A little Q&A

This month I combined forces with fellow Dietitian and foodie Sarah (could we have any more in common!) from The Good Food Clinic to chat all about period health and the role nutrition has on your monthly. 

Her gorgeous followers fronted with some great questions that many women may have but haven't thought to ask before so I wanted to share this Q&A session with you in this space too! 

Dive in and let me know what you think gorgeous! 

What is the relationship between carbohydrates/insulin during the menstrual cycle?

Carbohydrates continue to be a hot topic in the nutrition world, but what impact do they have on your period health? Some fad diets such as the ketogenic diet encourage restriction of carbohydrates in order to achieve weight loss. The reason these diets result in weight loss is because by depriving your body of glucose (from carbohydrates) you are asking it to break down muscle and fat to provide fuel. The same situation would occur in a famine as a starvation response. And guess what, the starvation response turns off your period!

On the other hand, women with polycystic ovarian syndrome (PCOS) may benefit from reducing carbohydrate intake. Some women will experience insulin resistance which results in common symptoms such as acne, unwanted hair growth and infertility. Insulin is released from the pancreas in response to carbohydrate intake so some women with PCOS find a lower carbohydrate diet reduces insulin levels and therefore symptoms.

How much impact does exercise have on the period?

Excessive exercise or exercise that is often associated with a low body weight (such as ultra-running or dancing) can result in a loss of menstruation. This absence of “your monthly” is known as Hypothalamic Amenorrhea and is your bodies response to stress or insufficient nutrition to compensate with the energy expenditure associated with intense physical activity. Your hypothalamus talks to your pituitary gland and tells it to switch off two hormones, LH (Luteinizing Hormone) and FSH (Follicle Stimulating Hormone) which are both essential in the pathway for oestrogen production. Without oestrogen there is no ovulation. In short, your body perceives the presence of stress hormones from exercise or low body weight (or both!) as a sign that the world isn’t safe or doesn’t have enough food to support mum and baby. If the world can’t support new life, why would your body allow a pregnancy to occur?

During ovulation, what should I be eating?

First things first, understanding whether or not you have ovulated isn’t as simple as getting your period each month or feeling twinges or pains at certain times in your cycle. Using methods such as temperature for fertility tracking and checking for fertile mucus are ways which you can check for ovulation at home. It is also important to note that if you are on hormonal contraception such as the oral contraceptive pill (OCP) then your monthly bleed isn’t a period by true definition (shredding of the uterine lining), it is a bleed due to synthetic hormones. In terms of what you should be eating for ovulation and period health there are some key micronutrients that you can focus on including in your diet.

Magnesium’s role in the production of hormones (yes including female sex hormones!) makes it a top priority in terms of micronutrients for period health. Aim to include a range of Magnesium containing foods such as dark leafy greens, nuts, seeds and even dark chocolate. Zinc is another star player and nourishes ovarian follicles, promoting ovulation and the hormone progesterone. Excellent sources of Zinc include seafood (in particular shellfish such as mussels and oysters), red meat, chickpeas and beans and nuts such as cashews and almonds. Iodine is also involved in ovulation as it is involved at the cell level in the ovaries (in particular your oestrogen receptors). Iodised salt is your best bet for including iodine in your diet (you may want to check which salt is in your salt grinder and remember not all salts are iodised!). Other sources include seafood and seaweed.

Does diet effect period pain? E.g restricting sugar or anti-inflammatory diets

Some women, in particular those with Endometriosis find a low wheat diet beneficial for reducing symptoms of painful periods. There is also some evidence that magnesium and omega-3’ supplementation (fish and flax seed oils) can reduce symptoms of period pain but information on an effective dose is still limited.

I am recovering from an ED, have not had a period for several years, how do I get my period back/ have regular periods?

Periods are sensitive things and even a small amount of weight loss (as little as 10%, for example 6kg in a 60kg female) is enough to switch your monthly off. Many women who are recovering from an eating disorder find that their period takes a while (months to years) to return despite weight gain or weight stability. The hormones involved in menstruation will be down regulated if you are not eating enough carbohydrate containing foods as well as overall energy intake as it will perceive the outside world as in a state of famine. Consider looking at your current intake and adding in some carbohydrate foods if you haven’t already (sweet potato, fruit, legumes, pulses, whole grains or oats for example) and be kind and patient with your body. If you are eating enough to support a healthy body weight and enjoying gentle movement such as yoga, walking or Pilates rather than stressful intense exercise then your monthly will come back.

Why does my appetite change during my period?

It is entirely normal for a women’s appetite to change over the course of their menstruation cycle. This is all thanks to the dancing of sex hormones oestrogen and progesterone which rise and fall during the month. Oestrogen (highest prior to ovulation) not only increases your appetite but also your basal metabolic rate, making you feel hungry! This super hormone also boosts our libido and confidence- which is why I affectionately refer to oestrogen as the goddess hormone! Progesterone on the other hand (highest post ovulation and falls during menstruation) is a hormone that brings a sense of calm. Some women crave certain foods during their period and I would invite you to think about whether or not such cravings are really in response to comfort eating as many of us can feel more irritable, low or short fused during our period than any other time in our cycle. Those feelings are all due to an absence of that calming hormone progesterone which falls away when a pregnancy does not occur. If you want chocolate or other sweet foods during your period, great! Please enjoy them. But also think about how else you can be kind to yourself over those few days in ways that doesn’t involve food (gentle walks, take a bath, treat yourself to a magazine).

Why do I experience diarrhea during my period?

Progesterone falls during your period, and as this hormone can make your bowels more sluggish its absence during menstruation causes the opposite effect!

Is it normal to gain weight (up to 1 kg) during my period?

Absolutely. A women’s body weight can fluctuate between 1-4 kg over the course of her monthly cycle. Remember there are various wonderful hormones rising and falling throughout the month and these hormones change our metabolism, appetite and mood among other physiological actions.

What is the healthiest form of contraception?

This question deserves a blog post of its own! Contraception methods, whether they are hormonal (the OCP, Mirena IUD or implants), non-hormonal (copper IUD) or barrier methods (condoms) all have their own pro’s and con’s. Some conditions such as Endometriosis may require the use of hormonal contraceptives as part of the management of symptoms such as heavy or painful periods. Contraception should be an individual choice, but it should also be an informed one. Did you know that hormonal contraceptive medication is the most popular choice of contraception for females in both Australia and New Zealand? The hormones used in these medications are synthetic hormones designed to switch off ovulation. While downregulating ovulation prevents a pregnancy, it also prevents you from experiencing all the wonderful highs of oestrogen and progesterone (increased mood, improved energy, skin health and libido just to name a few perks of our sex hormones!). Increased risk of blood clots, hair loss and poor libido for women on the OCP have been well documented in research, but new evidence also demonstrates a strong link between depression and hormonal contraception. We have to start teaching women to ask their GP or specialist questions about what medications, the indications for such medications and to encourage them to explore other options if possible.