Balance Festival talk highlights
This article was written by one of our regular contributors; female health writer – Kelly McNulty.
I didn’t really know health and wellness festivals were a thing, but when I was invited by Hazel Wallace to be a part of her panel ‘Working with your menstrual cycle’ alongside the wonderful Dr Anita Mitra (aka The Gynea Geek) and Renee McGregor at The Balance Festival, I was on the first train down to London. But, for those who couldn’t make it and have some serious FOMO, here’s a summary of what we discussed…
What is a ‘normal’ menstrual cycle with Dr Anita Mitra
“I genuinely thought a period was the contents of an egg cracking and being released through the vagina”.
Many people think that the length of the menstrual cycle is how long you bleed for, but this is a common misconception. Your cycle is actually the number of days from the start of one period until the start of the next. For example, day one is the first day of your period, and if you have a ‘textbook’ 28-day cycle then day 28 is the last day before your next period. But not all of us go by the book with only between 13 and 15% of women having a 28-day cycle, so anything between 21 and 35 days is ‘normal’.
Your menstrual cycle can be broken down into two main phases: 1) the follicular phase; and 2) the luteal phase. At the start of the follicular phase your uterus lining will be shed (aka your period) and this usually lasts around 3 to 8 days. At this point your hormones, oestrogen and progesterone, are low. Then, following your period oestrogen starts to rise and peaks just before ovulation. Ovulation refers to the release of an egg and marks the start of the luteal phase. After ovulation, both oestrogen and progesterone rise and reach a peak roughly 7 days post ovulation. Then, towards the end of the cycle, both hormones start to decline which means your uterus lining is no longer supported and the cycle begins again.
How can the menstrual cycle influence performance, training, and recovery with Kelly McNulty
“We have a pretty good guess that the changes in female sex hormones across the menstrual cycle have the potential to influence many physiological systems, which could translate into performance, training, recovery but right now we don’t have enough published, high-quality evidence to recommend general guidelines for practice”.
Whilst the main aim of the menstrual cycle is to support reproduction because we have hormone receptors for oestrogen and progesterone all over our bodies (i.e., in our muscles, in our brains, and in our gut) the fluctuations in these hormones across the menstrual cycle influence many other of our physiological systems (i.e., our cardiovascular system, our respiratory system, our metabolic system, and our muscular system). As such, they can subsequently affect things like performance, training, and recovery.
When it comes to performance, results from a recent systematic review and meta-analysis show that exercise performance might be slightly reduced in some women when oestrogen and progesterone are low, usually during days 1 to 5 of the menstrual cycle, compared with all other menstrual cycle phases. However, a large proportion of the studies included in this review were classified as “low” in quality and the effect of the menstrual cycle on performance was variable between studies. As such, when you add the small effect size, the poor quality of the research and the differences between studies together, general guidelines on performance across the menstrual cycle cannot, and should not, be formed and instead the focus should be on the individual.
When it comes to training (i.e., can we program certain training sessions across the menstrual cycle to maximise adaptation) and recovery there’s a lot less research, but the research that is available does suggest an effect (for more information see article ‘Strength training + the menstrual cycle’). However, at the moment we need to be cautious when applying this to our own training and recovery and again the best advice for now is to listen to your own body and do what’s best for you.
How to track your menstrual cycle with Anita Mitra
“I’m a massive fan of cycle tracking and love it when a patient tracks her cycle as it makes it so much easier for me to help”.
Whether you’re tracking for your general health and well-being or your sports performance and training, I recommend tracking using an app. The easiest way to start tracking is to record when your period starts and ends, and any symptoms experienced during this time. Additionally, some women might want to record symptoms (i.e., cramps, headaches, digestive upsets, breast pain, nausea etc.) that occur at other timepoints in their cycle. To add to this, you can record other physical and/or emotional changes to this data, such as any changes in sleep, energy levels, appetite, as well as changes in mood. Finally, women who are active might then want to add any changes in performance or training on certain days.
My period is out of whack/has totally disappeared with Renee McGregor
“Just like our menstrual cycle can impact how we perform in sports and exercise, how often, or how hard, we exercise, can impact our cycle. Additionally, if fuel intake from food is not adequate to support the daily energy expenditure (i.e., low energy availability) this can also impact your cycle”.
One of the most common causes of changes to cycles or missing cycles is functional hypothalamic amenorrhea. This refers to when the hypothalamus (i.e., the part of your brain that oversees the release of the sex hormones that control your cycle) prioritises other organs in your body by shutting down in times of stress, both physical and emotional. The common factors that might contribute to this include overtraining, under-fueling (intentionally or unintentionally), training in a fasted state, weight loss or having a low body weight, or restricting key macronutrients (such as carbohydrates).
You might be thinking ‘well it’s just my period and I don’t want children yet (or at all)’ but there are many health and performance effects of not having a regular cycle. For example, osteoporosis, heart disease, reduced immune function, increased injury risk and decreased performance or training response. Therefore, if you notice a change in your cycle then it’s always advised to seek medical help.
How is FHA diagnosed and how does someone go about getting their period back with Anita Mitra and Renee McGregor
“FHA is a diagnosis of exclusion which means we first must rule out any other medical causes”.
Firstly, and this might seem obvious, but we always check if you are pregnant first to rule this out. Next, because there are many other possible causes of missing periods and irregular cycles, such as PCOS, thyroid problems, premature menopause, and other medical conditions we must also rule these out. Then, if the above have been excluded, we can use the term FHA.
If you are diagnosed with FHA, then in most cases, the best way to go about getting your period back is to increase calorie intake and/or reduce training intensity and frequency – likely a combination of both. But the focus should be on yourself and your own individual needs. Often this will mean restoring weight or gaining some additional weight, if weight loss has occurred. Reducing stress where possible and optimising sleep is also very important. Additionally, working with an interdisciplinary team including a dietitian, medic, and psychologist is recommended.
Specific nutritional considerations for females when it comes to fuelling their sport/exercise with Renee McGregor
“Carbohydrates are friends not foe”
Recently, there has been an emphasis on fasted training to encourage optimal performance and adaptation, however what is often overlooked is that for females is that carbohydrate intake is important for optimal performance of the HPA axis which controls all the hormones within the body (i.e., the menstrual cycle). For this reason, fasted training is not ideal for women and should not be considered for those who have FHA. In reality, we should all be ensuring we intake carbohydrates around our training (even if that means having half a gel before we go out running first thing in the morning). In fact, one recent study shows that consuming glucose prior to and during performance reduces any potential negative effect of our hormones on metabolism during moderate intensity exercise (1).
As well as this we should be providing the body with protein at regular intervals post training, as well as essential fats to aid with recovery and inflammation. Finally, fruit and vegetables are essential for our micronutrient levels and dairy or non-dairy alternatives to support immune and bone health.
Renee McGregor: “Eat potatoes and please don’t ignore changes or cessation of your period”.
Anita Mitra: “Mine is a bit of an apology really. So many of you tell me that you have been dismissed or not listened to by a healthcare professional when it comes to a women’s health related issue, and I just want to say please do persist. I promise there’s someone out there who wants to hear and help you”.
Kelly McNulty: “In terms of performance and training we seem to have developed this messaging that women are weaker or slower in certain parts of our cycle, but women are always strong, fast and powerful and PB’s and world records have been set at every phase of the menstrual cycle”.
- Hulton, A. T., Malone, J. J., Campbell, I. T., & MacLaren, D. P. M. (2021). The effect of the menstrual cycle and hyperglycaemia on hormonal and metabolic responses during exercise. European Journal of Applied Physiology, 121(11), 2993-3003.