Dr Sarah E Hill is a psychologist and the author of the 2019 breakout book How the Pill Changes Everything. She is a leading researcher into the role that hormones, the immune system, and the environment play in women’s health. Her second book, The Period Brain, was released last year.
For our weekly series Life Lessons, she shares her own daily habits that are informed by her research and experience in the field.
I swapped hardcore cardio for morning walks – I’m fitter
I used to think that exercise only counted if you were sweating, but I’ve had a total change of perspective for the better. I used to be a gym rat and do heavy cardio four days a week, but now my cardio is a morning walk.
I had been aware of the science of circadian rhythms and getting morning sunlight, but the real change began when I decided to have my morning coffee on the patio and get sunlight in my eyes before going to the gym. I found that there was something about being outside with my coffee that was invigorating, so I decided to take a little walk. After a while I stopped going to the gym every day, and instead just lengthened the walk.
I could feel a real difference – I feel so much more calm and ready to start my day after a walk compared with the gym. It was just a better experience for me.
My fitness hasn’t changed, either – if anything, I think it is probably better because I’m doing things more consistently in a way that puts my brain in the right space. There’s some good science that suggests one of the best ways that we can keep our cardiovascular system fit is by doing a lot of work in zone two [low-to-moderate intensity where you are not so out of breath you can’t sustain conversation] – I’m able to get that when I walk briskly in the hilly area I live in.
Doing a really brisk walk, getting morning sunlight, and enjoying the greenery give a morning walk so much bang for your buck in terms of decreasing stress.
I only lift heavy for two weeks a month – and it works
I’ve also completely changed how I weight train. Now I heavily load my resistance training during the first two weeks of my cycle when oestrogen is up and go easier after I’ve ovulated until I start my period. I do strength training four times a week for the first two weeks, and during the other two weeks, if I feel like it, I might do some resistance bands, longer walks, or nothing at all.
I’ve been exercising in this way for the last seven years and I’ve really noticed the difference. It’s been great for my mood – I used to hate lifting weights in the luteal phase, and I feel so much better when I’m doing it now because I actually return having not done it for a couple of weeks. It feels like something that’s good and supportive of my body.
The result is that I’m actually getting stronger. I’ve been able to increase the amount of weight that I lift. I’ve always been pretty good about making sure that I’m doing things to maintain and build muscle mass, but this is something that has pushed me beyond my plateau.
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There’s been a lot of mixed research results into cycle-based training. However, there’s been some nicely done studies that found you get greater strength returns when oestrogen is high. Oestrogen activates a bunch of different pathways that help to promote muscle building, and it’s anabolic, meaning that it helps to promote tissue growth. The theoretical science behind it is really sound, which is why I’m inclined to follow that path.
The extra time that I get from not doing all the resistance training in the luteal phase I usually use to get extra sleep.
Our hormones influence how much sleep we need
I’ve found that in the second half of the menstrual cycle, my recovery tends to be worse, and that it takes me longer to recover from daily activities so I need more sleep.
I also need more time at night to dial down. Your heart rate and your respiration rate is faster in the luteal phase, and you’re keyed up across the day because your body is working harder. So I try to be intentional about trying to get my heart rate down, and getting myself to relax. Obviously I’m a real person: I’ve got kids and a job and it’s not like I can tell everybody “nobody’s getting lunch tomorrow because I need to unwind”.
But to the extent that is possible, I try to make sure that I’m not, for example, setting meetings until 6pm in the luteal phase because I know I’ll be eating too late, I won’t have enough recovery time at night, and my sleep will be trash.
Don’t fight your body telling you you need more food
Your resting metabolic rate increases in the second half of the cycle, and it’s why women are hungrier and want to eat more. During this phase of the cycle, I make sure that I’m listening to what my body is telling me.
As women, we’re given ‘one size fits all’ nutritional guidelines, which are based on men, and then a lot of us will feel like we need to stick to that. When it doesn’t work out, we get upset, we blame ourselves and think that there’s a problem. I tend to eat a healthy diet, so if my body is saying I’m hungry, that means I need to eat. I’m not gonna be eating Oreos, for example – if I get that cue, I just tend to eat more real food.
Whether we need to eat specific types of foods at specific points in our cycle, there’s not good evidence for it. And honestly, I think the best thing that any of us can do for our bodies is just nourish our bodies fully all the time.
I take expensive supplements even though I’m not sure they’ll work
I take supplements, but I don’t necessarily recommend them for people. There’s ones that I know work (vitamin D, omega-3 and so on), and ones that I don’t know if they work, but theories suggest that they should.
The ones we know work are vitamin D and omega three fatty acids. There’s a lot of good research suggesting those are both helpful, and magnesium too. I take a broad spectrum magnesium, which is good because it’s going to cover your bases. I also take creatine – there’s so much good research, everybody should take it. And then when I’m travelling or think I’m coming down with something I take zinc. Those are the ones that I would recommend to others.
I also take something that helps to promote NAD levels. The science on that is a little bit less robust, and expensive – I probably wouldn’t take it if my budget was more limited. I take TRU NIAGEN NAD+, which costs £49.95 a month. I also take akkermancia, a probiotic. It’s related to a variety of different positive outcomes in terms of immune function but the extent to which individual supplements are related to those outcomes is less concrete. But because I’m able to afford it, I do take it, even if I’m not totally sure that they’re going to work.
I regret staying on birth control as long as I did
I was on the birth control pill for over a decade, and at the time I didn’t really realise how profoundly hormones influence everything, or that by taking it I totally was changing my brain’s version of myself. I wish that I would have allowed myself to naturally cycle. I was one of those people who went on it when I was 17 and then stayed on it for a decade. Knowing what I know now, I would have had a completely different relationship with it than I did.
Every woman should track her hormones at home, if she can afford it
If there’s one expense I recommend (if you can afford it) it’s an at-home fertility monitor [starting from about £200] – and it has nothing to do with having babies. You pee on a stick, you have a little monitor and an app, and it maps your hormones across the cycle. Do that for one or two cycles, and during that time track everything: track your hunger, track your sexual desire, track your mood, and so on. You will learn so much about yourself and your hormones.
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You could track ovulation and start to see when your fertility starts to decline. There are so many things that you learn from that. And because I’m in my mid 40s, it’s useful for me to know whether or not I’m having a good cycle or a bad cycle – that’s also helping me better understand where I am in terms of the perimenopausal transition.
Having a benchmark for what’s normal for you is super helpful. Then if you start to get lower levels of hormones it can be a good opportunity to start a conversation with your doctor.
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