Menstrual Health Education 101

Medically Reviewed by
Dr. Stacy Henigsman
Nutritionally Reviewed by
Felice Ramallo, RDN

Believe it or not, at one point menstrual health was treated as a hygiene issue. Thankfully, in recent years, there has been a positive shift in the way we, as a society, think about women’s health – and part of that discussion is viewing menstruation as a global health concern.

This is important for not only increasing access to resources (such as sanitary pads, tampons, and menstrual cups) but also more openly discussing the many ways we can protect our well-being before, during, and after menstruation. So, that being said, you can think of this article as a crash-course in menstrual health! No questions are off the table, from understanding the phases of the menstrual cycle and how to relieve symptoms, to helpful tips that can work to protect your physical and mental health during your period.

Let’s dive in!

  • Phases of the menstrual cycle
  • Menses
  • Follicular
  • Ovulatory
  • Luteal
  • Foods to help relieve symptoms during each stage
  • Exercise on and off your period  
  • Protecting your mental and physical health during your period
  • PMDD and PMS

Phases of the menstrual cycle

The menstrual cycle itself can last somewhere between 21 and 35 days (with 28 days being thought of as ‘typical), and has four stages:

  • Menstrual
  • Follicular
  • Ovulatory
  • Luteal

Let’s break down each one in turn.

Menstrual phase

The first day of your period is the first day of your menstrual cycle. Periods last anywhere from 2 days, on the shorter side, to 7 days on the longer side; it signals that the lining of your uterus is being shed since fertilization (and subsequent pregnancy) hasn’t occurred.

Period symptoms often include:

  • Cramps
  • Tender breasts
  • Mood swings
  • Irritability
  • Headaches
  • Lower back pain

Follicular phase

When you finish your period, you go into the follicular phase; estrogen levels rise, which cause the lining of the uterus (ie the endometrium) to grow and thicken, while the levels of follicle-stimulating hormone (shortened to FSH) cause follicles in the ovaries to grow. One of these developing follicles will form a fully mature egg (otherwise known as an ovum).

During the follicular phase you may notice you have:

  • Higher energy levels
  • Higher sex drive
  • Increased optimism
  • Increased confidence

Ovulation phase

The point at which this occurs can vary between women, and even in your own body, according to the time of your life. Ovulation typically takes place around the timeframe of day 14, but it can vary widely from month to month even, occurring earlier if you have a naturally short cycle, or later if your cycle is longer. Ultimately, ovulation is not guaranteed on a certain day (or on a regular cadence), which is why – if you don’t plan on getting pregnant – a reliable form of birth control is extremely important.

Technically, a woman can only get pregnant during the time in her cycle in which she is fertile. This is 5 or 6 days prior to ovulation (since sperm can survive for up to a week in the vagina) and the day of ovulation itself.

Signs you’re about to be (or are) ovulating, include:

  • Changes in your cervical fluid
  • During this time, cervical fluid might be clear, wet, or stretchy, and may look similar to egg whites in consistency.
  • Cramping
  • Sore breasts
  • Bloating
  • Higher sex drive
  • Slightly higher basal body temperature
  • This is your temperature while at rest, and this method of knowing if you are ovulating is notoriously difficult to rely on since some women don’t experience a higher temperature until after they’ve ovulated.

It’s also important to point out that not all women ovulate – factors such as PCOS, as well as an overactive or underactive thyroid, and other health concerns can present obstacles to regular ovulation. In the case of PCOS, for instance, a hormonal imbalance (compounded by a vulnerability to insulin resistance) means that the process of growth and release of an egg from the ovaries is interfered with. This is not to say that women with certain hormonal health issues can’t get pregnant – that is certainly not the case! It may require some extra collaboration with a physician or reproductive health specialist, lifestyle adjustments, or even prescriptions, but PCOS does not equal infertility. It just means the approach to pregnancy may need to be tailored.

Luteal phase

This is the fourth stage of the menstrual cycle. Think of stages 1 to 3 as the first half, and the luteal phase as the second half. This phase lasts from approximately day 15 (or the day after ovulation) to day 28 (or the last day of your cycle, i.e. the day before your next period begins). In this phase, the egg leaves your ovary and begins to travel down the fallopian tubes to the uterus. Levels of progesterone rise to help prepare your uterine lining for pregnancy. In the case of a pregnancy, the egg will be fertilized by sperm and attach itself to your uterine wall; if not, then your estrogen and progesterone levels will drop and the thickened lining of your uterus will be shed during your period.

Then the cycle starts all over again!  

Food and exercise for each phase of your cycle

We’ll preface this by saying: whatever you feel like eating during each phase of your cycle, go ahead and eat it. This list isn’t meant to be prescriptive, but rather an additional resource to help balance symptoms that can accompany each stage of your menstrual cycle. For instance, if you suffer from menstrual cramps, then eating foods high in magnesium (or supplementing with a NSF-certified supplement) can be helpful! Alternatively, if it’s your follicular phase, but life has been hectic and you feel super tired, then don’t engage in a high energy activity, maybe go for a relaxing walk instead! Ultimately, you should listen to your body, and if something feels off, get in touch with your primary care provider to discuss your concerns.

Phase 1

Okay, so let’s talk about the menstrual phase. This is the time where you are on your period; symptoms that can accompany this include cramps, headaches, and a whole lot more.

Commonly recommended foods to eat include proteins, healthy fats, and complex carbs. In particular, look out for iron and magnesium-rich foods. If you consume meat, then grass-fed beef is a great option, while eggs and fish are ideal for pescaratians and vegetarians. Alternatively, if you follow a plant-based diet, then lentils, pumpkin seeds, leafy greens, and avocado can be helpful in getting a healthy dose of those minerals! Finally, adding ginger to your favorite dishes or drinks can also be effective in reducing menstrual cramps.

In terms of exercise, this is a time of rest. Avoid high-impact, high-energy exercises like running (unless you want to!). Try to engage in low-intensity exercise like yoga, stretching, and walking. Even an easy hike could be an option to move your body and get fresh air, while not pushing yourself too far.

Phase 2

During this phase, your body is gearing up for ovulation, with increases in estrogen levels.

Recommended foods include those that are phytoestrogen-rich, such as flaxseeds, pumpkin seeds, tofu, hummus, berries, grains, and spinach. Antioxidant-rich foods are always a good idea, but especially during this time, pecans, blueberries, dark chocolate, strawberries, goji berries, and artichoke are all wonderful options to add to your meals.

Since your energy levels will increase with hormone levels throughout this phase, consider working up to more intense exercises over the next 10 days. In particular, working in more cardiovascular activities (think running, jump-rope, tennis, and swimming) are good options that you can dedicate more time to as you feel increasingly energized.

Phase 3

Enter the ovulatory phase! During this time your estrogen and luteinizing hormones rise to stimulate the release of an egg, while your testosterone levels peak and during in this time, too.

In terms of recommended foods, consider working more fiber-rich foods into your diet, as well as protein, zinc-rich foods, and foods high in magnesium. Specifically, oats, beans, and lentils are all excellent options for increasing fiber intake, while punches of protein can be found in plenty of fatty fish (salmon, sardines), as well as meat and plant foods like chia seeds, chickpeas, and nut butter.

Again, since energy levels are higher during this time – and you may also be feeling extra social and confident – it may be the best time to experiment with new activities! Working in exercise by trying rock-climbing, taking a pilates class, cycling, and strength training are all great options during this time.

Phase 4

Last but not least, we have the luteal phase! Though this time can seem like a bit of a downer after the follicular and ovulatory phases, think of it as yin and yang: in order to be energized, you must also rest. During this time, progesterone and estrogen levels rise to build and thick the uterine lining, but if an egg isn’t fertilized, then hormone levels fall dramatically. In this phase, you may find your energy levels decrease over time.

Offset lower energy levels with nutrient dense foods and balanced meals. When constructing your plates during the week, try to add sources of protein, healthy fats (to rid excess estrogen and increase satiety), fiber, and complex carbohydrates (in particular, whole grains and sweet potatoes!). Cravings are particularly common during this phase of the cycle; this is because calorie needs increase during this phase of your cycle (to help build lining in the uterus) – eat what you feel your body needs, while also trying to prioritize nutritionally dense foods, like the ones listed above, so you don’t have energy ‘spikes’ and ‘crashes.’

Protecting your mental and physical health during your cycle

Premenstrual syndrome and premenstrual dysphoric disorder are both associated with physical and emotional symptoms that can be, at best, upsetting, and at worst, debilitating for women. According to the US Office on Women’s Health, approximately 90% of women report PMS symptoms, though it appears women in their 30s are at highest likelihood of experiencing PMS.

Physical symptoms of PMS include:

  • Headaches
  • Tender breasts
  • Diarrhea or constipation
  • Bloating
  • Cramping

Emotional/psychological symptoms include:

  • Irritability
  • Feeling tired
  • Tension or anxiety
  • Less interest in sex
  • Trouble with concentration
  • Cravings

Evidence-backed ways you can help relieve some of the above symptoms include:

  • Exercising
  • Eating foods that contain increased levels of vitamin D, vitamin B1, and vitamin B2
  • Taking magnesium supplements
  • Writing notes to yourself during the month before PMS hits
  • This can be a good reminder that these feelings are temporary, and will go away with time. We understand that in the moment, though, this can be hard to remember. That’s why notes from your past self can be helpful!

PMDD is thought to be an extension of PMS, but a worse version of it. Unfortunately, the exact cause of PMDD is not known; Johns Hopkins theorizes it could be an “abnormal reaction to normal hormone changes that happen with each menstrual cycle. The hormone changes can cause a serotonin deficiency . . . found naturally in the brain and intestines and can affect mood and cause physical symptoms.” Whatever the exact root cause, it appears that women with a family history of PMDD, history of postpartum depression, or family history of depression could also be at increased risk.

Physical symptoms of PMDD are similar for PMS, and include:

  • Cramps
  • Bloating
  • Muscle pain
  • Joint pain
  • Breast tenderness
  • Headaches

Emotional and psychological symptoms of PMDD include:

  • Lasting irritability or anger
  • Feelings of sadness and despair
  • In some cases, there may be thoughts of suicide
  • Panic attacks
  • Mood swings
  • Trouble sleeping
  • Food cravings
  • Feeling out of control

Common treatments for PMDD can range from antidepressants, to birth control pills, to over the counter pain relievers. One important point we’d like to raise is that, if you regularly face symptoms of PMS or PMDD, it is important to speak with someone you trust about them. If your symptoms resemble PMDD in particular, we strongly recommend speaking with your doctor.

That being said, since there is no known cure for either of these conditions, one benefit on your side is foresight. If you regularly struggle with PMS or PMDD, one way to relieve symptoms may be to try and get out in front of them, for example:

  • If possible, don’t schedule any stressful, strenuous, or intense tasks/assignments around this time. Try to give yourself a break and be kind to yourself.
  • Schedule a session with a trusted therapist the week, or several days, before your PMDD usually shows up. If you do therapy weekly and it is an option, consider having a standing appointment near the time of your period in order to offset the extra mental workload that comes with having PMDD.
  • Try to meditate, do light exercise, read a book, or engage in another activity that sparks relaxation.
  • Try to cut back on processed sugars and alcohol – though they bring short term relief, they can leave you feeling worse in the long-term.

Finally, remember that your PMDD or PMS is passing. Your body and mind are doing their best – be kind to yourself, use the information in this guide to tweak lifestyle changes (if you can) that make the run up to your period easier, and treat yourself the way you would a good friend: with kindness and compassion!

Allara Health provides personalized treatment that takes the guesswork out of managing PCOS, and offers a customized, holistic plan of attack that merges nutrition, medication. supplementation, and ongoing, expert support to begin healing your body.

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