The Basics Of The Menstrual Cycle
Stacey, thank you so much for chatting with me today. Welcome to the Bodies Built Better podcast.
Thanks for having me on opposite sides of the world today.
Well, I’m so excited to have you. You are changing women’s lives all over the world, you’ve made a huge impact on mine. Confession: I used to be one of those people who would train fasted. Oh my god. I know. And I’ve learned, obviously now. And surprise, surprise, I feel amazing. I’m much better. Hey now, who knew? You did?
Yeah, but you know, back in the day, I did the same thing because that was what we thought was right. It’s not right. So yeah.
So I thought we’d, um, we’d start with the basics because I still feel like when I chat to women, they think of their cycle as the time they bleed, and that’s it. So I thought we’d start there, lay the foundations of what our menstrual cycle is and what’s happening.
Sure. So I’ll describe it as if we’re looking at it in a textbook. Because we typically say that a textbook menstrual cycle is 28 days, with day one the first day bleeding, and day 28, the day before your next period. We know that women’s cycles can be anywhere from 25 to 40 days, and that’s normal. So when we look at what’s happening day one, the first day of bleeding, your oestrogen [and[ progesterone have dropped and you’re in your bleed phase, and oestrogen, progesterone stay low. Until around day 12 or 13 of that 28 day cycle and you have a surge of oestrogen right before ovulation. After ovulation, you have oestrogen and progesterone that slowly rise and their baseline in this phase, the luteal phase, is significantly higher than the first phase, the follicular phase. So oestrogen, progesterone rise, they peak, and then they drop off, and then you have your next period. So we’re looking at what’s happening. We have this perturbation of oestrogen, progesterone, it’s kind of flatline, peaks, tips off it, and then goes back up again before it drops off. And the whole goal of it is to create a really robust environment for pregnancy. But now we know that all of those hormones affect–all those hormones affect all the systems in the body.
When Your Menstrual Hormones Fall Out Of Balance
Yes, they do. So can you tell us, um, obviously, that is, if our hormones are at levels that they should be? What is happening, or what symptoms do we get when the hormones are, I guess, out of balance?
Well, when we look at things like oestrogen dominance, we have more sleep disorders, we have more inflammation, more bloating, we have a difficult time losing body fat, but we have a good amount of ability to put on lean mass. When we don’t have progesterone we have a lot of and while we have anovulatory cycles, and then you don’t have progesterone. When you don’t have progesterone, then your cycle significantly shortens. It’s called the luteal phase defect or progesterone insufficiency. So we’re looking at what happens when there’s an imbalance, we look at the length of the cycle, to see if there’s something going on, as well as the bleed pattern. Instead of always getting blood tests, we can keep track of what’s going on and say our bleed pattern goes from seven days where we have maybe two or three heavy days, and then it lightens up and then slowly you get spotting. So that might be your normal pattern. And then all of a sudden you have light days. So this is like what’s going on. And that’s an indication that you have anovulatory cycle or you don’t have a luteinizing pulse to create that ovulation. So you do have oestrogen and some progesterone that’s trying to do what it’s supposed to do, but not enough to actually create an endometrial lining that is available for pregnancy. And we see this in a lot of women who have, like, low energy availability, they’re not eating enough to support their training, they are delaying their eating, or they’re doing the fasted training. When we see things like a cycle that’s significantly lengthened, this is the next step. So you have the pattern changes. But then as you’re under a lot of stress, where you’re having more and more anovulatory cycles, your cycle will extend. And we say when you have three months of no bleed phase, that you are amenorrheaic. And they’re stuck patterns that you can see, when you are going down that track to getting hypothermic amenorrhea, or a secondary amenorrhea versus a bleed pattern changes, then you might not have as many PMS symptoms. So this is an indication that there’s something going on with these hormones.
What Happens When You Stop Getting Your Period
It’s so incredible that you just said that because I’m literally having a conversation with a client of mine who hasn’t had a period for three months.
Oh, no. So yeah, we know that. What happens when you have something like low energy availability to happen so much, and recreational athletes, you know, athletes, you know, I say you’re an athlete if you exercise on purpose. So when we look at recreational female athletes, and the diet trends, and the drive to either look a certain way, or follow certain strategies of nutrition or it’s just a busy lifestyle, and you don’t plan your nutrition appropriately. You stay in this breakdown state after exercise if you’re not eating or not eating enough, and your brain perceives that as not having enough calories to support general health as well as training stress. So what happens is things start to downturn, your thyroid starts to go down, start having a bit of that thyroid dysfunction, you’ll see a decrease in your serum levels of T3 and T4 and an increase in TSH because the thyroid is like, “Hey, what’s going on?” You’ll start to see irregularities in your menstrual cycle, like I was talking about, especially the bleed pattern. And it is because luteinizing hormone pulse is not pulsing so it’s flatlining. So you’re not ovulating. And it all has to do with two areas in the hypothalamus that have these neurons called kisspeptin. Kisspeptin, when it is on, it is responsible for oestrogen, it’s responsible for appetite hormones, it’s responsible for monitoring and having your daily rhythm of oestrogen progesterone pulses, luteinizing hormone pulse, it’s really, really intricately tied to the endocrine system. If you were in low energy availability, and we’re not eating enough, or staying in that long catabolic state because you forgot to eat, kisspeptin gets downturns in your endocrine cycle. So this is why we start to see these sleep pattern changes, we see lengthening in your menstrual cycle. And then you get to three months, you don’t cycle, it’s amenorrhea, because your hypothalamus is not working to actually create that luteinizing hormone to cause ovulation in a different system that’s working.
Training, Nutrition, And The Menstrual Cycle
And so then how do you reverse that? Is it about eating more and exercising less?
Yes, and no. And I say yes and no, because if it is the mentality of calories in, calories out, and I need to exercise, exercise, exercise, and I eat, then yes, definitely eat more exercise less. So when we look at a lot of other athletes, and I work with professional athletes who have to keep training, because they have a contract, right? Or we have women who just have a misstep, and they’re not eating enough, they’re not overly training, but they’re definitely not eating enough. And that tends to be the biggest pocket of women who aren’t eating enough because they’re following a clean diet, or they’re eating a lot of fruit and veg, and they’re too full to actually get what they need. Or they eat a big smoothie right after training. And then they have, you know, a big part of the day where they’re not eating food, because they’re still not hungry. All of this contributes to that low energy availability. So what we do is we look at the Delta, how do we change it. So if you are fueling for what you were doing, so not fasted training, and you’re making a point to eat after training, that’s the first step. Because that really stops the body from being in that breakdown state and signals to the brain, hey, we got nutrition. If we look at people who have been, in longer term, amenorrhea, and we need to get that luteinizing hormone pulse, we drop volume, we add a little bit of intensity. And we really focus on strength and strength development, because this works with the mental capacity of someone who’s always used to training, right? So we don’t take it away and say, No, you can’t train which tends to be like the go to if you go to a GP or something like that, we go, let’s reassess, we’re going to take this time, to periodized, making strong, we’re going to focus on strength, we’re not going to focus on cardiovascular work, and we’re not going to look on fuel depleting work, we’re going to specifically look at how we’re going to build strength and fuel for that lean mass and get body fat down, if that’s your goal. So there’s small strategies within that to make sure that we are, boom, really reducing the output and increasing the input without massive negative impact on body composition. Because that really messes over people’s heads.
Balancing Training With Mental Health
Yeah, well, that’s right, I was gonna say negative impact on the body composition, but also negative impact on our mental state as well, because especially if you’re someone who does train so much, and being told not to train, that just doesn’t work either.
Exactly. There is a colleague, friend of mine who wrote No Period, What Now? and she’s fantastic at addressing all of this, but the one thing that we don’t agree on is she tells everyone to absolutely stop doing all training, and increase your calorie intake to around 2500 calories. So if you’re in a severe state, and trying to get out of amenorrhea, because you’ve been in it for a while, then that is the way to go. But if you’re in the early stages, and you’re having these symptoms of low energy availability, we have these things that we can do to prevent you from getting into that severity. And then like I said, if you’re, have a contract or something and you can’t stop, then we have to reassess that. It’s not a blanket statement of “stop everything you’re doing and eat more.” It’s looking at the individual what their needs are, what the mental health aspect is, and working around that to bring those hormones back to put them in a positive energy state to get them healthy and still have that availability for mental and physical needs that so many of us have.
Exactly. That’s right. And you said in like the early stages compared to the severe stages, how, what are we talking in terms of–What is severe? How long have we not had the period that makes it severe?
Yeah, well, it can be that, that three months. But it can be something like a year, like if it’s three months, and you’re just new to amenorrhea. But your lifestyle is that there’s no way that we’re going to get those periods back unless we take a break, then that’s something to consider. But if you’ve been down that road, and it’s been a year or two, and you’re like, I don’t have my period, it’s not a big deal, then all of a sudden, you’re like, oh, my gosh, it is a big deal, what do I do? Then you’re almost too far down to really make a lot of these smaller changes that significantly look at the training volume, you’re still things to do. But we really have to assess that calorie and calorie out and volume of training, and make sure that we are addressing the nutrient needs first. And then we can look at putting training in to actually train for something.
How To Tell If You’re Losing Your Period
Is it something that just happens? Or, or are there symptoms, and signs that we can tell before, before we kind of lose the period? If that’s how you want to say it?
Yeah, for sure. A lot of people don’t realise that. gut issues, sleep issues, soft tissue injury, bone injury, like bone stress reactions, all of these are telling you that, hey, there’s something wrong, there’s not enough energy. Because when we look at those systems, they require a lot of creatine, they require a lot of glucose, just to maintain the integrity of things like the mucosal lining, to encourage bone turnover, to maintain gut integrity. So all of these things get degraded when there’s not enough energy coming in. So if you have someone who’s like, My training is not working for me, I don’t know what’s going on, I’m putting on body fat, I’m really tired. Maybe I need to change my training up. My first question to them is, how’s your gut? How’s your sleep? What’s your heart rate variability? Are you tracking, what’s your menstrual cycle bleed? Because then all of those things, like my head automatically goes to something like low energy available.
The Intersection Of Menstruation, Nutrition, and Sleep
And then we can be like, Okay, here’s the plan for the next six weeks, this is what we’re going to do, we’re going to stepwise increase calorie content. And this is why, and we really want to bookend your training with nutrition, some food before some food after looking at how you’re eating during the day. And if you feel like you need calorie restriction, because of body fat issues, then it’s a very small calorie restriction at the end of the day. So we just reassess the day, and a lot of women will fall into it not intentionally, because they are really super busy, you know, or they have kids that get them up in the middle of the night, really tired. And then they’re like, Oh, I forgot to eat or just coffee. So there’s a lot of lifestyle things that come into play that make women fall into this unintentionally.
Absolutely. I’m definitely one of those. I mean, exactly what you said before, you know, you train, have that big smoothie that keeps you going throughout the day, and then a little meal at night, and you think you’re good to go. And meanwhile, the worst sleep.
Yep, the worst sleep and one of the things that happens when you’re not eating enough is you have a lot of hypoglycemic incidences at night. So there’s small disturbances. So if you’re using something like the Fluke, or the Oura ring, or something like that, you might have 20 or 30 disturbances. So really poor sleep, because you’re falling into hypoglycemia. You haven’t been eating enough in the day.
Your Period And Birth Control Pills (It’s Not What You Think)
There you go. Huge, far. So the food is good, exactly. So what happens when we add The Pill to all of this?
This is interesting, because so many people don’t realise that when you’re on an oral contraceptive pill, you don’t have a period, you have a withdrawal. It’s not a true period. So you have the three weeks of active pills, and when you’re taking those pills, it down- regulates your own ovarian hormones. So you don’t produce your own natural hormones. You’re reliant on those external pills creating a hormone profile. And when you take the placebo pill, it’s a withdrawal bleed, meaning that those hormones are suddenly dropping, and you have a little bit of endometrial lining that’s not viable for pregnancy, but it’s still there, and it’s possible. So it’s not a true period because it’s not tied to your independent cycle, your endocrine system. And that placebo pill was put in there by the manufacturers and the inventors of the pill back in the 60s to make women feel like they were on a natural cycle. Well, if you talk to an endocrinonologist, or GP, they’re like, you can backup those pills, it doesn’t matter, you don’t need to have that bleed week. But when you look at it from a health and performance standpoint, it’s like, yeah, you do, because that’s when those hormones wash out and your body kind of has a break. So we look at training implementation on oral contraceptive pills, we look at recovery metrics, it’s completely different than a natural cycle.
I feel like we’ve been lied to, goodness.
I know. And so many young girls will get put on an oral contraceptive pill because of irregular periods, or bad skin anxiety, all these things, right. It’s the automatic response here to voc. But it doesn’t fix the problem. It doesn’t fix the symptoms, it masks everything. And then when you go off, and it’s still there, and younger girls don’t realise, and neither do their parents, that irregular cycle is absolutely 100% Normal.
In terms of performance, you just said that on the pill, there is major differences? So are we as women able to perform at our best or have the potential to perform even better if we don’t go on the pill?
So this is where it gets sticky, right? Yes, is the short answer. Definitely. I always tell people to get off the pill for a myriad of reasons. First and foremost is so we can keep track of that adaptation, if you stay at a low energy availability and that kind of stuff. But the other thing is, all the oral contraceptive pill formulations are kind of experimental, in their own right, and we see how they affect people. So say you have a woman who has a 30 microgram dose of estradiol and her friend’s on 20 micrograms of estradiol. And they’re doing the same training and they have the same morphology. The woman on the 30 gramme dose is going to increase her muscle mass, but not her strength. The woman on the 20 gramme, or microgram dose will increase her strength, but maybe not so much the muscle size, they’ll have the same strength, it’s just a 30 microgram dose increases lean mass hypertrophy, so the splitting of the muscle cells and the reparation, but it does not allow you to have subsequent strength increases with it. So those are some of the things to think about, like what is your sport? Are you more strength oriented and Olympic lifting, and you have to have a certain power-weight ratio, then definitely the pillar something to consider getting off. If you’re someone who has endometriosis, PCOS, or some other health reason to be on it, then absolutely stay on it. Right? There’s a rhyme and a reason for it. If we’re looking at people who are sprint oriented, so they’re doing a lot of sprint work, they might be Spartan athletes, they might be other obstacle racing, they might be high intensity, like CrossFit or whatever competitors, then yes, the pill does dampen your ability to hit those high intensities. So it’s something to think about. But if we look at taking people off the pill, and naturally cycling, we have to look at what is the training-training. Because if we are just doing traditional training on the menstrual cycle, natural menstrual cycle, you’re not optimising. So you probably won’t have that much of a difference between being on a COC and naturally cycling. When you come off the pill. And we start looking at your hormones and we start working according to how your body is resilient to stress, then yes, you get really good at a patient’s performance gains.
Training Optimally For Your Menstrual Cycle
Incredible. So where do we start building our knowledge around training optimally through our cycle?
The very first thing is to know your cycle, like track your cycle, understand your individual patterns, because yes, I can talk all day about the generalisations of a low hormone, you’re really resilient to stress, do high intensity work, and if you’re on the OCS the first five days, I really get into the nuances of generalisation. But if you don’t know that, on day 23 of your cycle, you always feel flat, you’re always going to be wondering what’s going on? Why can’t I do what I should be able to do? Or say you don’t know what heavy menstrual bleeding is, and you’re on, put on OC or no one’s told you that heavy menstrual bleeding is something that isn’t normal, and you can get help for it. Then if I tell you on the first day of leading into high intensity work because your body is able to and you’re like “Are you crazy? I can’t get out of bed because I have a really really heavy bleeding.: So understanding you and your cycle and maybe three months of tracking and understanding objectively what days are better days and others need to really, really dial in the generalisations to your own cycle.
The Simple Solution For Optimizing Nutrition And Training
incredible. And then from a nutrition standpoint, what are we more at? Simple, right, next?
Yeah, so in the nuances of nutrition, we know that women do better in a Fed state. And if you’re resistance trained, and that’s your main thing, is doing weight. But if you have around 90 calories of protein before resistance training, you actually enhance your signalling for adaptation and keep an elevation in your resting metabolic rate after because of that protein dose. Soon as you start adding cardio into that, it moves to the point. So it’s just resistance training. We look at the recovery window after training, women’s bodies come back down to metabolic baseline within an hour, whereas men are three to 18 hours depending on what they did. So we really have to fuel after training in order to stop that breakdown state and really start harnessing the signals for adaptations. So nutrient timing is super important for women, not so much from it. We look at, like, high hormone phase and luteal phase and people are like, “I feel really flat, I can’t do any high intensity.” Their bodies kind of have a switch when oestrogen and progesterone come up, because all the stuff that we’re taking in with regards to carbohydrate, fat protein, it’s primarily been broken down, shuttled to the endometrial lining, because the job of these hormones, again, is to create this really robust environment for implanting an egg. So we need to increase the amount of carbohydrate they’re eating throughout that phase, just daily carbohydrate intake, because that allows us to have more carbohydrate availability for intensity work or the training that we’re doing. And protein, again, is super important. We look at the range of protein between 1.8 and 2.2 grammes per kilo, you want to go for the higher end, and have it regularly spaced through your meals in that high hormone. There’s just small nuances that really support what you’re trying to do, and support your body and it’s signalling for adaptation.
Yeah, huge. And you said, just to clarify, it’s the second half of our phase where the hormones are high. And that’s when we need to be increasing our protein and carbohydrate intake. Yep.
Yep. And our resting metabolism comes up. Because the body is in a high energetic state. It’s building tissue, it needs building blocks. So women are like, I don’t want to eat more, because I’m going to put weight on it’s like, no, actually, you’re craving things because your body needs calories. You’re craving chocolate, because you need magnesium, you’re craving salty things because you’re having a boost in blood volume. And your body’s building this tissue. So these are the things that we need. So when women are like, “Oh, I feel bad, because I gave it to my cravings.” It’s like, “Oh, that’s good.” Because your metabolism is elevated, you need around another 100 to 200 calories a day in that high hormone.
And I mean, it’s as simple as listening to your body.
Exactly. Yeah. I know. But we’ve all been so conditioned to you know, like, there’s no difference. It’s all in your head. It’s a woman’s thing. It’s PMS. It’s that time of the month, which is the own narrative. But when you take a step back, and you actually listen, and you’re intuitive about it, and then you have objective data from tracking stuff, it all makes you think, yeah, okay. That’s why I can go really super hard on that day, because I’m on day five and my menstrual cycle. Oh, that’s why I need four calories. And I’m hungry, because I’m on day 23 of my menstrual cycle, my metabolism. So it really starts to make sense. You get all of this together, and you’re like, oh, there’s me. I see it. And it’s good.
Where To Find Dr. Stacy Sims
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