PERIOD TALK: HAVING
UNCOMFORTABLE CLIENT
CONVERSATIONS
with GEORGIA SMITH
Periods are not just a monthly reminder that someone is not pregnant, they can also be a
powerful monthly health assessment. In this class we’ll explore how exercise, nutrition, and
lifestyle behaviors can impact a woman’s menstrual cycle, and how changes can be an indication
that things are going well or a red flag that something needs attention.
Despite the incredible insight that can be gained from understanding menstrual cycles, many
coaches and clients feel uncomfortable discussing this topic. This is often due to a lack of
education or exposure to open conversations throughout life.
You don’t need to be a walking textbook on the subject, but having a basic understanding of
periods can go a long way in building confidence to carry out these conversations. In this class,
we will cover best practices for having these conversations and provide the tools you need to feel
comfortable and knowledgeable.
MENSTRUAL CYCLE 101
DAYS 1-14: FOLLICULAR PHASE
The follicular phase is the time from the first day of the period until ovulation. Follicle Stimulating
Hormone (FSH) is secreted and this signals follicles to rise on the surface of the ovary, which
each contain an egg. One follicle will become dominant and the egg inside grows and matures.
This maturing follicle produces estrogen, which rises and peaks 1-2 days before ovulation. The
increase in estrogen also stimulates production of gonadotropin-releasing hormone (GnRH),
which stimulates the secretion of luteinizing hormone (LH). On approximately day 12 the surge
of LH and FSH causes the egg to be released from the follicle. This rise in estrogen can positively
impact mood and energy levels, and the spike in testosterone that occurs 1-2 days prior to
ovulation can increase libido.
DAY 14: OVULATORY PHASE
During the ovulatory phase, a spike in luteinizing hormone and estrogen triggers the follicle to
burst and the release of an egg to the fallopian tube. Some people may feel a temporary low
mood when estrogen levels drop back down from this spike. If there is no fertilization, the egg
disintegrates in about 24 hours.
DAYS 14-28: LUTEAL PHASE
The luteal phase is the time after ovulation until the next period begins. FSH and LH decrease,
and progesterone is produced. Increased progesterone can help with sleep, a sense of calm, and
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minimal PMS. Progesterone is produced, but if no fertilization occurs progesterone levels drop,
which signal for the lining of the uterus to begin shedding. With progesterone and estrogen
falling, mood may shift too.
MENSTRUAL BLEEDING
While there is variance between everyone’s experience, normal menstrual bleeding lasts 3-8 days
and occurs in a cycle of 21-35 days, with around 2-3 tablespoons of total blood loss.
HORMONAL BIRTH CONTROL
All hormonal contraceptives are associated with changes in menstrual bleeding patterns.
Your body doesn’t ovulate or go through a regular menstrual cycle when you’re taking oral
contraceptives. Instead, what you experience as a period on birth control is called withdrawal
bleeding. While birth control is an individual decision, it is important to understand that if your
clients are on hormonal birth control, the menstrual cycle they appear to have isn’t real and can’t
be used as an assessment. That’s because it suppresses the signals from the brain to the ovaries
and alters the natural function of the reproductive system.
MENOPAUSE
Menopause marks the end of the menstrual cycle, with the average age being 51, though it can
start in the 40s. Consider that clients in their 40s and on may be experiencing menopause, with
changes in mood, hot flashes, irregular cycles, weight gain, thinning hair, and dry skin common
symptoms to be aware of.
PERIOD RED FLAGS
As a coach, it’s crucial to understand that diagnosing or treating health problems related to
menstrual cycles is not within your scope of practice, and seeking medical help is important.
However, changes or irregularities in your clients’ menstrual cycles can be an important feedback
loop that shouldn’t be overlooked and may require referring out.
PMS symptoms can include mood shifts, anxiety, fatigue, bloating, changes in appetite and
cravings, and breast tenderness. While some mild symptoms are normal, if PMS is disrupting
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PERIOD TALK: HAVING UNCOMFORTABLE CLIENT CONVERSATIONS
your client’s day-to-day life and ability to maintain healthy behaviors, something may be wrong.
Additionally, low progesterone levels and a genetic component that cause higher sensitivity
to hormone shifts can contribute. Refer out if your client is suffering from challenging monthly
symptoms.
Irregular cycles, painful and heavy periods can sometimes be caused by hormone imbalances,
including estrogen dominance, which can be exacerbated by poor lifestyle factors. If your client
is experiencing this, it’s best to refer them to a trusted female health specialist and continue to
emphasize supportive lifestyle behaviors.
Missing periods, or amenorrhea, can be primary (when the first menstrual period doesn’t occur
by age 15) or secondary (when periods stop after previously having them for a certain period).
If you are working with a client who has missing periods, refer them out, as conditions such as
PCOS, thyroid disease, and other hormone imbalances need to be tested for. Overexercising,
undereating, having a low body weight, and experiencing stress can lead to the loss of the
menstrual cycle. As a coach, it’s important to be aware of the connection between these factors
and the potential to lose the ability to menstruate. If you are working with female athletes
or clients who are striving for a low body fat percentage, it’s crucial to be aware of potential
tradeoffs and be prepared to have this conversation, as there are negative long-term effects,
including the loss of bone density and increased risk of certain diseases from amenorrhea.
To reiterate, it’s not within your scope of practice to diagnose irregular or missing cycles.
However, there is a significant connection between lifestyle and healthy menstrual cycles. As a
coach, you can do everything in your power to establish a base of healthy behaviors that will set
your female clients up for menstrual health.
LIFESTYLE & PERIODS
STRESS
When stress levels are high, whether from emotional or physical sources, your body goes into
survival mode. The female body responds to stress by activating the hypothalamic-pituitaryadrenal (HPA) axis. The HPA axis is a network that involves the hypothalamus (found in the brain),
pituitary (found in the brain), and adrenal glands (found on the kidneys) and is the connection
between our central nervous system and our endocrine system. This increases levels of two
stress hormones, cortisol and corticotropin-releasing hormone (CRH). Elevated CRH and cortisol
can suppress or delay ovulation, causing a change in cycle date.
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PERIOD TALK: HAVING UNCOMFORTABLE CLIENT CONVERSATIONS
SLEEP
Our circadian rhythm is closely tied to our menstrual rhythm, and lack of sleep or low quality
sleep can be a stressor to your body. Hormonal changes that occur in the days leading up to
menstruation can make falling and/or staying asleep more challenging. Practicing good sleep
hygiene, such as establishing a consistent sleep routine and optimizing your sleep environment,
can help improve the quality of your sleep.
NUTRITION
Adequate calories and nutrients signal to the body that the environment is safe for reproduction.
For example, vitamin D has been shown to play an essential role in regular periods. In one study
it was found that 13% of women with low vitamin D reported having amenorrhea. A prolonged
deficit in total calorie intake can cause disruption or even absence of a menstrual cycle, so it’s
important to check in during deficits and consider cycling into maintenance every 6-12 weeks,
depending on the client. Eating fiber and protein at each meal, eating at consistent times to help
stabilize blood sugar, and including healthy fats like avocados, olive oil, and nuts while limiting
simple carbs and sugary foods can also support hormone balance.
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Vitamin C acts as an antioxidant and improves iron absorption from food or other
supplements. Consuming enough vitamin C and iron can help prevent iron deficiency in
individuals who menstruate. (Source)
Vitamin B6 supplementation has been shown to help improve mood during the
premenstrual period as it plays a role in serotonin production. (Source)
Low levels of vitamin D have been linked to fertility issues and menstrual cycle
irregularities. (Source) According to a 2018 clinical trial, vitamin D supplementation
reduced the prevalence of PMS symptoms and dysmenorrhea (painful menstrual cramps).
(Source)
Magnesium has wide-ranging benefits for the menstrual cycle that include reducing
menstrual cramps, PMS symptoms, and preventing menstrual migraines. (Source)
Keeping the gut microbiome happy and healthy with probiotics can help support a healthy
menstrual cycle by improving the removal of excess estrogens from the body. (Source)
By providing omega-3 fatty acids, a fish oil supplement can help prevent period cramps
and other PMS symptoms by modulating inflammation. In fact, it was shown to outperform
ibuprofen in managing period pain. (Source)
EXERCISE
Daily movement with consistency as the guiding principle is crucial to supporting all elements
of health, including menstrual health. However, there is too much of a good thing, and overexercising can also be a stressor on the body, so it’s important to monitor changes in cycles,
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especially during intense training phases for female athletes. I’m personally not a big fan of trying
to plan training around the menstrual cycle as it is both very challenging for the coach to keep
track of and doesn’t always align with the reality of how each female feels throughout their cycle,
but I do believe in encouraging a degree of self-regulation where a client can use the fitness
autonomy you’ve given them to pull back or push hard based on how they’re feeling.
PERIOD TALK
INTAKE FORMS
Including “Please describe your menstrual cycle” in the intake form you send out through CoachRx
sets the tone that menstrual health is something that you as a fitness professional discuss with
your clients. It’s simply a part of your service.
It also gives you some insight into your client’s comfort level of discussing their cycles as for some
women the topic is taboo and something they’ve developed shame around. If they provide lots
of details, they’re probably comfortable with the topic. If they’re light on details, they might not
be. Look for anything in the intake that falls outside normal, as well as lifestyle factors you know
impact menstrual cycles, and note it to discuss in the initial consultation.
INITIAL CONSULTATION
The initial consultation is your opportunity to gain further context around the details provided
in the intake form. Prior to the initial consultation ensure you take time to review the intake
form and note down any red flags or discussion points you want to walk through in the
initial consultation. Even if they’ve described it as normal, taking the time to make it a part
of the conversation from day one again reiterates the tone that this is an important part of
understanding their health status now and ongoing.
Five Conversation Tips:
1. Build rapport and connection first by starting with the simpler stuff - questions about
hydration, movement, nutrition, etc.
2. Begin by explaining why you are asking about their menstrual cycle. Let them know that it
is an important factor in overall health, and that you want to make sure you are providing
them with the best possible guidance.
3. Use neutral and non-judgmental language when discussing menstrual cycles. For example,
instead of using colloquial phrases like “time of the month,” use terms like “menstrual
cycle” or “period.” Use an empathetic and supportive tone.
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4. Ask open-ended questions that allow the client to share as much or as little information
as they are comfortable with. For example, you could say, “Can you tell me about your
menstrual cycle and what’s typical for you?” or “How does your menstrual cycle typically affect
how you feel?”
5. Respect the client’s boundaries and comfort level. If they are not comfortable discussing
their menstrual cycle, let them know that it is not mandatory and that you can still work
with them to create an effective fitness plan. Equally important, you will encounter clients
who just don’t know and have never paid attention to their cycle. Save further questions
for monthly consultations.
Here’s how I like to initiate this conversation in an initial consultation:
“In the intake form I included a question about your menstrual cycle. The reason I like to ask
this question initially, as well as check in ongoing, is because your cycle can provide some
important insight into your overall health. Plus, shifts in nutrition, sleep, stress and exercise
can result in changes to your hormones and periods, so it can actually be a great tool to track
the effectiveness of your fitness program. In your intake form I noticed you wrote _________ ,
are you comfortable if I ask you a question or two about this?”
How you continue on this conversation will depend on their comfort level, as well as what they
wrote on the intake form. If they respond no or are closed off, reassure them that it is completely
fine and move the conversation forward to the next question. If they respond yes, you can probe
a little bit deeper to gain context. Keep in mind, the goal in the initial consultation shouldn’t be
to lecture or go really deep, just to gain a baseline understanding of their cycle and any medical
history, which you can then dig deeper into in the future.
“How does your menstrual cycle typically affect how you feel?” may encourage them to share
additional details, including how their periods may affect their exercise, lifestyle and nutrition
behaviors throughout the month (even if they’ve indicated things are normal).
A response that indicates abnormal or painful periods, bad PMS symptoms or missing periods
should be followed up by asking if they’ve discussed this with a medical professional before.
Some women don’t realize that while bad symptoms may be somewhat common, it’s not normal:
“Is ________ something you’ve discussed with your doctor before?”
“Did they provide any insight or further testing to indicate why you’re experiencing these
symptoms?”
“Thanks for the insight—I’d like to keep tabs on any changes you experience from month to
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month as your period is a really powerful tool to assess your overall health. Please keep me
updated if you notice any changes.”
It goes without saying that if your clients are menopausal or postmenopausal, how you carry out
the conversation will be different, perhaps as so:
“In the intake form I noticed you wrote that you’ve gone/are going through menopause.
The reason I like to ask this question is that shifts in hormones can change how your body
responds to a fitness program. Are you comfortable if I ask you a question or two about this?”
“Can you tell me a little bit about your experience with menopause? When did you go through
it, and are you experiencing any symptoms from menopause?”
A response that indicates challenging symptoms should be followed up by asking if they’ve
discussed this with a medical professional before and received any treatment for it:
“Is ________ something you’ve discussed with your doctor before?”
“Did they provide any insight or further testing to indicate why you’re experiencing these
symptoms?”
“Thanks for the insight—I’d like to keep tabs on any changes you experience from month
to month as hormone fluctuations are strongly connected to your health and fitness goals.
Please keep me updated if you notice any changes.”
MONTHLY CONSULTATIONS
As well as checking in on changes, ongoing consultations can be an opportunity to educate the
client about the benefits of understanding their menstrual cycle.
For clients who’ve shared that they have irregular periods, checking in regularly (every
consultation or two) is recommended:
“I know when we last spoke you were experiencing ______. Have there been any changes to
your menstrual cycle since then?”
If they are seeking medical support for hormone imbalances or irregular cycles:
“Have you and your doctor made any changes to support balanced hormones and a regular
menstrual cycle?”
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Take the opportunity to discuss the four pillars laid out in this class—sleep, stress, exercise and
nutrition—and how they connect to supporting healthy hormones. You can draw the connection
between the lifestyle Rx’s you provide and how they support regular cycles.
For the “I don’t know” client who has never paid attention to their cycle and symptoms
throughout the month, ongoing consultation can be a good opportunity to encourage them to
tune in. Using a cycle tracking app for at least 2 months may help them establish a baseline, even
just for their own awareness (Apple Health, Flo and Clue are popular ones that even have built in
education):
“I want to ensure we’re taking a holistic approach to your health and paying closer attention
to your menstrual cycle may help you gain an even greater insight into how your lifestyle is
supporting hormone balance now and in the future. Are you open to using an app to track
symptoms throughout the month and your period?”
For the client who was initially uncomfortable with the topic, as you build up rapport you can try
broaching the subject again in a way that gives them the power to choose whether or not they
want to discuss it:
“Have you noticed any changes to your energy, mood, digestion, or menstrual cycle?”
From intake to initial consultation to monthly consultation, encouraging open communication
around your clients’ menstrual cycles is key to making this sometimes taboo conversation feel
comfortable. Your clients comfort starts with you, so speak with confidence, empathy and
professionalism and you’ll set the tone for a healthy and productive coach-client relationship.
CONCLUSION
Menstrual cycles are a crucial indicator of a woman’s overall health, revealing the impact of
exercise, nutrition, and lifestyle behaviors. Unfortunately, the topic can be uncomfortable for
coaches and clients due to a lack of knowledge and cultural taboos.
As a coach, it’s essential to educate yourself on periods to feel confident and competent
discussing them with your clients. Establishing a respectful and sensitive approach to these
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conversations is also crucial to creating a safe space for clients to share their experiences.
By regularly checking in on menstrual cycles, coaches can gain valuable insight into a client’s
health and empower them with the knowledge to promote their own hormonal health.
Together, we can break down barriers and help women prioritize their health and wellness, one
conversation at a time.
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