Guest blog by Chartered Physiotherapist & Pilates Instructor Emily Russell (@my.pilates.life)
This blog will provide a brief summary of the hormone fluctuations within the menstrual cycle, in particular its relevance to physical exercise. Dr Jolene Brighten wrote a fantastically informative blog about the menstrual cycle which is a recommended read before diving into this post.
First of all, let’s briefly discuss the menstrual cycle. Do check out Jolene’s blog for a more comprehensive explanation on this. The menstrual cycle is driven by fluctuations in hormones: luteinising hormone (LH) & follicle-stimulating hormone (FSH). These hormones are secreted by the pituitary gland and stimulate the secretion of progesterone and oestrogen from the ovaries. The menstrual cycle is typically categorised into 4 phases based on hormonal profiles.
Why does this matter?
A recent study by Strava reported that over 70% of women & people who menstruate have never received any education about exercising during their menstrual cycle. There has been a lot of reporting in the press about the risk of ligament rupture & individuals being ‘weaker’ during certain points of their menstrual cycle. This unfortunately causes many people to feel unsure about whether or not they should be exercising throughout their menstrual cycle. Over 78% of people report that exercise improves symptoms of back pain, headaches, sleep disturbances, mood disturbances and stomach cramps. There is a distinct lack of clinical evidence looking at the relationship between menstrual cycle hormone fluctuations & the impact of this on exercise.
The relationship between hormones & exercise
Hormones are like internal, chemical messengers. They circulate within our blood and therefore travel all over our bodies & effect a huge range of functions, including the way muscles & connective tissue behave. Connective tissue is our internal scaffolding support system: it binds structures together, provides a framework and support for organs & structures & is found throughout our whole body. Connective tissue is made up of collagen and elastin.
Tendons (the connections between muscle & bone) are made up of 60-80% collagen & their job is to transmit muscle forces & withstand tension during muscle contractions. Ligaments provide support for joints & are made up of 70% collagen.
Oestrogen & progesterone receptors are present within bone, muscles, ligaments and tendons. There are oestrogen & progesterone receptors within the muscles & connective tissue of the pelvic floor and also within the smooth muscle cells of the vagina. This tells us that oestrogen & progesterone effects all of these areas and therefore fluctuating levels throughout the menstrual cycle can effect how these areas function & feel.
Now let’s relate this to each stages of the menstrual cycle & how this might impact on exercise. It is important to highlight that there is no definitive evidence to suggest that people can not exercise optimally at any stage of their cycle. It is recognised that individuals experience differing symptoms & I always suggest people track their cycle and symptoms to learn what works best for them.
Menstruation (days 1 - 5)
This phase is from the 1st day of the period to when bleeding stops. Both oestrogen & progesterone levels are low. There is some clinical evidence suggesting that individuals might have better endurance and performance in high intensity exercise during menstruation due to their ability to use glycogen (carbohydrate) stores more effectively. Throughout this phase, strength and HIIT training may therefore be good options. Also consider that moderate exercise has been shown to improve symptoms associated with menstruation (walking, swimming, Pilates & Yoga). Exercise also has the added benefit of releasing endorphins… these ‘happy’ hormones can help relieve tension & moderate changes in mood. Inflammation is high during this phase, so it is important to factor in adequate recovery post exercise (particularly with strength and high intensity exercise).
Follicular Phase (days 1 - 14)
This phase combines menstruation followed by an increase in oestrogen and luteinising hormone, leading up to ovulation. Progesterone levels are low, this has been linked to improved muscle tissue repair which can help recovery from intensive exercise. There is some research to suggest that focusing on fitness during this phase brings the most benefit. Energy levels and motivation are often high during this phase.
Ovulation (days 14 - 15)
Oestrogen levels peak, signalling a peak in luteinising hormone and the release of an egg (ovulation). Progesterone levels remain low.
Luteal Phase (days 14 - 28)
After Ovulation, oestrogen levels initially fall then rise along with rising progesterone levels. All types of exercise are beneficial in this phase, although energy levels sometimes don’t match those felt during days 1 - 14. Often the most benefit is gained from performing lower level / less intense exercises such as Pilates & Yoga. High progesterone levels can impact on recovery times after intense exercise.
Pre menstrual phase (days 21 - 28)
Oestrogen and progesterone levels fall in the lead up to menstruation. This decrease in hormone levels triggers an inflammatory response and has been linked to a number of pre menstrual symptoms. The peak in inflammation can slow down the recovery process post exercise, however light and moderate exercise has been shown to have anti-inflammatory and anti-oxidant properties which can improve pre-menstrual symptoms. This is a great time to focus on Pilates and Yoga exercise or any exercise which boosts mood (this will be different for everyone).
Take Home Message
Every individual’s response to the menstrual cycle and the fluctuations in hormones is unique, this article hopes to help you better understand why you may find a fluctuation in your exercise experience throughout your menstrual cycle. This may then guide you to plan your exercise so you have maximal enjoyment & ultimately gain most benefit from your individual regime.
The Vice President of the Royal College of Obstetrics and Gynaecologists stated that we “must treat people as individuals, not statistics” and this summarises perfectly the take home message. Listen to your body and learn what it needs. Recognise that the human physiology is wonderful and it is unique, so there is no ‘one size fits all’ approach.
If you would like to try a live online Pilates class then Emily is offering a free class using code BLOODYGOODPERIOD (apply code at checkout). Book your class here: https://www.mypilateslife.co.uk/book-online