By Madison Kelly
Editor’s Note: This article highlights findings from the original research study, “Menstrual cycle symptoms are associated with nutrient intake: Results from network analysis from an online survey” by Ghazzawi et al., which explores how specific nutrient patterns may influence the severity of psychological, physical, and functional symptoms across the menstrual cycle. The study, summarized by Madison Kelly while on the FACTS elective, emphasizes that dietary intake – particularly nutrients such as polyunsaturated fatty acids and B vitamins – may play a meaningful role in symptom experience and supports more integrative, cycle-aware approaches to women’s health. To build on these insights, explore the FACTS elective or our online Specialty CME course: Introduction to Lifestyle and Fertility.
Introduction
Menstrual cycle symptoms are experienced by many women and can impact their physical, psychological, and functional well-being. Although hormones play a central role in the development of symptoms during a woman’s cycle, lifestyle factors are believed to play a role in the severity of symptoms. Previous studies looking at the relationship between lifestyle and female cycles have focused on premenstrual syndrome (PMS) and have not included a comprehensive evaluation of diet. In their study, “Menstrual cycle symptoms are associated with nutrient intake: Results from network analysis from an online survey,” Ghazzawi et al. addressed this gap by evaluating how specific nutrients relate to cycle symptoms.[1]
Although hormones play a central role in the development of symptoms during a woman’s cycle, lifestyle factors are believed to play a role in the severity of symptoms.
This research is important to overall fertility awareness and women practicing fertility awareness-based methods (FABMs). By understanding the changes that occur during a woman’s cycle, including how diet may influence symptoms, women can better understand their bodies and support effective cycle charting.
Methodology
This cross-sectional study involved a self-administered online survey completed by 204 women in Jordan who regularly menstruated and were between 18 and 40 years old. Participants filled out a Food Frequency Questionnaire (FFQ) that measured the intake of 30 common food items during their menstrual cycle, using photographs to standardize serving sizes. The average total daily energy intake, as well as micro- and macro-nutrient consumption on specific cycle days, were estimated using a standard scoring method. [1]
Symptoms were analyzed using a modified Arabic Premenstrual Syndrome Scale (A-PMS-S) adapted to measure symptoms across all three domains (psychological, physical, functional) during menstruation rather than in the premenstrual phase. Psychological, physical, and functional symptoms were assessed with the following scoring system: “Zero” for no symptoms, “One” for mild, “Two” for moderate, and “Three” for severe. [1]
The survey also collected data on demographics, medical history, smoking status, sleep schedule, and physical activity. The authors used a multivariable logistic regression model to analyze the associations between nutrient intake and the severity of symptoms in the three domains. They adjusted for age, body mass index (BMI), and physical activity. As a cross-sectional study relying on self-reported observational data, it identified associations rather than causations.
Results
The average age of study participants was 29.8 years. Most participants were single (85%), nonsmokers (75%), and well-educated. BMI, as classified by the World Health Organization, ranged from normal (18.5-24.9) to overweight (25-29.9). Approximately 50% of the women reported moderate to severe symptoms across psychological, physical, and functional domains. Several associations were found between nutrient intake and symptom severity.
Intake of polyunsaturated fatty acids (PUFAs) was linked to lower odds of experiencing moderate to severe symptoms in all three domains. Thiamine demonstrated a strong protective effect, reducing the risk of moderate-to-severe symptoms across all three categories as well. Riboflavin showed a mixed association, increasing the likelihood of moderate-to-severe psychological and functional symptoms but decreasing the odds of severe physical symptoms. Zinc also showed a mixed association, reducing the risk of physical symptoms but increasing the risk of psychological symptoms. Vitamin B6 was associated with an increased risk of moderate-to-severe physical symptoms but decreased the risk of severe psychological and functional symptoms. Saturated fat, iron, and niacin were all associated with increased odds of moderate to-severe psychological symptoms. No significant association was found between energy intake, carbohydrates, fiber, total fat, cholesterol, magnesium, phosphorus, calcium, sodium, potassium, vitamin A, or vitamin C and symptom severity across all domains. [1]
Intake of polyunsaturated fatty acids (PUFAs) … (and) thiamine demonstrated a strong protective effect, reducing the risk of moderate-to-severe symptoms across all three categories.
Notably, many study participants exceeded the recommended dietary allowance for several nutrient categories, including carbohydrates, protein, iron, magnesium, sodium, potassium, niacin, thiamine, riboflavin, vitamin A, vitamin B6, and vitamin C. This may explain some of the mixed, multi-faceted associations.
Analysis using independent t-tests showed no significant links between smoking, BMI category, physical activity, or marital status and menstrual symptoms. However, the analysis did reveal that marital status was associated with increased PUFA intake, which would then decrease symptoms in all domains. BMI was linked to the intake of several nutrients – sodium, potassium, zinc, magnesium, vitamin A, and vitamin C – suggesting that body weight may influence patterns of nutrient consumption.
Discussion
This study enhances the understanding that dietary intake plays an important role in symptom experiences during menstruation. Women report physical, emotional, and functional symptoms during their cycles, and this research suggests that these symptoms may be modifiable with alterations in nutrient intake. It is known that a balanced diet plays a key role in overall health. Therefore, it is reasonable to hypothesize that dietary habits can have an ability to affect cognition, emotions, and functional status as a woman’s body undergoes metabolic and hormonal changes throughout her cycle. For women using FABMs to achieve or prevent pregnancy, recognizing how nutrition can influence the body and symptom experience is essential, as it may improve charting and overall awareness of one’s body.
Women report physical, emotional, and functional symptoms during their cycles, and this research suggests that these symptoms may be modifiable with alterations in nutrient intake.
The relatively large sample size, assessment tools, and adjustments for confounders are all strengths of this study. However, the study also has limitations. The cross-sectional design limits the ability to establish causation. Additionally, recall bias can be introduced when using self-reported data. The study did not control for some important external factors, such as the use of hormonal contraception or supplements, which could skew results. The participants were healthy women in Jordan within a specific age group, which also limits generalizability.
Despite some limitations, this study generated valuable insights. It provides evidence that diet may influence symptom experiences for women and raises questions about the role of cycle-phase-specific lifestyle interventions. From a fertility perspective, this study emphasizes that cycle symptoms are not solely hormonal but can reflect broader nutritional and behavioral patterns. It provides evidence that there may be an ability to improve symptoms and overall quality of life during a woman’s menstrual cycle by altering nutrient intake. This information provides important data to encourage clinicians to integrate cycle-based lifestyle counseling into their patient education models. Additionally, longitudinal studies exploring nutrient supplementation and timing of intake across the menstrual cycle may help determine how dietary interventions can be effectively integrated into women’s healthcare.
Conclusion
This study shows that dietary patterns during menstruation can either alleviate or worsen menstrual symptoms. Foods rich in polyunsaturated fats and thiamine appear to offer protective benefits, whereas diets high in saturated fats, iron, and niacin may worsen psychological symptoms. Diet is a modifiable risk factor, and these findings support the idea that well-being during menses – and by extension, the clarity and confidence with which women can chart their cycles using FABMs – may be improved through personalized dietary modifications. [1] Integrating nutritional guidance into women’s health care has the potential to enhance quality of life and support more informed use of FABMs.
Diet is a modifiable risk factor, and these findings support the idea that well-being during menses … may be improved through personalized dietary modifications.
References
[1] Ghazzawi HA, Alhaj O, Bragazzi N, Alnimer L, Jahrami H. Menstrual cycle symptoms are associated with nutrient intake: results from network analysis from an online survey. Womens Health (Lond). 2023;19:17455057231185624. doi:10.1177/17455057231185624
ABOUT THE AUTHOR
Madison Kelly is a fourth-year medical student a Kansas City University School of Osteopathic Medicine in Kansas City, MO. She completed her undergraduate education at Creighton University in Omaha, NE. She plans to pursue residency in Obstetrics and Gynecology. She enrolled in the FACTS elective to gain a better understanding of fertility awareness-based methods in order to share these methods with her future patients so they can feel empowered to make informed decisions about their bodies and reproductive health, whether for achieving or preventing pregnancy.
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