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PMS and Sex: Information Men and Women Need to Know

It wasn’t that long ago that frank discussions about the specific feelings women experience during their menstrual cycle were taboo; in fact, there are still cultures that consider women during certain phases of their cycle to be unclean. Ignoring this fundamental aspect of the female experience, especially with a woman whom you may be in an intimate relationship with, can only cause some degree of awkward misunderstanding and frustration. I don’t know if it is just my guy friends, but I know for a fact that even today there are a lot of men around who are “informationally challenged” when it comes to the menstrual cycle and sex. Here is a bit of basic information on the menstrual cycle and how it can impact women, as well as a few suggestions for how dating couples can be assured that the cycle is integrated into their relationships.

Here are the facts. The “average” menstrual cycle lasts 28 days for women, although it is not unusual if it fluctuates between 25 and 35 days. By definition, the menstrual cycle starts the first day there is menstrual bleeding. During the three to five days that bleeding occurs, the steroidal hormones estrogen and progesterone are at their lowest levels. During the next phase, often termed the follicular phase, which typically lasts from day 5 to day 14 of the cycle, women experience a dramatic increase in estrogen. This is the precursor to the reason for the entire cycle, which is the release of an egg, which usually happens around day 14. There is a marked decrease in estrogen with ovulation. After the release of an egg, there is generally a 14-day period until it all starts over again. This 14-day period is called the luteal phase, when estrogen gradually goes up and comes down, with progesterone following the same pattern, although with a much more dramatic peak around the middle of this two-week period.

So why all the information on progesterone and estrogen? Simply put, because these hormones impact the brain almost as much as they do the ovaries. And because of the impact on the brain, some women notice clear changes in both their mental acuity and their moods across the menstrual cycle. For example, estrogen has been repeatedly shown to enhance verbal skills and diminish spatial skills. Thus, it is no surprise that several researchers have found that women have better verbal skills, particularly verbal memory, at the times of the cycle when estrogen is high (prior to ovulation and in the middle of the luteal phase) and worse when it is low (during menstruation). Conversely, spatial skills seem to be higher during menstruation.

The role of progesterone on the brain is much less well understood. There are suggestions that some women are particularly sensitive to progesterone and therefore more prone to experience what is loosely referred to as premenstrual syndrome (PMS) at the end of the luteal phase when progesterone is declining rapidly. However, data linking these events is quite weak and the etiology of PMS is quite unclear. What is clear is that up to 80 percent of women have some unpleasant symptoms (physical, psychological and emotional) associated with the menstrual cycle. The most common symptoms are abdominal and vaginal pain, sweating, diarrhea and fatigue. These symptoms usually do not interfere with most women’s daily activities.

In addition to changes in mental acuity and mood, there are often changes associated with a woman’s sexual drive across the menstrual cycle. This is being found for subtle changes in women’s sex drive that women may not even be aware of. While libido is far too complex to be tied to a particular part of the menstrual cycle in all women (it is inextricably associated with culture and emotions), many women do notice particular times of the cycle when sex is different, perhaps feeling more tender at some times and more primitive at others. The point to remember is that women will experience sex differently across the menstrual cycle, and a lover who is attuned to how the woman is feeling will be a more satisfying lover.

One comment on the menstrual cycle and conception: if there is anything that is scientifically unreliable, it is the rhythm method of birth control. The reason for this is that the bulk of the fluctuation in the length of the menstrual cycle occurs before ovulation. The time after ovulation is much more consistent in being about 14 days. However, the time between menstrual bleeding and ovulation is extremely unpredictable. So people who count the number of days after bleeding stops and after 12 or 13 days stop having sex for a few days often find themselves with an unplanned bundle of joy nine months later.

Perhaps applying flexibility, sensitivity and true understanding is the best take-home message any dating couple could reach about the menstrual cycle and their relationship. While we know much about the endocrinology of the cycle, the most definitive thing we know about how the menstrual cycle impacts women’s emotions, mental acuity, sexual drive and physical sensations is that most women do experience differences in some or all of these areas across the menstrual cycle. These experiences are so different it is very hard to reach any generalizations that will fit most women—so good communication is key to meeting your partner’s specific needs during different phases of the menstrual cycle.

For those guys who still think you know what the experience is and how women feel during this process, and what is and isn’t “real,” get over it. The sensations women experience across the menstrual cycle are as real as every other physiological event. They do tend to differ greatly across women. Sensitivity, openness and support when requested seem to be the thinking man’s approach to dating a woman who has menstrual cycles. And for women, honesty and directness about your experience should help take the guessing out of the process for your man.

If you happen to be a postmenopausal woman or if you are dating a postmenopausal woman, this information may not be terribly relevant. But stay tuned, I plan to write on how both the postmenopausal and the male hormonal fluctuation may impact your dating life in the future.