As veterinary professionals, we're no strangers to challenges.
From long hours and emotionally taxing cases to the physical demands of the job, our profession can often ask a lot of us. But for many women and AFAB (Assigned Female at Birth) individuals in veterinary medicine, there's an additional factor to consider: our menstrual cycles.
We just don't talk about them.
Periods and menstrual cycles have long been a taboo, which ironically stands in the way of us doing something to help ourselves, especially as a huge portion of the world will experience this.
This blog is aimed at discussing menstrual cycles prior to perimenopause and menopause.
Understanding Our Cyclical Nature
While men typically experience hormonal changes over a 24-hour period, women and AFAB individuals are cyclical beings, with hormonal fluctuations occurring over an average 28-day cycle. This means our energy levels, mood, and even cognitive functions can vary significantly throughout the month.
Dr. Alisa Vitti, author of "In the FLO," explains that "women are cyclical beings, not linear beings like men. Our hormones create a 28-day cycle that affects our brain chemistry, metabolism, and stress response."
Here's a nudge to be a little kinder to yourself!
We live in a world that expects the same energy and effort every single day, like machines, but our bodies don't work in this way. (If you want to go down a rabbit hole, go and look up Cycle Syncing, and see how many women adjust their lives around their cycles to good effect).
Wait, what if I'm on a hormonal contraceptive?
It's crucial to note that experiences can vary significantly for those using hormonal contraceptives, everyone is different. Oral contraceptives often suppresses the natural hormonal fluctuations of the menstrual cycle, which can lead to a more stable hormonal environment throughout the month - for some people.
Some individuals on oral hormones may not experience the cyclical changes described above, or may experience them to a lesser degree. Others might still notice mood and energy fluctuations, especially during the pill-free week if they're on a 21/7 regimen. Others will have side effects from the contraceptives themselves.
Each type of contraceptive comes with its own set of potential benefits and side effects, and these can differ greatly from person to person. Some might find that the pill reduces symptoms like pre-menstrual syndrome (PMS) or heavy periods, while others might experience side effects like mood changes or decreased libido.
It's also worth noting that some people might not experience significant cyclical changes even without hormonal contraception. The key is to pay attention to your own body and experiences, and to work with a healthcare provider to find the best approach for your individual needs. Remember, there's no one-size-fits-all solution when it comes to managing your menstrual cycle and overall health.
A Quick Hormone Recap
Let's remember that everyone is different! This is a general overview, and it's important to get to know yourself, rather than just what's on this list. It can be valuable to remember what's going on during our cycle and ask "could this be my hormones speaking here?"
Menstrual Phase (Days 1-5 on average) Hormones: Oestrogen and progesterone are at their lowest levels Some may experience: Menstrual bleeding, possible cramps, fatigue, and mood changes. Some may feel relief from premenstrual symptoms.
Follicular Phase (Days 1-13) Hormones: Oestrogen begins to rise, FSH (Follicle Stimulating Hormone) increases Some may experience: Increased energy, improved mood, enhanced cognitive function. Skin may appear clearer and more radiant. At this stage, you might feel able to take on the world!
Ovulatory Phase (Day 14 on average) Hormones: Oestrogen peaks, LH (Luteinising Hormone) surges Experience: Peak in energy and libido, increased confidence, and improved communication skills. Some may experience mild ovulation pain. Others will feel a peak of anxiety or worry during ovulation.
Luteal Phase (Days 15-28) Hormones: Progesterone rises, oestrogen and testosterone have a second, smaller peak
Early Luteal (Days 15-21): Experience: Some people may feel continued high energy, good mood, increased appetite. Others find the start of a drop in energy and mood
Late Luteal Phase (Days 22-28) Possible pre-menstrual syndrome (PMS) symptoms including mood swings, breast tenderness, bloating, headaches, fatigue. Some may experience food cravings and changes in sleep patterns. It is shared by some that at this time they feel like quitting projects or running away.
Top tip to remember which part is which!
F = Follicular = First half
L = Luteal = Last half
Embracing Your Changing 'Best'
It's crucial to understand that your 'best' will look different at various points in your cycle. Some days you might feel like you can take on the world, while others might require more rest and self-care.
This isn't a weakness - it's your body's natural rhythm.
Dr. Stacy Sims, exercise physiologist and nutrition scientist, emphasises, "Women are not small men. We have unique physiological differences that affect how we respond to exercise, stress, and nutrition throughout our menstrual cycle."
A kind reminder from us: you can never do more than the best that you can with what you have available to you.
Top Insights for Navigating Your Cycle
1. Track Your Cycle: There are lots of apps out there to help you monitor your cycle and understand your patterns. Read reviews and see which one suits you. Others prefer to note symptoms in a diary. As with everything at Vet Empowered, we invite you to bring curiosity not criticism. Even realising that a certain time of the month is often tricky, can help us to be kinder to ourselves.
2. Harness Your Power: Each phase of your cycle brings different strengths. For instance, the follicular phase (days 1-14) is often associated with increased creativity and energy, making it an ideal time for tackling challenging tasks. Whilst the late luteal phase is challenging for some in terms of mood and energy levels, it might be a time to double down on self-care and set stricter boundaries.
3. Plan According to Your Cycle: If possible, try to schedule important meetings or procedures during your most energetic phases. We realise this isn't always possible, but it can be a valuable question to consider.
4. Listen to Your Body: If you're feeling particularly fatigued or irritable during your luteal phase (days 15-28), it's okay to take it easier. Your body probably needs it. Schedule in rest pro-actively and notice the difference it makes.
5. Adjust Your Workouts: Research shows that high-intensity workouts may be more beneficial during the follicular phase, while lower-intensity exercises might be more appropriate during the luteal phase. 6. Find what helps you to navigate the challenges. We've made a few suggestions through this post, but please also remember the value of things such as breath work, meditation, hydration, nutrition etc. Create yourself a care pack - a list of resources, reminders and things that set you up for success.
7. Communicate with those you love, if you feel able to. Explain what you notice, how you feel and what you need during various times. Mind made a resource for supporting family members with PMDD (we explain PMDD further down this blog), but it might give you some inspiration.
Making Decisions Throughout Your Cycle
Understanding your cycle can help you make decisions more effectively:
Follicular Phase: Often a good time for big decisions and new projects, when you're most likely full of energy.
Ovulatory Phase: Great for networking and communication, if you're one of those who has a surge of confidence.
Luteal Phase: Ideal for detail-oriented work and wrapping up projects, think of this like winter. Time to bunker down, be snug and kind.
Menstrual Phase: Can be great for reflection and planning.
Remember, these are general guidelines. Your personal experience may vary, which is why tracking your cycle is so valuable.
What do you notice about each stage, for you?
Co-founder Katie has previously shared that she knows her luteal phase isn't a time to make bigger life or business decisions, and often if there's doubt over a decision, she often waits a week.
Nutrition
Your nutritional needs can change throughout your cycle. It's worth learning about, as well as noticing what does and doesn't help you.
There are some great resources out there to read further on this topic:
Read up and learn about our energy intake and requirements at each stage, and reflect on what small changes you could make.
Action: What have been your key take homes?
What about supplements?
Again, everyone is different. Always consult with a healthcare provider before starting any new supplement regimen.
Porri et al (2021) found magnesium supplementation to be valuable for a number of women's health challenges from PCOS to PMS. There's a whole article from Holland and Barrett here which was reviewed by a doctor and well referenced on the benefits of magnesium in menstrual health. The women's health network talk about magnesium glycinate in particular, including its role in anxiety, hormones and sleep. (Interesting fact, magnesium deficiency has also been linked to migraines too - read more here).
There is also suggestion that Vitamin B6 can be valuable in stabilising hormones and reducing PMS symptoms too. Read more in this article and check out their references.
Omega-3s have emerging evidence for helping with PMS (Mohammadi et al 2022), where a review article concluded: Omega-3 fatty acids could reduce the severity of PMS. However, we should caution in the conclusion in affirming the beneficial effects of n-3 PUFAs on PMS, since the heterogeneity is evident in the analysis. The efficacy of the treatment was enhanced by increase of the treatment duration.
Holland and Barrett share a well referenced article here explaining even more supplements and the potential evidence base behind them.
Action: Is there anything you've learned about here that you'd like to pursue further? Do you need any more information or to discuss this with anyone?
Understanding PMDD: When the symptoms are really impactful
It's important to be aware of PMDD, especially in a world that often casts off any hormonal symptoms as simply being 'that time of the month'.
Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS that affects 3-8% of women. PMDD is currently the sole premenstrual disorder recognised in the DSM-V (the textbook in which psychiatrists make their diagnosis from). Although PMS and PMDD are frequently confused and used interchangeably in popular media and everyday chat, they are distinct conditions with significant differences in their origins, diagnostic criteria, and treatment approaches.
Symptoms of PMDD can include severe mood swings, depression, anxiety, and physical discomfort. Many will describe feeling to be a different person for part of their menstrual cycle. If you suspect you might have PMDD, it's crucial to speak with a healthcare provider, such as a GP initially.
The International Association for Pre-Menstrual Disorders (IAPMD) provides invaluable resources and support around this subject. Their articles on PMDD are a great place to start.
"PMDD can cause severe emotional, professional, and personal harm to those who have it. Sufferers of PMDD report damaging and impulsive behaviors that may include suddenly leaving a job or a relationship." - IAMPD
Dr. Tory Eisenlohr-Moul, a leading PMDD researcher, states, "PMDD is a very real and debilitating disorder. It's not just 'bad PMS' - it can significantly impact a person's ability to function in daily life."
As more discussions are happening in veterinary around neurodiversity, it's worth knowing about the PMDD and ADHD/ASD Comorbidity. Research suggests that individuals with ADHD or ASD may be more likely to experience PMDD. The exact reasons for this are not fully understood, but it's thought that the hormonal fluctuations associated with the menstrual cycle can exacerbate some symptoms of ADHD and ASD.
Remember, it's always good to talk. Vetlife is available 24/7 for the UK Vet community on 0303 040 2551.
Navigating Veterinary Work with Your Cycle
Here are a few starting points for things to consider around navigating your cycle at work as a veterinary professional.
1. Communicate with Your Team: If you're comfortable, share your cycle-related needs with your colleagues. This can foster understanding and support. Here's an article you might find valuable: How to create a menstrual-friendly workforce and there's an article from Edinburgh University on How to talk to your boss about menstruation. If you're open as a practice to being more supportive of women's health in general, take a look at Westport Vets becoming the first endometriosis friendly practice.
2. Create a Self-Care Routine: This might include meditation, gentle exercise, or simply taking a few minutes for yourself during busy shifts. How might this vary during different stages of your cycle? Reflect on what helps you, and set future you up for success at various points in your cycle. Example action point: some like to create an extra pack for self-care and reminders for their luteal phase, as well as schedule in more rest.
3. Advocate for Yourself: If you're struggling with severe symptoms, don't hesitate to speak with your supervisor about accommodations. Remember, organisations such as ACAS can give you impartial, free employment advice.
4. Stay Hydrated and Nourished: Keep nutritious snacks on hand and a water bottle nearby, especially during long shifts.
5. Reflect, reflect, reflect - with compassion. Notice what happens at each stage and be curious about what and who could help you. During certain stages of our cycle, it can feel as though our armour is reduced to self criticism, or we make decisions we later regret. Even understanding this and raising our awareness can help us navigate this. We can ask, "is now a good time for me to make this decision?". We've popped you some reflective prompts at the end, if they feel right.
6. Ask for support. Dare to advocate yourself. We hear you, it can sometimes feel frustrating, but educate yourself and keep going. There are lots of resources about how to have this discussion with healthcare professionals, particularly on IAMPD.
Remember, understanding and working with your cycle isn't about limiting yourself - it's about optimising your performance and wellbeing. By tuning into your body's natural rhythms, you can navigate the demands of veterinary work more effectively and compassionately.
Further Resources:
The book "Period Power" by Maisie Hill is a great read!
IAPMD (International Association for Premenstrual Disorders)
If you're looking for menopause resources, WellVet have some excellent ones
If you'd like to catch up on the two sessions we did with Adele Johnston, you can view them here: Nab TWO free webinars HERE.
Conclusion
Remember, every body is different. What works for one person may not work for another. The key is to listen to your body, track your experiences, and seek professional help when needed.
You're not just a veterinary professional - you're a complex, cyclical being with unique needs and strengths.
Embrace your cyclical nature and let it guide you to a more balanced, fulfilling career in veterinary medicine.
Reflective Prompts
Here are some think-points to reflect on, if you feel able to do so. Remember, if anything feels tricky or upsetting, step away. Please do follow up with your support systems as you need to:
How does my energy level change throughout my cycle? Are there patterns I notice?
In which phase of my cycle do I feel most confident at work? Least confident?
How do my communication skills vary throughout my cycle? Are there times when I find it easier or harder to interact with clients or colleagues?
What are my biggest challenges during each phase of my cycle in relation to my work?
How does my cycle affect my decision-making abilities? Are there times when I feel more or less decisive?
What self-care practices have I found most helpful during different phases of my cycle?
How does my cycle impact my physical capabilities at work (e.g., during surgeries or handling animals)?
Are there any recurring emotional patterns I notice throughout my cycle? How do these affect my work relationships?
In which phase of my cycle do I feel most creative or innovative in my approach to veterinary challenges?
How does my cycle affect my ability to handle stress at work?
What accommodations or changes could I implement in my work routine to better support my cyclical nature?
How does my cycle impact my learning and retention of new information or skills?
In which phase do I find it easiest to set and maintain boundaries with clients or colleagues?
What strategies have I found effective for managing any challenging pre-menstrual symptoms while at work?
How does my sleep quality change throughout my cycle, and how does this impact my work performance?
In which phase do I find it easiest to empathise with distressed clients or patients?
How does my cycle affect my ability to multitask or handle a busy clinic day?
What positive aspects of my cyclical nature have I noticed in relation to my veterinary work?
What action steps could I take to be more compassionate during different stages?
A Post from Katie
We wanted to share one of the posts from Katie, one of our co-founders from LinkedIn a few years ago:
"Could this be to do with your hormones?"
This isn't my usual type of post, but it helped a lot of people on my other platforms from the feedback.
(And vet employers, I'd read this too because I had so many employees reach out to me yesterday to thank me for raising awareness on this ❤️...)
I'll be totally honest, I remember years ago in clinical veterinary practice having a really emotionally charged few days. I can't even remember what I was upset about, but it was intense. Everything felt out of sync, I was very anxious and my experiences felt big. I nearly quit my job, I felt under appreciated but at the same time useless....despite any evidence in front of me. That's the tame version.
It wasn't the first time. As much as I didn't want to admit it, this had happened before.
Days later it would pass and I'd feel a bit embarrassed, and I'd apologise and not quite know what had happened; it didn't feel like me.
I remember a good (and Eagle eyed) friend pointing out the cyclicity of it. She asked if it could be my hormones.
I didn't know how powerful hormones could be at the time, and in the midst of such a heavy experience, I really didn't want to take that on board. It maybe felt a bit invalidating.
When we grow up in a world of being told "oh is it the time of the month?" and it being laughed off, it's understandable for that to be a first reaction.
Years later, I learned that indeed hormones ARE powerful and Pre-Menstrual Dysphoric Disorder (PMDD) is a very real thing.
It's not an imbalance of hormones but believed to be the brain's reaction to the changes in them pre-period.
Around 1 in 20 that menstruate will experience this, and there are studies to show the experience is especially common in neurodivergent individuals interestingly (in fact, the stats are quite astounding - see link in comments).
The good news is there are plenty of things and professionals that absolutely can help.
I feel thankful that although I do experience some changes with hormones I have a way to navigate it in a way that works for me. ❤️ I work my diary around this, lean into self care and self compassion. It's absolutely not as intense as it ever was, and I understand it much more now.
If you resonate, check out resources like IAPMD, Dr. Helena Tucker and speaking with your GP - plus starting to track symptoms with kindness and curiosity. Please do advocate yourself and be pleasantly persistent where you need to.
There's also Vetlife available 24/7 for the UK Vet community on 0303 040 2551.
It's PMDD Awareness Month and I couldn't not use my profile to raise awareness and signpost support.
I don't do this for sympathy - I feel fortunate that I'm in the position that I am now.
It's great to see more on menopause these days, but can we keep opening the hormonal conversations earlier too? ❤️"
References:
Debora Porri, Hans K. Biesalski, Antonio Limitone, Laura Bertuzzo, Hellas Cena,
Effect of magnesium supplementation on women's health and well-being,
NFS Journal, Volume 23, 2021, Pages 30-36,
Mohammadi, M.M., Dehghan Nayeri, N., Mashhadi, M. and Varaei, S. (2022), Effect of omega-3 fatty acids on premenstrual syndrome: A systematic review and meta-analysis. J. Obstet. Gynaecol. Res., 48: 1293-1305. https://doi.org/10.1111/jog.15217
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