Dr. Ruth K. Westheimer - Sex For Dummies

What can be good about having blood come out of your vagina once a month, you ask?

First, because menstruation is part of the process of making babies — and I love babies — the ability to have a child is definitely worth such a small inconvenience.

Second, ask any woman who has problems with her menstruation, such as irregular bleeding, and you suddenly discover how nice it is to be able to know approximately when “your friend” will next pay a visit so you can prepare yourself.

Third, disruptions in a woman’s cycle can serve as an early warning signal of possible health problems, so be aware of your body’s regular functioning.

The hormones in birth control pills would stop a woman from having her periods, but because the makers of the Pill thought women would find it strange not to have periods, they put placebos in the cycle so women on the Pill do have their periods. However, the FDA has approved a drug, called Seasonale, that continues the estrogen treatment for longer time frames. Women taking these pills have only four periods a year. The FDA also approved the use of continuous progestin that stops a woman’s periods completely, marketed as Lybrel. And Implanon, which is implanted under the skin on the inside of a woman’s upper arm and can be effective for up to three years, will also stop a woman’s periods.

The IUD and DepoProvera shot may also stop your period after a time, though probably not for several months. As far as doctors know, there is no downside to not having your period. When you’re on these birth control medications, you’re not going to get pregnant, so the lining of your uterus doesn’t have to be prepared with an extra blood supply. Because the world of medicine changes regularly, and because you need a prescription for any of these medications, talk to your doctor and see what might be right for you.

I suppose that I can’t address the topic of menstruation without also addressing premenstrual syndrome (PMS). Does the onset of menstruation affect women in various physical and psychological ways? Yes. The most recent statistic shows that three out of four women have some sort of PMS symptoms. The medical profession has associated many symptoms with PMS, including irritation, depression, changes in appetite, abdominal bloating, breast tenderness, poor concentration, insomnia, crying spells, and swelling of the extremities.

PMS may occur anytime during a 14-day period after ovulation and before the menstrual period begins. Some women have only a few symptoms; many may only have symptoms irregularly.

Of women who suffer from PMS, 3 to 9 percent have symptoms so severe they can’t keep up with the activities of daily living — they seem to have a “supercharged PMS” every month. This condition is real and called premenstrual dysphoric disorder (PMDD). These women often need medical intervention, and I recommend they seek help from their physician and not “just try to deal with it.”

No scientific evidence supports any one cause of PMS/PMDD, although the possible suspected causes include a hormonal imbalance and interaction with brain chemistry, fluid balance abnormalities, and nutritional imbalances. Treatments range from dietary changes and eliminating caffeine to taking medications such as antidepressants and anti-anxiety medications.

While PMS does affect some women severely, I would hate for anyone, male or female, to hold women back by labeling us as unstable in any way. Anyone of either sex can have a disability, which may or may not hold them back, but PMS should never be used as an excuse to hold back women as an entire gender.

I’m Jewish, and for Orthodox Jews, sex is absolutely forbidden while a woman has her period. Many people share this attitude, whether it comes from religious beliefs or just plain squeamishness at the sight of blood. Ironically, however, many women actually feel more aroused when they have their period, because the pelvic region fills with blood, similar to the flow of blood that occurs in the genitals during sexual arousal.

What if you do feel aroused during your period? There is a slight increase in the risk of catching an STD, but if you’re having sex with a partner who has not been tested so that you don’t know whether or not he is disease free, that’s a risk you have to account for whether or not you are having your period. You may want to place a towel under you to protect the sheets, and if the man feels strange about having blood on his penis, he can use a condom. But if the urge hits you, you have no reason not to give in to it. Unless your religion forbids it, of course.

Studies show that orgasm can actually relieve some of the discomfort women feel while they are having their period by reducing the feeling of pelvic fullness and cramping.

Although, technically speaking, you shouldn’t be able to get pregnant while you’re menstruating, Mother Nature sometimes plays tricks on you. You may have some vaginal bleeding that you interpret as the start of your period when it may not be. In addition, women who have a shorter-than-normal cycle may ovulate while they are still having their period. So if you have unprotected intercourse because you are bleeding, you may wind up pregnant. If you decide to use natural family planning and rely on your menstrual cycle to plan your sexual activities, then you must follow a method that relies on other factors besides just your period to avoid an unintended pregnancy.

Now you may think that women would feel their sexiest when they’re ovulating, because that’s when they can become pregnant and hence continue the species. In fact, during ovulation is the only time that females in the rest of the animal kingdom become sexually aroused. Although this heightened arousal may occur in some women, no research has ever found that the condition is widespread, so why this trait has disappeared almost entirely in humans is a mystery.

Menopause is that time in a woman’s life when she stops releasing eggs and shedding the lining of her uterus through menstruation. She is no longer fertile and has no more risk of getting pregnant. Although every woman is different, the average American woman hits menopause at 51, so we spend the last third of our lives as postmenopausal women.

Now, if all that happened to women during menopause was that their monthly bout of bleeding stopped, the commercial world would already have made a celebration out of this day, complete with parties and gifts. However, the cessation of ovulation also causes a decrease in the production of the female hormones, estrogen and progesterone, which means menopause has other effects that women sometimes find unsettling.

Menopause isn’t something that occurs suddenly. Usually the changes develop slowly, and the period of change is called the climacteric . A woman’s period may become irregular and the flow lighter or heavier. The actual length of time for the woman to cease having periods may be one to two years from the start of the climacteric.

However, women may start having hormonal symptoms as many as 10 to 15 years before menopause, and this period of time is known as perimenopause . During perimenopause, the egg-producing follicles in a woman’s ovaries may become resistant to FSH (follicle stimulating hormone), which is what kicks off ovulation. In an attempt to get those eggs released, the body produces extra FSH, causing a spike in estrogen levels. But because the body produces no normal matching increase in progesterone, rather than a steady decline in hormones, a roller-coaster effect results, which may cause a variety of symptoms including abnormal bleeding, depression, and even hot flashes (see later in this section for a further explanation of this symptom).