Treating the Fear, Not the Folklore: A PEOP Lens on Hormones & Strength

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Transcript

All right, picture this. You're halfway through a session with a client.

Maybe it's a follow-up, maybe it's a discharge visit, and your client says something that sounds like a casual comment, but it hits you like a brick. She says, so, my group chat has a rule now. No heavy lifting the week before your period.

She laughs, but you can tell she's just not sure what to make of it, right? It's that little laugh that people do when they're checking if you're safe. Kind of like, are you gonna tell me I'm stupid for believing this? Are you gonna judge my thought process on this? Are you gonna tell me my friends are doing it wrong? 

All right, so this actually happened a couple weeks ago to my client, and I'm gonna call her Maya. Maya is organized, she's smart, she's the kind of person who does hard things, and she's been trying to do everything right with her health for a long time.

She's in Pelvic Health OT because she's got a constellation, some pelvic pain that flares, constipation that gets worse in certain parts of her cycle, occasional urgency, and sex that has become complicated. It's not always painful, but it's unpredictable enough that Maya can't relax. So she's bracing, and she knows she's bracing.

And on top of that, she wants to get strong. She wants muscle, she wants longevity, she wants to age well, and she wants to feel capable in her body again. But she's drowning in hormone fitness content, such as her WhatsApp group, that makes her feel like women's bodies are basically kind of like a fragile science experiment.

So when she says the group chat thing, my OT brain goes in two directions at once. One direction is the obvious fitness question. 

One direction is the obvious fitness question, right? Like, is this true? Like, does the menstrual cycle actually change muscle gain? Is luteal phase a phase where you shouldn't actually be lifting heavy? 

The other direction is the real issue, and that is, this is fear in disguise. This is a participation barrier. This is a nervous system issue now, not just an exercise program problem.

So today on the OTs and Pelvic Health Podcast, I'm gonna walk you through how I handled Maya's question, in a way that's evidence-aligned, trauma-informed, and actually usable in real life. We're gonna talk cycle syncing, oral contraceptives, progesterone, fast training in cortisol, menopause body composition, but I'm going to keep coming back to one thing. The goal is not perfect hormone optimization.

The goal is participation. All right, let's start where it starts, why Maya is asking this question in the first place. 

INTRO 

So maybe you guessed this already, but Maya's not actually asking about reps and sets. Well, not primarily. She's asking, is it safe to trust my body? Because when you have pelvic symptoms, right, I'm talking pain, urgency, constipation, painful sex, your relationship with exertion changes.

You start scanning, will this flare me? Will I regret this tomorrow? And then social media shows up and says, hey, your hormones are unstable and you should only train hard during certain windows. That's actually a threat message, and threat messages land hard in bodies that already feel threatened. So before I answer her week before the period question, I'm doing trauma-informed care in real time.

So I think I said something like this, right? Totally get why you're asking that, Maya. There's a lot of loud messaging around women's hormones. Before we decide what you should do, tell me what you're afraid will happen if you lift heavy next week.

Because this question does two things. Number one, it gives her nervous system a chance to name the threat. Number two, it tells her, I'm not going to bulldoze her with a lecture.

I wanna actually work through this with her side by side. And so she said something to me like, I think I'm gonna get injured. I'm afraid my pelvic floor will flare.

I'm afraid I'll gain belly fat because of cortisol. I'm afraid I'll mess up my hormones. Okay, great.

Now we kind of know what she's thinking. And because I love leaning into person, environment, occupation, and performance, or PEOP, this is what I'm thinking. For the first P, person, I'm thinking fatigue.

I'm thinking pelvic symptoms, cycle-related symptom patterns, beliefs about hormones, maybe pain sensitivity, right? For environment, I'm thinking social media, group chat rules, probably gym culture, partner expectations, maybe work stress, and maybe even a lack of consistent childcare. For occupation, I'm thinking exercise, right? Exercise is an occupation. So is meal planning, so is symptom management, and so is intimacy.

Last up, performance. So what actually happens? Does she stop training a week every month? Does she white-knuckle it? Does she spiral and quit? So once you see it like that, right, once you realize the rule is not harmless, if Maya stops lifting 25% of the time because she's scared, it affects her progress, her confidence, and her identity. And then she may interpret the lack of progress as my hormones are the problem, and the loop tightens, right? So we need a reframe that reduces threat and protects participation.

This is where the science comes in, as nervous system medicine. So I tell Maya something I think she needs to hear. I say, cycle syncing can sound empowering, but a lot of it is based on the idea that your cycle has a good half and a bad half for gains.

And really, evidence doesn't support that in a meaningful way. I stop here, because if I keep talking, it sounds like I'm dismissing her experience. She might actually feel worse at certain times.

She does have an experience with this cycle, right? So I followed up with, now, symptoms are different, right? If you get cramps, migraines, fatigue, GI upset, whatever, right? We can adjust training based on how you feel. Let's call it auto-regulation. But we don't need to pre-plan that you'll be weaker or that you can't make progress.

So the distinction here is auto-regulate to symptoms versus pre-plan limitation based on hormone folklore. So here's a pain neuroscience angle. When you pre-plan weakness, you're essentially teaching the nervous system to expect threat.

Expectation drives protective output. Protective output changes movement, breathing, pelvic floor tone, performance, and confidence. So I will often use an analogy here.

I'll say something like, you know what? If I tell you, Maya, that this week is dangerous for your body, your brain will brace for danger. And bracing is one of the things we're literally treating in pelvic health OT.

Because that's the truth. Most of our pelvic pain clients don't need more bracing rolls. They actually need, right? And now Maya is gonna ask the question every usually asks next.

Okay, but what about progesterone? Everyone says progesterone is catabolic. 

I then explain a little bit about progesterone casually and clearly.

I'll say something like, you know, progesterone is a hormone that usually rises after ovulation, right? Online, it gets blamed for everything. Bloat, bad mood, bad workouts, you name it, right? But when researchers look at meaningful muscle outcomes across cycle phases, they don't see the kind of big catabolic cycle swing that would justify don't lift in the luteal phase. Then I'll add the part that respects her lived experience.

So you might still feel different at different times. That's because sleep can shift, appetite shifts, perceived effort shifts. That can change how training feels.

But feels harder is not the same as you can't build muscle. And because I'm an OT, I like practical things, right? So I then say something like, instead of asking what does progesterone do to my gains, I might ask, what do I need to do to keep training sustainably when my symptoms are louder? That's P-E-O-P again, supporting performance in context, right?

  I try to wrap things up in a way that really empowers her. I said something like Maya, your physio as a woman is not a limitation.

Try to make it practical. How does it sound to not plan your month around her? What if you plan your training around consistency? She lit up. She was like, tell me more.

What are you thinking? So we created a plan that was simple because complexity can kill adherence, auto-regulation because symptoms are real, something that's pelvic floor smart because pressure management matters, and values-based because we want her to feel capable. So what I said was pick two strength days that you can actually do most weeks, right? Keep your program progressive. When you're feeling good, push close to your end range.

When you're crampy or flaring, scale, right? Maybe lighter loads, fewer sets. Maybe swap a movement that feels better in the moment. But how about, how does it sound if we don't disappear for a week because a calendar told us to? I followed it up with something like, if you train less right before your period sometimes because you feel worse, that's totally cool, right? That's not cycle syncing as a rule.

That's you responding to symptoms. The goal is to stay in a habit, not win the perfect week, right?

When this conversation comes up in your group chat again, I want you to say something inside your own mind that says, I lift based on my body today, not my fear about hormones. 

Thank you so much for being here today. It has been such a pleasure to chat about these things with you.

If this resonates with you, if you are interested in more sessions like this, come over to Pelvic OTPs United. It's my off social media community. We have four faculty guest experts that speak monthly.

I speak four times a month. On top of that, we have an incredibly supportive forum. Check it out in the link.

It's only $39 a month, and I would love to see you there.