low body weight is typically caused by low energy intake – a calorie deficit that is too aggressive, causing a reduction in both fat and fat-free mass. There is also a strong link between disordered eating patterns/clinical eating disorders and amenorrhea.

When low bodyweight occurs, your hypothalamus doesn’t trigger the pituitary gland to release LH. If there’s no trigger from LH there’s no ovulation. This is what’s referred to as functional hypothalamic amenorrhea.

Reversing Hypothalamic Amenorrhea?

If you have suffered with the loss of your cycle, your number one priority when wanting to kickstart it is to increase energy intake. Low energy intake was more than likely the cause of secondary amenorrhea, focusing on upping your calories is a priority. You can also combine this with a reduction in physical activity and energy expenditure. If you do this correctly, your body weight and fat mass will begin to increase.

You should do this for an initial period of 2-4 weeks, or 6-8 weeks if you are an inexperienced athlete. Calories can be adjusted to suit, but a moderate calorie surplus works well.

Studies show that reducing training by just one session per week, coupled with an increase in calories by 200-350 can also have a kickstart effect on periods.

PMS

Introduction

Premenstrual syndrome (PMS) refers to changes in mood and emotions, physical health, and behaviour that:

develop between ovulation and the start of your period

last until a few days after your period begins

show up consistently each month

have some impact on everyday life and regular activities

PMS, contrary to what I have heard some people suggest, is a real condition and one that can have a very real impact on women's daily life and regular routine. Many women who are of reproductive age experience it and for many of them, the symptoms are severe enough to affect their regular routine and cause significant physical discomfort and emotional distress.

Symptoms

If you have PMS, you’ll experience symptoms consistently before each menstrual period. You might experience only some of the symptoms below, or several, but PMS typically involves at least a few different symptoms.

Emotional and behavioral symptoms

- PMS-related changes in your mood, emotions, and behavior might include:

anxiety, restlessness, or feeling on edge

- unusual anger and irritability

- changes in appetite, including increased food cravings, especially for sweets/chocolate

- changes in sleep patterns, including fatigue and trouble sleeping

- a sad or low mood, which might involve tearfulness or sudden, uncontrollable crying

- rapid shifts in mood and emotional outbursts

- decreased sex drive

- difficulty concentrating or remembering information

Physical symptoms

With PMS, you’ll likely also notice some physical symptoms, such as:

- abdominal bloating

- cramping

- sore and swollen breasts

- acne

- constipation

- diarrhoea

- headaches

- back and muscle pain

- unusual sensitivity to light or sound

- unusual clumsiness

What Causes PMS?

There is no firm reason as to what causes PMS, or why some women experience the symptoms more severely than others. However many experts in women's health believe PMS happens in response to changing levels of the hormones oestrogen and progesterone. As we have discussed these hormones naturally fluctuate throughout your menstrual cycle. During the luteal phase, which follows ovulation, hormones reach a peak and then decline rapidly, which may lead to anxiety, irritability, and other changes in mood.

It is also suggested that chemical changes in the brain can have an impact. The neurotransmitters serotonin and norepinephrine have several important functions in the body, including helping regulate mood, emotions, and behavior. These chemical messengers may also factor into symptoms of PMS. For example, a drop in oestrogen may prompt the release of norepinephrine, which leads to declining production of dopamine, acetylcholine, and serotonin. These changes can trigger sleep problems and lead to a low or depressed mood.

Supplements

Evidence based research in this area has yielded positive symptom relieving results in many women with PMS relating to various supplements.

Magnesium - lots of women who struggle with PMS and dysmenorrhea are deficient in magnesium. It’s a mineral that isn’t stored well in the body. Magnesium, when combined with B6 can alleviate some emotional and physical symptoms. Due to it being hard to get what you need from food, i recommended supplementing with a Bis-Glycinate chelate of magnesium.

Vitamin B6 - vital for many bodily functions (regulates metabolism, aids immune function) and can also relieve menstrual pain. Deficiency is not common, therefore a blood test is wise before starting to supplement.

Chasteberry (Vitex) - beneficial for physical symptoms such as cramps, headaches and breast pain. Could also aid psychological symptoms.

Other worthy mentions include Omega 3 (oily fish or a good EPA/DHA) supplement and adequate B12.

Bowel Movements

Bowel movements changes are quite common during the menstrual cycle and are commonly referred to as 'period poop'. A change in the consistency, frequency, and smell of your poo during your period is very common.

Frequency

Just before your period begins, the cells that make up the lining of your uterus, begin producing more prostaglandins. These chemicals stimulate the smooth muscles in your uterus to help it contract and shed its lining each month. If your body produces more prostaglandins than it needs, they’ll enter your bloodstream and have a similar effect on other smooth muscles in your body, like in your bowels. The result is more poo.

Constipation

Hormones can also cause constipation. Low levels of prostaglandins and high levels of progesterone can both slow digestion and make your poo go MIA. If you have regular period constipation, making sure you consume a good amount of fibre (as we spoke about before) in your diet, exercise, and drinking plenty of water can keep things moving.

In Summary

The Menstrual Cycle lies at the core of a woman's health and wellbeing and having a regular cycle is a sign of good health. It can however be a very challenging period both physically and mentally. For women who are passionate about training or exercise, it can mean having to adapt what you do, or in some cases skip sessions due to the discomfort caused.

Nutritionally you will also be challenged as it does change the way you eat. You may want to eat more, or crave certain foods. This is completely normal and doesn't make you undisciplined or lacking motivation if you find it hard to stick to any sort of nutritional plan or targets during this time. As a woman you will know best what your body is capable of and you must listen to it during that time relating to both training and nutrition.