Safe exercise throughout your cycle: A TCM hormonal health guide

Respecting your body’s natural rhythms throughout your menstrual cycle can make all of the difference when it comes to your fertility, hormone health, and overall well-being. When it comes to getting pregnant, especially, it can sometimes feel confusing whether the exercises that you are doing are beneficial or harmful. Women are often not taught to exercise differently according to where they are in their cycles. 

I guide my patients about their diet and lifestyle in my Traditional Chinese medicine (TCM) practice on a daily basis. While acupuncture treatments and customized herbal prescriptions are the modalities that I work with, it’s also important to get customized diet and lifestyle recommendations around your menstrual cycle. This includes recommendations on safe exercise. 

Your body certainly has different needs at different phases. Your hormones are shifting as you move from one phase of your cycle to the next. Your Qi (life force energy) and blood are also shifting, sometimes dramatically, as you move through the phases of your cycle. 

In this article, I will go through each phase – the menstrual phase, follicular phase, ovulation, and luteal phase – and give concrete suggestions on the safest exercise to protect your hormone and fertility health. 

Phase 1 Menstrual Phase (Days 1 to 5)

Note: Day one of your menstrual cycle is the first day of real bleeding, not just spotting. 

What is happening hormonally: 
Before your menstrual cycle begins, the hormones progesterone and estrogen drop significantly. This hormonal withdrawal signals the uterus to shed its lining that was built in preparation for pregnancy.

The uterus contracts and releases menstrual blood. These contractions are normal, but inflammation can contribute to menstrual cramping pain and even to headaches, nausea, bowel changes, or fatigue (think PMS).

Because hormones are at their lowest point during menstruation, many women naturally experience:

• Lower energy
• Increased need for sleep
• Reduced exercise tolerance
• A desire to withdraw socially

The body is expending energy through tissue breakdown, blood loss, and uterine contractions.

TCM perspective
In TCM, menstruation is understood as a time when blood must move smoothly downward and outward. The body is actively releasing what is no longer needed.

This movement depends heavily on the Liver system, whose role in Chinese medicine is to ensure the smooth flow of Qi and Blood throughout the body.

If Qi and Blood move freely:

• Menstrual flow is smooth
• Cramping is minimal (or none)
• Mood is stable (not irritable, not depressed or overly sad/teary)
• The period starts strong (doesn’t start with many days of spotting)
• The cycle is regular (every 28 days or so)

However, if Qi becomes constrained or blocked, often referred to as Liver Qi stagnation, Blood may not move efficiently causing blood stasis. This is because Qi moves the blood along with it. This can create:

• Sharp very painful periods
• Dark large clots
• Irritability and emotional frustration
• Breast tenderness

Many women also have some degree of Blood deficiency, especially after years of overwork, restrictive dieting, overexercise, lack of rest, postpartum depletion, or heavy menstrual bleeding. This can lead to:

• Fatigue
• Dizziness
• Pale flow
• Dry skin or hair
• Anxiety
• Difficulty recovering after menstruation

Menstruation is therefore not considered an ideal time for intense physical exertion in TCM as this can worsen Qi and blood deficiency and may increase cramping or prolong bleeding.

Best safe exercise during the menstrual phase is gentle walking, yin yoga or restorative (hatha) yoga, Qi Gong, light stretching

Rest is the most important thing you can do during your menstrual phase

Avoid high-intensity workouts, heavy strength training, running or HIIT

Phase 2: Follicular Phase (Days 6 to 14 of the cycle)

In TCM, because we break up the cycle into four phases, the follicular phase is defined as after the menstruation (the blood has been already shed), leading into ovulation.

What is happening hormonally:
Estrogen begins to rise as the follicles start to mature and develop to lead into ovulation. One follicle becomes dominant and prepares to release an egg at ovulation. The uterine lining starts to thicken in preparation for a potential pregnancy. Progesterone remains low at this phase while estrogen rises. Estrogen usually reaches its peak right before ovulation. 

While estrogen is rising, women tend to feel quite good at this phase. Better energy, mood, motivation, and overall well-being. 

TCM perspective:
The blood and yin is rising at this phase in order to replenish what was shed at menstruation. This phase is often discussed in terms of rebuilding blood and yin, while supporting the smooth flow of Liver Qi. Yin and blood provide the foundation for the development of the egg. Liver Qi is needed for the proper release of the egg. Exercise is needed to support the smooth flow of Liver Qi and proper nutrition is needed to support the blood and yin. 

Here are some good exercise choices: 

• Strength training
• Cardio exercise: biking, elliptical, treadmill, brisk walking, and jogging are good examples of cardio exercises. 
• Pilates and yoga
• Don’t push yourself to exhaustion
• If you feel stronger and more energetic during this phase, you can feel free to push yourself a little harder and progress your workouts. Listen to your body and choose the intensity based on how you feel and your individual needs. 

Phase 3: Ovulation (Days 14 to 17 of the cycle)

What is happening hormonally?

Ovulation usually occurs around the middle of the menstrual cycle, although the exact timing varies from woman to woman and from cycle to cycle. It is the point at which a mature egg is released from the ovary.

As ovulation approaches, the maturing follicle produces increasing amounts of estrogen. When estrogen levels become sufficiently high, they trigger a surge in luteinizing hormone (LH). This LH surge signals the follicle to release the egg and initiates the changes that will transform the remaining follicle into a structure called the corpus luteum. The corpus luteum produces progesterone, which helps prepare the uterine lining for a possible pregnancy. Progesterone levels begin to rise around ovulation and increase further during the days that follow.

Once released, the egg is picked up by the fallopian tube, where fertilization can occur if sperm are present.

Some women also notice clear, slippery, egg-white-like cervical mucus around ovulation. This mucus helps sperm travel through the cervix and reproductive tract, and is a common sign of the fertile window.

What is happening in TCM?

In TCM, ovulation is the time when yin transforms into yang. The follicular phase is considered a “yin phase” where yin and blood are being built and nourished, and the luteal phase is considered a “yang phase” where warmth, activity, and movement happen..You can also think of estrogen as a yin hormone. When this yin hormone reaches its peak, progesterone (yang hormone) then becomes dominant. 

We want there to be enough yin in order to transfer to yang. So the nourishment and building of yin and blood in the follicular phase is key to a successful ovulation. 

Another important factor at ovulation time is the Liver Qi. The liver controls the smooth flow of Qi in the body. Without smooth flow, ovulation is negatively impacted. 

For proper release of the egg, Liver Qi is also crucial as smooth flow of Qi is needed. 

Best exercise choices

• The suggested exercises at ovulation do not differ greatly from the exercises recommended at the follicula phase above. 
• Moderate movement to get the liver Qi flowing and improve Qi and blood flow to the uterus and ovaries is highly recommended. Some good examples are swimming, walking, light jogging, yoga, stretching, and cycling. . 

Phase 4: Luteal Phase (from ovulation until your next period begins)

The length of the luteal phase varies but is roughly 12-14 days long. It is when ovulation ends until your next period. 

What is happening hormonally?

After ovulation, the corpus luteum produces progesterone (and some estrogen). The purpose of progesterone is to maintain a healthy uterine lining for healthy implantation of an embryo and to support a healthy pregnancy. 

Many women feel warmer in the luteal phase because progesterone increases the basal body temperature. 

If pregnancy doesn’t occur, the corpus luteum breaks down and progesterone and estrogen levels decrease. The uterine lining begins to shed and menstruation occurs. 

The luteal phase (or premenstrual phase) can be a difficult phase for many women. Some symptoms that may present in the days leading up to the period are breast tenderness, bloating, acne, fatigue, headaches, low mood and irritability. 

What is happening in TCM?

In TCM, the luteal phase is the warming activated phase where yin has transformed into yang. There are two important systems at play at this time: kidney yang for reproductive function and Liver Qi for smooth movement of Qi flow. 

Kidney yang is the body’s warming force and is needed to create a supportive environment for the uterus in preparation for a possible pregnancy. 

Liver Qi stagnation is the main pattern involved when there is PMS and PMDD. 

Best exercise choices during the luteal phase are moderate movement like walking, swimming, yoga, and light strength work. If you feel tired on the days leading up to your period, take a step back from your workouts and make them feel more manageable. Make sure that you get sufficient rest at this time. 

I tell my patients to use their cycle as information. Your body is giving you clues all the time. It may be beneficial to you to keep track of uncomfortable symptoms that you may experience throughout your cycle, your energy levels,  your mood, your stress, sleep quality, and how different exercises feel to you at different points in your cycle. Over time you may notice patterns that help you make appropriate diet and lifestyle choices, especially when it comes to your workouts, rest, and recovery. 

Try to stay active in a way that feels sustainable to you and make sure you choose activities that you genuinely enjoy. 

With Warmth & Support, 

Dr. Maryam