Show Notes

Welcome back to The Designer Practice Podcast, and I’m your host, Kayla Das.

In today’s episode, MC Decker, registered psychologist and owner of Mindful Cycles Psychology, will discuss cycle-informed therapy an approach rooted in neurobiology of mental health and the menstrual cycle.

Hi, MC, welcome to the show. I’m so glad to have you here today.

Hi, Kayla. Thank you so much for having me. I’ve been really looking forward to our conversation today.

MC, before we dive into today’s episode, please introduce yourself, where you’re from, and tell us a little bit about your practice journey.

Yeah, absolutely. So as you mentioned in the intro, I’m a registered psychologist and I am located right now in Calgary, Alberta. So practicing in Calgary. In this field, my journey began back in 2013. I graduated from SFU, Simon Fraser in Vancouver. And then fairly soon after moved to Calgary and I think like many therapists in the field, I got started in the nonprofit sector. My career began at CASA, which is the Sexual Assault and Sexual Abuse Center here in Calgary, and it was a wonderful place to work. I got really awesome experience in training in trauma, and that’s where I developed a lot of my trauma informed therapy skills. And so I spent many years there, met some really good people along the way.

And then from there, I moved into healthcare. So practicing in the healthcare system here in Alberta, and I still have a part-time role there. I’m still doing some work within the healthcare system.

But about four years ago yeah, I got curious about private practice and what it could look like to go into private practice. So I started initially as a generalist, working general mental health. Though the beginnings of this mindful cycle’s work was already at play inside me, but I didn’t really know how to bring it forward into my practice. It was just a side note at that point. And so I did that general work for about a year or so, and then as I went along, I discovered I really just wanted to do this cycle work and so I pivoted my practice to really focus and specialize on this area.

And so I have started working exclusively with people who were noticing changes in their mental health across their menstrual cycle. Then even over the last few years, Kayla, I’d say it’s pivoted again. So I still have a small clinical practice, but what I’ve been doing and what I’m really interested in doing is I’ve been facilitating and offering workshops and trainings and teaching on this topic. I’m really passionate about sharing this information with other therapists. So my practice is, again, pivoted a little bit. So I have a bit of clinical work and then also I’m doing this education piece. So that’s a little bit about the journey for me in terms of getting to this place right now. Yeah.

I love that and I think like we all pivot in our practice and pivoting I actually think is a requirement in private practice so that we start learning where it is that we want to show up. So I love to hear that you’re moving into areas that you love to talk about and I love that you’re here today sharing this particular concept with our listeners.

So can you tell us how mental health and the menstrual cycle are connected?

Yeah, absolutely. So really it comes down to hormones and the way that the hormones that are involved in the menstrual cycle now, there are a number of hormones involved in the menstrual cycle. But primarily, I’ll be referring to estrogen and progesterone because those are the more primary hormones that affect the menstrual cycle. But they’re also the hormones that we have the most research on in terms of mental health. So it really comes down to hormones.

But from a mental health perspective Kayla, what we see is that almost every diagnosis or diagnostic category in the DSM has some research to support that a proportion of those people with that diagnosis will experience something called PME, which stands for premenstrual exacerbation.

So what that means is somebody experiencing PME is experiencing worsening or an exacerbation of their mental health symptoms, primarily in the premenstrual phase of their cycle, but it could be actually at other points in the cycle as well. And so we have research that tells us that there are a proportion of people who experience PME of depression of various anxiety disorders, OCD, panic disorder, PTSD and trauma. We see this happening in ADHD in addictions bipolar disorder, borderline personality disorder. The list really goes on. So there’s such a connection between how people experience their symptoms and how they report those symptoms to us in therapy as it ebbs and flows along their menstrual cycle.

This is also the case for people who maybe don’t necessarily meet a diagnostic criteria, but are just coming to therapy for challenges or struggles or difficulties that they’re experiencing that maybe don’t meet a diagnostic criteria. But those folks will often experience changes in their mental health and their emotional health and their symptoms along the cycle as well.

So we see quite a large proportion of people whose mental health is affected by the menstrual cycle.

That’s really interesting. And so this actually goes into my next question. What are the most important things therapists should know about the neurobiology of the cycle?

Yes. So this is such an interesting topic for me, Kayla. I can nerd out on this topic all day. But what I typically talk about is that there are three primary ways that mental health affects the neurobiology. And so the first sort of pathway, or the first route that the two of those things intersect on is with neurotransmitters. So what we see is that estrogen and progesterone act on and they affect certain neurotransmitters in our brain.

As an example, estrogen tends to affect the serotonin system. And we know that serotonin is an important neurotransmitter for a number of different mental health diagnoses or mental health experiences or symptoms that people will experience.

Estrogen also affects the dopaminergic, the dopamine system in the brain. Which has to do with the learning centers in the brain, the reward centers in the brain, pleasure centers in the brain. So estrogen affects that as well. It also affects the opioid system. And many of us in our private practice or in our practices, work with folks who experience chronic pain. And so estrogen also plays a role in opioids as well. And all that to say that estrogen and progesterone act quite significantly on those neurotransmitters. And then those neurotransmitters go on to affect our mental health. So that’s one pathway that mental health neurobiology is important for clinical practice.

The second pathway is actually in the way that those hormones affect certain structures in the brain. So what we have seen in the research is that there are estrogen receptors all throughout the brain and the body, but the brain. And we see the highest concentration of estrogen receptors in three really important areas in the brain that pertain to mental health.

So we see high concentrations in the hippocampus, which has to do with memory. We see high concentrations in the amygdala, which is the emotional center in the brain. That’s also the part of the brain that is connected to trauma responses that. Fight, flight, freeze fawning response. And then we see the highest concentration of estrogen receptors in the prefrontal cortex.

And this is such an important part of the brain that we talk so much about in therapy, it’s the regulation center in the brain. And so what we see is that at points in the menstrual cycle where estrogen is higher. We have higher or increased regulatory ability, and this is extremely important and relevant in our clinical work.

And likewise, as estrogen changes or declines in the second half of the cycle, we have changes in our regulatory ability. And so that’s really important. So that’s the second pathway. Kayla, is that the menstrual cycle affects certain cortical structures or brain structures that then affect mental health and how we practice therapy.

And then the third way that neurobiology of the menstrual cycle is important for clinical practice is the nervous system. So of course, the neurotransmitters and brain structures are a part of the nervous system, but how we access various branches of the nervous system also ebbs and flows across the cycle.

So at points in the cycle where estrogen is higher, we’re more easily able to access those parasympathetic branches in the nervous system that calming regulated rest and digest state, it’s far easier for us to move into that branch of the nervous system early to mid cycle.

Similarly in the second half of the cycle when progesterone is the dominant hormone, we’re more quick to move into the sympathetic part of our nervous system, so we more easily shift into sort of stressed out states and more activated states, and it’s more difficult to get into parasympathetic states. We need different things at that point in the menstrual cycle.

So those are the three. I’d say most important things to hang onto in terms of the neurobiology of the menstrual cycle is it affects neurotransmitters, cortical structures, as well as branches of the nervous system.

This is interesting, and I’m sure I’m not the first person to probably hear about this the first time, even though we know that, hormones impact mental health and impact how we feel at any given moment. But I’m curious on why we don’t talk about this enough. Like, why are we not talking about this more? How come this isn’t something that we’re learning about, especially when we think of, half of the population has a menstrual cycle.

I love this question. It’s such an important part of this work, Kayla, because, yeah, I think there’s a few answers to that question, and what’s interesting actually is anytime I’ve done any trainings or offered workshops or even spoken at conferences, one of the questions I do often get is, how am I only learning about this now? Like, how is this only coming up at this point in my practice?

And so I think, one of the reasons why we don’t hear enough about this topic is because as we know, the menstrual cycle and menstruation is still not really a dinner table topic of conversation. There’s still some stigma and secrecy and shame that kind of surrounds this topic. I think that’s changing. I think we’re noticing, an increase in dialogue around this and comfort in dialogue around this. But I do think that there is a stigma that persists that affects our willingness to talk about this topic, client’s willingness to share about this topic. And so it’s allowed for this topic to just hide off in the shadow still. So I think that’s a really important piece of this.

The other thing I think that has affected this is that, historically we haven’t researched it. And this is what’s starting to really change. In fact, it wasn’t even until 1993 that women were required to be included in health research studies.

And so that’s fairly recently if we really put that into perspective, that women were included in research studies. And my understanding is that even after that happened. What was happening was that women were being included in health research studies, but only on days one through seven of their cycle when levels of hormones are at their lowest. So then we’re not actually getting accurate pictures of what’s happening for people in these health studies when estrogen changes or when progesterone changes later on in the cycle. And so I think the second part to that question, Kayla, is that we just haven’t had the research in this area, and that is starting to change as well.

There’s still not a lot of research in this area as compared to other topics, but we’re starting to get more. And so I’m hopeful that as we do get more and we start to put these pieces of the puzzle together about mental health in the menstrual cycle, that we’ll hopefully start hearing about this, earlier on in our practice. And that’s part of my goal in this practice is to also bring more awareness to this as well.

Absolutely. So I know this is probably a new term for people. So what is Cycle-Informed therapy?

Yeah, it is a term that I have coined and it’s exactly as it sounds in some ways, Kayla. It’s mental health therapy that is informed by the neurobiology of the cycle. So it’s taking into account those things that we talked about and then looking at what types of therapeutic, interventions, skills, offerings, might be most helpful for that client given where they’re at in their menstrual cycle, or given how their symptoms might be changing across the menstrual cycle.

So it’s really just therapy that aligns with the menstrual cycle and doesn’t necessarily work against it.

I love this, and I’m really thinking now, from a practical level. If we’re thinking about therapists listening to this podcast episode, they might be thinking how do I incorporate, cycle informed therapy into my practice. Do I ask my clients, where they are in their menstrual cycle? Do I include that as a part of the history taking? What are some of the things that I could be noticing to help me be more cycle informed?

Yeah. So if someone is curious about how to begin integrating this into practice Kayla, one of the things I often say is just get curious with your clients. Just ask the questions. As your client is explaining and talking about, what, they’re there to see you for. It’s okay to ask the question, Hey, have you noticed that any of this changes in relationship to your menstrual cycle? Sometimes I’ll preface that with a little bit of psychoeducation. We’re learning a lot more about how mental health is related to the menstrual cycle. Have you noticed that this is the case for you? Have you noticed any changes along the menstrual cycle? I think one of the most important places to start is just start asking the questions and getting some comfort in asking the questions because from my experience, most people will say yes to that question. If you ask them whether they’ve noticed changes in their mental health and relationship to their cycle.

The other thing that I often listen out for in the session, Kayla, is you might ask them how things have been going or how their symptoms are, and they say things like up and down. It ebbs and flows or, there’s highs and lows, like any kind of indication that there’s this fluctuating or changing experience for them. That’s an awesome opportunity to just ask the question, to get curious about whether those ebbs and flows are happening across their menstrual cycle. And that might be something that they haven’t even thought of tracking, and it could be or could be something that they know right away. Yes, absolutely that does change, but it’s rare that we ask that question. So what I would say to people is listen out for those moments where your clients are describing these ups and downs or these ebbs and flows, and that’s a really nice opportunity to start asking the questions.

You Know, I’m going back a little bit, but we’re talking a little bit about the how, but why is it important for us to integrate this into our practice?

I love this question too because I feel so strongly with this. It’s important for us to integrate this into our practice, Kayla, for a few reasons, because. For me, this really comes down in some ways, to a bit of a social justice piece in that, as you said, it’s how people often respond with, how am I only finding out about this now? This is information that we all deserve to know and have. If we are a woman or a person with a menstrual cycle, we deserve to know how our brain and how our bodies and nervous systems are different than men or a male nervous system. It is different. There are some things that fundamentally make this nervous system different. And so we deserve to know that and we deserve to be aware of how that could be affecting our mental health, our physical health, and also we deserve care, medical care and support that understands this as well. So that’s one reason why I believe we should be integrating this into our practice because this is really about, information that we all deserve to know.

I think the other reason Kayla, just from actually a practice perspective or a business perspective, is that being able to say that you offer therapy that is cycle informed really can give you practice a unique edge. It’s something different. Clients are really curious about it. Actually, when I was working as a generalist in my private practice and just had this tiny little thing on my website that says I also do this. Almost every client that came to see me for a general reason would ask me about this, would say, Hey, I saw this on your website. Can you tell me more about this? Or Can we have a few sessions where we focus on this? And so I think it’s important for us, a therapist to have this because it really does give our practice a unique edge.

And then along those lines. It helps to deepen our practice. It gives us another lens within which we can support our clients, within which we can view what our clients are experiencing. And it really helps with stuckness. So if you’re feeling stuck with a client, you’ve been working on something and it’s just not quite shifting, try taking the cycle approach to it and just see if that sort of frees something up. If it gives another angle to things.

Yeah, I would say it’s a social justice issue. I would say, it gives your practice a little bit of an edge and it supports your practice in deepening the work with your clients.

I love that, and it’s making me think of a few different things. One, I’m thinking about all the clients that I’ve had that, subtly stated, I’m on my period I’m feeling a little down and how I personally may not have acknowledged it to what it might be, and to how that influences how they’re feeling where they are currently.

And I’m thinking of other therapists who may or may not have heard that statement said but I just know like I’ve probably had at least a handful if not more clients, state that yet we just move on from that statement being said.

The second piece I’m thinking is how, at least in recent years we do talk more about, say, perinatal mental health or, going through menopause and the changes in hormones. And we acknowledge and we recognize and we even have therapists specialize in those particular areas. But at least as of right now, you are the only practitioner that I know who specializes in cycle informed therapy and the menstrual cycle and mental health. And it just makes sense that it would be connected because we know it’s connected to those drastic shifts.

So why wouldn’t it be connected in, I don’t want to call them gradual shifts, but like the cycle that is quite natural to go through, but we don’t, again talk about it. So these are just some of the reflections I’m thinking about today. I’m not sure if other listeners are thinking the same, but I am going to say that this is making me think about how do I integrate this more into practice.

Yeah, that’s a really important reflection. Kayla, I’m glad you mentioned that because actually what we see in the research is that people who experience, changes in their mental health, in relationship to their menstrual cycle are more likely to be somebody who will experience significant changes in mental health perinatally and in perimenopause. And so it’s one of the reasons why this is such an important thing for us to do in our work with people who still have a menstrual cycle because it will also help that client, if that client is learning to track their cycle and learning about how their mental health is related to their cycle. That will help prepare them when they enter perimenopause because if they’re somebody whose mental health is affected by their menstrual cycle, they’re more likely to be somebody who is going to experience changes in their mental health during perimenopause. So it’s all connected. And absolutely we should be looking at how do we integrate all of these things into practice. Yeah.

Absolutely. So do you have any additional advice, insights, or tips for listeners about how to integrate cycle informed therapy into their practice?

Yeah, I would reiterate the piece around just asking the questions and from a place of curiosity, what I often say to people is just to be aware of your own discomfort with it. Like what comes up for you around asking people about this topic. I’ve had some questions in some of my workshops where people have said isn’t this kind of a medical thing? Is within our scope of practice to ask somebody about this, and what I really want to offer people is permission to ask about this because this is not outside of our scope. The mental health and the menstrual cycle are so deeply connected and it’s really okay to ask and get curious with your clients about their experience of this.

So the additional pieces of advice would just be notice what comes up for you, and also just full permission to get curious with your clients about this and to be actually integrating and asking the questions as it shows up in your practice.

Amazing. MC, you have a free resource you’d like to share. Can you tell us what it is and how it can help listeners?

I do, yes, I have a free resource that can be found on my website, Kayla, but it is an introduction to incorporating cycle tracking into your psychotherapy practice. So one of the foundational skills in psycho informed therapy is, teaching your clients how to track their cycle for mental health. Now many people track their cycles for other reasons. We track our cycles for, physical health reasons. We track our cycle for fertility, but not all of us are doing it for mental health. So this resource introduces therapists to the topic of cycle tracking for mental health.

And then what to track. So if you’re going to invite your client to track their menstrual cycle for mental health, what are we asking them to track? How do we do that? And so the resource is a little bit of an introduction and a bit of a deeper dive into introducing cycle tracking in your practice.

And I also know you have a free upcoming webinar. Can you share a little bit about that webinar?

Yes, I do. I have an upcoming webinar that I would love to invite people to check out to. It’s a 90-minute webinar and I’ll be doing a bit more of a deeper dive into the topic that we’ve talked about today. Kayla, just looking a little bit more deeply at the neurobiology of the menstrual cycle and then how exactly we can begin to incorporate that into our clinical practice. It’s an opportunity to hear a little bit more about that topic. And it’s also an introduction to, I will be offering a course a program that will begin in the fall. And so for those people who are feeling really interested in this, the webinar is a bit more of an introduction to that and an opportunity to hear a little bit more about what the course will cover and if it feels like it’ll be a good fit for them.

Amazing. So to sign up for MCs, free resource and webinar, head to offerings.mindfulcycles.com.

Also, you can check out her course and any information about Mindful Cycles at mindfulcycles.com.

Or you could simply scroll down to the show notes and click on the link.

MC, thank you so much for joining us on the podcast today to discuss cycle informed therapy, an approach rooted in neurobiology of mental health and the menstrual cycle.

Thank you so much for having me on, Kayla. I really, feel so passionate about this topic and it’s been, such an honor to be able to share this with your listeners today.

And thank you everyone for tuning into today’s episode, and I hope you join me again soon on The Designer Practice Podcast.

Until next time, bye for now.

Credits & Disclaimers

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