The Physiological Elephant in the Room

When I was 16, I had an ovarian cyst rupture that sent me to the emergency room.  After the meds kicked in and the pain subsided, the doctor came in with a prescription for hormonal birth control.  

"Take this every day, and you shouldn't have any more problems."  With that, he sent me on my way.

I believed him.  Why?  Because I was 16, in pain that I desperately wanted to get out of and fearful of a stage of life that was just beginning for me.  I had heard ALL the horror stories, like: 

“Periods make you bloated.”  

“Periods give you horrible cramps.”

“You're not going to be able to play sports on your period.”  

“Periods make you crave sweets and you'll probably get fat.” 

“Oh, and by the way, you'll also get horrible acne.”  

Long story short, I took the pills.

The doctor was right, or so I thought.  I went from age 16 to 27 with no problems-- and no period.  Ever. I didn't understand when girls on my sports teams would talk about their salty and sweet food cravings or cramps when surrounding that time of the month.  I didn't understand the fatigue, and thought they were simply making it up to get out of working hard.  I didn't really take them seriously when they were complaining of nausea during ovulation.  And honestly, it made me kind of uncomfortable to talk about it.  Until now. 

Fast forward to 2020.  This year, I took a huge leap after doing some research on the long term effects of hormonal birth control, specifically for athletes.  I decided that continuing taking HBC was not something I wanted to be involved with anymore, so I stopped.  I had very little idea about what was going to happen to me, so I actively searched for information.  

Unfortunately, this is the society we currently live in.  I never had any education about my own bodily functions as it pertained to sport, so I beat it into submission in hopes to sidestep it completely through the use of hormonal birth control.  

It’s time to get comfortable with the uncomfortable-your menstrual cycle is the single most important sign of endocrine health as a female athlete. 

Similarly, intelligent program design and nutrition planning are the most important methods of mastering your menstrual cycle (and even using it to your advantage!).  

On days 1 thru 10 (with day 1 being the first day of bleeding), our physiology makes us primed and ready for battle.  This is contrary to popular belief that activity should stop when a female is on her period.  As hormone levels drop, the body is ready to hit higher intensity during the follicular phase, with better access to carbohydrates and higher perceived pain tolerance.  We have greater muscular contractions and less nervous system fatigue.  As a coach, I typically like to plan testing, heavy singles (weightlifting) or any other types of personal record attempts during this time, especially after bleeding is over and cramping subsides.  Women will usually complete their most intense exercise at this time.  

From days 10-14, estrogen levels rapidly increase with luteinizing hormone, causing ovulation.  This can cause many women to feel stronger and powerful, but this isn’t always the case.  During this time, I communicate a lot with my females to determine how they are feeling and together, we determine the path forward.  The body becomes more carb sparing and more reliant on fats for fuel, and we become less primed for high intense efforts as the body transitions to the luteal phase.

During the luteal phase (days 14-28), exercise becomes difficult and fatigue sets in (if you know, you know).  It's harder to make muscle and recover from intense efforts due to higher levels of estrogen and progesterone.  For these reasons, I typically plan for back off weeks or technique oriented training during the end of a cycle.  Nutrition should also change during this time to account for the increase in metabolism the days leading up to the period.  The last few days of a cycle (pre-menstrual) are typically the most challenging for females.  Many women experience cramps, bloating, and depression, to name just a few.  Instead of working up to specific percentages, or focusing on flawless execution of a workout, I make sure the women I work with are prioritizing sleep, nutrition, reflection/journaling, mental health, and body positivity.    

Of course, all females and cycles are different, so ongoing conversations between the athlete and coach must occur.  This is why it is so important to work with a coach who keeps your unique physiology in mind when designing a workout program.  

After stopping hormonal birth control, I became extremely familiar with the above experiences and symptoms.  It has taken nearly 6 months for my cycle to become predictable, and I am learning more each day on little things I can do to mitigate my pre-menstrual symptoms so that I can keep hitting it hard in the gym, regardless of where I am in my cycle.   

First and most importantly, I began tracking my cycle.  To do this, take your temperature every morning upon waking using a basal thermometer (must read to .00 degrees) and track it in an app (Natural Cycles is a great one and what I use).  This way, you can predict ovulation and the beginning of a new cycle (period).  Communicate with your coach about where you are at in your cycle so that training can be adjusted as needed.  

Additionally, I began supplementing with Magnesium and Omega-3 Fatty Acids to help control my menstrual cramps and cravings, and loaded up on cruciferous greens (broccoli, spinach, kale, etc.) to offset the estrogen dominance that was created in my body through over 10 years of continuous birth control pill usage (as always, please work with your GP or RD prior to making any supplemental or dietary changes).  I am purposeful with my nutrition and limit alcohol and caffeine as much as possible throughout my cycle to support liver function and decrease cramping.  These guidelines have helped tremendously in gaining more control over my pre-menstrual symptoms so that I can continue to work hard in the gym and stay out of pain.  

The bottom line is that your coach should be planning your training with your cycle in mind.  If they aren’t, it’s time to level up.  Women are complex organisms worthy of intelligent, planned out and logical training, all aligned with their physiology.