Menstrual Cycle Tolerance: A Monthly Test

June 21, 2021 | Dr. Linda J. Dobberstein, DC, Board Certified in Clinical Nutrition

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 Menstrual Cycle Tolerance: A Monthly Test
Does your menstrual cycle run you into the ground each month? The ease or distress that occurs with your period gives an indication as to your physical tolerance from the added metabolic work. Management of oxidative stress and nutrient status make an impact on managing this normal monthly event.

The menstrual cycle is a masterful orchestration that ultimately allows the possibility and creation of new life. Hormones like LH, FSH, estrogen, and progesterone are produced in a sophisticated and complex web of interactions and balance by the brain, adrenal glands, and ovaries every 28 days for decades in a woman’s lifetime.

Building and remodeling of the uterine lining occurs because of hormonal shifts in anticipation of implantation of a fertilized egg. When there is no egg implantation, shedding of the uterine lining occurs as your period.

When your body is out of balance, stressed, and/or depleted, this natural phenomenon wreaks havoc on emotions, energy, and stability of health and becomes the “monthly curse.” Many girls and women suffer greatly with menstrual fatigue, pain, mood swings, insomnia, cramps, bloating, and even worse. Symptoms may occur for a day or two or be disabling for two weeks or more out of the month. The menstrual cycle is a hormonal workout with increased metabolic requirements and a test of your nutrient reserves and inflammation status.


A healthy diet rich in nutrient dense foods that is balanced with proteins, unprocessed carbohydrates, and a variety of fats is first and foremost in any health scenario and is certainly vital for menstrual stress tolerance. The Western diet notoriously lacks nutrients as it is calorie-rich and nutrient poor. Even well-intentioned diets may lack nutrients because of elimination of foods due to allergies, intolerance, dislike, or lack of access. Adequate antioxidants and nutrients are a necessity to manage menstrual cycle wear and tear.

Other factors compete against menstrual cycle tolerance. Smoking, high calorie diets and high fat/sugar/processed salt intake are strong risk factors for a bad mood, negative behaviors, and physical symptoms. Higher consumption of coffee, tea, and carbonated beverages with caffeine and sugar are also linked with greater menstrual distress.

Take the time to read your food labels and choose quality foods. An Asian study on food choices and habits found that women who did not read food labels had a much higher prevalence of menstrual cycle irregularity compared to those who read food labels and consumed healthier choices. Avoid foods with ingredients that you do not understand or cannot pronounce. Choose whole foods that come from something with a “root” (plants/tree) or from a “parent” (animal/fish/eggs).

Cravings, Estrogen, and Leptin

Sugar, carbs, and chocolate are go-to foods to relieve intense food cravings and fix immediate energy demands. Here are two recent, interesting findings. A small study evaluated dietary patterns of healthy women in their 20’s with normal BMIs (body mass index) and regular menstrual cycles. Estradiol, leptin, and other hormones were measured during the luteal phase or second half of the menstrual cycle.

Results found that women with higher levels of estrogen, specifically estradiol, relative to leptin experienced more carbohydrate and sweet cravings compared to women with better ratios. Despite the appearance of health with normal body weight and leptin levels and regular menses, women with estrogen dominance had more sugar cravings.

Other research suggested that chocolate cravings during the menstrual cycle occur because of its fat content. Chocolate contains high amounts of stearic acid, a type of saturated fat that provides metabolic energy. Chocolate consumption was linked with an improvement of menstrual stress tolerance. This does not mean that chocolate is to be the main course of your diet. Choose a couple squares of dark chocolate with at least 70% cocoa to also get higher amounts of antioxidants and phenols.

Menstrual Cycle and Oxidative Stress

Hormone shifts and tissue changes of the menstrual cycle produce high amounts of free-radicals and oxidative stress. Ongoing research has demonstrated that women who experience more symptoms with the menstrual cycle have higher levels of oxidative stress and cellular inflammation. Studies have found increased levels of lipid peroxidation markers and hs-C-Reactive Protein (CRP) in women with more menstrual discomfort. Abdominal cramps, bloating, back pain, appetite changes and cravings, mood stress, breast discomfort, and weight gain were positively related with higher levels of CRP, a marker of cellular inflammation.

Lipid peroxidation refers to a breakdown of lipids caused by free radicals trying to steal electrons from the fats inside cell membranes. Elevated lipid peroxidation levels reflect cell damage. Breakdown of cell membranes makes cells leaky, less metabolically efficient, and unprotected. More waste products and free radicals are produced, which increases antioxidant and nutrient needs. Lipid peroxidation is a definite sign of cellular stress.

Female Athletes and Menstrual Cycle

Female athletes in their reproductive years deserve special attention. The stress demands of athletic activities can be too much to handle and maintain a menstrual cycle. Young girls deeply involved with athletics may delay onset of puberty or lose their menstrual cycle after puberty because of the high energy demands and inadequate nutrient status. If this happens during adolescence, it leads to low estrogen levels.

This hormonal inadequacy is linked with compromised bone growth and density, delayed sexual development, loss of breast tissue and vaginal atrophy or problems with fertility and painful intercourse in young women. In order to maintain a healthy period, female athletes must ensure a nutrient dense diet with adequate protein, complex carbohydrates, antioxidant rich fruits and vegetables and a variety of fats and not fall into patterns of extreme dieting..

Nutritional Fortification is the Game

In addition to a whole foods diet, many nutrients are critical for menstrual cycle tolerance. Antioxidants help quench free radical stress from increased metabolic demands, lipid peroxidation, and cellular inflammation. Indole-3- carbinol (I3C) from cruciferous vegetables, glutathione, selenium, zinc, coenzyme Q10 ubiquinol, vitamins A, C, and E, and many more nutrients help protect lipids, cell membranes, and nerves from free radical stress.

A January 2020 study evaluated vitamin A and vitamin E status and oxidative stress in adolescent girls. Girls with sufficient vitamin A intake experienced a healthier menstrual cycle and better oxidative stress/inflammatory management. Girls with longer menstrual cycles had lower levels of the antioxidant vitamin E. The best sources of (preformed) vitamin A are from beef liver, fish oils, eggs, and dairy. Plant-sources contain pro-formed vitamin A as carotenes. These are found in leafy greens, orange, red, yellow vegetables and fruits. Carotenes must be converted into vitamin A. This conversion process may not be efficient or adequate in some individuals.

Adequate antioxidant protection against lipid peroxidation is especially important in the event of conception. Note that oral contraceptives/birth control pills may adversely increase lipid peroxidation.

Vitamin D

Numerous studies have demonstrated the role of vitamin D in menstrual health. Vitamin D affects calcium metabolism, hormone (estrogen, progesterone, testosterone, cortisol, DHEA) metabolism, gene signals, inflammation management, and neurotransmitter function. Vitamin D status affects the hypothalamus, pituitary, and ovary communication system.

Insufficient vitamin D has been linked with menstrual challenges in all ages. Higher vitamin D intake in adolescent girls was found helpful for backache and those who had a tendency to cry easily. Women/girls who had vitamin D level lower than 30 ng/mL were five times more likely to experience menstrual cycle problems.

A 2019 cross-sectional study evaluated the status of blood levels of zinc, iron, calcium, magnesium, potassium, sodium, and vitamin D in female college students with emotional and physical symptoms during the second half of their cycle. Nearly 1 out of 2 women lacked adequate vitamin D. Out of all the nutrients tested, insufficient vitamin D was considered the most important reason for their symptoms. Vitamin D is used by every cell in your body.


Randomized control trials with systematic reviews showed that calcium is highly vital for menstrual health and reduction of period related symptoms. If you follow a plant-based diet or have eliminated dairy from your diet, you may not be getting the necessary 1000-1200 mg of calcium needed per day. There are many phone apps and websites that can help you track your daily nutrient intake. If that time of month is nasty for you, check your calcium intake.

Chaste Berry Extract and I3C+DIM

Chase berry extract may be used to support menstrual cycle rhythm and mood stress symptoms. Chaste berry extract may be combined with the cruciferous vegetable extracts I3C + DIM to support estrogen metabolism and balance. I3C +DIM provides powerful support for xenobiotic detoxification or endocrine disrupting compounds that further stress hormone balance.

One More Note on Cell Membranes

An interesting randomized, placebo-controlled, double-blind clinical trial found phosphatidylserine (PS) helpful for mood support with the menstrual cycle. Dosage used was 400 mg per day. Phosphatidylserine is used by your nervous system for neurotransmitter support. This special fatty acid is integral for the building blocks of cell membranes.

Ramen noodles, mac and cheese, Big Gulps, cappuccinos and lattes, plates of French fries, or quarts of Ben and Jerry’s may taste great momentarily, but they fail to nutritionally fortify your body and just provide empty calories. Intentional mindful eating with a wide variety of quality rich foods is the first step in menstrual cycle management. You cannot go wrong with that.

The next step is to ensure adequate vitamin D levels by sun exposure and/or supplementation. Optimal vitamin D lab values are between 50-80 ng/mL. Check your dietary calcium intake. Extra support with highly absorbable calcium may be found with Daily Bone Xcel, Daily Builder, or Coral Calcium. Magnesium is also good for stress tolerance, sleep, cramps and mood.

Use a multiple vitamin with activated B vitamins like Daily Energy Multiple Vitamin or Daily Prenatal Multiple Vitamin which has iron. B vitamins aid stress tolerance and hundreds of energy mechanisms. If your diet is low in fruits and vegetables, then consider Daily Protector to provide a foundation of those red-orange super food antioxidants to help manage oxidative stress and damaging free radicals. It also supports your glutathione status.

Add in I3C+DIM or Female Plus for additional hormone support. PhosphatidylSerine and Adrenal Helper add another layer of support for nervous system vitality, energy, and stress tolerance. Many other nutrients may also be supportive.

If you turn into an unrecognizable fraction of yourself and fall apart during that time of the month, you have some work to do. The menstrual cycle is a natural, normal process. It does not require birth control to regulate it or pounds of sugar, caffeine, and chocolate to get you through it. You can take charge of your health and teach your daughters too.

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