Nutrition for Menstruating and Active Women (Athletes): There’s a "cycle" way around them!
A woman's menstrual cycle (aka period) varies from woman to woman and there are factors which can affect this cycle; these include; body fat percentage, stress levels, polycystic ovary syndrome (PCOS) and contraception. Typically, a woman’s period can begin aged 12-18 and occurs up to age 45-50, each cycle lasting around 21-36 days; on average 28 days. Throughout the menstrual cycle, the body undergoes significant hormonal fluctuations which can impact not only reproductive health but also overall health & wellbeing. The average woman has an average of 400 periods in a lifetime, - that’s a lot! Therefore, the cycle will also have the potential to impact nutrition and training-related factors on a regular basis. These impacts include appetite, metabolic rate and strength.
It is important to understand a woman’s menstrual cycle in order to make the most of progress in training and nutrition.
The menstrual cycle is divided into 4 phases:
The first stage of the cycle, when the period begins, lasts approximately 5 days for most women.
This phase starts when an egg from the previous cycle is not fertilised. The hormone levels of estrogen and progesterone drop due to no pregnancy. A thickened lining of the uterus is not needed to support a pregnancy, therefore it begins to shed through the vagina. A combination of blood, mucus and tissues is released from the uterus during menstruation.
Often women experience menstrual symptoms such as; cramps, headaches, tiredness, bloating, tender breasts, mood swings, irritability and lower back pain.
Training nutrition tips during this phase
Typically, women feel quite low and depleted of energy around the first three days of the period, this is the phase where most feel they need a rest in their cycle. However, this may not always be necessary. Body temperature, metabolic rate and insulin sensitivity are at normal levels during this phase, therefore, training can resume as normal, so long as it is comfortable to do so. Any movement of the body will improve any low feelings in mood even if it is a 20 minutes' walk.
Appetite is generally lower in this phase, so if you’re considering diet changes this is the best phase to begin your diet plan.
During menstruation, you will be losing a lot of blood, so ensure your diet is rich in iron to replace the lost iron via blood to avoid iron deficiencies. Vitamin C is a precursor of iron, this means when consumed with iron, it helps iron to be better absorbed in the body, therefore, it is important to include that with iron-rich foods.
Food sources of iron: Red meat, liver, red kidney beans, chickpeas, dried apricots.
Food sources of vitamin C: citrus fruits (e.g. oranges, grapefruit, kiwis and lemon), bell peppers, strawberries, cruciferous vegetables (e.g. broccoli, brussel sprouts, cabbage, cauliflower).
This phase begins from the day menstruation starts to ovulation day. The first approximate 5 days make up the menstruation phase.
The follicular phase is the duration of when the follicles mature in the ovaries; it lasts approximately 14 days.
The hypothalamus sends a signal to the pituitary gland to release follicle-stimulating hormone (FSH). The ovaries become stimulated to produce 5-20 small sacs known as follicles. Each follicle carries an immature egg. Only the healthiest egg will eventually mature, the rest are absorbed into the body. This maturing of follicles set off a surge in estrogen which thickens the lining of the uterus, creating a nutrient-rich environment for an embryo to grow.
On average the follicular phase lasts for approximately 16 days, depending on each cycle, it can range from 11-27 days.
Training/ nutrition tips during this phase
Testosterone levels are highest at this stage, so making the most of your training and pushing for your hardest at this stage is advised for potential increased muscle gains (sung et al., 2014) and strength (Wikstrom-Frisen et al., 2017). This is the best time to hit those personal bests, lift your heaviest, and include your most intense workouts in this phase!
Research shows women feel strongest at this phase and can tolerate the most volume in training, hence making the most gains.
Furthermore, metabolic rate during this phase is lower (Solomon et al., 1982), as a consequence of this, energy expenditure is lower at rest than normal, this shouldn’t be an issue, but taking full advantage of the potential for increased endurance and strength is highly recommended at this phase.
During this phase and menstruation phase, the body utilises carbohydrates as an energy source and the body has low calorie needs. If you make the most of the high intensity and heavy lifting in this phase then, as always, remember to support the volume of training with a diet rich in protein, protein is essential for the growth and repair of our working muscle cells, rich sources of protein include; fish, poultry, lean meats, eggs, beans, lentils, tofu and pulses, with the latest nutritional research suggesting plant based proteins are the healthiest for the body.
Also as always vegetables are a must! They provide the body with important vitamins, minerals and powerful antioxidants which help strengthen the body’s immunity and aid with normal body/ hormone functions.
The ovaries release a mature egg which becomes available for fertilisation by sperm.
Estrogen and luteinizing hormone (LH) reach their peak on ovulation day, testosterone is also high around this time, the body temperature increases as progesterone also increases.
The Pituitary gland is triggered to release luteinizing hormone (LH) by the rising levels of estrogen. This kick starts the ovulation process. Ovulation is the release of a mature egg from the ovaries; the egg travels via the fallopian tube toward the uterus; ready to be fertilised by sperm.
Training/ nutrition tips during this phase
Just like the follicular phase, this is the phase of the cycle where mood is at its peak. The day of ovulation may be a good time to perform maximum strength exercises. Hormonal fluctuations take place as you approach ovulation, and estrogen increases (Herzberg et al., 2017), this may increase risk of injury which can be avoided by ensuring you perform adequate warm-ups and cool-downs pre, and post intense workouts.
Again, like in the follicular phase, supporting your training with a good balanced diet which includes rich sources of protein will help with training progress.
This phase begins a day after ovulation until the day menstruation begins again. In this phase, the lining of the uterus begins to thicken in preparation for a possible pregnancy. Estrogen and progesterone levels drop in this stage.
After the release of the egg, the follicle changes into corpus luteum. This environment allows for the release of hormones such as progesterone and estrogen which maintain the thickening lining of the uterus to be ready for a fertilised egg to implant. If pregnancy is successful the body produces human chorionic gonadotropin (hCG) - the hormone which helps maintain the corpus luteum; uterine lining thickness and is the hormone which is detected in pregnancy tests.
If pregnancy doesn’t happen, the corpus luteum will shrink away and become reabsorbed, leading to reduced levels of the hormones estrogen and progesterone, leading onto the onset of a woman’s period where the lining of the uterus is shed.
Furthermore, PMS symptoms can also be experienced. PMS is an abbreviation for Premenstrual Syndrome and is a range of symptoms experienced by women 1 to 2 weeks before menstruation, at the luteal phase. Symptoms vary and can include mood swings, headaches, bloating, irritability, breast tenderness and increased appetite, carbs & alcohol cravings.
Training/ nutrition tips during this phase:
The effects of the menstrual cycle, specifically around the later stage of the luteal phase, can have on physical activity routines, especially in female athletes. There are ways to alleviate some of the effects:
● Sufficient intake of Vitamin D and calcium are associated with reduced PMS. (Bertone-Johnson et al., 2005)
○ Good food sources of both: milk/ plant-based milk and yogurt/ plant-based yogurt, mackerel, salmon, tuna, mushrooms, some fortified fat spreads such as margarine and some breakfast cereals.
● Magnesium can reduce the effects of PMS by approximately 33% (Quaranta et al., 2007)
○ Food Sources include green vegetables and wholegrain breakfast cereals.
● B vitamins such as thiamine and riboflavin can significantly reduce PMS by 35% (Chocano-Bedoya , et al 2011) .
○ Food sources: meat, liver, milk and dairy products, seafood, poultry, eggs, legumes, leafy greens, seeds & fortified foods such as breakfast cereals and yeast.
In the luteal phase, women often feel tired and lethargic; a workout which felt strong in the follicular phase may not feel as strong in this phase. It is still recommended to participate in exercise as there are always benefits and it will definitely improve mood and health even if it is not the strongest workout done!
Participating in low impact exercises/ light cardio is recommended such as yoga, swimming, light cycling or going for light-brisk walks. If you can manage more, then go for it!
In this phase, generally, women experience an increase in appetite, many crave carbohydrate rich foods. In this phase your body utilises fats as a source of energy, and burns calories at a higher rate. Ensure you have healthy snacks prepared to avoid overindulging in unhealthy snacking, as always; everything’s good in moderation, however being prepared with a range of healthy snack options might help you opt for those options as well and the treats, hence reducing over-doing the unhealthy snacks, balance always!
Examples of healthy starchy snacks include: carrot sticks and hummus, roasted corn, rice cakes with peanut butter, green apple and peanut butter drizzle.
Every woman’s body is different! Women's bodies undergo a fluctuation of hormones throughout each month and this has an effect on mood and strength.
Please note, this is a general guideline, don’t feel you have to follow it religiously, you may feel you can do less/ more, and if so, then go for it! Do not be hard on yourself if you feel your training is not as good as it is certain times of the month, understanding your body and how it reacts at certain times of the month is key! It is going to be useful to use that knowledge in planning your workouts and setting your expectations. Regardless of which phase you are on in your menstrual cycle, moving your body in any way will definitely have a positive impact on your health and mood versus not moving at all. As always, supporting that movement with the correct nutrition is as important as moving, learning how our body works will help us in understanding what it needs and this helps us plan good meals and a good workout!
The main ideas around supporting your menstrual cycle are:
● To consuming nutrient-dense foods
● Gut-healthy foods
● Including self-care practices such as taking time out to relax and unwind, participating in activities
● Adequate sleep/ rest
● Exercise / positive body movement
Rule of thumb: failing to plan is planning to fail! Remember, your diet is not about depriving, so treat-size treats are a real treat! So long as they are not a feast.
Finally, if you have any concerns regarding your menstrual cycle’s health do not hesitate to consult your health physician/ doctor!
Bertone-Johnson ER., et al 2005. Calcium and vitamin D intake and risk of incident premenstrual syndrome. https://pubmed.ncbi.nlm.nih.gov/15956003/
Chocano-Bedoya PO., et al 2011. Dietary B vitamin intake and incident premenstrual syndrome. https://academic.oup.com/ajcn/article/93/5/1080/4597745
Quaranta S., et al 2007.
Pilot study of the efficacy and safety of a modified-release magnesium 250 mg tablet (Sincromag) for the treatment of premenstrual syndrome https://link.springer.com/article/10.2165/00044011-200727010-00004
Solomon et al., 1982. https://pubmed.ncbi.nlm.nih.gov/7124662/
Sung E, Han A, Hinrichs T, Vorgerd M, Manchado C, Platen P. (2014). Effects of follicular versus luteal phase-based strength training in young women. https://springerplus.springeropen.com/articles/10.1186/2193-1801-3-668
Wikström-Frisén L, Boraxbekk CJ, Henriksson-Larsén K. (2017)
Effects on power, strength and lean body mass of menstrual/oral contraceptive cycle based resistance training. https://pubmed.ncbi.nlm.nih.gov/26558833/