The menstrual cycle is not just periods
Gaëlle Baldassari starts from what she sees in the field: in Kiffe Ton Cycle workshops, when people are asked how long a cycle lasts, many answer "two or three days". They know when their period is due, but have no idea how the cycle affects the rest of their life. For practitioners, this means that the people concerned rarely bring up their cycle in consultation. It is up to the professional to ask.
The subject also has a history. A hundred years ago, a woman lived around fifty cycles on average, between later first periods, closely spaced pregnancies and long breastfeeding. Today it is 400 to 500 cycles in a lifetime: a phenomenon that is more present and more repetitive, which research is only beginning to explore.
Finally, the cycle is not only about the uterus. Oestradiol and progesterone act on almost every organ, which carry their receptors: brain, gut, bones, muscles, skin, blood vessels and the cardiovascular system.
The four phases of the cycle, seen as a surf session
To make the physiology tangible, Gaëlle Baldassari compares each cycle to a wave, which you can either take in the face or learn to surf:
- Menstruation: sex hormones are at their lowest. It is a time of rest and stepping back, when fatigue may be more present.
- The follicular phase: oestradiol rises gradually and works like an accelerator pedal. This is the build-up of momentum.
- Ovulation: oestrogens are at their peak, with a small testosterone peak that leans more towards interaction and connection.
- The luteal phase: progesterone takes over. More calm and creativity, less of a social mask, but also heightened sensitivity to what is not working.
Luteal phase and premenstrual syndrome: stop confusing the two
This is one of the messages she insists on most. The luteal phase is normal: in this period it is normal to notice what could be improved in your life. Premenstrual syndrome, on the other hand, signals an imbalance. In her words, it is not normal to suffer or to be in distress during this period.
Ovulation, not menstruation, at the centre of the cycle
Periods are the most visible element, but the biological goal of the cycle is ovulation: without ovulation, there is no progesterone secretion and no normal cycle. For Gaëlle Baldassari, knowing how to identify one's ovulation should be part of every woman's basic knowledge.
What the cycle changes in your consultations
The thread running through her talk fits into one question: is the symptom I am being told about present only at certain times of the cycle, amplified at certain times, or unrelated to the cycle? The answer changes how the case is read.
Digestion
According to the figure she quotes, 73% of women have a digestive symptom before or during their period. Progesterone tends to slow intestinal transit: constipation can increase in the premenstrual period, then give way to diarrhoea when the period arrives. Alternating constipation and diarrhoea that is present all the time does not tell the same story as an alternation that systematically returns as the period approaches. In the second case, the body is reacting to hormonal fluctuations, and hormonal support may be more relevant than addressing the digestive symptom alone.
Temperature and sleep
After ovulation, core body temperature rises by 0.3 to 0.7 degrees. Connected rings, watches and bracelets that track temperature can then wrongly flag fatigue or the onset of illness. This rise also affects sleep: the body needs its temperature to drop in order to fall asleep, and manages this less well in the luteal phase. Sleep there is often harder to find and less restorative. Faced with a sleep complaint, the question becomes: a permanent problem, one that worsens in the luteal phase, or one linked to the drop in progesterone a few days before the period?
Hunger and cravings
Resting energy expenditure is higher in the luteal phase. In a food plan that reduces intake in a linear way, without taking the cycle into account, the extra need of this phase can show up as cravings experienced as a relapse. Gaëlle Baldassari sees a risk of failure, guilt, and worsening of eating disorders where they are present. Her advice: tell patients it is normal to be hungrier during this period, and work with them on meals that cover this need.
Weight and water retention
In a study she cites, carried out on 62 women over one year, perceived bloating peaks on the first day of the cycle. Weight itself can vary from one week to the next depending on the phase, and an imbalance between oestrogens and progesterone can encourage water retention. She has experienced it herself: at a time when she had significant premenstrual syndrome, her weight varied by two kilos on each cycle, without her or the dietitian following her being aware of it. When you ask a patient to step on the scales, she recommends asking where she is in her cycle: weight gain before a period is not necessarily a question of rebalancing the diet.
Period pain: a signal, not a fate
According to the figure presented, 40% of women aged 18 to 49 have painful periods that they rate above 4 out of 10. For Gaëlle Baldassari, the pain has been trivialised for lack of means of investigation, even though it always signals something. She uses a simple comparison: someone with severe knee pain three days a month would be investigated. Contractions of the myometrium can be felt, even be uncomfortable, but physiological periods are not painful.
When the pain stops someone from getting on with their activities, it should be investigated by a health professional. Endometriosis is an increasingly well-known cause, with a diagnostic delay estimated at seven to nine years between the first report and the diagnosis. Once investigations have been carried out and if no cause is identified, lifestyle support and support for hormonal balance can help reduce the pain.
Competence and perception: the limits of "cycle syncing"
The trend coming from the United States consists of organising your life around your cycle, for example scheduling important meetings in the ovulatory phase. Gaëlle Baldassari advises against passing it on in consultation. According to the studies she refers to, sporting or intellectual competence does not vary over the cycle; it is the perception of it that changes. An athlete may feel less capable before her period while objective measurement shows no drop, even less so in competition.
She also sees an extra mental load in it, and a perverse effect: believing you are competent a few days a month means believing you are incompetent the rest of the time. Her message to practitioners: reassure people that they are competent at all times. In answer to a question, she adds that mobilising cognitive resources can take more energy at the end of the luteal phase, and that the inner dialogue can become more critical then, which practitioners supporting the mental side would do well to keep in mind. Premenstrual brain fog, however, is not normal in her view and may signal an imbalance.
Why cycle length is not enough
The 28-day cycle of the textbooks concerns only 13% of people who have a cycle. The normal range runs from 21 to 35 days, and up to 45 days in the two or three years after the first period; it also widens as menopause approaches.
But two cycles of identical length can tell very different stories. A 29-day cycle can hide a late ovulation and a luteal phase that is too short, while a 38-day cycle can include a 14-day luteal phase. To be considered normal, a luteal phase should last at least 10 days. And a perfectly regular cycle can be anovulatory, which is often discovered when a pregnancy is planned. To date symptoms correctly, you therefore need to know when the person ovulates, not just how long her cycle lasts.
Gaëlle Baldassari also points out the periods when the cycle falls outside the norms without there being any cause for concern: puberty, stopping hormonal contraception, the postpartum period and breastfeeding, perimenopause. Finally, she mentions PCOS, which would affect 10 to 13% of the population according to the figure she quotes, 70% of those concerned being unaware of it.
Identifying ovulation: two simple tools
The "ice rink effect"
This is the tool she suggests passing on first: the slippery feeling when wiping, linked to cervical mucus. The more stretchy the mucus and the more it stretches between the fingers, the closer ovulation is; the day it is most stretchy is followed by a clear drying, which signals ovulation. Noting the date of the ice rink effect and the number of days until the period already gives first clues. She points out that this tool is not used to track fertility in order to avoid a pregnancy.
Basal body temperature
Taken on waking, before putting a foot on the floor, with a thermometer showing two decimals: you look for a low plateau followed by a higher plateau, which signals ovulation. It is the most accessible marker when mucus is hard to read, for example with a hormonal intrauterine device.
Cycles without visible periods
Asked about this case, she explains that having no fallopian tubes has no direct impact on the cycle, and that with a hormonal IUD some people continue to ovulate: 30 to 40% with the higher-dose devices, up to 90% with the lower-dose ones, according to the figures she gives. Periods may disappear while cyclical fluctuations remain. A patient who says she feels a cycle without having periods therefore deserves to be heard.
In practice: the question to ask at every consultation
Gaëlle Baldassari's suggestion is simple and works for every speciality: ask the person where she is in her cycle, have her note how symptoms evolve between sessions and set this against the cycle, and do not take raw information at a single point in time. A patient who arrives saying everything is collapsing may feel very differently a week later. And before concluding that a protocol is not working, ask whether there is a cyclical dimension to the assessment. As she stresses, you are often the first professional the person has time to talk to about it.
Watch the webinar
The full replay (in French) is available below, with chapters. The last part answers practitioners' questions: cycles without periods with a hormonal IUD, the impact of the cycle on mental sharpness, menopausal hormone therapy and perceived performance, and identifying ovulation with the ice rink effect.
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