Sex For Dummies. Dr. Ruth K. Westheimer

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.

      Sex and the menses

      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 — “The change of life”

      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.

      Easing into menopause

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).

      Abnormal bleeding may cause your gynecologist to order an endometrial biopsy and/or a dilation and curettage (or D&C). An endometrial biopsy is done in your gynecologist’s office. A small tube is inserted through the cervix into the uterus, and a sample of the endometrium, the lining of the uterus, is extracted for microscopic evaluation. A D&C is an invasive scraping of the uterus done in the operating room under anesthesia.

      But new techniques using sonograms are now available that can prevent you from having to go through a D&C, so talk to your doctor extensively before agreeing to any procedure. If your doctor doesn’t have the necessary equipment to perform the new, less invasive procedures, then you may want to find one who does.

      Just being aware of perimenopause can bring you great relief because you’ll at least know that you’re not going crazy.

      A classic symptom of menopause is the hot flash, a sudden feeling of heat that takes over the entire body. This can happen at any time of the day or night, and the number of hot flashes and their duration is different for every woman. Because the woman’s face usually also becomes flushed, these hot flashes may be visible to the entire world and can be embarrassing, though she certainly has no need to feel embarrassed. Although not every woman experiences hot flashes, the normal duration for this symptom is two years. About 25 percent of women have hot flashes for a longer period of time if they go untreated, right into their 90s. (Skip ahead to the section on hormone replacement therapy to learn more about the treatment.)

      The decrease in hormone production during menopause also causes changes in the vagina and bladder. The vaginal walls thin out, causing vaginal dryness. This dryness, in turn, can cause burning, irritation, and decreased lubrication, which can result in painful intercourse (see Chapter 19). Similar changes in the bladder can cause a woman to feel the urge to urinate more frequently.

Many women also experience some psychological changes, although these haven’t been medically proven to be tied to the effects of menopause. They may, in part, be due simply to interruptions in sleeping patterns caused by the hot flashes, or to a woman’s reflections on this permanent physical change in her life, which signals the end of youth.

      Some harmful side effects of menopause may be osteoporosis — a loss of bone strength caused by lower levels of calcium being retained — and possible heart problems.

      

If you know any families who have two or three children grouped around one age bracket and then another child who arrived ten years later,