By Jennifer Qulity, RMT
Massage Therapists are well aware of how communication can significantly impact the therapeutic relationships with their patients. However, what is less understood is the impact that hormones play and how this may affect communication from appointment to appointment. This leads to the question: do you have a hormone-informed practice?
Background
Hormones are chemical messengers that are sent to cells in order to change their function. In a female, pre-menopausal body, these hormones are always rising and falling. This differs in comparison with male anatomy where hormones are solely governed by the circadian rhythm. The physiologically male body will start the day with testosterone at its highest concentration and will slowly decrease throughout the day. Whereas, the female body’s hormonal concentration is governed by an infradian rhythm (a biological process that lasts longer than 24 hours and less than one year); the Menstrual Cycle.
Throughout the menstrual cycle, hormones will fluctuate and each phase of the cycle will influence the brain, immune system, metabolism, microbiome and stress response. The major events in the menstrual cycle are: menstruation, the pre-ovulatory phase, ovulation and the post-ovulatory phase.
The pre-ovulatory phase is also known as the follicular phase. When menstruation occurs, hormones are at an all-time low concentration. During the Follicular phase, hormones will begin to rise. This causes changes in the brain that can make individuals more open to new experiences, can spark creativity & evoke an openness to new beginnings. The gradual increase of estrogen can contribute to increased focus and increased memory retention. As ovulation approaches, this allows for an increase in energy and the tendency to be more social.
The post-ovulatory phase is also known as the luteal phase, and this phase generally lasts about 14 days, making it the longest phase of the menstrual cycle. After ovulation, estrogen will slightly dip. If ovulation occurs, the body will produce progesterone. During this phase, it is common and normal for individuals to feel the need to be less social and turn inwards. This is the phase where Pre-Menstrual Symptoms (PMS) may appear and can greatly impact mood.
These hormonal shifts are not common knowledge. In Massage Therapy Education, we learn about the different phases of the cycle and some physiology, but we don’t learn about how this can affect our patients’ mood and how that may affect our treatment plans; or even how a pre-menopausal therapist may operate within their own practice.
How the Menstrual Cycle May Effect Treatment
For example, a patient has their initial appointment in their follicular phase when they are open to new techniques. They agree to have cupping done and are quite chatty through their appointment. They have a follow up in two weeks when they are in their luteal phase and they prefer to have Swedish massage techniques and are less communicative compared to their last appointment. A therapist that has knowledge of how the menstrual cycle can affect mood may be able to understand this variance in the patient’s treatment desires. Having fluidity in how we provide care can better support a patient who has variations in their communication and treatment goals.
These hormonal shifts can also affect how pre-menopausal individuals can respond to exercise. The pre-ovulatory body has more energy and may respond better to more intense activities. After ovulation occurs the body can respond better to split body workouts. During menstruation, this can be a great time to include more time to stretching and restorative movement. Being hormone aware within your practice can help guide home care recommendations and make a therapist more aware of why certain routines may not be working for their patients.
How the Menstrual Cycle May Affect Our Practice
Knowledge about the menstrual cycle can also help therapists themselves within their own practice. The hormonal changes that occur during menstruation can cause an individual to feel the need for rest and an increased ability for self-reflection. This can be an opportune time to reflect on your practice. Are you happy with your current policies? Is there any area you feel you need to improve on? Have there been any client interactions that you wish you handled differently?
The follicular phase would be an opportune time to create change. This would be a great time to start that online course that you have had your eye on or implement techniques from a recent training. It can be a great time to take advantage of creativity. If you are a business owner and regularly hold meetings with your team, this would be a great time to schedule one of those meetings. Being social also comes easier with this phase. This can be a great time to network and form new relationships within your practice and or field.
Post-ovulatory hormonal changes can make an individual directed towards completing tasks. This can be an excellent time to organize your treatment space, sort through taxes and complete administrative tasks.
Conclusion
Every therapist can benefit from being hormone aware within their practice. Hormones are a driving force behind a body’s biological processes and all forms of healthcare should be aware of their impact on our health. This will allow us to understand how the menstrual cycle may be affecting our patients’ treatment goals, communication and needs. Of course, every body is unique and some individuals may be more sensitive to these hormonal shifts than others. Having an understanding of the menstrual cycle will allow our field to greater support women’s health, while having a positive impact on our patients’ lives.
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