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Periods and Polycystic Ovarian Syndrome (PCOS) Explained

Updated: Dec 18, 2023

Let's start with the menstrual cycle.

The textbook cycle is 28 days BUT let’s get it out of the way early and remember to be aware that just about no-one is textbook with a ‘normal’ cycle, if you like, ranging from 21-35 days perhaps.

The menstrual Cycle is split into two phases – the follicular phase(1st) followed by the luteal phase (2nd) – they are split by when we ovulate in middle.

Our hormones oestrogen and progesterone fluctuate during the entire menstrual cycle at different rates.

Day 1 of the menstrual cycle is day 1 of your period and generally lasts up to day 5-7, oestrogen and progesterone are low at this time. Bleeding starts, oestrogen rises and then there is an additional surge of oestrogen just before ovulation which then drops after ovulation. Progesterone rises again then too in the luteal phase.

What’s really important is to TRACK this – we track steps, calories, sleep, exercise, all that stuff why not periods, I can’t tell you how important this is, this is such an important variable in our health. There are some amazing apps which can really help you to get to know your own body and what is going on with your own menstrual cycle.

PMS – What does it even mean? Simply, pre-menstrual symptoms. The symptoms that us ladies feel in the run up and into the early days of our period. 90% of women experience pre-menstrual symptoms. Of course, every woman’s experience is different, that is very important to remember.

GENERALLY (as research into women’s health leaves a lot to be desired - but all is not lost, it’s growing!!), how we feel in training is hugely affected here. It’s normal to feel a couple of days before your period low in motivation, sluggish and generally pretty pants, this can continue as low oestrogen and progesterone continue into the early part of the period. BUT there is evidence to show that moving gently during your period may be helpful for symptom management, it’s perfectly safe to train during this time and evidence shows some benefit so unless you really can’t face it, let’s get moving.

We can feel SO different from week to week and even month to month with little to no explanation – this is normal, help the people around you understand why you may act the way you do.

It’s normal to suffer cravings, carbs is a common one in the run up to your period, we do a lot of work on adjusting nutrition around this time to keep it as symptom free and happy as possible while still shooting towards your goals, be it performance, weight loss or simply health.

In my role as a PT I see that ladies often neglect to think about why they may have a slow week or a week feeling ‘weaker’ than usual – think about it, the body is doing crazy things.

Poly Cystic Ovarian Syndrome (PCOS) is another biggy worthy of a little air time here – it is a condition defined by two of three criteria – raised testosterone, absent or irregular periods or cysts on the ovaries. You need two of the three to be diagnosed. There is a lot of misdiagnosis but it is also under diagnosed. It’s more common than you think. Note that you can have absent or irregular periods for reasons other than PCOS and cysts on the ovaries don’t always mean PCOS. Common symptoms include acne, increased bodily hair, patients are often overweight but there is also such a thing as lean PCOS in those with normal considered BMI. This leads to missed cases.

We don’t actually know what causes PCOS but it is thought that it is largely driven by insulin resistance (meaning the body doesn’t handle insulin very well in simple terms). Innositol is a supplement that has been well researched but it isn’t widely prescribed in PCOS. It has been shown to help fertility in ladies with PCOS which is a common struggle. There are a number of ways that we can work to improve insulin sensitivity along with inositol including medications including metformin but also most importantly, resistance training!! This can help the body to handle glucose by allowing it to enter cells independent of insulin. This is often something neglected by medical professionals.

Be careful with recommendations to steer clear from carbs with PCOS too – education needs improving around this area, even medical professionals updating their knowledge is probably necessary here. Nutrition is very important around PCOS and we do see a big fear of carbs in ladies with PCOS. There is NO evidence to prove that removing carbs will be beneficial for those with PCOS however, there is some evidence for a low glycaemic diet overall. This means consuming more of those foods that create a lower spike in insulin levels, like things high in fibre, wholegrains, veg, all the good stuff. Diets high in these things could prove to be beneficial. Let’s try and steers away from very low carb or even ketogenic diets as a written rule for those with PCOS if not necessary for the individual for weight loss (I have a couple of blogs on what ketogenic diets are if you fancy a gander). Let’s stay in line with the research and be PRO keeping all of the bits you enjoy to lead a normal life but in MODERATION – yes that old M word again.

Moderation, all the healthy habits we know and that I continually harp on about. Girls, let’s be intuitive, tune in to the way that we FEEL, learn what you body needs and wants, listen to it, honour it. We MUST get better at this. Notice, why might you feel down? Is there a pattern? Is it at the same time each month? Are you feeling lacklustre? Is your period potentially approaching?

Talk to me, I love your questions, observations, all that jazz.

Peace and love, A.

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