It's no secret that of all the things about women that mystify (horrify/traumatize/totally freak out) men, the menstrual cycle is the most perplexing. Who hasn't heard the classic "I don't trust anything that bleeds for five days and doesn't die?" It is totally possible in a variety of ways, as long as you bleed slowly enough. As a woman, it's disturbing to hear that same tired saying because it only reinforces our own negative perceptions about our menstrual cycles. So -- what is really going on down there?
We all took high school biology and have vague recollections of little graphs outlining the peaks and troughs of estrogen and progesterone levels. These are the hormones that cause ovulation and the build-up and shedding of endometrial tissue. Most basically, estrogen causes the build-up of endometrial tissue, and a build-up followed by a sudden drop in both progesterone and estrogen causes menstruation. If you're anything like me, you slept through that and many other parts of high school. But there are real-world consequences of those hormones worth knowing.
In terms of pregnancy prevention, the biggest event is ovulation. If you can avoid egg meeting sperm, problem solved, which is how birth control pills work. By maintaining a steady level of hormones, rather than the natural increases and decreases, your ovaries never get the signal to ovulate. No egg, no fetus. The sudden removal of these hormone supplements by taking the placebo week in your pack of pills causes menstruation. It's kind of a false period. Pretty much the only reason placebo week exists is to reassure you that you're not pregnant -- which also means that most women who can take the pill can manipulate their menstruation and even prevent it altogether by skipping that placebo week. Many women simply don't take that fourth week of pills and jump straight to the next pack, or they can take the new 13-week or even newer 52-week pill packs.
Whatever the length of cycle, many things can affect the success of birth control pills. One of the simplest but often overlooked things that stops the pill from working: antibiotics. Many different antibiotics can decrease the effectiveness of birth control, specifically Rifampin, which counteracts hormonal contraceptives by increasing their metabolism in the liver. Yes, there are people walking around today who owe their lives to antibiotics. And not in that cured-a-raging-infection kind of way.
If you're a barrier-method (condoms, diaphragms) type, rather than a hormone-method (pills, implants) type, it's good to be aware of your cycle. Because once sperm are inside the uterus, they can hang out for a couple days, which means that even if you haven't ovulated, you're not out of the woods yet. Likewise, the egg is viable for a couple days, so sex a few days after ovulation can still be baby-making sex. This is the time when couples trying to get pregnant are instructed to go wild. It's also the time that those who rely on natural family planning know to avoid each other like the plague (although this system has a pretty high failure rate). Being familiar with ovulatory patterns can help you out. In the standard textbook cycle, ovulation occurs two weeks after the start of your last period, which in real life can mean anywhere from 11 to 21 days after the start of your last period. Unprotected sex -- never encouraged here, by the way -- is the least risky, in terms of fertility, right before or right after your period. It's never advisable, as there are plenty of pregnancies that resulted from sex during these supposedly less fertile times, even mid-period. But you might want to be extra careful about birth control mishaps such as broken condoms during the middle of your cycle.
As for the hated topic of PMS (hated because having it is miserable, and hated because it's the reason, according to a few misguided sources, why women are too emotionally inept to do much but cook while barefoot), it is pretty simple. Those high levels of hormones (that drop off to cause menstruation) cause the physical and mental discomfort that many women experience at the end of their cycle.
What does all this mean? Embrace your (or your girlfriend's) period in whatever way you see fit. Or ignore it. Just don't be scared of a little bit of blood.
Anna is a University Medical student. She can be reached at asedney@cavalierdaily.com.
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