Picture this: a normal menstrual cycle that arrives on time without significant symptoms. Unfortunately, for many individuals, this is not the reality. While painful and excessively symptomatic menstrual cycles are common, they are not normal and indicate potential underlying health concerns.
In this article, we’ll talk about menstrual cycle phases, menstrual cycle hormones, and how to have a healthy menstrual cycle using tools like diet, exercise, and targeted supplementation.
What is the menstrual cycle?
The menstrual cycle is the natural, monthly hormonal rhythm that individuals with ovaries and a uterus experience during childbearing years. This distinct rise and fall of specific hormones across the cycle is what makes pregnancy possible. In addition to making pregnancy possible, this hormonal pattern has wide-reaching effects on many other aspects of health, including mood regulation, metabolism, energy, digestion, and libido. (11)
Stages of the menstrual cycle
The menstrual cycle consists of four stages outlined below.
When the menstrual cycle starts, menstruation lasts anywhere between three to seven days. At this time, both estrogen and progesterone are at their lowest, causing the uterine lining to shed and prepare for the next cycle. (26)
2. Follicular phase
During the follicular phase, which begins on the first day of menstrual bleeding, estrogen steadily climbs, which helps to mature a follicle in the ovaries. Estrogen is a proliferative hormone, meaning that it helps to build up the lining of the uterus to create a safe, nutrient-rich environment should conception occur. The peak in estrogen just prior to ovulation is what stimulates the follicle to release an egg during ovulation. This stage of the menstrual cycle lasts for about 14 days. (26)
When ovulation occurs, an egg is released from an ovarian follicle, making conception possible at this time. This stage only lasts one day. (26)
4. Luteal phase
After ovulation, the follicle that released the egg turns into the corpus luteum which produces large amounts of progesterone. In this phase, progesterone rises and peaks around day 21. Progesterone, as the name implies, is “pro-gestation” or supportive of a pregnancy. If conception occurs, progesterone stays high throughout the duration of pregnancy. If conception does not occur, progesterone levels decline and this triggers the start of the next period and next round through the menstrual cycle. This phase typically lasts 14 days. (26)
Note: While the typical/average cycle is described above, there is some variation in the amount of days each individual spends in each phase of the menstrual cycle. (26)
What is a healthy menstrual cycle?
A healthy menstrual cycle is one that occurs regularly and has a duration between 21 to 35 days. There should be only minor symptoms that occur during phases of hormonal changes. The menstrual cycle should occur without any excessive premenstrual syndrome (PMS) symptoms in the luteal phase. Menstruation may last between three to seven days and bleeding, cramping, and mood changes should be mild. (3)
Abnormal menstrual cycles
The hormones estrogen and progesterone have a major impact on the way a woman feels throughout a cycle, which means it’s normal to notice changes across the monthly cycle. Mild changes in mood, energy levels, libido, and even creativity are normal and expected. (8)(27)(31)
Symptoms that get in the way of normal daily activities, however, are not normal and are a sign that underlying health issues may need to be addressed. (23)
Abnormal menstrual cycle symptoms include:
- Abnormally short or long periods (outside of the three to seven day range)
- Absent or irregular periods
- Excessive cramping and pain that requires medication or missed work days
- Extreme mood changes before or during menstruation
- Severe breast tenderness
- Severe headaches or menstrual migraines
- Significant digestive symptoms, such as diarrhea, constipation, or vomiting
- Spotting or bleeding between periods
- Very heavy bleeding (23)
What causes the menstrual cycle to change dates?
Small changes in menstrual cycle length within +/- four days is normal. Anything outside of that or any change that causes you to fall outside of the 21 to 35 day cycle length range is not normal. Various factors, such as stress, diet changes, and exercise, can influence the length of your menstrual cycle. (12)(13)(28)
1. Stress and menstrual cycle changes
One of the biggest factors that can impact the menstrual cycle is stress. When the female body experiences stress, a central stress response system known as the hypothalamic-pituitary-adrenal (HPA) axis is activated. (2) The HPA axis is a network that involves the hypothalamus (found in the brain), pituitary (found in the brain), and adrenal glands (found on the kidneys) and is the connection between our central nervous system and our endocrine system. When activated, the HPA axis increases levels of two stress hormones, cortisol and corticotropin-releasing hormone (CRH), that help the body respond to stress. (2) Elevated CRH and cortisol can suppress or delay ovulation, causing a change in cycle date. (13)(29)
2. Diet and menstrual cycle changes
Major changes to your diet can impact the length and regularity of your cycle as well as the severity of menstrual symptoms. Dieting or the restriction of calories or macronutrients is a potential source of stress for your body if your intake falls below the body’s baseline needs. (13)
Consuming a nutrient-rich diet is important to support the health of your menstrual cycle. Your body manufactures hormones out of a combination of both macronutrients and micronutrients. Macronutrients include carbohydrates, proteins, and fats, which are the calorie-containing portion of foods. Micronutrients include non-caloric nutrients like vitamins, minerals, and antioxidants. A diet that falls short in either category can potentially disrupt a healthy menstrual cycle. Research shows that a prolonged deficit in total calorie intake can cause disruption or even absence of a menstrual cycle. (28) Certain vitamin deficiencies can also impact the menstrual cycle. For example, one study found that women with inadequate levels of vitamin D were at an increased risk of menstrual disorders. (17)
The overall quality of an individual’s diet may also be important to consider. The Standard American Diet is one that is laden with highly processed, calorie dense yet nutrient deficient foods available at high convenience. Unfortunately many of these ingredients like high-fructose corn syrup, chemical additives, and processed oils can cause inflammation in the body. Research has shown a direct association between elevated inflammatory markers (hs-CRP) and the severity of menstrual symptoms, such as cramps and mood swings. (9)
3. Exercise and menstrual cycle changes
Research shows that exercise can both positively and negatively affect the menstrual cycle. The female athlete triad is a combination of low energy availability, menstrual irregularities, and low bone density. (12) This condition occurs when energy availability dips too low as a result of high training volume and/or underfueling.
Regular exercise has been shown to improve cardiovascular risk factors and improve hormonal profile and reproductive function by reducing abdominal fat, blood glucose, and blood lipids. (21) While there are many hormonal benefits to exercises that can help maintain a healthy menstrual cycle, it’s important to always look at total exercise volume and ensure that total calorie intake and recovery measures are sufficient to match it. (5)
How to support a healthy menstrual cycle
A combination of diet and lifestyle modifications and supplements can help support overall health and may minimize symptoms associated with the menstrual cycle.
1. Follow a healthy diet
A diet that supports a healthy menstrual cycle is one that provides adequate total calories, balanced macronutrients, and plenty of micronutrients. This helps ensure that dietary stress on the body is at a minimum and the body has the raw materials it needs to manufacture hormones. (10)
Opting for a variety of fresh, whole foods whenever possible helps fill potential micronutrient gaps. Building meals to contain a source of protein, healthy fat, and carbohydrate together can help make sure macronutrient and micronutrient needs are met. (7)
Healthy menstrual cycle supporting foods include:
- Anti-inflammatory fats (e.g., olive oil, avocados)
- Anti-inflammatory spices (e.g., ginger, turmeric)
- Cruciferous vegetables (e.g., kale, cabbage, Brussels sprouts)
- Fibrous carbohydrates (e.g., berries, potatoes, and oats)
- Highly pigmented (brightly colored) fruits and vegetables (e.g., beets, carrots, and oranges)
- Quality animal proteins (e.g., grass fed beef, organic poultry) (15)(19)(24)
2. Get enough sleep
Getting enough quality sleep each night is essential for hormonal health and reproductive capacity. (16) Hormonal changes that occur in the days leading up to menstruation can make falling and/or staying asleep more challenging. Practicing good sleep hygiene, which involves establishing a consistent sleep routine and optimizing your sleep environment, can help improve the quality of your sleep. (25) As a general recommendation, aim for between seven and nine hours of sleep per night. (6)
3. Manage stress levels
Considering that stress can affect the menstrual cycle, it’s important to keep your stress levels in check. Manage your stress levels by staying active, practicing mindfulness meditation or deep breathing, or spending time outdoors. (20)(30)
4. Supplemental nutrients for a healthy menstrual cycle
There are several important nutrients for a healthy menstrual cycle.
Vitamin C acts as an antioxidant and improves iron absorption from food or other supplements. Consuming enough vitamin C and iron can help prevent iron deficiency in individuals who menstruate. (18)
Vitamin B6 supplementation has been shown to help improve mood during the premenstrual period as it plays a role in serotonin production. (14)
Low levels of vitamin D have been linked to fertility issues and menstrual cycle irregularities. (17) According to a 2018 clinical trial, vitamin D supplementation reduced the prevalence of PMS symptoms and dysmenorrhea (painful menstrual cramps). (1)
This mineral has wide-ranging benefits for the menstrual cycle that include reducing menstrual cramps, PMS symptoms, and preventing menstrual migraines. (22)
Keeping the gut microbiome happy and healthy can help support a healthy menstrual cycle by improving the removal of excess estrogens from the body. (4)
Omega-3 fatty acids
By providing omega-3 fatty acids, a fish oil supplement can help prevent period cramps and other PMS symptoms by modulating inflammation. In fact, it was shown to outperform ibuprofen in managing period pain. (32)
The bottom line
The menstrual cycle is a complex, multi-phase hormonal process that occurs in individuals with ovaries and a uterus of childbearing age. There are many diet, lifestyle, and supplement changes that can support a healthy menstrual cycle.
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