Janelle’s Background
• Janelle Van Leeuwen graduated from the University of Waterloo studying Kinesiology with a minor in nutrition. At the university she worked as a Strength and Conditioning coach for the women's hockey team and Personal Trainer for the general population. During her time at the university Janelle was not only involved in exercise prescription but also gave advice on nutrition and supplementation for her clients. This led her to study Naturopathic Medicine at the Canadian College of Naturopathic Medicine, where she is currently in her 3rd year. Her passion is in women's wellness, focusing on hormone imbalances and PMS.
IG: @janellevanleeuwen (PMS queen) Private Facebook group: PMS Freedom for Women with Janelle van LeeuwenWebsite: Janellevanleeuwen.com

Basics of the Menstrual Cycle
• Hormones & Phases of the Cycle
o Menstrual Phase  Day 1 of your cycle is the first day of your period. This happens because your estrogen and progesterone levels drop, which triggers the endometrial lining of your uterus to shed, which results in a period lasting 1 to 7 days.  The drop in estrogen and progesterone signals to the brain to release follicle stimulating hormone (FSH), which stimulates the growth of follicles in your ovaries to get the egg ready for ovulation

o Follicular Phase Around day 8 of your cycle estrogen begins to rise and you start to feel more energetic
o Ovulatory phase  At day 9-10 testosterone is rising which increases your libido/sex drive. This is the body being super smart… because sperm can survive for 3-5 days your body will keep them alive until you ovulate and release an egg 5 days later (on day 14). Estrogen spikes around day 12-14 to trigger luteinizing hormone (LH) which marks the beginning of the ovulatory phase, stimulating the ovaries to release an egg (ovulation usually occurs on day 14). Estrogen also stimulates the growth of the endometrial lining. If the egg is fertilized it is implanted into the endometrial lining, if not fertilized it dissolves and passes out of the body.
o Luteal phase  After the egg is released, it leaves behind a ruptured follicle (now called the corpus luteum) which releases progesterone and makes you feel chilled out and calm and in love with life. A sign of low progesterone is if instead of feeling calm you feel aggravated with everyone, can't sleep, cry easily, and irritable. The corpus luteum also releases estrogen  Progesterone peaks around day 21, then falls. The fall in progesterone triggers your period if you have not become pregnant.

Exercising with the Cycle
• Menstrual Phase o Energy is low, this is a tome of nourishment. Focus on low intensity exercises, o Eg: walking, yoga, swimming, hikes, breathing
• Follicular Phaseo Energy is rising, take advantage of this with intense workoutso Eg: HIIT workouts, heavy strength training, CrossFit training, kettlebell workouts
• Ovulatory phase o You Are feeling more social at this time so do group workouts. o Keep the intensity of the workouts high o Eg: spin class
• Luteal phase o Keep workouts increase into the first half of the Luteal Phase, then decrease intensity for the second half of the Luteal phase.o Energy begins to decrease, more restorative exercise, o Eg: yoga, Pilates, low intensity strength training, barre class
• The USA women's soccer team won the World Cup when training in sync with their cycles. They used Dr. Georgie Bruinvels, a U.K.-based research scientist who created an app for training around your cycle https://www.fitrwoman.com/  
Estrogen's Effect on MSK
• Estrogen directly affects the structure and function of other musculoskeletal tissues such as muscle, tendon, and ligament.
• Estrogen improves muscle mass and strength, and increases the collagen content of connective tissues.
• In tendons and ligaments estrogen decreases stiffness, and this directly affects performance and injury rates.
• High estrogen levels can decrease power and performance and make women more prone for catastrophic ligament injury.
• To accommodate for this focus on a proper warm up and cool down around exercise session.

Treatment Around the Cycle
• Treatment costs energy, whether you are mobilizing tissues, correcting posture or prescribing correct exercise.
• The body has to accommodate every one of its systems around the changes being made in treatment. Knowing that there are physiological differences at different points of the menstrual cycle, the practitioner can utilize this information to better cater their treatment to the needs of the body.

Birth Control Basics
• Taking birth control which contains synthetic hormones sends a signal to your brain that there are enough hormones and no need to make more. Your brain in turn does not secrete hormones and the ovaries receive no signal to ovulate. Specifically, the pill suppresses hypothalamic gonadotropin-releasing hormone (GnRH), which results in less pituitary gonadotropin secretion. As a result less luteinizing hormone (LH) and Follicle stimulating hormone (FSH) is released from the pituitary gland. Without LH your ovaries don't get the signal to ovulate. So, no egg is released.
• In addition to disrupting the communication between your brain and ovaries, the pill also:o Changes the Endometrium (aka lining of the uterus)—> Progestin makes the endometrium less favorable for an embryo to implant. So yes, you could have a situation where a sperm fertilizes the egg, but the egg fails to implant.o Changes to Cervical Mucus—> Progestin causes changes in cervical mucus so it is much more difficult for sperm to swim and make it to the egg.o Changes to Tubal Motility—> The pill may also alter how your female reproductive tract functions in terms of escorting the egg to meet sperm.
• When you take that week of placebo pills, you're not actually getting a period because you never ovulated. Instead, this is what we call a withdrawal bleed.
• Two types of pills: combination of estrogen and progestin, and progestin only.o Combination pills are more effective and have less breakthrough bleeding. This pill surpasses ovulation, thickens cervical mucus to block sperm, changes tubal motility, and thins the uterine lining. o Progestin only pill (mini-pill) - is used on women who have adverse reactions to synthetic estrogen or who are currently breastfeeding. It stops ovulation in 60% of women.

PMS types
• See Janelle’s website for a FREE PMS type quiz (https://janellevanleeuwen.com/articles-resources/pms-type-quiz)
• 80% of women experience emotional and mental changes due to PMS
• 20-40% notice a decrease in their QUALITY of LIFE!
1. PMS A (Anxiety)• Tension (often nervous, anxious)• Feeling out of control• Palpitations• Cramping• Back pain• Hostility, Irritability• Fatigue• Mood swings• Foggy thinking Attributed to low progesterone (either frank low progesterone or low relative to estrogen). Most common PMS Type. Experienced by 80% of those with PMS.
2. PMS C (Craving) • Hypoglycemia• Fainting spells or lightheaded• Heart palpitations• Headaches• Increased appetite, Crave sweets, salty• Insomnia (all types)• Mood changes• Poor memory, concentration, focus• Fatigue Attributed to low testosterone or androgen levels relative to other hormones. Found in as high as 50% of people with PMS
3. PMS H (Hyperhydration) • Anger/irritability/• increased interpersonal conflicts• GI bloating• Breast congestion, mastalgia (tenderness)• Water retention• Acne, oily skin• Swelling of the face, hands, ankles• Weight gain (likely d/t water retention) Attributed to relative androgen excess, can be found in as high as 40% of women. Remember that with increased testosterone there is also increased aldosterone which can lead to water retention in the kidneys, resulting in higher blood volume, which can appear as painful breast congestion, bloating, water retention.
4. PMS D (Depression) • Decreased interest in work, school or hobbies• Difficulty concentrating• Excessive sleepiness• Insomnia• Decreased coordination• Clumsiness, Confusion• Forgetfulness• Fatigue• Mood changes, cry easily Attribute to low estrogen relative to progesterone levels


Osteopathic Considerations
• Mechanical influence on the organic field (viscera):o As much as we think of organs being responsible for physiological function, they are physical structures that are affected by compression and tensiono The uterus is connected through ligaments of the peritoneum to the bladder, pubis, mons pubis, pelvic floor ovaries and Sacrum. The ovaries attach to the lateral walls of the pelvis.o Also, organs responsible for elimination, detoxification, assimilation, digestion, will also influence the total health of the body and therefore the menstrual cycle.
• Neurovascular influences: o The connective tissues and fascias discussed above create neurovascular bundles that convey the nerves and vessels to and from these organs. o Mechanical fixations can change the fluid mechanics of the vessels, affecting drainage/supply as well as changing not alone the pressure on the nerve (mechanotransduction) but the fluid environment around them affecting their functiono Inferior hypogastric plexus: uteroovaginal plexuso Ovarian nerve:T10-L2 SNS, S2-4
• Endocrine:o Hormones travel through the vasculature and lympho These move relatively slowly in comparison to nerve firing communicationo Fluid movement requires motion, mobility and stabilityo Over the long term, if the fluid flow is even slightly compromised, this can affect the negative feedback loop and create situations of up or down-regulationo Postural fixations create a situation with which the body must compensate to continually function. This costs energy as well as creates a stressful environment. Stress hormones will be released to help with this stressor. For example, Thyroxine is a stress hormone that works synergistically with catecholamines. Thyroxine also affects menstrual and reproductive health. Thyroid-stimulating hormone (released by the anterior pituitary to stimulate thyroid’s release of thyroxine) increases prolactin secretion, which then decreases FSH and LH secretion. This can affect infertility in both men and women.

Janelle’s Approach to Helping Her Clients
• Janelle takes a holistic approach to address hormonal imbalances. These are her 6 pillars for PMS freedom: o Liver function & detoxificationo Digestion and eliminationo The circadian rhythm & sleep qualityo Nutrient deficiencieso Adrenal Function, Stress and inflammationo Thyroid health & metabolism
• Regular exercise & movement
• Decrease overall inflammation through diet (avoid inflammatory oils and inflammatory foods), focus on anti-inflammatory foods, avoid food intolerances (common intolerances are dairy, eggs, nightshades, and gluten)
• Decreasing caffeine intake o Caffeine can spike cortisol levels, which results in less resources available to synthesize our sex hormones, leading to hormone imbalances.
• It takes time to heal hormone imbalances. 
Hormone Testing
• Janelle recommends the DUTCH test to evaluate your hormones (able to access this without Medical Doctor Referral) o https://dutchtest.com/

Post Birth Control Syndrome
• After stopping birth control you might experience more intense “PMS'' symptoms such as acne, painful heavy periods, period cramps, etc. So if you originally went on hormonal birth control for acne, when you discontinue that birth control your acne can come back, and come back with vengeance. This is called Post Birth Control Syndrome.
• Why does this happen? Hormonal birth control shuts down communication between your brain and ovaries, so it takes time to reestablish that connection. These symptoms can show up 3-6 months after stopping the pill. Research shows it takes up to 9 months to normalize your cycle after stopping the pill.
• Symptoms of post birth control syndrome:o Headaches o Acne o Hair loss o Blood sugar issues o Healy & painful periods o Missing/irregular periods o Digestive issues - Gas & bloating, Changes to your bowel movements o Nutrient deficiencieso Recent Hypothyroidism o Depression o Anxiety o Inflammation o Autoimmune concerns
Alternative Forms of Birth control
• Natural birth control options o Fertility awareness method - a non-hormonal birth control method that is designed to teach you how to recognize the signs of ovulation based on your body’s symptoms. This method builds great self-awareness. o Temperature trackingo Cervical mucuso Symptom trackingo LH stripso Condom -Barrier method using male or female condomso Diaphragm/cup/shield - this barrier method uses a dome shaped device made of flexible silicone that fits over your cervix, worn during sex. o Sponge – a white foam disc containing spermicide that covers your cervix blocking sperm from entering and killing the sperm with the spermicide. Wear as needed. This combines the barrier which is the sponge and the chemical which is the spermicide.o vaginal contraceptive film - it’s a thin parchment like sheet that dissolves instantly when inserted on or near the cervix. You can use it in combination with a condom diaphragm or sponge.o Copper IUD – this IUD does not contain hormones and can be worn for 7 to 10 yearso Withdrawal method - Stats say with a correct use it is 96% affectiveo Tubal ligation – a surgical procedure in which your fallopian tubes are tied or blocks to prevent pregnancy
Why Track your Cycle
• Understand why your body feels different week to week• You’ll notice a cyclical pattern to those symptoms, aka you’ll see them coming and be able to prepare for them• self-awareness• mind-body connection• track fertility• You’ll understand how your hormones influence how your body works• cycle syncing & optimization - optimize your energy and vitality
How to work with Janelle
• See appointment options on my website! o Infinite Woman Program - 3 month hormone reboot program (group and private options available) o Initial appointment + follow ups as needed o Natural Birth control webinar
• See my website for FREE PMS QUIZ! (link in Instagram bio) Free Private facebook group community: PMS freedom for woman (https://www.facebook.com/groups/422263318864769/)