Women's Health with Evolve Feb 2023

From the best time for strength training, to a confidence high when you should schedule those important meetings, to when it’s key to focus on rest and fuel, this Women’s Health With Evolve column looks at the seasons of your cycle and how to work with them

Hands up if you approach “that time of the month” with a sense of dread, embarrassment and inconvenience? You are not alone. Polls show that a large majority of women are too ashamed to mention periods or talk openly about menstruation, which is why nicknames such as ‘Aunt Flo’ or “M” perpetuate adding to the stigma associated with menstruation. The taboo that exists around periods prevents people from knowing what's normal, seeking medical help when needed and feeling good about their own bodies.

What if we could change this narrative and embrace our period as an indicator of health and wellbeing? What if we could feel empowered through an understanding of the different menstrual cycle phases? What if we used period products that make us feel good, are functional and give us the confidence to tackle any activity?

Menstruation is a normal biological function and can offer a window into how our body is faring. The American College of Obstetricians and Gynecologists (ACOG) has proposed that the menstrual cycle be given status as the fifth vital sign, as important an indicator of essential bodily function as body temperature, pulse, respiratory rate and blood pressure. Periods, and in particular ovulation, are key measures of health and contribute significantly to wellbeing. Changes to your cycle and symptoms can be your body’s way of indicating that something is out of balance and may need further medical investigation. Stress, changes in diet or weight, over-training, under-fuelling, lifestyle factors or certain medication use can impact your menstrual cycle. Checking in regularly can help you identify when things are out of sync and analyse why so that you can take action.

Tuning in and understanding your period

A good starting point is an understanding of your menstrual cycle and the hormones involved in the reproductive process, and what you can expect. The menstrual cycle sets us biologically apart from males with its primary function being to prepare for reproduction. Oestrogen and progesterone are the main hormones involved in menstruation, however they also influence other body systems. Women have receptors for these hormones located all over the body, including in our muscles, heart, brain, digestive and respiratory systems, hence why we may notice symptoms at different times of our cycle—think headaches, nausea and sleep disruption—beyond just the uterus. Your menstrual cycle is happening all the time—the bleeding phase is just one part. 

The seasons of the menstrual cycle

One way to look at your cycle and start to understand what your body may be telling you is by likening it to seasons. Of course, everyone is unique and our cycles don’t neatly fall into four seasons of equal length, nor do all women experience the same symptoms or respond the same way to hormonal fluctuations. However, it can be helpful to learn what is happening and start to identify your personal pinch points.

Phase 1: "Winter"

The beginning of your cycle is the bleeding phase, when your uterus sheds its lining. We start counting the cycle from the first day of bleeding (day 1) and the winter phase usually extends to day seven. The hormones oestrogen and progesterone are at their lowest at this point, which can contribute to a variety of symptoms, including bloating, cramping and discomfort. Your immune system may be impacted so it can be worthwhile considering extra immune support and prioritising sleep, rest and nutrition.

If you experience more significant symptoms in this phase, particularly loss of your period (and you aren't on contraception), irregular cycles, pain that impacts your day-to-day function, very heavy bleeding or bleeding between cycles, seek help from your GP or gynaecologist.

Tips for "Winter"

  • Good period care: Use products that are good for your body and avoid synthetics which may aggravate your vulva and vagina such as Luuna’s natural products, reusable products such as Intimina's menstrual cups, or reusable period pants from brands including Kiri.
  • Keep moving: Motivation may be low but even gentle exercise, such as yoga or hiking, can help to relieve symptoms, improve circulation and mood, and help with sleep.

Phase 2: "Spring"

During this phase oestrogen is rising, which can have a positive effect on mood and wellbeing.  This hormonal boost may improve motivation to train, tackle difficult projects and take on tough challenges. Oestrogen also helps to build muscle and contributes to improved muscular recovery between workout sessions.

Tips for "Spring"

  • Maximise your strength training: This is a great time to push it at the gym, prioritise weight training or add in that extra run. You can likely manage with less recovery and add an extra session or two—just don’t forget to fuel properly.
  • Say yes with intention: The extra oestrogen can boost your energy, sociability and confidence. Some women move big meetings or deadlines to this phase, so if you have control over your diary, why not try?

Phase 3: "Summer"

Ovulation occurs at the midpoint in the cycle. Biologically, your body is fertile and looking for a partner to create a baby so at the beginning of this phase you may feel sexy, sociable and confident. Shortly after ovulation, progesterone becomes the dominant hormone and this can have a calming effect on mood, aiding stress management and promoting good sleep patterns, but it can also contribute to slower gut transit and cause constipation.

Tips for "Summer"

  • Endurance exercise: During this phase, studies have shown potential for improved endurance and this can be a great time to schedule longer training sessions.
  • Watch the heat: Progesterone can have a thermogenic effect, meaning your core body temperature rises, so pay particular attention to hydration and cooling strategies, particularly in the humidity.

Phase 4: "Autumn"

During this phase, if a pregnancy is not sustained, hormone levels drop. This sudden change can cause typical pre-menstrual symptoms such as anxiety, breast tenderness, skin imbalances or abdominal discomfort. In turn, this can affect mood, motivation and performance. 

Tips for "Autumn"

  • Slow down and cut yourself some slack: Say no to those extra commitments and focus on relaxation and self-care.
  • Prioritise rest: Sleep disturbances are common, so paying attention to good sleep hygiene and nightly routines can be helpful.
  • Food is fuel: Your calorie needs and cravings might be higher in this phase; listen to your body and ensure you are eating a nutrient-dense and balanced diet.

How to work with your period

The best way to learn more about your cycle and how you can harness its power is to track it. Take note of when you ovulate. Around this time, you should notice your basal body temperature rises (ideally check this first thing in the morning), your cervix is higher, and your discharge changes to a wet, stretchy and slippery consistency, much like raw egg white. You can track ovulation even when you are on certain types of contraception, such as an IUD where you may not have a period.

Record individual symptoms, such as energy level, activity, sleep quality, appetite, mood, breast tenderness and recovery. There will be some variability so it’s recommended to monitor your period for a minimum of three months in order to learn how you respond to each phase. You can then start to tailor your work schedule, exercise routines and social engagements to each phase. You may also start to notice if things are different, so you can identify any changes in your overall health and wellbeing early.

Being able to gauge how you may be feeling and why, and knowing what your body needs means that you can give yourself the self-care and compassion you deserve in the phases you are impacted more. Your menstrual cycle is your own internal feedback system. Learn to work with it.

Kym Toller is a women’s health physiotherapist at Joint Dynamics Evolve.

Front & Female’s Women’s Health with Evolve series is a collaboration with Joint Dynamics Evolve, Hong Kong’s first multidisciplinary women’s health clinic with services spanning physiotherapy, osteopathy, rehabilitation, personal training, nutrition and psychology. The series addresses all aspects of female health to support women at various life stages and open up the conversation around women's health topics, from the awkward to the unknown.

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