Women's Wellness Obstacles: Period Problems (part 2)

The average woman will experience over 450 periods in her life.  That's anywhere from 1300 to  3000+ days.   Days in which we do what we need and want to do.  But when you have a period problem, it becomes more challenging.  If you are doubled over in pain or have to change your tampon every 45 minutes for several days each month, of course your productivity is going to suffer. (which we know is not normal and warrants a doctor's visit!) While figuring out a treatment plan for improvement, it’d be nice to have the option to plan around the times you feel the most awful, however, how many women can actually do that?  The show must go on.  While we may not be able to plan around it completely, we can develop a better understanding of what’s going on at different points during the cycle and become aware of symptoms and how they respond to various activities.  It’s important to give yourself grace too. Sometimes sweatpants and a hot water bottle is required!

Round and Round
The average cycle is 21 to 35 days from the first day of one period to when the next one begins. It's helpful to think of the menstrual cycle in phases.  Phase 1 – menstrual, phase 2 – follicular (post-menstrual, pre-ovulation), phase 3 - ovulatory, phase 4 – luteal (post-ovulation, pre-menstrual). More information about each phase can be found here:  https://www.healthline.com/health/womens-health/stages-of-menstrual-cycle#menstrual

Hormones fluctuate throughout each cycle. You may notice corresponding changes in your sleep, mood, digestive system function, energy levels, and sex drive.  Many of these changes are normal and to be expected but hormonal imbalances or gynecological conditions can contribute to more extreme changes.

Exercise?
Those who deal with pelvic pain, heavy bleeding, or other symptoms are well-aware of how difficult it can be to maintain regular exercise and sometimes, even movement.  However, a consistent exercise habit can be a powerful and natural way to improve quality of life.  In this study, regular aerobic training using a treadmill over a six month time-period found a reduction in pain and improvement in quality of life and sleep.  It is important to note that this study was done on women who have primary dysmenorrhea. This means menstrual pain without any pelvic pathology present, so no endometriosis, fibroids, etc. Additional studies such as this and this have demonstrated similar results.   

Mixed information can be found on the impact of exercise on endometriosis.  An interesting study found that moderate to intense exercise may help reduce the size of endometriotic lesions BUT this study was done on rats.  Still sounds promising though, right?  My personal experience is that I had a decent amount of pain each month despite a very consistent exercise habit. However, it’s quite possible my pain levels would have been worse if I wasn't active.  Now, that’s a scary thought! 

We’ve all heard the advice, "you should exercise to improve period symptoms."  The above studies reference consistent exercise throughout the month and are not referring to exercise during your period as symptom relief. Research on that topic is limited and what exists contains mixed results.  It doesn’t make much sense to tell a woman to go work out when she is experiencing extremely heavy flow or cramps so bad she’s nauseated.  Exercise as period symptom relief is not necessarily the best advice for all situations.  You will need to experiment to see how your body responds to various types and intensities. Include stretching and breathing exercises as well as more intense forms of activity to discover what works better for you.  This is where tracking is useful.

Your Strategy
You will be better equipped to manage the obstacles your period creates if you track your cycle along with sleep, mood, energy and pain levels,  changes in eating habits, and, if you are currently exercising, rate of perceived exertion and if/how exercise affects your symptoms.  Use a calendar or an app to track your cycle,  even the FitBit app now has a cycle tracking feature.  Do this for three to six months.  You may find consistent patterns which will be beneficial in planning exercise sessions, recovery activities, and even dietary choices.   I am sure I’m not the only one who finds herself in the kitchen eating untold amounts of carbs right before my period starts.  I realized this pattern pretty quickly so I make sure I have appealing nutrient dense options as well as a few treats available.  I don’t want to make myself feel even worse by eating loads of processed foods.  I mean, I enjoy cookies and fries, but eating an inordinate amount of either adds an icky stomach and foggy head to the already unpleasant symptoms that I typically experience.

If you are a fitness instructor, have serious training goals or are an athlete, it becomes even more important to recognize the impact your cycle can have on performance.  By tracking, you can identify the specific points in the month that are affected and adjust your activities or your expectations for these sessions.   The data you collect could also point to the need for a doctor's visit.  For example, if you experience significant levels of fatigue, you may need your iron levels checked.

Typically, women feel best right after menstruation and before ovulation during the follicular phase (around days 7-14).  Estrogen is on the rise.  You may experience increases in endurance and strength.  This is the week to plan more challenging training sessions or go for that PR.   If you don’t currently exercise, this is the point in your cycle that you may find it easiest to start.

Exercise just before and during your menstrual cycle may feel more challenging. It’s not news that women dealing with primary or secondary dysmenorrhea are gonna have a tougher time.  Even those without specific period issues may experience a drop in endurance as hormone levels drop.   This is okay.  Adjust your training volume and intensity as needed.   Plan your rest day on the day that’s roughest for you if you can.  Side note:  studies have found pain tolerance tends to be lower during the premenstrual period.  (Also a great reason to plan any dental work accordingly!)

Recently I read Dr. Lara Briden's book, The Period Repair Manual.   This book combined with other sources convinced me it would be worthwhile to make some changes despite having underlying conditions. I added a supplement (magnesium/zinc) and removed dairy (cow's milk products) from my diet (mostly...I've had a couple of slip-ups). I was skeptical but figured it couldn't hurt to try.  Surprisingly, I am feeling some slight improvements in my pain levels and bloating.  So far this month, I've had to take fewer ibuprofen.  Last month, I was doubled over in pain a few times.  It may be too early to tell (or could be placebo?) but I'm remaining cautiously optimistic.  Definitely talk to your doc and do your own research before adding any supplements and make sure you are getting adequate nutrients from other foods if you decide to remove an entire food group from your diet.  

You don't have to resign yourself to letting those wellness goals fall apart each month because you feel terrible.   With a bit of knowledge and understanding about your body (via tracking), support from a health professional (a doctor who listens and takes your pain/symptoms seriously), and willingness to experiment (exercise, food choices, relaxation techniques, etc.) you can better manage your period problems and, hopefully, do more of what you need and want to do!

Thanks for reading!