The impact of the hormonal fluctuations women encounter as a result of the menstrual cycle can bring about a variety of symptoms.
Only around 13% of women have what is considered to be a typical menstrual cycle and up to 83% of women experience premenstrual syndrome.
AXA Health Health and Wellbeing Programme Manager Sarah Kemp and Junior Physiologist Polly Smith share their top tips below on how your diet and exercise can make a difference and help you manage a menstrual cycle.
What is the menstrual cycle?
The menstrual cycle is a cycle of the production and release of the sex hormones oestrogen and progesterone, which is subject to large individual variation, so the menstrual cycle is different for everyone. A ‘typical’ cycle lasts anything from 21-35 days and the menstrual cycle is split into three phases: the follicular phase (from the first day of menstruation until ovulation), ovulation and the luteal phase 1. Let’s take a more detailed look into what these are.
The follicular phase (day 1-13)
Day one of your menstrual cycle, and the follicular phase, is marked by menstruation. This is the shedding of the uterine lining that has been thickening over the course of the month in preparation for an egg to implant into. If the egg is unfertilised i.e., we do not become pregnant, this layer is shed in the form of a period, which can last anything from 3-7 days. At the start of this phase, the hormones oestrogen and progesterone are at their lowest. You might feel more tired than usual during this phase and may experience cramps and reduced focus.
Ovulation (day 14-15)
In the middle of your cycle is ovulation, where the changes in hormones trigger an egg to be released from the ovaries. At ovulation, oestrogen is now high, whilst progesterone is still low. During ovulation, energy levels are typically a lot higher so it can be a great time to put those high energy levels to good use and have a great workout. This is the time to get creative.
The luteal phase (day 16-28)
The last phase of your cycle is the luteal phase and is characterised by both high oestrogen and surpassing high levels of progesterone. Pre-menstrual syndrome (PMS) symptoms are a very common feature of this phase and include cramps, headaches, mood swings, bloating, muscle aches and pains, fatigue and constipation just to name a few.
Nutritional considerations
Many women experience PMS, and it can be possible to manage some of the associated symptoms. Consider incorporating some of the below nutritional suggestions which could help you to manage your symptoms.
Iron
During menstruation, we lose on average 30ml of blood during a period, however this can vary from person to person. Iron plays an important role in the production of red blood cells and energy production as it delivers oxygen to our cells to allow for energy production. It’s important to be mindful of your iron consumption during your period, as deficiency can lead to fatigue.
There are two forms of dietary iron: Heme iron and non-heme iron. Heme iron is found in animal food sources and is easily absorbed by the body, whereas non-heme iron is found in plant-based food sources and is not as well absorbed by the body.
Some good sources of iron include beef, lamb, pork, chicken, liver, oysters, tuna, prawns, mackerel, salmon, chickpeas, kidney beans, tofu, figs, dates, almonds, brazil nuts, spinach, broccoli and peanut butter.
Tips to aid non-heme iron absorption:
- Consume an iron source with a source of vitamin C, e.g. cooking spinach with tomatoes or red pepper.
- Avoid consuming tea or coffee around mealtimes. Tannins, a type of chemical found in plants, may inhibit the absorption of the iron in your meal.
Cravings
It’s during the luteal phase that cravings tend to kick in. These vary from person to person, but tend to be for chocolate, sweets and salty foods. Whilst it is isn’t possible to offset our cravings, it can be useful to keep track of what food you typically crave in order to be able to recognise these as a normal part of your PMS symptoms.
Fibre
As mentioned, both oestrogen and progesterone are high during the luteal phase. Both hormones are positively associated with slower gastrointestinal motility, which can lead to constipation so it can be useful to increase your fibre intake to help move things along your gastrointestinal tract and prevent constipation. Great sources of fibre include wholegrains such as oats, bran cereal and quinoa, pulses and legumes such as kidney beans, chickpeas, peas, lentils and fruits and vegetables.
Exercise considerations
Your period may not be something you normally think of as having influence over your exercise regime, but our hormonal changes may in fact play their part. However, always remember that everyone is different, and research in this area is always growing, so it’s important to listen to your body and learn what works and what doesn’t for you.
Feel-good hormones
Endorphins are our feel-good hormones and it’s well established that exercise helps stimulate their production. This can be especially helpful if you’re perhaps feeling low due to your period. Not only can these hormones make you feel better, they can also positively impact your sleep too, so there’s no reason why your period should stop you doing your favourite workout. However, if you’re experiencing a particularly painful period, choose an exercise that suits how you feel, whether it be a gentle walk, some yoga or a swim.
Relax
It’s OK to feel the complete opposite and want to take some time out; we all experience things differently. Common PMS symptoms include fatigue, muscle aches, and cramps; for some women, it can really take its toll. It’s therefore important to listen to your body and give it what it needs. For some, that may be a relaxing bath, for others it may be a hot water bottle and some cosy pyjamas!
Ligament laxity
If you play sports or generally do a lot of high-impact activity, it’s worth knowing that during the pre-ovulatory phase, women can be at higher risk of ACL injuries. Your ACL (anterior cruciate ligament) is a major stabilising ligament in the knee joint, and if injured, can have severe impact on mobility and athletic performance. This risk may occur due to greater ligament laxity, meaning how loose it is. It’s therefore recommended to have a good understanding of your own cycle, and perhaps adjusting training schedules to minimise this risk. However, more research is needed in this area, so as mentioned previously, it’s not necessarily something that applies to everyone.
Temperature changes
During the mid-luteal phase of the menstrual cycle, it’s common for a woman’s body temperature to elevate. Research has reported a potentially negative affect on prolonged exercise performance through elevated body temperature and a potential higher strain on the cardiovascular system. For those who regularly partake in endurance sports, it’s worth considering adjusting your training schedules during this phase, particularly in hot, humid conditions.
Top tips
- Tracking your cycle and where you are at can be a really useful tool to understanding what is normal for you. There are lots of apps that you can use to log symptoms and periods to help you get a picture of your menstrual cycle.
- Listen to your body. Everyone reacts differently to their period and while some people may be able to carry on as usual, others get side effects that mean they need to some time out or make some changes to help ease them.
- Talk about it – letting someone know if you’re having a particularly bad time of things can really help to normalise it.
The menstrual cycle is a natural part of a woman’s life. Knowing how your body responds and managing symptoms can have positive effects on daily life.
1. Reed BG, Carr BR. The Normal Menstrual Cycle and the Control of Ovulation. In: Feingold KR, Anawalt B, Boyce A, et al., eds. Endotext. South Dartmouth (MA): MDText.com, Inc.; August 5, 2018.
2. Findlay RJ, et al. How the menstrual cycle and menstruation affect sporting performance: experiences and perceptions of elite female rugby players. BJSM (2020) 54, 1108-1113.
3. Armour M, et al. Australian female athlete perceptions of the challenges associated with training and competing when menstrual symptoms are present. Int J Sports Sci Coach (2020) 15(3), 316-323.
4. Magnay JL, et al. A systematic review of methods to measure menstrual blood loss. BMC Women’s Health (2018) 18(1),142.
5. McClung JP, et al. Female athletes: a population at risk of vitamin and mineral deficiencies affecting health and performance. J Trace Elem Med Biol (2014) 28(4), 388-392.
6. Beck KL, et al. Dietary determinants of and possible solutions to iron deficiency for young women living in industrialized countries: A review. Nutrients (2014) 6(9), 3747-3776.
7. Zijp IM, et al. Effect of tea and other dietary factors on iron absorption. Crit Rev Food Sci Nutr (2000) 40(5), 371-398.
8. Bronzi de Souza L, et al. Do food intake and food cravings change during the menstrual cycle of young women? Rev Bras Ginecol Obstet (2018) 40(11), 686-692.
9. McNulty KL, et al. The effects of menstrual cycle phase on exercise performance in eumenorrheic women: A systematic review and meta-analysis. Sports Med (2020); 10.1007/s40279-020-01319-3[published online ahead of print].
10. Raval CM, et al. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder among college students of Bhavnagar, Gujarat. J Psychiatry (2016) 58(2), 164-170.
11. Gorczyca AM, et al. Changes in macronutrient, micronutrient, and food group intakes throughout the menstrual cycle in healthy, premenopausal women. Eur J Nutr (2016) 55 (3), 1181-1188.
12. Judkins TC, et al. Stool frequency and form and gastrointestinal symptoms differ by day of the menstrual cycle in healthy adult women taking oral contraceptives: a prospective observational study. BMC Women’s Health (2020) 20(136).
13. Balachandar, V., et al. (2017) Effects of the menstrual cycle on lower-limb biomechanics, neuromuscular control, and anterior cruciate ligament injury risk: a systematic review. Muscles, ligaments and tendons journal, 7 (1) pp: 136-146.
14. Janse de Jonge, XA. (2003) Effect of the menstrual cycle on exercise performance. Sports Medicine, 33 (11) pp. 833-851.