Dynamic Dialogue with Danny Matranga - 214: From Menstruation to Menopause, how Hormones impact Training/Recovery

Episode Date: August 23, 2022

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Starting point is 00:00:00 Before we get into today's episode, I wanted to kind of record a little caveat that I'm not a doctor, I'm not a exercise physiologist, and I'm not a women's health specialist, okay? But what I am going to do is share with you a lot of what I've seen work for my clients with their health, with their fitness, to best work within the kind of unique framework that is female physiology. Whether you're menstruating or you're at the point in your life where you're either paramenopause or actively in menopause, you're going to learn a lot today. But remember, develop the best relationship you can with your physician and work together to make sure that you're aging gracefully and performing your best.
Starting point is 00:00:44 Enjoy the episode. Hey, everybody, welcome into another episode of the Dynamic Dialogue podcast. As always, I'm your host, Danny Matranga. And in today's episode, we're going to talk a little bit more about training with your menstrual cycle. Now, if you've been a listener of the podcast for any amount of time, you're probably pretty aware that we've discussed this topic a number of times before here on the podcast. I've sat down and spoke with people who are much more well-versed in the kind of expansive differences between male and female physiology than myself. So we've talked to some real, real smart peeps on this episode. As a good primer, if you're listening here in 2022, you should go back and listen to the episodes I did with Lyle McDonald in 2020. Those episodes are super, super good and go even greater into detail about how the menstrual cycle, things like PMS,
Starting point is 00:01:47 things like the various phases, the specific female physiological conditions like PCOS. We talk about a lot of different stuff specifically to kind of help many of the female lifters and athletes and women looking to change the way their bodies look, move, and feel that listen to this podcast. Things that I think really give you some good ammunition, if you will, or arrows in your quiver. But today, what we're going to talk about specifically is the menstrual cycle and menopause and what you really need to know about how those two things affect your training. So, to kind of make it as simple as possible, there's two categories of women that we're going to talk about today.
Starting point is 00:02:26 We're going to talk about women who have entered into menopause. That would be perimenopause and, of course, menopause. Para means around. We're going to talk about women who are premenopause. So these are women who are still menstruating. To put it quite simply, once you stop menstruating, right, about one year after that, when you stop seeing estrogen coming out at its kind of more typical rate, that's the break there. That's where you say, okay, you've crossed from premenopause, maybe perimenopause, into menopause. the kind of end of your traditional menstrual cycle. And that's when we see the change in hormones like estrogen. And we'll talk about kind of the differences in training there and what we might know. And we'll even talk about a few different studies that I pulled to really help
Starting point is 00:03:13 us look at this, try to help you guys have some more ammunition. There's plenty of podcasts like this. For those of you who are coaches, man, oh man, especially male coaches, this stuff is really, really, really important to learn. So much of what we do as evidence-based coaches, whether we're pulling from the literature, what we know from exercise science labs and colleges and universities all around the world, what we know anecdotally, meaning like what we've experienced with clients or in our own training and what we've learned kind of from our field, what we've observed other people doing, that's
Starting point is 00:03:45 very limited by not having experienced any of that as a woman. So there's a lot of things you'd stand to benefit here as a man listening to this podcast, especially if you're a personal trainer. But we'll talk quite a bit about this stuff today. So first, just a quick primer. Let's break down the menstrual cycle in terms of its phases. I do think this is important to know as we move forward, just because these terms are going to come up a lot.
Starting point is 00:04:10 The first portion of the menstrual cycle is considered menstruation. So that could be between one to five days. We're going to use the 28 day model as has been discussed multiple times in this podcast before. Again, not all cycles are 28 days. That just tends to be the average. So if yours is 29 days, 30 days, these numbers might not add up perfectly and they probably wouldn't anyway, but just bear with me. So the menstrual cycle usually is days one to five of this 28 day cycle. And what's happening here is the hormones, estrogen and progesterone are running quite low, which is why oftentimes for training, this can be a, let's call it less than ideal time. You kind of need those hormones to feel your best. And the lining of the uterus, the endometrium, if we're being specific, is shed.
Starting point is 00:04:57 And so that is what causes the traditional bleeding associated with getting your period or hitting menstruation. Okay, then you move into the follicular phase, okay? Estrogen and progesterone start to come up. This is usually from days, let's say, 6 to 14. This is a money time for training. The spike, the increase in estrogen and progesterone are really, really valuable for your training. Those things coming up generally makes you feel better than when they're all the way down low, and we'll talk about that more when we get to the section of the podcast where we discuss menopause and how that affects training. Okay. So around days 15 to 17, so sandwiched between the first primary phase of this sucker, which is going to be that follicular phase, days one to five of which are again, menstruation, days six to 14 or the late follicular. That's the money zone
Starting point is 00:05:45 for training. You have kind of your peak potential peak here, uh, around days 15, 16, 17, where typically you'll see ovulation, right? So this is where estrogen is going to peak. It's going to climb. Testosterone is actually on the rise. Progesterone is on the rise here. So like PR time, if you could ever time this up, that's just going to be awesome for you. Now, I train a ton of women all over the world, and many of them are in this portion of their life where they're actively menstruating, they're having a menstrual cycle regularly each and every month, and so there is a lot of dialogue with the things that change around the physiology here. It's really important to know that in your training and in the way you're constructing things, and more importantly, I think your expectations,
Starting point is 00:06:28 right? So you can try to dial up training so that the bulk of the volume is around this time, you know, between the late follicular to early luteal right around, you know, sandwiching the ovulatory in there, of course, days 15 to 17, and really just trying to always peak then, but that's not particularly practical. And I do find that the variations in performance for most women aren't huge. Most of my female clients can train just fine in the early follicular phase or during menstruation, not nearly as well, maybe 10 to 20% less ideal or less output than when they're around that ovulatory kind of 15 to 17 day window where
Starting point is 00:07:07 they're like really kind of peaked hormonally. Like there is a difference, but for many of them, it's not precipitous, but every woman's different. I do find that sometimes out of the blue, depending on stress, depending on hydration, food status, and sleep, sometimes my clients can get hit by a really heavy menstrual cycle, not in flow per se, okay, but more that it just seems that the effect of the estrogen and progesterone being so low is really creating lethargy with the increased allostatic load or with the greater stress placed on the body. So there's not only variances between women, but there's variances within women. So meaning like one period could be wildly more dysregulated by other stress factors. So none of this is universal, but
Starting point is 00:07:49 if you just try to kind of give yourself a little grace, if you have volume kind of baked into your program around days one through five and let it rip when you're between like days, say six to 22, like that might be a generally good rule of thumb. So back to the cycle here, after you have ovulation days, 15 to 17, that testosterone spike is going to dissipate a little bit. We're going to head into the later or earlier portion of the luteal phase. The luteal phase is where we start to see like that peak estrogen and progesterone area starts to come down if there's no conception. So if you don't get pregnant, that peak in estrogen and progesterone actually starts to come down. So we're going to see those level out, get a little bit lower,
Starting point is 00:08:39 lower, lower, lower. And it is in that decrease, right? It's important to remember this is kind of all happening cyclically each and every month. So we can, in some ways as coaches know when this is coming for our clients or as trainees, especially for, for those of you who are training really regularly, right? You know, okay, I'm approaching this time. You know, again, I know what to expect a little bit. I have a good idea of what my physiology is going to do I i've been through this a couple months as a in a row as a lifter I can't recommend enough just paying attention to it trying to be aware of it Uh, it's made a really big difference for me to just learn about this stuff as a coach like big time
Starting point is 00:09:19 I think it really really has helped me out a lot So I would encourage you guys to do the same just gives just gives me more insights. Like I don't change much about lifting mechanics. I don't change much about exercise selection. None of the like programming stuff changes too much, but it's in how I apply it with this, with this stuff in context that really helps me make a difference between how I train men and women. But the nuts and the bolts don't change too much. Like it's not going to influence the lifts we select or the volume landmarks we really select overall, but we might tweak those things in the micro. So at the end of the phase, right, the end of the luteal phase specifically, which is the final phase of the menstrual cycle, we're going to see estrogen and progesterone start to come
Starting point is 00:10:00 down. And as they get lower and lower and lower, many women will experience what's known as PMS or PMDD if it's really severe. I learned that one from Lyle. And that's going to result eventually in the repeat of the cycle around the 28th day where usually you will have menstruation reoccur. So if you exercise really severely and restrict your calories, that can be delayed. If you're super stressed, that could be delayed. Obviously, if you're pregnant, you're going to see that delayed. But usually every 28 days, this whole thing is going to turn over and you're going to start over. And you'll know, okay, you know, I've got to deal with that low progesterone and that low estrogen again at the beginning of the cycle when you're menstruating. And then it'll start to
Starting point is 00:10:42 climb, climb, climb, climb. Testosterone will bump right around ovulation. You'll get great training for two to two and a half weeks there. And then the hormones, they kind of change a little bit, slow climb down depending on your sensitivity to that. That might mean training dips a lot. That might mean training doesn't dip at all. This is why I'm encouraging you to track. So let's talk a little bit about recovery because I think recovery is super important when we look at this and we talk about how it will impact your training and inform your training. So I did find a really, really good meta-analyses here or a kind of an aggregate of studies, if you will. This one is called the menstrual cycles effects on exercise-induced fatigability, meaning your fatigue from. This is one was written in 2020 from Pereira et al. Okay. So we are going to take a look here at what we can see and what we can glean from this study. So what we can glean from this is that the cycle just being there, like the reliable cycle, like, okay, it's going to come. We can't use that to infer whether or not somebody is going to be fatigued. If you look at the studies, we can't glean, which is what this meta-analysis does,
Starting point is 00:11:52 this is what meta-analyses do, they analyze meta-many studies. Okay, so we can't definitively say, this was the finding from Pereira, we can't definitively say that the cycle is a reliable metric for gauging fatigue, like you won't always be fatigued. But many female athletes will, of course, report that their sports performance, their output, their strength is hindered by the symptoms of their menstrual cycle. So there's a contradiction there. And again, these fluctuations are going to be experienced differently. So this study or meta-analysis kind of tells us, okay, anecdotal data, what we see is a lot of variance. We couldn't put a pin on this thing when we looked at all the studies. So your individual, your lived experience is going to be big here.
Starting point is 00:12:38 That is huge. That basically is, again, another reason. Pay attention to this thing. Track this thing. Focus on this thing. It's really, really important. Another study, this one specific to performance, Ansdall et al. from 2019, menstrual cycle-associated modulations in neuromuscular function and fatigability. Okay, knee extensors were what they looked at here,
Starting point is 00:13:00 meaning the quads, the muscles that extend the knee. And what was found was that quad strength does not vary significantly on average over the course of the menstrual cycle. That's a big deal. That really helps us, at least in this singular study. Again, this was included in this meta analysis, I bet. We can say that, okay, at least for people who participated in this study, they were pretty good across the cycle. Okay, endurance though, endurance, this study, they were pretty good across the cycle. Endurance though, endurance, this study found that endurance is highest during the luteal phase and lowest during the follicular phase, so towards the end as the progesterone and estrogen come down. Super, super helpful.
Starting point is 00:13:37 I actually pulled these study summaries from Mass Monthly Applications in Sports Science, and that is just the best darn aggregate of, I guess you could call it research review. It's more than that. There's like a lot of really good educational audio roundtables. And there's some really, really killer video presentations, but I pulled these out of mass and it makes it really easy for me to share studies with you. And a lot of you guys ask like, Hey, how can I learn more about this? Uh, how can I get, get more info on the scientific side of things? Monthly applications of sports science is my go-to can't recommend it enough. I'm not affiliated with them. I don't have a code for them, but Eric has been kind enough to be on my podcast, uh, Eric Trexler
Starting point is 00:14:19 and Eric Helms, both of whom contribute you guys. If you're into lifting, if you're a coach, great way to spend your money, even continuing education, uh NSCA and NASM. So can't recommend it enough, makes it really easy for me to take a deep dive into this stuff as somebody who's only modestly scientifically literate. I can parse things out. I'm getting better as I go. But again, mass, super, super cool. So let's transition here in our discussion point Um, we we can circle the wagons really quick here Hey guys taking a break from the action to tell you about one of our favorite new sponsors underdog fantasy If you're like me you love sports sports was actually how I got into fitness in the first place
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Starting point is 00:20:11 You can't go wrong. You can shop using the show notes below or by going to legionathletics.com and checking out using the promo code Danny. That will save you 20% and it will actually help you get two times points towards future orders, which you can use the same as cash. Pretty cool, guys. So head over to legionathletics.com and check out using the promo code DANNY to save on all your sports supplement needs. Back to the show. We know that the menstrual cycle is about 28 days long. We know that days one to five is the average amount of time a woman will be menstruating with suppressed estrogen and progesterone levels, this is going to generally lead to a lower training output. Days six to 14, round out the follicular phase, okay? This is where progesterone and estrogen are on the rise, and training starts to pick up around ovulation right there in the middle. Days 15 to 17, we get an assistant spike in testosterone, if you will, that can lead to
Starting point is 00:21:01 even better training. Ideally, if you were an Olympic athlete and you had four years to plan out and you had a 28 day cycle that was going to be entirely perfect and never miss a day, which would be extremely rare for a high level athlete, either way, like, and you could say, okay, this is the day that I will be ovulating, or these are the days that I will be ovulating four years from now. You could hope that your Olympic event would fall on that, but you. But you don't get to do that. And people break world records and win gold medals all the time. And the likelihood of them being in that phase
Starting point is 00:21:30 is like, if you think about it, three days out of a 28-day cycle. So right about three and nine. So somewhere around, what is that? 11.5% or something like that. 11.5% chance, but that you'd be perfectly physiologically optimized. But the good thing is you don't have to worry about it too much because the meta-analyses
Starting point is 00:21:49 and the data point us in the direction of saying, hey, track this thing, pay attention to the individual variants. There's a good chance you might not see any decrease in performance at all. But depending on stressors, allostatic load, stuff that I have seen in working with clients like lack of sleep, stress at work, stress around home with spouses, with kids, travel. These things can all influence how the physiology experiences these different phases. And then, of course, on the back end of the ovulatory cycle, we got the luteal phase. And that's where things start to kind of climb down. That's where you're going to see PMS occur.
Starting point is 00:22:23 And so that can usually lead to kind of a decline in training output. This is what I have seen as a male coach with female clients. So again, I can't give you any personal experience here because I haven't experienced it myself. I've only witnessed it, paid more and more attention to it as I've been coaching. And I think you guys should do the same. So what about people who are outside of that menstrual timeframe? They're no longer pre-menopause. They're in either perimenopause or menopause, meaning they have not had a cycle in about a year. And so what generally happens here is we see less estrogen. The ovaries kind of stop producing estrogen. The female physiology is kind of telling the woman, hey, you know, enough is enough here. You are kind of out of that reproductive window of your life.
Starting point is 00:23:05 And we're going to kind of allocate our resources elsewhere. Not to say that, you know, they're being allocated anywhere more or less important, only that these are kind of baked in evolutionary mechanisms that exist in the human body. And we don't know a ton because when you think about how you have to study or how you have to do studies, it's really hard to get standardized populations. So like it's hard to get studies done with well trained adults. It'd be really even that much harder to get studies done with like well-trained adult menopausal women. Because think about the things that would make that challenging. First of all, you need enough menopausal women who have been introduced to resistance training, which wasn't particularly even popular with women until like 20 to 30 years ago. And it's really peaked in popularity within the last five.
Starting point is 00:24:04 regular lifters aren't in that demographic. There's not a lot of demographic crossover. So it would be really, really hard to have a bunch of studies that looked at what, what could we do to optimize resistance training, body fat reduction, uh, you know, sports performance, living your healthier life. Every time you, you shrink the demographic, every time you go from, uh, women to, uh, women between this age to women between this age who are menopausal between women, uh, to then women between this age who are menopausal, to then women between this age who are menopausal who resistance train regularly or who follow this diet, it gets really hard. So not a ton of research out there. But some consistent trends amongst women who are menopausal is we see a decrease in muscle mass and we see an increase in body fat gain. This can
Starting point is 00:24:43 oftentimes be due to a decrease in physical activity. Ponser, one of the more popular metabolic researchers out there, kind of put into the space the notion that our actual age-related declines in metabolism aren't as much as we think. I think it was somewhere between like 6% to 10% per decade, which isn't a huge decrease. I want to say it was in the lower end, enough that I was like, wow, I even added up like 20, 30 years, two, three decades. And I was like, that's still not enough of a decline in just general metabolic output that would lead me to believe that women are just doomed to gain body fat and have no muscle as
Starting point is 00:25:20 they age. You hear this a lot, but I think a lot of the reduction in muscle and increase in body fat comes from being sedentary. Many of the clients who I've started working with many, many years ago, particularly in person who are in their, let's say, late 40s, early 50s, who resistance trained either at the beginning of their menopause experience or journey, whatever you want to call it, the beginning of menopause, they started in perimenopause to then being all the way into full-blown menopause. I didn't see a ton of change in their physique. And I think that's a good thing here in large part due to the fact that they didn't experience a lot of what you'll see reported, which is increases in body fat and decreases in muscle mass. So I think the best thing one could do just based purely off
Starting point is 00:26:02 what I've seen and what I've done with clients, get lifting as early as you can. And we know that it will make the symptomology or the experience of those fluctuations, that precipitous drop in estrogen, less intense. That I have heard, that I have read, that I tend to believe more generally because of resistance trainings, heavy kind of correlation with these sex hormones. It seems like to me, from what I've seen and what I know, the sex hormones, estrogen, progesterone, testosterone, to those like secondary like influenced hormones, like insulin, these aren't secondary sexual hormones, they're just secondary hormones that I'm going to talk about. Insulin and growth hormone, these are all really, really impacted by resistance training. And they're all heavily, heavily involved in body composition, appetite, and all kinds of stuff that could affect what your body looks like. So if lifting helps with all those, lifting during menopause or at the beginning of menopause is kind of a very, very helpful, in my opinion, thing to do. And if you want to know what kind of happens
Starting point is 00:27:05 during menopause, in perimenopause, we see testosterone come down a considerable amount to, it basically reaches next to zero. We see this with men over the lifespan where we see a slow decrease in testosterone. But if you look at charts of what happens to women's testosterone from perimenopause through menopause and into that postmenopausal time frame, it just comes down, down, down. We see a slow and kind of steady decrease in progesterone, which is a drop in progesterone, the hormone progesterone. So we know how that can affect things like water retention. When progesterone gets high, water retention gets high. That's why when you're in that portion of your menstrual cycle, uh, like particularly where estrogen and progesterone fluctuate wildly, if it gets too
Starting point is 00:27:52 high, it gets too low, it's going to impact your, uh, water retention. So, you know, if you are getting to that PMS phase where progesterone is really, really high, you know, you might start to see some water retention. And so that comes down kind of in a more general, it doesn't spike as much when you go through paramenopause and into menopause, it just comes down, down, down, down, down. The one that does fluctuate a lot is estrogen. Estrogen seems to go all over the place and then kind of bottom out. And so then you're kind of through it. And a lot of those, as I understand it, and having worked with many women who are menopausal and, you know, my mom is at that age. A lot of my mom's friends are at that age. You know, my girlfriend's mom's around that age. Like you can definitely lean into the fact that like, oh, menopause makes women's
Starting point is 00:28:43 mood and hormones and stuff go erratic and crazy. But I personally have not experienced a ton of that. And I deal with a lot of these people like a lot of the time. And I think one of the reasons why is because they're all active and exercising. That's what I've seen. Like, why is it that I don't see that? Maybe it's because most of the menopausal women I hang out with are pretty active and they're working on their, you know, their fitness and they're getting an evening out effect, if you will, of these hormones. So again, I'm not a doctor. I'm not an expert on this stuff, but again, gosh, can you say, but again, one more time guy? No, but for real, I think as these things come down, one of the best things you can do is stay active.
Starting point is 00:29:19 So again, looking at another study, this is exercised induced muscle damage in post-menopausal well-trained women. Another awesome study from Mass. And so basically just throwing it all out there, these women did 10 by 10 squats with about 60% of their one rep max. They looked at how they recovered. They looked at some markers of muscle damage two hours after they trained, 24 hours after, and 48 hours. And things seem to be pretty similar when trained post-menopausal women worked out compared to pre-menopausal women. So it doesn't impact your recovery too much. So it's probably one of those things that's a good idea to do. And so those are kind of my more general recommendations for how to handle it. Just speaking anecdotally, I think doing
Starting point is 00:30:04 resistance training across the lifespan would be a really good way to help modulate some of these hormones. I've seen it anecdotally. I've talked to a lot of really smart people who seem to believe the same thing. All the literature I've looked at kind of just says, hey, if you're remotely trying to manage the health of kind of some of your secondary physiological stuff, like maybe not your body mass, maybe not your blood pressure, but like, yeah, Hey, you want your hormones to be pretty decent. You want to feel vivacious and vibrant and good all the time. Like, uh, I would probably lift weights. And I know that that seems like, okay, duh, he's shilling for big iron. He has a, he's a fitness coach. He has a personal training business. He, you know, of course he wants people
Starting point is 00:30:43 to lift weights. You know, I'm somebody who's very, very invested in people's health too, not just that they're working out and lifting weights. I'm health-centric. I'm not just kind of a shill for big iron here. This is big, big time stuff, guys. Weight lifting could really make it easier to work with some of the uniquities of female physiology, make the aging experience better.
Starting point is 00:31:03 I'm lifting so that the aging experience is better for me as a guy. Uh, and I think women could stand to gain the same. So I hope you all enjoyed this episode, tried to unpack that to the best of my ability so that it was, uh, tolerable and easy to access and kind of not from the hip, but, uh, generally scientifically informed as well as sharing some of what I've seen. So I'll catch you guys on the next episode. Thank you so much for tuning in and listening to me on your health, fitness, and wellness journey.

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