I am a woman, embrace it
Okay - brace yourself. I am about to talk about periods, boobies and bloating. It’s about to get REAL. But honestly, this is something that I think should be shared because more women need to be educated in this area and not enough people talk about it. As a medical provider, I also hear a ton of misinformation on the female cycle and it drives me bonkers. But before I start, I also want to add that I share this information from my own perspective as an athlete. I also have worked in the medical field and have a strong knowledge base of human physiology but this is not medical advice. The recommendations here are my opinions and you should always consult your medical provider such as your PCP, OBGYN, dietician, etc. for any medical advice or treatment options to help manage your hormonal symptoms.
If you are a male reading this - kudos to you. You will hopefully be able to understand the mysterious female body a bit better and have insight into why we are so complicated :)
Let’s start by making the female cycle very simple. A woman’s cycle can basically be divided into 2 parts: a “low hormone” phase and a “high hormone” phase. The low hormone phase is also known as the follicular phase (first half of the cycle) and the high hormone phase is the luteal phase (second half). See the graph below which is a good visualization of the hormones spiking in the second half. The low hormone phase starts on the first day of bleeding/menses - and this phase is when we are most physiologically like men (from a hormone perspective).
For me, I know that I have about 5-7 days of really bad bloating/swelling, breast pain, constipation and very intense fatigue. This happens around day 12-14 of my cycle and then the following 5-7 days are still high in hormones but are much more tolerable as my energy comes up a bit. Then as soon as my period comes, I feel excellent. I usually have a day of intense urinating - literally shedding the water weight I had previously retained from the higher hormones. From the day I start my period to the next 10-12 days, I feel excellent. Lean, strong and energetic. Mood is great and I feel like I can conquer the world! Then BOOM reality hits again as the high hormone symptoms take over my body 12-14 days later and I repeat the process again.
So ladies, what to do about all this??? Track your symptoms, study the trends. This is by far the most important suggestion I have in all of this information. Get a calendar or an app can track your period but most important track how you feel. I know exactly when I will get my period based on when I start to bloat and get my high hormone symptoms. I have it dialed by this point, but it’s taken me many months if not years to perfect this.
Why is this important? Well, the high hormones in the luteal phase are estrogen and progesterone. These hormones have pervasive effects on the female body which can negatively impact training (in theory - data has yet to really show on a large scale). So for me, if I understand what my body is doing, it makes the symptoms more tolerable knowing how long they will last and trying to develop and experiment with anything that could help.
Things to do to combat high hormone symptoms:
Track your symptoms
This is by far my top recommendation. Track, track and track!!!! Get a calendar or an app that can track your period but most importantly can track how you FEEL. I have it dialed by this point, but it’s taken me many months if not years to perfect this.
I also think there is a level of body dysmorphia around female cycles. I used to have a pattern of bloating, feeling fat, then restricting, then binging - my relationship with food was greatly impacted by my cycle and I never understood this until I started tracking my period with my weight, hunger, bloat and symptoms. If you track, you will understand and then can better manage these symptoms.
Understand your body
Tracking is important, but you also have to accept how your body changes when you have a regular cycle. As a previous amenorrheic athlete that did not have a period for over 5 years, I now celebrate my monthly cycle because it means that I am eating enough, fueling my body for top performance and reducing my chances of both physical and mental burnout and injuries by under fueling. So when I start to feel tired and bloated, I look at my tracker and calendar and then feel less concerned knowing it will pass in a few days and I can do the small things to help reduce additional symptoms.
Eat more carbs (almost always the answer…..)
High hormones can impair gluconeogenesis and females will rely less on muscle glycogen for fueling compared to exercise in the low hormone phase and compared to men. This can be improved by taking in MORE exogenous carbohydrates during this time. Despite being bloated ladies, you probably need more carbs and most ladies restrict since they feel more full during this time and that can negatively impact performance.
Accept the weight gain/bloat
I gain anywhere from 2-6 lbs depending on the day. This is almost all water weight and if I track this it comes off immediately as my high hormone phase ends.
If you find this is demoralizing or messing with your body image or relationship with food, then I strongly encourage you to stop weighing yourself during this time. This is what I do and it has greatly helped how I view my body. I know I am heavier during this time but the following week my weight goes back to what it normally is. I’m okay with it since it’s predictable and there’s an end date in a few days. I also change my mindset to celebrate the regular changes as my body’s way of telling me it is getting what it needs despite my rigorous training schedule.
How to manage breast pain/swelling
On my high hormone phase, my breasts actually can swell an entire cup size. I recently started using a different bra on my high hormone phase which has helped. So consider going bra shopping when you are in your high hormone phase and have 2 different sets depending on the time of the month.
Reduce caffeine - CRAZY……I know it sounds wild to say reduce that coffee intake when you are tired and feeling crappy, but reducing caffeine can help some people with breast pain associated with their cycle. I switch to a decaf or half-calf during my high hormone phase and that’s helped me personally.
Communicate with your coach
I have yet to see convincing data that indicates you should change your workouts around with your cycle. In theory, the higher hormones are more catabolic so there are some who favor limiting heavy lifting or really intense efforts during the high hormone phase, but I don’t think the performance reductions warrant the change. Additionally, I find with my own athletes that I coach that we want to ensure the athlete can show up and race, even if their priority race is during this high hormone phase in the future. So, talk with your coach or medical provider if you feel your symptoms are limiting your ability to do your workouts. There are supplements which I won’t go over in this post, but you have options and your medical team and your coach can point you in the right direction.
Consider changing your hydration strategy
During the high hormone phase, your body temperature can be increased by an entire degree C! Heat regulation can be much worse for athletes during the high hormone phase and we all know heat regulation greatly impacts performance. I personally like to do more iced water bottles during this time of the month but that’s not always an option. But think of any additional ways you can reduce your core temperature or try to train your body to adapt to this.
When you are bloated, this doesn’t mean you are necessarily hydrated.
During the high hormone phase, the body retains fluid. This is commonly the “bloat” that females report during this time. This extra water weight/retention results in intravascular volume being depleted due to extravasation.
Basically, due to complex hormone regulations and changes, the fluid we have in our blood volume (which helps us perform better) is shifted and fluid “leaks” into other tissue spaces vs blood stream.
In theory, this means hydration may be even more important during this phase
Preloading (as Stacy Simms recommends) is another way to combat this, since it increases salt/osmotic pressure and draws more fluid into blood volume.
Preloading with salt can be really helpful for high hormone phases, or really any time of the cycle when heat will be a factor.
I’m personally a big fan of salt preloading especially in my high hormone phase. But again, you should talk to your dietician and coach before making any of these changes!
And as a side note - if you are amenorrheic and a provider has suggested taking hormones as an alternative you need to get a second opinion with a sports specific physician and dietician. You cannot fix that with taking exogenous hormones - at the root of it there is a mismatch of energy demands and fueling. You likely need to eat more and train less, and likely gain weight. No one wants to hear this, but it’s the safest option and best option for long term performance as well. Again - this is my opinion (not medical advice) but I see this frequently and it really is a disservice to athletes when they get incorrect information from providers who are not educated on RED-S and amenorrhea.
So there you have it. Just my personal perspective on how hormones can impact how you FEEL and in turn impact your performance. We as high achieving athletes can be quite hard on ourselves and I’ve learned that my body is not a robot (as much as I want it to be). We as female athletes should talk openly about this and as a previous RED-S athlete and long term amenorrhea athlete I now celebrate my regular menses and use it as a way to ensure I am fueling correctly to be strong long term in a sustainable way.