Health

15 min read

The 4 Key Pillars of Women’s Health: Pillar One – Physical Health

Women's health is often treated as an afterthought. For centuries, medicine and the research community have viewed the male body as the default, with many recommendations for women based on male data.

This is not a feeling, it is a fact. Women were not even included in clinical trials before 1993, not even in mice, despite the fact that women's health affects society greatly.

This gender health gap explains why women are more likely to be misdiagnosed, why our symptoms are often dismissed, and why we've been told that pain, exhaustion, and anxiety are just part of being a woman.

We say all this to highlight why there’s fragmented advice around women’s health and the need for wholesome advice that puts you at the centre.

This guide does exactly that, exploring the four pillars of women’s health and providing women's health strategies for improving women’s health outcomes. These whole-body approach pillars are: physical health, emotional wellbeing, meaningful social interactions, and a healthy environment.

Foundational differences: Why "women are not small men"

Dr Stacy Sims, a renowned exercise physiologist, nutrition scientist, and women’s health advocate, coined the phrase “women are not small men.”

Women are not a lesser or inferior variant of men. They are inherently different.
And she’s right! Science has shown us this time and time again.

If you train and eat like men, expecting the same results and rules to apply, you’ll mostly hit brick walls and not get the desired results.

Below, we highlight some of the key differences that influence male and female health outcomes.

The brain

Our brains are different. A woman’s hippocampus is bigger than a man’s, and works differently, too. [1] But a woman’s amygdala, which helps process emotional experiences and the recollection of such experiences, is smaller than men’s.

Men and women’s brains differ in many more ways. Ultimately, these differences explain how women learn, remember things, and process emotions differently.

For example, women remember emotional memories more quickly and at a more intense scale than men. This predisposes women to conditions like depression and anxiety, especially in the presence of biological predisposition, social stressors, and hormonal shifts. [1]

No wonder women are twice as likely as men to develop depression. [2]

The two clocks: Circadian vs. infradian rhythms

Men and women run on a 24-hour biological cycle, the circadian rhythm. This rhythm regulates when we sleep and when we wake up, hormone secretion, metabolism, and alertness cycles.
But women also run on an infradian rhythm (longer than 24 hours), with the menstrual or ovarian cycle (approximately 28–30 days) being a prime example. [3]

For men, their hormones, like testosterone and cortisol, peak in the morning and reach low levels at night. [4] It’s predictable. Think of it like a train that runs on the same reliable schedule every single day.
For women, although some hormones follow the internal 24-hour clock, they are more tied to the longer, monthly rhythm of the menstrual cycle, called the infradian rhythm. The net result is that women’s internal timing is more dynamic in nature.

Both the daily and monthly rhythms are easily subjected to disruptive influences that can affect hormonal processes. These hormonal fluctuations are less predictable too. [5] These changes and fluctuations affect women’s emotional and mental wellbeing. [6]

Additionally, when combining menstrual phase and time of day, some studies report that physical performance fluctuates more in women. [3]

The key takeaway here is that a woman’s physiology isn’t just running a 24-hour loop. This reality means that women’s responses to the environment, stress, physical training and exertion, rest, and diet are more dynamic and sometimes less predictable.

The hormonal architecture

Men’s hormonal environment is more stable across days. The reverse is the case for women.
Hormones such as oestrogen, progesterone, luteinising hormone (LH), follicle-stimulating hormone (FSH), and inhibin fluctuate dramatically across the cycle as women move through each phase (follicular phase, ovulation, luteal phase, and menstruation). [5]

A modest caloric deficit, a few poor nights of sleep, poor emotional state, or chronic stress can tilt the system, leading to suppressed ovulation, altered oestrogen/progesterone balance, and increased cortisol.

Beyond hormonal stability, women also experience life-stage shifts that affect their system and health. The hormonal framework changes at puberty, pregnancy, postpartum, perimenopause, and menopause. Each stage has its peculiarities and attendant health risks.
For example, due to reduced oestrogen levels, menopausal women have an increased risk of developing osteoporosis. [7]

Ultimately, these differences play a key role in molecular and cellular processes. Consequently, sex is a determinant in health and disease outcomes and response to treatment. [8]

Pillar One: Physical Health

This pillar is the bedrock of your wellbeing. In the context of women’s physical health, it’s not just about “don’t get sick, move your body, eat your veggies and a balanced diet,” and all other generic recommendations. We mean:

Having enough energy to do the things you want to do, day in, day out;
Maintaining metabolic balance, that is, blood sugar, lipids, insulin, in a hormonally dynamic system;
Supporting structural integrity, that is, your bones, muscles, and connective tissues;
Preserving women’s reproductive health and hormonal harmony (even if you choose not to have children);
Minimising risk of chronic disease, such as heart disease, osteoporosis, and metabolic syndrome across women’s peculiar life stages.

Women and exercise: Why and what works

For decades, the fitness industry has pushed a "no pain, no gain," crush-it-every-day mentality. This approach, born mostly from research on men and their experience, can be counterproductive and even harmful for the female body. Our bodies aren’t designed for the same workout day in and day out.

What women often benefit from more is consistency, a sound strategy, variation, and listening to their body. But before outlining specific strategies, let’s examine some of the benefits of taking physical activity and exercise seriously as a woman.

The biological payoffs of exercise for women

Physical activity has many benefits for women and men alike. For women especially, it helps in the following ways:

1. Hormonal modulation
High levels of certain hormones in a woman pose certain risks. For example, high levels of endogenous oestrogens (estrone, estradiol, and estriol) are one of the leading risk factors for breast cancer in women. [9]
Research shows that physical activity can help decrease the level of circulating hormones. A meta-analysis of previous research revealed that physical activity led to a decrease of both total estradiol and free estradiol. This result was consistent irrespective of menopausal status. [9]

2. Weight loss
If you want to lose weight, exercise can help. A large meta-analysis of 116 randomised trials involving 6,880 adults showed that aerobic exercise leads to reductions in body weight, waist circumference, and body fat. [10]

3. Increasing and maintaining bone density in old age
We’ve already mentioned how menopausal women are at risk of osteoporosis. Weight-bearing aerobic exercises and strength and/or resistance exercises have been shown to preserve bone mass, stimulate bone growth, and can be a wonderful option for women in this category. [11]

What kind of exercise, when, and how much?

In choosing the appropriate exercise, women must consider their physiology.
For instance, women have a wider pelvis to accommodate childbirth, which creates a larger quadriceps angle (Q-angle). The Q-angle is the angle from the hip to the knee. The average angle for women is 17 degrees and 14 degrees for men. [12]

This larger angle can put more stress on knee joints, making women more susceptible to certain injuries if the choice of exercise is not well-considered or if form isn't correct. A larger Q-angle is a risk factor for patellar dislocation, ankle injuries, anterior cruciate ligament injuries, and more. [12]

Then there are the hormones. In the first half of your monthly cycle, rising oestrogen makes you more energetic and your body is primed to build muscle. [13]

But as progesterone rises in the second half, your energy can dip, and your ligaments can become slightly laxer, with the latter increasing the risk of sprains. [14] Pushing yourself too hard a few days before your period will likely feel herculean, as you’re actively working against your body’s natural rhythm.

Summarily, your menstrual cycle “necessitates adjustments in training intensity, volume, and type at different phases of the cycle.” [14]

Cycle syncing your workouts: a detailed guide

Cycle syncing is all about flowing with your body rather than forcing it. It’s the practice of aligning your workout intensity with the four phases of your menstrual cycle.
It’s important to stress that scientists are still examining the benefits of syncing your exercise routines with your monthly cycle.

While the evidence is still thin, experts like Dr Cassandra Simmons, chief of the Division of General Obstetrics & Gynaecology at NewYork-Presbyterian Westchester and NewYork-Presbyterian, recommend it as a vital tool for improving mood and energy throughout the month. [15]

Here’s how cycle syncing works:

Phase 1: Menstrual (Days 1–5, your period)
Your hormones, especially oestrogen, are at their lowest. As such, energy is typically down. This is not the time to force a grueling workout if you’re not up to it.
We recommend focusing on restorative movement like gentle yoga, stretching, long walks, and light Pilates. [16] The goal during this period is to promote blood flow and ease cramps, not to over-exert and exhaust yourself.

Phase 2: Follicular (Days 6–14, after your period ends)
After your period ends, oestrogen is rising, and so is your energy and mood. Your body is more receptive to higher physical intensity.
This is a great time for cardio, light HIIT, trying a new dance class, or starting to increase weights in strength training.

Phase 3: Ovulatory (Around Days 15–17)
During this phase, hormones such as oestrogen and testosterone are at their peak. It is your peak performance window. You’ll likely feel your strongest and most energetic during this period.
Go for it with high-intensity workouts, heavy strength training, sprints, and challenging classes.

Phase 4: Luteal (Days 18–28, the premenstrual phase)
Progesterone rises, and oestrogen takes a second, smaller peak before they both drop off. Energy wanes in the later part of this phase.
You may shift to moderate-intensity strength training, Pilates, and sustained cardio like jogging or swimming. As you get closer to your period, you might shift back toward more restorative movements.

Adapting exercise for every age and stage

Not every woman has a predictable 28-day cycle or the ability to menstruate. Your movement may need to change dramatically through different life stages or if you're managing a chronic condition.
That said, the principle remains the same: always listen to your body, adapt, and do physical activities you enjoy. Experts believe that cycle syncing may also benefit women enduring any of the following:

Endometriosis
Polycystic ovarian syndrome (PCOS)
Premenstrual syndrome (PMS)
Premenstrual dysphoric disorder (PMDD)
Women’s health conditions that worsen around your cycle [16]

Women in perimenopause and menopause

Exercise is equally critical for perimenopausal and menopausal women. The focus here is more about building a resilient body for the long haul. Women in this category should prioritise the following:

Strength training

This is your number one priority. [17] Lifting weights (or using your bodyweight) puts stress on your bones, signalling them to stay strong and dense, which is your best defence against osteoporosis. It also builds and maintains muscle mass.

Research by the University of Exeter on 72 pre-, peri-, and post-menopausal women (aged between 40–60 years) not on hormone replacement therapy (HRT) found that women who participated in a “whole-body, low-impact resistance training program” enjoyed increased muscle mass and strength; improved flexibility, balance, mobility, and stability; and an increase in hip function. [17]

Cardio for heart health

As oestrogen declines, cardiovascular risk increases in menopausal women. [18] Consistent moderate cardio, like brisk walking, jogging, swimming, or cycling, is vital. [19]

Mobility and balance

Incorporate activities like yoga or tai chi to maintain flexibility and improve balance, all important for reducing the risk of falls. [19]

Nourishment: Eating well and building a healthy relationship with food

The world of nutrition is littered with misinformation, much of it harmful to women’s hormonal health. Trends like aggressive intermittent fasting, for example, can be beneficial for some, but not for many women.

Going long periods without food can signal scarcity to the brain and disrupt the delicate signals needed for a regular menstrual cycle. Undereating (even unintentionally) can suppress GnRH (gonadotropin-releasing hormone) secretion, leading to cycle disruption. [20] GnRH is a key regulator of the reproductive axis.

That said, intermittent fasting has been shown to improve fertility in women with PCOS. [21] All this highlights the importance of not joining every diet trend and tailoring your food choices to your unique peculiarities.

The gut–hormone connection

You have a specific collection of bacteria in your gut called the estrobolome. Its main job is to process and metabolise oestrogen. [22]

If your gut health is poor, this process breaks down. This can lead to either too much or too little oestrogen circulating in your body, contributing to issues like premenstrual syndrome, heavy periods, and an increased risk for oestrogen-dominant conditions like breast cancer and PCOS. [22]
Eating your leafy greens directly supports your gut and hormonal health.

The core of a balanced diet for women

1. Macronutrients

Protein: Essential for everything, especially for making neurotransmitters and providing amino acids to support detoxification in your liver. Aim for a palm-sized portion with every meal, about 1.2–1.6 g/kg body weight. [23] Sources include fish, poultry, legumes, eggs, and dairy. For vegans and vegetarians, opt for soy products high in protein and other sources like seitan, beans, and lentils.
Healthy fats: Your sex hormones are made from fat and cholesterol. Avocados, olive oil, nuts, flax, chia seeds, and fatty fish are non-negotiable for hormonal balance and brain health. Avoid minimal trans fats and ultra-processed oils.
Complex carbohydrates: Think fibre and complex carbs: sweet potatoes and most tubers, quinoa, oats, and plenty of vegetables and fruits. Fibre feeds your beneficial gut bacteria.

2. Key micronutrients
For hormones, the small stuff is everything. Iron (especially during your period), magnesium (needed for managing stress and cramps), B vitamins (for energy metabolism), and zinc (for skin and immunity) are all critical.

Building a positive relationship with food

Many women’s relationship with food is tainted with guilt and shame, often due to diet culture that brands food as an enemy. Tips for building a positive relationship with food:

Shift from a diet culture mindset to intuitive eating, which promotes healthy eating behaviour. [24] Intuitive eating is about listening and obeying your body’s innate signals of hunger and fullness: respect hunger, honour fullness, and enjoy healthy foods that make you feel good.
Reframe “cheat days” as days of more flexible food choices.
Disabuse the notion that you must earn food through physical activity. Treat food as fuel your body needs to perform optimally. Ask, “What does my body actually need today?” Some days, that might be a big salad; other days, especially before your period, it might be a burger and sweet potato fries. Both are okay.

Reproductive and hormonal health

Optimal health of your reproductive system is fundamentally tied to your hormonal health. Even for women who don’t want children or are menopausal, the hormonal infrastructure remains central to mood, metabolism, bone health, and more. [25, 26]

Your menstrual cycle as a vital sign of reproductive health

Your menstrual cycle is not a curse; it is your body’s monthly report card. It’s a vital sign, like blood pressure or temperature. The symptoms you experience are a direct reflection of your overall health. [27] Irregular cycles, absent menses, heavy bleeding, and severe pains should be taken seriously; they are not trivial.

Tracking your cycle

Track your cycle using an app or notebook: note the first and last day of your period, how you feel, energy levels, cravings, and sleep pattern. Note any pain and its severity. After a few months, you’ll notice patterns, providing invaluable data for you and your doctor.

Listening to your body's signals

We have been conditioned to ignore our bodies, push through pain, and believe that suffering is part of being a woman. This is dangerous.
Many women dismiss heart attack symptoms until they are severe. [28] Women are more likely to die from a heart attack than men. [29]

Pain is not normal. Paralyzing period pain or painful sex is a sign of an underlying condition like endometriosis or fibroids. Diagnosis of endometriosis currently takes 4–12 years on average. [30]

Hormonal balance and why it matters

Hormonal balance occurs when your body produces the right amount of hormones when needed. Imbalances can cause:

Menstrual changes (absent, increased frequency, heavy flow, irregular flow)
Hair issues
Skin problems like hyperpigmentation
Sex-related issues (low libido, painful sex, vaginal dryness)
Weight changes
Mood and sleep issues
Digestive problems [32]

Hormonal health across key life stages

Hormonal shifts are significant throughout life, with each stage having its challenges and priorities. [33]

Puberty and adolescence: Massive hormonal fluctuations; nutrient-dense food, menstrual education, and positive body image are essential. [34, 35]
Fertility years: Focus on maintaining hormonal balance throughout the cycle. [36]
Perimenopause (5–15 years before menopause): Chaotic hormonal fluctuations; anxiety, insomnia, and irregular cycles are common. [37]
Menopause and post-menopause: Estrogen levels are consistently low. Goals: protect bone density, maintain muscle mass, and support cardiovascular health. [38]

Continue with Pillar 2