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MENSTRUATION AND MENOPAUSE
MENSTRUATION

From the onset of puberty through the duration of a woman's fertile years, her glands and hormones govern a monthly fertility cycle called  the Menstrual Cycle. This cycle is divided into three phases:

The Proliferative Phase

During the proliferative phase, two organs in the brain become active: the hypothalamus releases chemicals that travel to the pituitary gland. The pituitary gland then releases two hormones: FSH or the follicle stimulating hormone, and LH or the luteinizing hormone. These facilitate ovulation – the maturation and release of an ovum (egg) into the fallopian tubes – in two ways: 

1. At the beginning of each new menstrual cycle, the hormone estrogen drops to a low level. This causes the hypothalamus to send a message to the pituitary gland to secrete FSH. The ovaries react to this increased FSH level by beginning the maturation process of in an egg within its follicle. As the egg grows, it facilitates the production of the hormone progesterone, which causes the endometrium, or the endometrial lining of the uterus, to react by increasing. 

2. As the egg develops in the ovary, rising estrogen also causes changes in the cervix and increases  in the cervical mucus level. After about ten days of steady estrogen elevation, this hormonal accretion stimulates the pituitary gland to secrete LH, which in turn causes the ovaries to release the mature egg.  

The Ovulatory Phase (Menses)

The ovulatory phase occurs when the monthly egg is released into a fallopian tube to begin its journey towards the uterus. Fertilization most often occurs during this phase, when an egg traveling down a fallopian tube fuses with a sperm traveling up the fallopian tube to form a zygote, or fertilized egg.  

The Luteal or Secretory Phase (Getting your period)

The luteal or secretory phase begins at ovulation. If a zygotic successfully travels down a fallopian tube into the uterus and implants in the endometrium, pregnancy is initiated.  

During pregnancy, more progesterone is released into the uterine lining, increasing and enriching its nutrition-dense composition to nurture embryonic growth. But when no fertilized egg implants in the uterine wall, progesterone levels drop, causing the uterus to shed the built-up endometrial lining. The endometrial tissue and the unfertilized egg mix with with other cervical and vaginal secretions and about 35% blood to flow out of the uterus into the vaginal canal. The Menarche is the term for a woman’s first menstrual secretions (is that a gorgeous royal name or what!) of this cycle.  

This secretory phase of the menstrual cycle can last from a couple of days to a week or more, with varying degrees of menstrual flow. 

After your monthly menstrual cycle is over, it’s normal for the vagina to continue to secrete some brownish discharge for a while, mixed in with your natural cleansing discharge. This is just your body doing some housekeeping by flushing out a bit of leftover secretory residue. 

Is Sex during Menstruation Okay?

Sex during normal menstruation is fine; some women even find it relieves their menstrual cramps. This is because an orgasm can cause your uterus to contract, enabling it to use up excess prostaglandins in the process. Prostaglandins are hormones produced by your uterine lining. They help to stimulate the contractions that move menstrual blood out of the uterus, causing those cramps that occur during your period.

Pregnancy Alert!

A young woman who has never menstruated can ovulate and conceive even before she first secretes menstrual fluid during her Luteal phase (when she gets her period).

And yes, you can get pregnant during menstruation.

Sometimes women mistake the mild bleeding that can occur with ovulation for their period. Unprotected sex at this time can greatly increase your chances of becoming pregnant. Additionally, male sperm can live in the female reproductive system for three days or more. Because some women ovulate at the end of their menstrual periods, or ovulate more than one egg, sperm may still be alive at this point and thus able to fertilize an egg.

Painful Menstrual Flow (Dysmenorrhea)

During menstruation the increase of the hormone prostaglandin decreases blood flow to the uterus, causing it to contract; a process that sometimes causes painful cramps. 

There are a lot of things that you can do to relieve menstrual cramps. These are some that many women have found helpful, when done prudently and in accord with their individual medical needs: 

Heat

Heat can heal. Rest a heating pad over your uterus or lower back, take a warm bath, or sit in a sauna or whirlpool.  

Diet and Nutrition

Try eating foods rich in calcium, magnesium, and vitamins E and K. Follow your pharmacists or doctors quantity instructions. 

It's also helpful to avoid certain things. The intake of alcohol, sugar, salt, caffeine, processed foods, and dairy products can contribute to cramping, bloating, and other menstrual discomforts. Eating whole, light, nutritious, plant-based whole foods during menstruation is best. 

Exercise and Massage

Deep stretching and yoga coordinated with breathing, mindful physical activity, massage, pressure point reflexology and acupuncture may help, too. Pressure point massage on the lower back, sacrum, ankles and feet pinpoints areas in reflexology that correspond to the female reproductive system, and may ease cramps. Here are some basic pressure points:

 Ankle pressure points and sacral pressure points corresponding to the reproductive organs.

AN INTERESTING FACT ABOUT CRAMPS AND SPERM
Semen contains prostaglandins which can cause cramps. This is to  help move the sperm up the vagina on its journey to fertilize ovarian eggs. Another reason to use a condom!

 

Traditional Medicine

If all of these fail to relieve your cramps, speak to your doctor about an over-the-counter anti-inflammatory like Midol, ibuprofen, or another analgesic.  

Herbal Medicine

Drinking a warm beverage such as a caffeine free herb tea brings welcome warmth to the inner body and may provide relief. Certain herbs teas are thought to have properties that ease uncomfortable menstrual symptoms. NOTE: These herbs are powerful medicines. Use them only under qualified medical supervision.  

Herbs thought to be useful for menstrual symptoms include:

·       black cohosh (Cimicifuga racemosa): mood swings, tension, establishing ovulation (an important source of phytoestrogens). The German Commission E, however, states that women should not take black cohosh for menstrual problems for longer than six months because of the risk of side effects.

·       black haw (Viburnum prunifolium): crampschamomile (Matricaria recutita): mood swings, tension, and cramps

·       cramp bark (Viburnum opulus): cramps

·       dandelion (Taraxacum dang gui): fluid retention and bloating

·       fenugreek (Trigonella foenum-graecum): irregular bowel movements

·       feverfew (Chrysanthemum parthenium): headaches and PMS symptoms

·       ginger (Zingiber officinale): cramps, irregular cycles, heavy bleeding, or bleeding in between cycles

·       goldenseal (Hydrastis canadensis): heavy bleeding

·       horsetail (Equisetum arvense): heavy bleeding

·       licorice: PMS symptoms

·       milk thistle (Silybum marianum) extract: heavy bleeding

·       nettle (Urtica dioica) extract: heavy bleeding

·       peppermint (Mentha piperita): mood swings and tension

·       raspberry tea: cramps, irregular cycles, heavy bleeding, or bleeding in between cycles

·       red clover (Trifolium pratense): phytoestrogen source

·       rosemary (Rosmarinus officinalis): cramps

·       shepherd's purse (Capsella bursa–pastoris): heavy bleeding

·       St. John's wort (Hypericum perforatum): depression associated with PMS

·       valerian (Valeriana officinales): mood swings and tension

·       vitex: PMS symptoms

·       wild yam: phytoestrogen source

·       yarrow (Achillea millefolium): cramps

·       dong quai (Benincasa cerifera): PMS symptoms, cramps, irregular cycles, heavy bleeding, or bleeding in between cycles

Medical Causes of Cramping and Menstrual Flow Pain

Sometimes a painful menstrual flow is indicative of something that needs medical attention, such as endometriosis or pelvic inflammatory disease (PID). Either of these conditions can cause intense pain during menstruation, and neither should be neglected. 

Endometriosis occurs when the endometrial lining of the uterus becomes misplaced and occurs in the fallopian tubes, the ovaries, the vaginal canal, or other areas of the body where it is not meant to be. In addition to causing painful menstrual cramps, this condition can interfere with fertility, cause pain during sex, and create other issues of concern that should be treated by a doctor's care. 

Pelvic inflammatory disease can cause scarring of the fallopian tubes and lead to sterility. Extreme inflammation may require surgical removal of part or all of the reproductive organs. It must be diagnosed and treated in order to prevent serious consequences.

Premenstrual Syndrome (PMS)

Don't Ignore the Impact of Serious PMS

Severe PMS is a very real condition that can have negative repercussions on your quality of life, relationships, and work.

Don’t ignore it: take constructive action. See your doctor about treatment. Explain PMS to your family members and friends,

and enlist their understanding and support.

 An Option for Some

Oral contraceptives may relieve many symptoms associated with PMS. Oral contraceptives aren't for everyone, but this may be an option to discuss with our doctor.

 

Premenstrual syndrome affects up to forty percent of women of reproductive age. The product of hormonal activity, it generally occurs during the luteal phase of menstruation (when ovulation begins) and lasts from one to ten days.

 Symptoms of PMS:

Premenstrual dysphoric disorder:

Mood swings, depression or feelings of hopelessness, sadness, self-deprecating thoughts, anxiety, tension, crying easily, marked emotional lability  

Confusion, forgetfulness, lack of efficiency, difficulty concentrating 

Restlessness or jitteriness, feeling on edge

Persistent anger, increase in personal conflicts and conflicts that interfere with work and social activities

Decreased interest in usual activities, social avoidance and withdrawal 

Marked fatigue, lack of energy  

Sudden bursts of frenetic energy 

Food cravings 

Dysmenorrhea (painful menstruation): Painful menstrual cramps, joint or muscle pain, back pain, abdominal cramps

Sleep disturbances: Sleeping too much or too little

Mastalgia: Breast tenderness or swelling

Fluid retention: Weight gain, uterine and/or abdominal bloating or swelling, swelling of extremities 

Nutritional deficiencies: Deficiency in magnesium, manganese, B vitamins, vitamin E, linoleic acid and its metabolites, and calcium 

PMS migraine symptoms: Headache, dizziness, vertigo, nausea  

Treatment for PMS: It’s important to work with a good doctor to determine the factors involved in your PMS, so that your treatment is geared to your individual needs.  

Premenstrual dysphoric disorder: Biofeedback, yoga and relaxation techniques, massage, cognitive therapy, exercise and selective serotonin reuptake inhibitors (a class of anti-depressants) during the luteal phase are treatment options for the mood and emotion related symptoms of PMS. If you and your relationships are suffering as a result of your symptoms, don’t hesitate to get help.   

Your doctor must prescribe any anti-depressants and monitor their affect; never take other persons’ medicine. 

Dysmenorrhea (painful menstruation): The application of a heating pad, sitting in a warm bath or sauna, orgasm, massage, or physical exercise may alleviate this symptom. If not, speak to your doctor about using an over-the-counter analgesic. In severe cases, the use of non-steroidal anti-inflammatory medications may bring also relief, but your doctor must prescribe these for you; never take another persons’ medicine. 

Sleep disturbances: Treatment methods that may be effective include eliminating caffeine, progressive relaxation and biofeedback therapy, cultivating a relaxed, undisturbed sleep environment and changing sleep patterns, avoiding stimulating events before bedtime, and taking calcium and certain herbal teas such as red raspberry leaf, strawberry leaf, peppermint or ginger before sleep. 

Pharmaceutical sleeping aids such as Doxepin may be helpful when limited to use during the luteal phase. 

Mastalgia: Use of a comfortable support bra, following a low-fat diet, eliminating caffeine, taking vitamin E supplements, oral contraceptives, or non-steroidal anti-inflammatory drugs during the luteal phase, may effectively reduce breast tenderness and swelling. 

Fluid Retention: Adopting a light, low-sodium (salt), low-fat, low cholesterol, nutritionally balanced diet that eliminates simple sugars and alcohol during the luteal phase may significantly reduce fluid retention. In serious cases of edema (fluid retention), use of a diuretic medication such as Spironolactone (Aldactone) may be called for. 

Nutritional deficiencies: Following a diagnosis of your nutritional deficiencies, moderate your diet to feature whole foods and supplements that are rich in the vitamins, micronutrients and minerals you’re missing. Speak with your doctor or nutritionist to work out the proper proportions your body requires. (Remember: you can overdose on certain vitamins and minerals. Don’t self-medicate).  

PMS migraine symptoms: Progressive relaxation techniques and biofeedback therapy, rest and quiet, the elimination of stressful behavior patterns, and the administration of non-steroidal anti-inflammatory drugs, antidepressants or muscle relaxant medications before bedtime are treatment options for PMS related migraine. 

Exercise May Help
Incorporate moderate exercise into your daily routine if possible. A half hour of walking or running, yoga, aerobics or dancing may alleviate many PMS symptoms.

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Menstrual Products
                        

It’s not necessary to use menstrual products during your period, and some women choose to just let go and flow, or use a designated pair of underwear and sheets during the secretory phase of menstruation. But: a heavy flow may stain your clothing, or become otherwise inconvenient when you're active. If this occurs, there are a number of products available which can absorb or obstruct menstrual secretions.  

Menstrual Pads, Tampons, and Cups  

Menstrual pads are cotton pads that have a sticky side that adheres to your underpants. They absorb menstrual secretions as they flow from the vagina, keeping your clothing protected.  

Pads come in different sizes for the different stages of menstrual flow - light, medium, heavy, extra heavy - and should be adjusted to your secretory output. 

Tampons are cotton cylinders that are inserted into the vaginal canal to absorb menstrual secretions. A string is attached to the bottom of the tampon which should hang out of the vaginal canal after insertion so that you can pull it to remove the tampon.  

Like pads, tampons come in different sizes to match the various quantities of menstrual secretions discharged during the cycle, and should be adjusted accordingly to lower the risk of Toxic Shock Syndrome.  

Some tampons come inside tube-like containers, and some don’t; if you use a tampon that comes in a holder, make sure to remove the holder when you insert the tampon. 

Toxic Shock Syndrome (TSS)

TSS is a rare but potentially fatal illness associated with the use of tampons. The best way to reduce the risk of TSS when using tampons is to avoid an oversaturated tampon, so change tampons frequently, use tampons appropriate for the level of flow you are experiencing (light, medium, heavy), and use a pad when you sleep. 

If you experience any of the following symptoms, STOP using tampons and see a doctor immediately: High fever, body rash, chills, dizziness, nausea, weakness or faintness, sharp abdominal or genital pain.

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Menstrual Products Should Never Hurt

Q. I have begun getting menstruation and have no one to talk to. I live alone with my father. My father says it is "women's sin of blood". I put in a tampon at school but it hurts. Is it supposed to? Am I sick? 

A. Sweetheart, nothing should hurt your vagina. Stop using a tampon and use a menstrual pad instead until you get sorted out. A menstrual pad is attached to your underwear, where it catches menstrual fluids, and is not inserted in any way. Nothing should ever be inserted into the vaginal canal if it causes pain. 

Lots of things could cause the pain your experiencing. A simple question: did the tampon you used come in an inserter or container, and did you remove the inserter/container when you inserted the tampon? If you didn't remove it but were walking around with it inside you, it can really hurt! Check the instructions on the package and see if this is the case. 

Other things that can cause pain are a closed hymen, an STI, vaginismus (clenched vaginal muscles), endometriosis, cysts - but the only way to find out is to see a gynecologist, and you must. Your father does not sound like a good candidate for help in this regard. If he will not take you for a gynecological examination - or if you don't want to approach him about it - speak to the nurse at school or a teacher that you trust about your need. If necessary, they can contact a social worker to help you, but there may be other alternatives. 

Menstruation is not "women's sin of blood". It is the fabulous process through which we women become fertile and can have children, if we choose. Welcome to this rich phase of your life!  Welcome to choice and responsibility and the incredible transition that marks the change from girlhood to womanhood. Please get going reading the Informed About Sex sections on menstruation, conception, teens, and anatomy and physiology, and peruse the resource sections for on-line groups to join. Check out Scarleteen, All-Girl Army, and the other links for a friendly place to talk and question. You may feel very separate but really you are part of a community of young women going through the same things you are - reach out and connect to them.

Shain

Menstrual cups are flexible cups that are placed in the vagina to catch menstrual secretions. They’re simply emptied when full, and then put back in place. When the menses pass, the cup is boiled to sterilize it. A single rubber or silicone cup may last a lifetime. 

Disposable cups are also available.


Avoid Bleach in Menstrual Products

Avoid bleached menstrual products. Bleach is abrasive to the vaginal tissues and poisonous to the environment (including the micro-environment of your body). Most health food stores carry bleach-free menstrual products, and you can request them at your local drug store.

The Red Tent Movement: Talking about Menstruation Together (and Other Good Stuff)

Sharing stories and information about menstruation is an important way for women to connect, gain knowledge, and care for each other. The Red Tent Movement is a worldwide phenomenon in which women gather in a red tent, or menstrual tent, to share wisdom and compassion. Inspired by the book The Red Tent by Anita Diamant, Red Tent gatherings inform, nurture and affirm participants in a non-judgmental, supportive environment. Join one or start one!

 

SHARED WORDS: MENSTRUAL TALES

Georgia O'Keefe

Yoko: "I was so entranced by the miraculous beauty of the colors and shapes that my menstrual secretions created in the toilet bowl. They unfurled like delicate flowers with flaming nerve tendrils, like dancers, like ice-crystals stained in primordial blood. I couldn’t share this with my parents because they were too freaked out by the fact that I had an actual working vagina, my class mates because they had the sensitivity of concrete slabs, or my brother because the issue of the body gave him the jitters, poor lost soul. So I contented myself with writing poems – love poems to the beauty of my menstrual flow."

Rea Red Wolf, Indian Nations: "When I first began to menstruate, the people of my tribe (Navajo) all gathered to honor and celebrate my fertility with singing, feasting and story-telling. I learned about the origin myth of White Shell Woman and how to walk in the sacred way of beauty, at harmony with all things. Uplifted by my people and our spiritual traditions, I felt peace and pride in being cyclic like the Mother earth, and proud to be responsible for my capacity to give life."

Louisa: "I first menstruated during sex. My boyfriend looked at me and said "Baby, I think I broke you!"

Maria Justine: "I started menstruating exceptionally young and I had a really, really heavy flow. It seemed like no matter what I did I couldn’t plug it up. I would lay on two heavy-flow pads and a heavy-flow tampon, and change them every twenty minutes - and I STILL SOAKED THROUGH. One day I was sitting at my desk in school during math class and realized that not only was my skirt soaked in blood, but my whole chair was drenched. O.M.G. I jumped up and backed against the wall, and got out of school doing a side-ways crab walk, edging against the walls the whole way. Then I sprinted home- honey, you never saw a kid move so fast – and plunged into the tub. Women need menstrual days off!!!"

Our House
Ida: "In our house when any female member of the family got her first period she got to stay home from school (if she wanted too). We had her favorite foods for dinner and dad made his special Rumless Choco Cake for desert. Mom wrote a poem/note just for her, which she received under their pillow in a colored condom topped with a bow, because yes, no matter what you already knew, mom and dad gave you The Talk again.

Getting the P. was like a one time Holiday.

Esther: "When each of my daughters began menstruating we had a special dinner for them with all their favorite foods, and they got to choose what the family did together that night. I showed them the video of their births, and told them what it was like to be pregnant with them and bear them. We sang ancient Hebrew songs that my mother taught me, and contemporary songs that they picked about birth and womanhood. It was joyous and holy.
Shalom"

Drop By Drop
Marisol: "Drop by drop is how my nutty family let me know menstruation was dirty, a scandal! I had endometriosis and bled so heavily that anemia was a constant problem. Vomited, passed out from the pain. Dreaded it every month. "like labor twelve times a year" as a doctor put it.

Occasionally a single drop of my menstrual blood (flood is more accurate) fell on the floor, and I was in too much hurt to notice. My family would scream -SCREAM - like banshees that the bathroom floor was defiled, carry on like they'd witnessed a murder. Literally get hysterical.

"It's just blood" I'd say. Good god, we all have blood. Is weirdness genetic? Why were they so unhinged because it passed through my vagina?

I was a happy puppy when I got to go away to school and be around other women who were at ease about menstruating. I still tense up when I think about how crazy they got about something natural. Dark places lurk in our society!"

Rachel: "Menstruation was taken seriously in my home. We are Orthodox, and women are considered unclean during menses. We had to stay separate from the men, who wouldn't look at us.

This was not a positive approach, but my sister and I rebelled by creating a kind of Red Tent together. Since we were left alone alone -a rarity in our household - we read outlaw fashion and sex magazines, and looked at things on the computer that our parents normally forbid.

When I look back on it, this was our way of fighting back in an inequitable situation. I do not think girl children should be taught they are unclean because they have become fertile, and my daughter was not raised this way. Fertility is sacred, and should be treated with respect, not abhorrence."

Estella: "When I began menstruating, my mother and our best friends had a party for me. Rama, our dear friend from Egypt, taught us beautiful belly dance movements demonstrating how to ease menstrual cramps and childbirth. We all danced together, and then she danced with me in the middle of a circle of our friends. Now my own daughters and I are part of a Red Tent, where we share sacred stories and dance with our sisters."

Karla:. Moss between thighs
sweet and dry on the dirt
menses snaking lava down my mound
into the warm, sun-baked earth
sky wide above
earth core below

Peaceful.

Sierra Leone 

 

Dawn ComesWithWar: My story was one of returning to tradition with my tribe. I grew up off the reservation in the Christian religion, and my family considered menstruation a manifestation of Original Sin, Woman's punishment.

I visited my grandmother on the reservation when I turned 12, just before menstruation began for me. She explained to me how sacred and connected to the earth women are through The Cycle, and brought me into my peoples tradition - of spiritual passage. All women must be honored as they pass into the Cyclic phase that connects them to fertility, whether or not they bear children.

Beauty all around.
 
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Q & A with Sex Educator Shain Stodt

PMS Is Keeping Us From Living Together

Q. I’ve had a relationship with a woman I adore for four years now. We live in separate homes but spend a lot of the month together. For the last year we’ve talked about living together but she is reluctant because, as she puts it, she gets “crazy and bitchy” during her menstrual cycle. She also has endometriosis, apparently a contributing factor, and describes severe pain and mood swings. She says she is concerned that this will have an adverse effect on our relationship. 

We are very companionable and at ease together, and I miss her every month when she isolates herself for about a week until her cycle is passed. I can’t help but think we could work this out in a living situation if we try, and I truly don’t understand how getting her period can make this much of a difference. Is there something I’m missing? I menstruate, too, and it doesn’t radically change my feelings about our relationship or my outlook on life. 

A. It sounds like your partner may be suffering from some of the more serious effects of PMS. This is to be taken seriously. 

Premenstrual Syndrome, or PMS, is caused by the enormous hormonal changes that take place during the menstrual cycle. PMS can start up to 10 days before menstruation begins, but it most commonly starts to three days prior to menstruation. It can cause very serious depression, mood swings, irritability, cravings for certain foods, and a lot of unpleasant physical symptoms like headache, backache, cramps, bloating of the uterus, breast tenderness, nausea, and vertigo, to name a few. Some women really do feel like they become a Mr. Hyde- like alter ego, and hate burdening their friends and family with difficult personality changes that they feel they can't control.  

Things that may help to alleviate PMS symptoms are: 

1. Engage in regular physical exercise, and continue it through the menstrual cycle. Yoga combined with cardio is ideal, but any kind of stretching followed by activity that gets the cardiovascular system working is great. It can do a great deal to help ameliorate or alleviate symptoms. 

2. Apply heat. A hot bath, sauna or a heating pad placed on the lower back or area over the uterus may help relieve cramps. 

3. Have orgasms, either through masturbation or, if tolerable, partner sex. Orgasm releases relaxing endomorphs, and sends a flush of blood into the vulva, which relieves tension and cramping. (A good vibrator can be just right for this). 

4. Eat a healthy, plant-based diet. Avoid dairy, meat, and processed foods. Deleting sugar, caffeine salts candy and alcohol from all food intake may greatly reduce mood swings, headaches and cramps. 

5. Consult with a doctor about the use of over-the-counter medications specific to relieving the symptoms of PMS and menstrual cramps, such as ibuprofen, aspirin, Midol, or Motrin. Some women find them very helpful. 

6. Consult with a psychiatrist about extreme mood swings or depression. The limited use of antidepressants taken specifically during each month's period of concentrated symptoms may provide very worthwhile relief. 

7. Rest a lot, and avoid stress. 

Endometriosis, the misplacement of the endometrial uterine lining into the intestines, vaginal canal, or other areas of the body where it is not meant to be, can be extraordinarily painful. For women with extensive endometriosis, menstrual cramps sometimes resemble labor pains. It hurts fiercely! In extreme cases, surgery may be necessary to remove it. Sometimes heat, massage, exercise, or homeopathic remedies help, as well as some medications your partner’s doctor may recommend or prescribe. Certainly, the combination of PMS and endometriosis could be a lot to manage! 

If your partner is experiencing these issues, then believe her that she is being protective of your relationship by separating herself from you during her menstrual cycle. Her concerns are real. What you might do is suggest that you try and stay with her at her apartment and see if the application of massage, heat, medications, quiet, etc., and lots of patience and sensitivity make the experience acceptable to her. 

If not, be prepared to completely respect either her decision to continue to be separate from you altogether when she's menstruating, or if she tries coping with your company, but finds it too difficult, be prepared to lovingly leave until she can see you comfortably. Like the song says, we earn the precious right to love. This means accepting each other's boundaries, limitations and needs. Cherish the time you do have together, and except that her need for separation has no negative connotation in regard to her love for you. On the contrary, it is a step she's taking to keep your relationship happy and strong.  

Shain 

 
 
MENOPAUSE

             Many women's sexuality blossoms during and after menopause:

"Not the end of choice, daughter,
 
                                    the beginning of freedom" - proverb

Menopause is the cessation of ovulation and menstruation. It occurs naturally with age as the ovaries decline in function and gradually secrete less hormones, and the quantity of eggs stored in the ovaries dwindle.

Some women experience a diminishment of sexual desire with these lessened hormone levels, especially with the loss of estrogen. Others experience an increase of desire because decreased estrogen production allows the libido-linked hormone testosterone to become more prominent.

Estrogen is a major factor in the development of female sex characteristics, and its decrease during menopause directly affects female sex traits. This includes some breast shrinkage, and the loss of approximately half of the uteruses’ weight. It also causes the vaginal canal to shrink about an inch, the vaginal walls to become less elastic, and vaginal lubrication to dry up. These latter changes can be significant deterrents to pleasure during vaginal penetration.

With estrogen loss the vaginal canal may shrink, or develop adhesions blocking entrance.

Hot flashes, which can cause copious sweating and disrupt healthy sleep patterns, are a common symptom of menopause, as are mood swings, depression, and difficulty concentrating. These states can all impact sexual motivation and desire; who wants to make love when they’re tired, depressed or distracted?  

What to do about these uncomfortable symptoms

 Keep the vaginal canal active and its’ muscles open, toned and flexible with some form of penetration on a regular basis. Fingers, a penis, a dildo, or an appropriate pleasure toy will all do. This will also help prevent adhesions from forming within the canal that can lead to vaginal obstruction and closure.  

Use a good, natural-feeling, water-based lubricant during vaginal penetration and manual stimulation. Add as needed during sexual activity. 

Homeopathic remedies, or, in some cases, short term medications, are worth exploring with your doctor, as long as the prescribed medication does not decrease libido.  

Hormone Replacement Therapy (HRT). Some women find HRT remedies uncomfortable post-menopausal symptoms. This method is NOT for everyone: there are pros and cons to HRT. Its benefits and risks must be weighed on an individual basis. In some situations, the use of HRT is thought to increase the risk of certain illnesses, especially breast and uterine cancer. In other cases, women and their physicians decide that the benefits of HRT outweigh the risks.  

HRT is also thought to reduce the risk of estrogen related post-menopausal bone - loss and osteoporosis. 

From the Mayo Clinic:

What are the benefits of hormone therapy?

The benefits of hormone therapy depend, in part, on whether you take systemic hormone therapy or low-dose vaginal preparations of estrogen.

  • Systemic hormone therapy. Systemic estrogen — which comes in pill, skin patch, gel, cream or spray form — remains the most effective treatment for relief of troublesome menopausal hot flashes and night sweats. Estrogen can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.

    Although the Food and Drug Administration (FDA) still approves estrogen for the prevention of the bone-thinning disease called osteoporosis, doctors usually recommend medications called bisphosphonates to treat osteoporosis.

  • Low-dose vaginal products. Low-dose vaginal preparations of estrogen — which come in cream, tablet or ring form — can effectively treat vaginal symptoms and some urinary symptoms, while minimizing absorption into the body. Low-dose vaginal preparations do not help with hot flashes, night sweats or protection against osteoporosis.

Long-term systemic hormone therapy for the prevention of postmenopausal conditions is no longer routinely recommended. But some data suggest that estrogen can decrease the risk of heart disease when taken early in postmenopausal years.

A recent, randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — explored estrogen use and heart disease in younger postmenopausal women. The study found no significant association between hormone therapy and heart disease.

For women who haven't had their uterus removed, estrogen is typically prescribed along with progesterone or progestin (progesterone-like medication). This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of uterine cancer. Women who have had their uterus removed (hysterectomy) don't need to take progestin.

What are the risks of hormone therapy?

In the largest clinical trial to date, a combination estrogen-progestin pill (Prempro) increased the risk of certain serious conditions, including:

  • Heart disease
  • Stroke
  • Blood clots
  • Breast cancer

A related clinical trial evaluating estrogen alone (Premarin) in women who previously had a hysterectomy found no increased risk of breast cancer or heart disease. The risks of stroke and blood clots were similar to the combination therapy.

Hormone therapy, particularly estrogen combined with a progestin, can make your breasts look more dense on mammograms, making breast cancer more difficult to detect. Also, especially when taken for more than a few years, hormone therapy increases the risk of breast cancer, a finding confirmed in multiple studies of different hormone therapy combinations, not just limited to a combination estrogen-progestin pill (Prempro).

The risks of hormone therapy may vary depending on whether estrogen is given alone or with a progestin, and depending on your current age and age at menopause, the dose and type of estrogen, and other health risks such as your risks of heart and blood vessel (cardiovascular) disease, cancer risks and family medical history.

All of these risks should be considered in deciding whether hormone therapy might be an option for you.


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Increasingly, natural, plant-based hormone substitutes, such as those made from soy, appear to be the most viable and effective form of HRT treatment for women. And synthetic hormones such as Premarin include production methods based on cruelty to horses, which I think is abhorrent.

Soy products, calcium and vitamin D, and weight-bearing exercise fights bone loss. In some cases, an annual infusion of Antiresorptive Medications or Anabolic Drugs may also help rebuild or prevent further bone loss.

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Post-Menopausal Pregnancy Alert

 Menopause generally takes place between the ages of forty and fifty-five, and is considered “complete” a year after the last menstrual period.

Fertility diminishes exponentially during this period.

But pregnancy may still be possible years after you stop menstruating!

If you practice sexual activities that place sperm in or near your vagina, use a reliable method of contraception for your peace of mind and heart!

 

From Q&A with Shain Stodt: FAMINE OR FEAST

Q. I'm going through menopause and I have periods of intense, driving sexual desire and then periods of little or no desire. My partner has complained about this see-saw ride, which while I'm okay with these fluctuations, understandably he is not. I do feel guilty about it, depriving him of his needs. Can I regulate these fluctuations? 

~ Reggie 

A. You have written that you feel guilty about "depriving him", but that you are not uncomfortable with your own fluctuations in sexual desire. Reggie, you do not "owe" your partner sex. Obligation is not what sharing intimacy is about. Hormonal fluctuations are normal during menopause, with a resulting feast and famine sexual cycle. As long as your partner feels comfortable masturbating, and you do not withdraw your emotional giving –affectionate touching, holding, tenderness, attention – then this is a period that he needs to understand and adjust to.

Please talk to him about it. Assure him that your periods of lessened sexual interest are not about caring less about him or finding him undesirable; they are about a physiological change you’re going through. Make it very clear you want him to continue to enjoy his own sexuality, and to freely and joyfully masturbate, when your hormones are on a downswing.  

As far as regulation, a doctor may be able to administer pharmaceutical hormone therapy, if you wish it (the soy-based hormones are less invasive). This might help, if you can find the right dosage. However, there are always pros and cons involved about hormone therapy that you must weigh (see above).  

With the coming of menopause and reduced estrogen, you will need to pay attention to bone density loss. Take calcium and vitamin D supplements (speak with your doctor about the proper dosage) and add weight – bearing exercise to your wellness routine to strengthen your bones and muscles. And do it NOW, before you experience bone density loss. 

 And enjoy those feasts! 

 ~Shain  

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