Eleven studies met criteria for being considered high quality, with nine studies indicating that rates of completed or attempted suicide were highest during menstruation and two studies indicating these rates were highest premenstrually. – Handy, Ariel B et al. “Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review.” 

This startling revelation appears in an article published in the April 2022 edition of the Harvard Review of Psychiatry.

Notably, the study continues to connect specific phases of the menstrual cycle to psychosis, mania, depression, binge eating, and alcohol abuse – comorbidities rarely seen outside of severe psychiatric disorders.

Challenging the conventional view of the menstrual cycle as a mere monthly inconvenience, this research reveals hormonal fluctuations as complex physiological processes with a profound (and potentially deadly) impact on female physical and mental health – an impact that extends far beyond the commonly understood symptoms of premenstrual syndrome, or PMS.

The Need for Cycle-Aware Healthcare

For healthcare providers, this research underscores the necessity of a more nuanced, cycle-aware approach to women’s health that recognizes and leverages hormonal rhythms to enhance overall wellness and potentially mitigate serious health risks.

The statistics paint a compelling picture: menstruating individuals comprise approximately 26% of the global population, ranging from about 12 to 55 years old. Over their lifetime, women experience an average of 450 periods, which translates to roughly 3,500 days or seven years of menstruation. With over 90% of women experiencing premenstrual syndrome (PMS), it’s clear that addressing the health needs of this demographic is paramount.

These figures emphasize the urgent need to address the health needs of women throughout their reproductive years, not just during menopausal transitions or when dealing with fertility issues. However, in today’s digital age, many women find themselves navigating this complex landscape alone, often turning to the internet as their primary resource for health information.

The Digital Health Dilemma and the Role of Functional Medicine

In their quest for understanding and validation, women seek answers in online forums, follow wellness influencers, and attempt self-diagnosis. While some fortunate individuals stumble upon credible resources, others succumb to misinformation or relentless targeted advertising.

This digital Wild West of health information often leaves women feeling overwhelmed and unsure of how to truly optimize their health in harmony with their natural cycles.

Enter the functional medicine practitioner – uniquely positioned to serve as comprehensive patient resources, capable of identifying root causes of disease, explaining ‘unexplainable’ symptoms, and harmonizing biological systems for whole-person wellness. Their holistic approach is particularly well-suited to addressing the complex interplay of hormones throughout the menstrual cycle.

The Rising Tide Of Cycle Awareness

Emerging social media and digital wellness trends indicate a growing awareness of the unique and influential nature of menstrual cycle-related hormonal fluctuations. Practices such as seed cycling, yin yoga, and cycle-specific supplements are gaining popularity. At the forefront of this movement is cycle syncing – a method that aligns exercise, nutrition, and overall lifestyle with the natural rhythm of the menstrual cycle to reduce symptoms, optimize performance, and improve overall wellbeing.

OB/GYN at New York Presbyterian/Columbia University Irving Medical Center Dr. Hoosna Haque, a prominent expert in the field, explains: “Although cycle syncing has not been formally studied, it makes sense that paying attention to how hormonal fluctuations throughout your menstrual cycle affect your mood, appetite, and energy levels can help you be more in tune with your body. Adjusting nutrition and exercise to match phases in your cycle may optimize how you feel and perform.”

Breaking Down The Four-Phase Cycle

To truly leverage the potential of cyclic hormonal shifts, it’s crucial to understand the intricacies of the menstrual cycle itself.

The average menstrual cycle lasts about 28 days, though it can range from 21 to 35 days. It consists of four distinct phases: menstruation, the follicular phase, ovulation, and the luteal phase. Each phase brings a host of symptoms – both pleasant and unpleasant – and important considerations for overall health and wellbeing.

The Functional Guide To Cycle-Based Care

By comprehending these distinct phases and their individual characteristics, practitioners can provide tailored, efficient support that caters to women’s specific requirements throughout their menstrual journey. This strategy not only aids in symptom management but also capitalizes on the inherent advantages of each stage to enhance overall wellbeing and maximize physical and mental performance, empowering women to feel more in control and confident about their health.

Menstruation
Timing: Days 1-5

Hormonal Context: Estrogen and progesterone drop significantly.

Common Symptoms: Menstruation typically brings a host of physical and emotional symptoms. Common experiences include abdominal cramps, bloating, mood swings, irritability, headaches, fatigue, lower back pain, digestive issues, and nausea.

Atypical Manifestations: Some women may also encounter hot flashes, night sweats, easy bruising, herpes virus outbreaks, worsening allergy symptoms, lightheadedness, tinnitus, sore throat, pain outside the pelvic region, and mouth or gum pain.

In rare but not anomalous instances, women may experience disordered eating, self-harming behaviors, suicidal thoughts, post-traumatic stress disorder flare-ups, addictive behaviors, and, in rare cases, psychotic symptoms.

Optimizing The Menstrual Phase
Recommendations

Nutrition:

Dietary choices can play a crucial role in managing menstrual symptoms. Patients should be advised to increase their intake of iron-rich foods to combat blood loss. Recommended sources include red meat, seafood, iron-enriched cereals, dried fruits, nuts, legumes, beans, and green leafy vegetables. To enhance iron absorption, they can pair these foods with vitamin C sources. Foods high in zinc can aid tissue repair, while omega-3 fatty acids found in salmon, flax seeds, and walnuts may help reduce menstrual cramping. Drinking stinging nettle tea and increasing water intake can further support wellbeing during this phase.

Exercise: During menstruation, focusing on lower-impact exercises is generally advisable. Yoga and pilates can be especially effective in alleviating cramps and improving mood. Light cardio activities such as walking or hiking can help maintain energy levels without overexertion. Incorporating stretching and light weight training can also be advantageous, with the intensity adapted to individual comfort levels. These gentler forms of exercise can help manage symptoms while maintaining physical activity during menstruation.

Wellbeing: Prioritizing rest is crucial during menstruation. Suggesting low-key activities, such as a movie night instead of a night out dancing, can help manage energy levels. Stress-reduction techniques like breathing exercises, mindfulness, meditation, or journaling can be recommended as additional mental health support.

The Follicular Phase
Timing: Days 1 to 14

Hormonal Context: During the follicular phase, follicle-stimulating hormone (FSH) is released, estradiol levels rise, serotonin increases, and progesterone remains stable and low.

Common Symptoms: Besides menstrual symptoms, the follicular phase often brings a welcome shift in mood and energy levels, increasing productivity and motivation and enhancing creativity. Clearer skin, increased strength, and extended endurance are also common.

Atypical Manifestations: Some women may experience spotting or breakthrough bleeding, shortened follicular phases (particularly in younger patients), nausea, headaches, irritability, anxiety, and sudden onset of fatigue. Interestingly, some women report PMS-like symptoms before ovulation, including worsening of mood and depression. These pre-ovulation symptoms can be unexpected and may be mistaken for early PMS.

Optimizing The Follicular Phase
Recommendations

Nutrition: As the body transitions from menstruation, maintaining an iron-rich diet remains important alongside incorporating lean proteins and complex carbohydrates, such as chicken, fish, brown rice, and quinoa, to support increasing energy levels. Cruciferous vegetables like broccoli, cabbage, and cauliflower can help balance rising estrogen levels. Drinking dandelion herbal tea can support estrogen detoxification and liver function.

Exercise: Patients can be encouraged to engage in more high-impact activities during this phase. Many women find they have increased energy and stamina, making it ideal for activities like running, swimming, or cycling. It’s also a great time to focus on strength and high-intensity interval training (HIIT). Advising patients to aim for mid-day workout timing can help align with natural energy peaks.

Wellbeing: The increased energy and creativity of the follicular phase make it an ideal time for socializing and tackling challenging tasks. However, avoiding overexertion is important as the body is still recovering from menstruation. As moods and energy levels may shift throughout the month, grounding and mindfulness practices are highly recommended in each phase.

Ovulation
Timing: Days 14-17

Hormonal Context: During ovulation, estrogen peaks, luteinizing hormone is released, testosterone rises, and serotonin increases.

Common Symptoms: Ovulation is characterized by increased happiness and mood, enhanced attractiveness and sexual desirability, heightened energy levels, improved sociability and confidence, and a slight rise in basal body temperature. Some women may experience a brief low mood coinciding with the post-ovulation estrogen drop.

Atypical Manifestations: While less prevalent, some patients may experience mittelschmerz (ovulation pain), light spotting, heightened sense of smell, increased skin sensitivity, or changes in appetite. In rare cases, ovulation may trigger migraine headaches, particularly in women with a history of migraines. Temporary vision changes or light sensitivity have also been reported.

Optimizing The Ovulatory Phase
Recommendations

Nutrition: For those trying to conceive, the emphasis should be on B complex vitamins, iron-rich foods, and folic acid sources like leafy greens and whole grains. For others, complex carbohydrates support increased energy levels, and foods rich in zinc (pumpkin seeds, lean meats) and antioxidants (berries) support immune function and combat inflammation. In addition, increasing water intake and consumption of probiotic- and magnesium-rich foods can aid in alleviating any ovulation discomfort while promoting gut health and hormonal homeostasis.

Exercise: Ovulation is a great time to focus on functional workouts that improve endurance. Many women find they have peak energy levels during this phase, making it ideal for high-intensity interval training (HIIT) or circuit training.

Wellbeing: The natural boost in energy and confidence can be leveraged for important meetings and social events; however, maintaining emotional balance with mindfulness practices is key. This phase often brings heightened creativity, ideal for brainstorming or starting new projects. For ovulation discomfort, suggest relaxation techniques like warm baths or gentle yoga.

The Luteal Phase
Timing: Days 15 to 28

Hormonal Context: During the luteal phase, progesterone peaks, and estrogen rises slightly. Later in the cycle, estradiol, progesterone, and testosterone decrease to their lowest levels, serotonin dips, and cortisol rises.

Common Symptoms: The luteal phase is divided into two stages. Mid-luteal phase symptoms include shifting mood and energy levels, relaxation, improved sleep, feelings of calm, and positive mood. Late luteal phase – PMS – symptoms often include bloating, mood changes, weight gain, food cravings, insomnia, difficulty sleeping, headaches, breast swelling, appetite changes, difficulty concentrating, anxiety, sadness, depression, and irritability. Additionally, immune system function has been found to decrease around this time.

Atypical Manifestations: Some women may also experience hot flashes, night sweats, easy bruising, herpes virus outbreaks, worsening of allergy symptoms, lightheadedness, tinnitus, sore throat, worsening of skin conditions, anger, aggression, paranoia, fearfulness, suicidal thoughts, lack of coordination, and a possible increase in criminal behavior.

Optimizing The Luteal Phase
Recommendations

Nutrition: Dietary choices during the luteal phase can significantly impact symptom management. Patients should be advised to consume fiber-rich and anti-inflammatory foods to combat bloating and to incorporate a diverse array of brightly colored vegetables and fruits to provide essential nutrients and antioxidants. Healthy fats from sources like avocado, nuts, and fresh fish (particularly salmon) can help balance mood and reduce inflammation.

To minimize bloating, suggest limiting salt intake, carbonated beverages, and chewing gum. Dark chocolate can satisfy sweet cravings while providing antioxidants and minerals. Raspberry leaf tea may help reduce cramps.

Consuming processed foods, caffeine, alcohol, and foods high in salt and sugar can significantly exacerbate PMS symptoms. To maintain blood sugar levels, meals should be smaller and more frequent during this phase.

Supplements such as magnesium, chaste tree berry, and phosphatidylserine may be beneficial for symptom management; ashwagandha, passion flower, and l-theanine have proven helpful for managing stress and improving sleep quality. Additionally, probiotics may help decrease PMS symptoms by promoting estrogen excretion and beta-glucuronidase enzyme activity.

Exercise: As the luteal phase progresses, transitioning to lower-impact activities is often beneficial. Pilates, non-cardio strength training, and yoga can be particularly helpful. During the first half of the luteal phase, aim for early-day workouts. As PMS symptoms appear, consider switching to early evening workouts. Regular walks and stretching can help manage stress and maintain mobility. If feeling anxious, engaging in exercises that move large muscle groups, such as jump squats or lunges, can help release tension and improve mood.

Wellbeing: Prioritizing sleep and rest becomes crucial during the luteal phase as fatigue intensifies. Stress-relieving techniques like yoga, meditation, and deep breathing can be particularly beneficial as anxiety and insomnia become more prevalent. Minimizing caffeine intake, blue light exposure, and stimulating activities, as well as establishing a relaxing nighttime routine, including a warm bath and reading before bedtime may help improve sleep quality. Creating a serene environment and focusing on relaxation techniques can significantly enhance overall wellbeing during this challenging phase of the menstrual cycle.

A Note On Menstrual Disorders

While cycle-based care can benefit most women, it’s crucial to recognize that patients with menstrual disorders, including severe PMS and premenstrual dysphoric disorder (PMDD), require more specialized attention. PMDD, affecting 3-8% of women, includes symptoms that can severely interfere with daily life and interpersonal relationships. Notable differences between PMS and PMDD include suicidal ideation, high anxiety, severe mood swings, violent outbursts, apathy, and feelings of hopelessness. For these patients, cycle-based care should be integrated with more intensive medical management and psychiatric support where necessary.

Cycle Tracking: The Foundation of Personalized Women’s Healthcare

Encouraging patients to track their menstrual cycles is a cornerstone of personalized, cycle-based care. This practice not only helps women become more in tune with their bodies but also provides valuable data for healthcare providers. By tracking their cycles, women can plan fitness routines and rest periods more effectively, assist in conception attempts with greater precision, and differentiate between cycle-related symptoms and potential illness. This wealth of information allows women to identify patterns, predict upcoming cycle phases, and make informed decisions about lifestyle adjustments. For healthcare providers, these insights can guide more targeted interventions and help identify potential issues before they become serious health concerns.

Empowering Women Through Cycle-Based Care

Cycle-based care represents a paradigm shift in women’s health, acknowledging the unique physiology of women and individual-specific variations to finally debunk the mythical one-size-fits-all care model. By tailoring nutrition, exercise, and lifestyle recommendations to each menstrual cycle phase, practitioners empower women to harness their hormonal fluctuations effectively. Such an approach goes beyond managing acute symptoms, fostering long-term hormonal balance, overall wellness, and longevity. Furthermore, as a powerful preventive tool, it enables early identification and addressing of potential health issues, averting more serious adverse outcomes.

Revolutionary yet innate, cycle-based care provides a framework for truly personalized medicine, setting the stage for genuine transformation – one phase at a time.

Redefining Female Wellness At The Landmark Women’s Health Summit

The upcoming Women’s Health Summit offers an unrivaled opportunity for those seeking to provide the best possible care and help their female patients flourish. Internationally recognized experts will cover a range of topics, including hormone balance, mental health, and evidence-based solutions to women’s health challenges. Don’t miss this chance to enhance your clinical strategies and transform your women’s health care (and your patients’ lives). Learn more and register for this pioneering event here.