We've all heard that exercise can affect our hormones, whether it's balancing them or wrecking them. But how do you know which exercise is right for you? In this article, we asked Dr. Laura Decesaris, a Functional Medicine doctor-turned-health strategist who is passionate about helping women achieve optimal health, to help us understand how exercise affects women's hormones both positively and negatively and to break it down into actionable steps.
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How Does Exercise Affect Female Hormones?
Exercise is undoubtedly one of the best lifestyle habits women can utilize to support healthy hormones and metabolic health, in addition to the mental health benefits. Regular exercise can help to decrease excess circulating estrogen levels, improving symptoms of PMS and other estrogen-dominant conditions. Studies of the PCOS population have also shown that exercise can help improve the regularity and quality of menstrual cycles, contributing to better hormone regulation.
After an exercise session, followed by optimal nutrition and recovery, there's a transient increase in hormones like estradiol, testosterone, growth hormone, and DHEA. This increase is how we adapt to training, get stronger, gain muscle, and improve endurance. In women, moderate-intensity resistance training and cardiovascular exercise have been linked to beneficial effects on testosterone and progesterone levels.
There is, however, a point where exercise can potentially harm women's health, though it's more likely that under-recovery and inadequate nutritional intake are more to blame. The combination of high-frequency, high-intensity exercise with a lack of adequate recovery and caloric intake can lead to a decline in female hormones like estrogen, progesterone, and testosterone, often alongside a chronic elevation of the stress hormone cortisol. This combination of hormonal changes can lead to anovulation, fatigue, and, even in more severe cases, amenorrhea (the loss of the menstrual period).
Intense exercise, when performed without adequate recovery and nutrition, can impact the HPA axis. It can also cause a state of relative energy deficiency that may negatively affect the production of hormones like growth hormone and luteinizing hormone, both of which are important for directing the female body on how to make sex hormones like progesterone.
What is Female Hormonal Imbalance?
A female hormone imbalance refers to a state where a woman's hormones are not at optimal levels, independently or in relation to other hormones. Because our hormones are powerful signaling molecules that impact fertility, the menstrual cycle, brain health, gut health, mood, and performance, even a slight variation in the amount of female hormones can affect how women feel and perform.
Some common presentations of female hormone imbalance include:
- Low progesterone, creating a relative estrogen dominance state
- High circulating estrogen, creating a relative estrogen dominance state
- Depressed estrogen and progesterone, often accompanied by anovulation
Other hormones, such as thyroid hormone, cortisol, and insulin, are often impacted alongside female sex hormones, making the signs and symptoms of a female hormonal imbalance highly variable amongst women.
Female Hormonal Imbalance Symptoms
The signs and symptoms of female hormonal imbalances may include:
- Acne (face or body)
- Irregular menstrual cycles
- Heavy periods, or skipped periods
- Hair thinning/loss
- Hot flashes
- Low libido
- Infertility
- Vaginal dryness
- Depression, anxiety
- Fatigue
- Unexplained weight gain or weight loss
- Sleep disturbances
Symptoms may come and go at various times in a woman's menstrual cycle, making it difficult to keep track of them and understand which lifestyle habits affect her hormones.
How Fasted Exercise Affects Women's Hormones
It's no secret that intermittent fasting has been a popular health tool in recent years, and proponents of "fasted workouts" claim that exercising in a fasted state can help burn more fat than exercising in a fed state.
While some studies show that fasted exercise can increase fat burn, it is an acute effect that only happens during the workout. Another study on women showed that body composition changes occurred with exercise and calorie restriction, and there was no difference between women who trained fasted and women who trained fed.
Long-term training in a fed state is likely better for women's hormones and athletic performance. Calorie restriction in active women long-term can lead to poor performance and can negatively impact female hormones by raising cortisol and affecting ovulation.
Most proponents of fasted exercise suggest doing it first thing in the morning, before your first meal. Cortisol, our stress hormone, is highest in the morning (assuming a healthy cortisol response), and fasted training potentially increases it further. So this would not be recommended for women with high stress levels. Chronically elevated cortisol can lead to a decline in estrogen and progesterone and ultimately promote fat gain and muscle loss.
Additionally, during fasting, there's a decrease in a molecule called kisspeptin, a critical signaling molecule in the release of growth hormone and signaling ovulation. This decrease in kisspeptin can disrupt overall estrogen and progesterone production, potentially contributing to why so many women experience hormone dysfunction with excess fasting. Ultimately, our hormone profile makes women more sensitive to lower nutrient availability than men, meaning fasted exercise will likely not confer the same long-term benefits it does for men.
RED-S
Relative energy deficiency in sports (RED-S) can affect active females and occurs when women consistently burn more calories than they consume. This condition used to be referred to as the Female Athlete Triad and is characterized by fatigue, changing menstrual cycles/anovulation or amenorrhea, a loss of bone density, and higher risk of stress fractures, and poor recovery.
RED-s highlights the issues women face when they train at a high intensity, do not adequately fuel their performance with enough calories, and do not recover from intense training sessions. It's a contributor to hormone imbalance that is getting more common across the lifespan in women and underlines the importance of educating women on how to fuel their activity level properly.
Cycling Your Exercise with Your Menstrual Cycle
Cycle syncing has become very popular in the last few years as a means of helping women live in better alignment with their changing hormone profiles throughout the month. A general cycle syncing guideline suggests more intense exercise during the front half of the menstrual cycle (follicular/ovulation) and to taper-off intensity in the second half (luteal/menstrual). The reality is that every woman's ability to exercise will be variable and depend on her unique biochemistry.
Studies do show a few aspects to cycle syncing exercise that can be helpful for women looking to keep their hormones balanced for optimal health and athletic performance:
- Women may need enhanced recovery with intense workouts during the menstrual/follicular phase as women are slightly more prone to DOMS (delayed-onset muscle soreness) and strength loss due to lower hormone concentrations during this time.
- High-intensity workouts can increase cortisol. So, frequency and adequate recovery are essential during the menstrual/follicular phases when women tend to have higher cortisol levels. Research suggests reducing workouts' intensity or prioritizing more recovery periods during these phases.
- Aerobic exercise has been linked to healthier estrogen metabolism and a reduction in high circulating estrogen levels. So, including that as part of a woman's training regiment from the mid-follicular phase through the luteal phase (when estrogen levels are higher) can help keep estrogen in a healthy range.
- Strength training in the follicular phase has been linked to increased strength gains compared to the luteal phase. Strength training in the luteal phase might need to look different since women historically have lower endurance during this half of the cycle.
How Exercise Should Change as We Age
As women move through different hormonal transitional periods, exercise can also be adjusted to match fluctuating hormones.
Perimenopause into Menopause
- Incorporating HIIT sessions alongside strength training into your routine benefits insulin sensitivity, weight management, and metabolic health, which can all become challenging for women due to fluctuating hormones during this transition.
Menopause and Post-menopause
- It's imperative to emphasize weight-bearing strength training even more as we age.
- Due to declining estrogen, women's bone mass and lean mass start to decrease in post-menopause. Focusing more on resistance and weight-bearing exercise is essential to mitigate these age-related changes.
- Bursts of anaerobic resistance training have been linked to increased estradiol levels in post-menopausal women compared to aerobic cardiovascular exercise alone.
Strength training and regular cardiovascular exercise are staples at any stage of a woman's life. Tweaking the frequency and duration of high-intensity exercise and increasing recovery time can help support healthy hormones as women move through hormonal transition periods.
How to Fix Hormonal Imbalance Affected By Exercise
A functional medicine approach to supporting your hormone health can be a game-changer in helping you feel your best. The first start is testing to get an individualized approach to what could be going on below the surface.
Functional Medicine Labs to Consider for Balancing Female Hormones
Comprehensive Female Hormone Testing
A Comprehensive Female Hormone Testing, including 4-Point Cortisol, gives a great baseline. Understanding your hormone baseline can help you create a sustainable exercise routine that confers the benefits of physical activity without creating too much stress on your hormones. You can't optimize what you don't measure and track. Understanding your starting point and checking labs annually can keep you moving and feeling your best. It's important to check cortisol levels as part of that hormone evaluation to ensure your training, recovery, and nutrition are on par to support healthy hormones without overly stressing them.
Iron Testing
Serum iron is essential for menstruating women. Female athletes are more likely to experience iron deficiency which may impact athletic performance and can contribute to menstrual cycle irregularities.
Comprehensive Gut Microbiome Testing
A Comprehensive Gut Microbiome Test is also beneficial. An unhealthy gut microbiome has been linked to hormone imbalances and conditions such as PCOS. Exercise has been linked to improvements in gut microbiome health. So, this test can be used as part of a comprehensive treatment plan to improve gut microbiome health in women dealing with hormone imbalances.
Comprehensive Thyroid Panel
A Thyroid Panel is another essential test. Overtraining (or under-recovery) can negatively impact your thyroid function, leading to fatigue and subclinical hypothyroidism. Checking in on your thyroid labs can help address any fluctuations in your levels before they become more problematic.
Micronutrient Testing
A Micronutrient Evaluation is also recommended. One of the most significant contributors to hormone imbalances in the exercising population is inadequate nutrition for the body's needs. Micronutrients like zinc, vitamin D, and magnesium are essential for hormone production and metabolism. Evaluating levels of vitamins and minerals can help ensure you're getting everything you need from your diet to support healthy hormone levels while working out and can help guide supplementation if required.
Lifestyle Habits to Support Healthy Hormones
Nutrition for Women's Hormones
- It's vital to ensure you're eating enough food to fuel your training. To get the benefits of exercise, like increased muscle mass and stronger bones, you need to be able to fuel your body with the appropriate macro- and micronutrients.
- The type of exercise you're doing can help guide nutrition. For example, walking only requires a little fuel. So, women can benefit from fasted exercise through walking and lower-intensity movement. But a fasted heavy-weight training session or a long fasted cardio session will likely not bring the benefits you think if they are continually done without food.
- Increasing protein intake, especially with age, can help support age-related bone and muscle loss.
- Protein supplementation can help make it easier to reach protein goals. A low-protein diet has been linked with low estrogen, anovulation, low growth hormone, and compromised thyroid function.
- Training frequency and lean muscle mass will increase women's protein needs. Postmenopausal women need a higher protein intake to maintain lean muscle and offset the age-related muscle mass decline.
- Healthy fats, like olive oil or avocados, are linked with a lower risk of anovulation and better sex hormone levels in women.
- Eating a balanced diet with quality animal proteins, a variety of plant foods, root vegetables, and other starches around exercise can help ensure you're reaching the nutrient requirements needed to make and regulate hormones.
Herbs/Supplements That Help Balance Hormones
Creatine is particularly important for women with low estrogen (post-menopausal, hormone imbalance, late luteal/early follicular phase) and to offset muscle loss in the luteal and menstrual phase. Health benefits of creatine have been linked to improved athletic performance and improvement in depression symptoms.
- Improves athletic performance and recovery and may help reduce hot flash intensity and frequency in menopausal women.
- As a bonus, it can help ward off hot flashes during menopause.
Branched-Chain Amino Acids (BCAA's)
- In addition to reducing muscle soreness and improving recovery, BCAAs help keep cortisol regulated when training hard so that you don't start to negatively impact your hormones with exercise.
Electrolytes/Coconut water
- Especially in the luteal phase, when progesterone is higher, electrolytes can help maintain fluid balance. Progesterone can contribute to a higher body temperature, putting women exercising intensely or in warm conditions at a higher risk of dehydration. Utilizing electrolytes helps maintain fluid balance so the body can better thermoregulate.
Summary
It's no secret that regularly exercising is essential to any healthy lifestyle. Women can fine-tune their exercise and recovery to their hormones throughout various stages of life and can reduce the risk of hormone imbalances caused by RED-s by matching their nutrition and recovery with training.
Functional medicine can help to guide nutrition and lifestyle support for a woman's exercise regimen and can help to evaluate changing hormone levels before an imbalance occurs as part of a proactive lifestyle plan.
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