Energy Balance Across the Menstrual Cycle

In the episode, we discuss changes in appetite, cravings, energy intake and energy expenditure across different phases of the menstrual cycle 

Menstrual Cycles and Disorders Couse for Dietitians:https://whnlearninghub.thinkific.com/courses/menstrualhealth

Women's Health Nutrition Learning Hub: 

www.whnlearninghub.com

References:

1. Gorczyca AM, Sjaarda LA, Mitchell EM, et al. Changes in macronutrient, micronutrient, and food group intakes throughout the menstrual cycle in healthy, premenopausal women. Eur J Nutr. 2016;55(3):1181–1188.
   
   
   
2. Tucker JAL, McCarthy SF, Bornath DPD, Khoja JS, Hazell TJ. The Effect of the Menstrual Cycle on Energy Intake: A Systematic Review and Meta-analysis. Nutr Rev. 2024;83(3):e866–e876.
   
   
   
3. Rogan MM, Black KE. Dietary energy intake across the menstrual cycle: a narrative review. Nutr Rev. 2022;81(7):869–886.
   
   
   
4. Salem AM, Latif R, Rafique N, et al. Variations of Ghrelin and Obestatin Hormones During the Menstrual Cycle of Women of Different BMIs. Int J Women’s Health. 2022;14:1297–1305.
   
   
   
5. Reed SC, Levin FR, Evans SM. Changes in mood, cognitive performance and appetite in the late luteal and follicular phases of the menstrual cycle in women with and without PMDD. Horm Behav. 2008;54(1):185–193. (Control group details cited here).
   
   
   

Lorenz TK, Gesselman AN, Vitzthum VJ. Variance in Mood Symptoms Across Menstrual Cycles: Implications for PMDD. Women’s Reprod Health. 2017;4(2):77–88. (Mood-focused; not directly used for appetite but included as provided.)

Transcript

0:00

Hi, and welcome to the Femme Health Nutrition Podcast. I am Nilou Deilami a registered dietician and founder of the Women's Health Nutrition Learning Hub, a platform where dieticians and nutrition professionals can learn about all things related to female health and nutrition. If you haven't already, you can check out the website at whnlearninghub.com. You can find many blog posts on there on women's health Nutrition, as well as some free resources that you can download and use in your practice. You can also join my newsletter where I send biweekly research updates on various topics, as well as share new courses and upcoming learning opportunities like webinars as well. You can find the link for the website in the episode description. If you're new to the podcast, welcome. I'm so glad that you're here and joining us on this learning journey. And if you've been listening for a while, thank you so much for tuning in and your continued support and your commitment to learning about and advancing women's health nutrition. So if you've been a listener for a while, you may have noticed that I didn't publish any new episodes over the past month. Um, things have been quite busy here. On my end, I was developing a course, which I'll talk about shortly. Um, and I was also a bit sick for a little while. So, um, I am back at it and. We will be returning to regular programming with podcast episodes being published every two to three weeks. Now, over the past few months, I have been working really hard on this upcoming course called Menstrual Health and Disorders Advanced Course for dieticians and nutritionists. The course will officially be launching and the content will be available starting from October 27th, but we do have early bird pricing up until October 16th with code menstrual 25. I'll put all the details for that in the show notes in case you're interested and want to check it out. So let's jump into today's topic, which is energy balance across the menstrual cycle, which is a little bit of a sneak peek into the upcoming course. And as a reminder, this podcast is of course, intended as an educational podcast for dieticians, healthcare professionals, and anyone interested. In female health and nutrition, it is not intended as medical advice. And if you have any questions or concerns about your own health, please consult your healthcare team. So when it comes to energy balance across the menstrual cycle, we often hear anecdotes from clients about feeling hungrier at certain times of the month. We hear specific cravings like cravings for chocolate or sweet foods or carbohydrates, and some people may feel like their energy levels, their mood even might shift across different phases as well. So what I'd like to do here today is to really look into the research and see what it actually says in terms of the link between the menstrual cycle and things like appetite, cravings, energy intake, and energy expenditure as well, and to see if it actually does tend to fluctuate across the cycle, or if some of these claims are being overstated. Now before we dig into the data, we'll do a quick review of the four phases of a menstrual cycle so we're all on the same page. So there are four phases of the menstrual cycle. The first is the menstrual phase, and this is the start of the cycle when bleeding occurs and there's that shedding of the uterine lining. at this point, both estrogen and progesterone levels are at their lowest. Now our next phase is the follicular phase, which does overlap the menstrual phase. And this is where FSH or a hormone called the follicle stimulating hormone is released from the pituitary gland and stimulates follicle development in the ovaries. And as follicles mature, estrogen levels start to rise. We then have ovulation. This typically happens mid cycle where there is a surge in LH or luteinizing hormone, which triggers ovulation. And ovulation is when an egg is released from the follicle and moves into the fallopian tube. Now that. Empty follicle will then transition into a structure called the corpus lutetium, and that's where we head into the next phase of the menstrual cycle, which is the luteal phase or the last two weeks of that menstrual cycle. So that Corpus LTM will start to produce progesterone, which tends to thicken the uterine lining in preparation for potential pregnancy. Estrogen levels at this point are moderate. LH and FSH will be suppressed during this phase. And then once we get to the late luteal phase, as we start to approach the menstrual phase again, progesterone and estrogen drop If a pregnancy does not occur. Now with that in mind, let's move into the evidence on how different aspects of energy balance may be influenced across these different phases where the hormonal profiles are quite different in each phase. Okay, so let's start with mood, because it's often assumed that changes in mood will drive changes in eating behaviors across the menstrual cycle. And many people believe that mood consistently dips in the luteal phase, which again is that second part of the menstrual cycle. But the evidence actually shows a little bit more of a nuanced picture. There was a group of researchers that compared women with and without PMDD, and they actually found that those who did not have PMDD didn't show a significant increase in negative mood in the luteal phase compared to the follicular phase. And this was really in sharp contrast to that pronounced. Deterioration and mood that we see in PMDD. And for those who are not familiar with PMDD. PMDD is an acronym for Premenstrual Dysphoric Disorder, which is a psychiatric disorder of low mood in the luteal phase of the menstrual cycle. That is actually included in the DSM five. Basically a more severe form of PMS and it can be very, very debilitating, uh, for some individuals so just getting back to the research, there was another group of researchers who actually tracked daily mood across two to six cycles in 27 healthy women, so no PMS or PMDD, and they found that up to 98% of mood variability was explained by day-to-day fluctuations, not the menstrual cycle phase. So what we can take away from this is that in individuals who do not have PMS or PMDD, mood is not really consistently tied to that menstrual phase. So to say that mood. Changes in the menstrual phase for somebody who has a normal menstrual cycle is leading to increased energy intake or changes in appetite may not be that accurate, and we'll talk about this in a little bit more detail in the next section. So now let's talk about appetite and energy intake. And this is where many clients might express that. You know, when I'm on my period, I just feel like I need to eat a lot more. I'm craving Sweetss. So when we look at the research, there was this one study that followed about 250 women across their menstrual cycle, and they found that both appetite and cravings were significantly higher in the late luteal phase compared to the menstrual follicular and ovulatory phases. cravings for things like chocolate, sweets, and salty foods were actually particularly pronounced in these individuals in their luteal phase. Now, in this study, despite the stronger cravings, total energy intake didn't actually differ that much in the cohort. Now going back to the study that we talked about earlier where they compared women with PMDD and without PMDD and looked at their mood, they were also looking at their energy intake throughout the. Different phases of the cycle, and they were actually giving, lunches to these participants in the luteal phase and the follicular phase. So they found that in those who did not have PMDD or PMS, there were cravings present, but actual intake didn't really change across the different phases of the cycle. Without PMDD only consumed about 3% more at their luteal phase lunch. However, they did find that those did have PMDD had a more significant increase in their cravings as well as their energy intake. Now, when we look at other studies that also look at energy intake throughout the different phases. There's a big range. So studies have found anywhere from 160 calories to 500 calories increase in energy intake in the luteal phase compared to the follicular phase. But we have to think about how some of these studies are flawed. So some of them will not confirm the phase of the menstrual cycle by testing hormones. Some of them will be through dietary recall. And some of those that provide lunches will actually provide the lunches at times where we wouldn't expect a peak in appetite. So that's probably why we see that there is so much variability. Now there was a meta-analysis done that kind of helps balance this out, uh, and they looked at 15 data sets and found that an average increase of 168 calories per day was common in the luteal phase. So because the quality of the evidence is not great, we can't really draw any definitive conclusions. but what we can take away from some of the studies is that for some people there might be no changes in mood, appetite or energy intake, in different phases of the menstrual cycle. For some people there might be increased cravings and appetite, but not necessarily increased intake. And for some people there might be increased cravings and appetite changes in mood and significantly increased energy intake and the luteal phase and that this is more likely if there is a diagnosis of PMS or PMDD. Now the best way for you to help your individual clients is to actually suggest a little bit of tracking in different phases of the cycle. Short term, it doesn't have to be for months and months, but maybe for a couple of cycles, and to really get to know that individual's unique pattern that will help you provide better and more tailored guidance to that individual. So for example, you might want to work on things like protein and fiber and meal timings to help manage those cravings and those changes in appetite. Now another thing that I wanted to talk about was actually energy expenditure. So up to this point we've been talking about energy intake, how cravings and changes in mood might impact energy intake. There are also theories that energy expenditure shifts across the phases of the menstrual cycle, So when we look at the actual research, there was a systematic review and meta-analysis of 26 studies that found a small but statistically significant increase in resting energy expenditure in the luteal phase. But when they. Analyze this a little bit further, and they restricted the studies to only recent studies where they were well controlled and the phases of the menstrual cycle were studied better and were confirmed in these studies. We see that the effect actually diminishes and there was no statistically significant difference between energy expenditure. across the different phases of the menstrual cycle. So older studies showed statistically significant findings, but better design studies showed that there's really no difference in resting energy expenditure. it seems that resting energy expenditure seems to be quite stable across the phases of the menstrual cycle. And in those few studies that do show a small statistically significant change, if there are variations, it's actually well within the range of normal day-to-day variability and fluctuations between resting energy expenditure, and it's not necessarily because of the phase of the menstrual cycle. So putting this all together. We know that mood changes are minimal in those without PMS and PMGD, and mostly if there are changes, it's likely due to daily fluctuations. If your client experiences severe fluctuations that are cyclic, then they should be evaluated for PMS or PMDD. We're also finding that these mood changes. Are more likely to cause an increased energy intake. again, in those who have PMS or PMGT, rather than the average individual who does not have any underlying condition. It seems that appetite and cravings do reliably increase in the late luteal phase, but whether it actually increases energy intake. Is not quite clear, and we kind of need to look that more on an individual basis. Best way to learn about that is by tracking mood, food, and symptoms And finally, newer research shows that energy expenditure is pretty stable throughout the menstrual cycle and unlikely to drive significant changes in energy balance. So that brings us to the end of the episode I hope you found this helpful. If you have any suggestions for future topics or any feedback for me, please feel free to reach out at Hello@whnlearninghub.com. And if you enjoyed this episode, if it provided any value to you and you would like to see more content for me, I would be so grateful if you would subscribe, leave a rating or share this episode or the podcast with your colleagues. Thank you again for tuning in, and I hope you have a lovely day.