Your menstrual cycle alongside your therapy journey

Unfortunately, it is still uncommon for therapy training programmes to include detailed education on the menstrual cycle physiology and the psychological impact.

However, research is starting to slowly grow, which is highlighting how hormonal fluctuations across the menstrual cycle can influence mental health. For both therapists and clients, cycle awareness can provide a very important context.

Where you are in your cycle can impact:

• mood and emotional regulation 
• anxiety and overwhelm
• energy and motivation
• focus, intuition and clarity
• nervous system capacity
• mental health
• emotional health
• physical health
• and so much more

Which is why it is absolutely relevant in the therapy room.

The brain across the menstrual cycle

The brain does not operate the same way every day of the cycle. Research shows that the brain connectivity (how different areas of the brain communicate with each other) can change by up to 25% across a single cycle.

At some points:

• brain networks communicate more fluidly
• reflection will feel easier
• intuition, creativity and emotional insight feel more natural

At others times:

• the prefrontal cortex is more dominant
• planning, focus and decision-making feel clearer
• problem-solving can feel easier

Nothing is wrong – it's just the brain adapting to your cycle. And this can be unique for the individual. 

Energy, metabolism, nervous system and immunity

Metabolism and energy levels change across the cycle, too.

At times, an individual may:

• need more calories and feel hungrier
• experience insulin sensitivity shifts

This means that bodies which menstruate are not designed to eat, train, work or push exactly the same every day.

The nervous system also fluctuates across the cycle. 

There are phases where:

• stress and pressure feel more manageable
• multitasking is doable

And phases where:

• tolerance is lower
• rest is essential
• immunity dips

Capacity isn’t constant, and it’s not meant to be. 

Infradian vs circadian

Those who menstruate live on an Infradian Rhythm – a longer hormonal cycle, roughly around 28-days (unique to each person), like the moon. This infradian rhythm sits alongside a circadian rhythm, which influences sleep, wakefulness and daily energy.

Non-menstruating bodies operate mainly on a Circadian Rhythm – roughly a 24-hour hormonal cycle, like the sun. Different biology. Different hormonal patterns. Different needs. Different support required.

Now that we know about the Infradian and Circadian Rhythms, we can go into one of the reasons why research often overlooks menstruating people. Many studies have historically been based on men and a 24-hour circadian rhythm. Why?

Menstruating bodies were/are often excluded because:

• change of hormones introduces “too many variables”
• results are harder to standardise
• studies then take longer and cost more

To get around this and reduce complexity, many studies either:

• Exclude those who menstruate altogether
• only include those who are post-menopausal

This means a lot of “evidence-based” knowledge doesn’t fully reflect the lived experience of those who menstruate. This is changing slowly, but it is not fully there yet. But within therapy, people who menstruate absolutely count.

Cycle awareness in therapy is not about blaming hormones or reducing experiences to just biology. Instead, it gives us understanding. If energy, focus, or emotional sensitivity change across a month, it may not indicate regression, but instead it may reflect a shift in hormonal context.

A helpful question in therapy might be: What is your body asking for right now? Not as a judgment, or an excuse, but as information.

For so long, society has told us to stay quiet and private about menstruation, but I say let's talk about it. Imagine living in a world where asking these questions is normal and supportive, not asked with judgment, shame or disgust.

Inclusive and included

Cycle-informed approaches are relevant for:

• those who menstruate
• those in perimenopause or menopause
• those whose cycles are irregular, absent, or changing
• some people who have a womb but don’t menstruate
• some who don’t have a womb and still experience hormonal cycling
• some are post-hysterectomy and continue to cycle hormonally

There is no one-size-fits-all approach. Your body still has rhythms. Your experience still matters. Therapy meets you where you are.

References

Energy intakes are higher during the luteal phase of ovulatory menstrual cycles: https://pubmed.ncbi.nlm.nih.gov/7825535/

Functional reorganisation of brain networks across the human menstrual cycle: https://www.sciencedirect.com/science/article/pii/S1053811920305772

Evidence from neuroimaging for the role of the menstrual cycle in the interplay of emotion and cognition: https://pmc.ncbi.nlm.nih.gov/articles/PMC3721046/

Whole-brain dynamics across the menstrual cycle: the role of hormonal fluctuations and age in healthy women: https://www.nature.com/articles/s44294-024-00012-4

Menstrual Cycle and Athletic Status Interact to Influence Symptoms, Mood, and Cognition in Females: https://link.springer.com/article/10.1186/s40798-025-00924-8

The Menstrual Cycle Modulates Whole-Brain Turbulent Dynamics: https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2021.753820/full