The Manly Guide to Menstruation

Many men are uncomfortable talking about things like periods, premenstrual symptoms and unintended pregnancies. Despite growing media coverage of reproductive issues, female reproductive biology remains a taboo topic within many homes and relationships. This is a problem, given that about half the population spends roughly 40 reproductive years with a menstrual cycle. That adds up to about 450 periods over one person’s lifetime.

It’s not helpful that something so prevalent feels off-limits for discussion. Being able to talk openly about health issues leads to better understanding, better health and stronger relationships with the women in your life. Removing taboos around menstruation is good for everyone. On a larger scale, culture is evolving. 2015 was the year of the period. Now is a better time than ever to start opening these conversations.

What do I know about this? It’s my job. As Chief Product Officer and co-founder of the popular female health app, Clue, I’ve spoken to hundreds of people about these issues, ranging from 9 to 90 years old, including medical researchers and OB/GYNS, from South Africa to China.

Here are what I’ve found to be the most useful things for men to know about menstruation.

1. Most adults still have a junior-high level of education about sexual health and the female body.

As an adult, both men and women are typically still operating with whatever they remember from the socially awkward sex-ed classes they had in school (if they were lucky enough to have sex education at all). Most sex-educators emphasize two practical points, with the goal of preventing unintended pregnancies:

  1. Having a period means a girl can get pregnant.
  2. Having sex leads to pregnancy.

This knowledge gap doesn’t usually close until later in life when cycle-specifics become important. This can happen when a couple is actively trying to have a baby, when pregnancy doesn’t come easily, or when a partner develops a medical condition that affects their menstrual cycle.

Tip: This article is just a start. Learning about these topics can lead to closer relationships and may even affect the health of the women in your life.

2. Statistically speaking, around 1 in every 7 women you encounter is on their period right now.

The median cycle length of Clue users is 29 days, with menstruation lasting a median of 4 days. This means women with a cycle are menstruating about 14% of the time and 1 in every 7 women you encounter is on their period right now. Periods are literally happening all the time.

Tip: Keep a small number of high absorbency pads and tampons on hand for the 1 in 7 women you encounter. Ask a pharmacist or female friend for advice and ideas on which brands to buy.

3. The period is obvious, but there’s a lot more going on.

The menstrual cycle is more than just a period. It’s how the female body prepares to get pregnant. Hormonal changes happen on every day of the cycle, creating symptoms that are subtle (cervical fluid) and not subtle (painful cramps). Every cycle, extra blood and tissue are added to the lining of the uterus (the endometrium) and an ovary releases an egg for fertilization (ovulation). The lining of the uterus is where a fertilized egg can attach and grow. If there is no fertilized egg, or if pregnancy doesn’t occur, that extra blood and tissue is expelled from the body. That’s what the period is. The period is not just blood, but also contains clots of endometrial tissue and the dissolved remnants of a tiny egg.

Tip: Everyone has their own experience of cycle-related symptoms. Try not to make incorrect assumptions based on what one woman has gone through, or on other anecdotal information.

4. There are over a hundred premenstrual symptoms. Most of them are uncomfortable.

Premenstrual symptoms are a set of symptoms that repeat every month in the days before the period starts. Contrary to what pop culture tells us, premenstrual symptoms are not only about mood swings and chocolate cravings.

  • Up to 88% of women experience cramps every cycle. Painful cramps can make it difficult to concentrate (1).
  • ~ 60% of women get acne breakouts (2).
  • ~ 70% have sore breasts (3).
  • ~ 60% feel bloated (4).
  • ~ 25% have diarrhea (5).

As for emotional symptoms, it’s important to note that despite cultural messaging, not everyone’s emotions change when experiencing premenstrual symptoms. (Though, it stands to reason that anybody who’s going through a lot of physical discomfort is likely to be grumpy). For those who do have emotional changes, the direct cause of these has been difficult to determine. Complex interactions between hormones, health and chemicals in the brain all play a role. Emotional symptoms and their intensity are unique to each person, from mild, to debilitating. Premenstrual symptoms can negatively affect personal relationships, or make it hard to hold down a regular job. Even post traumatic stress syndrome (PTSD), is more easily triggered during the week before the period starts. Severe cases of premenstrual symptoms are called premenstrual dysphoric disorder (PMDD), which usually require medical management.

Dismissing emotional responses as PMS (premenstrual syndrome) is unlikely to be helpful. Cyclical or not, the experience of these emotions is real. Joking about it is like joking about a recurring illness. Some women have a sense of humor about it, but many don’t. For people who don’t experience premenstrual symptoms, it’s best to be empathetic and follow the other person’s lead.

Tip: Try learning about the premenstrual symptoms and coping strategies of women you’re close to. If they have painful cramps, for example, there may be something you can do to help out.

5. A “regular” cycle is 23–35 days long and may vary by as many as ±8 days from month to month.

The body is not a clock. Every woman’s cycle is different. It’s normal for a cycle to be between 23–35 days long and for the start date of a period to vary by ±8 days. That means the first day of menstruation can often be a surprise. The heaviest bleeding is usually one of the first few days of the period, so when the period has a surprise start, it could be on the heaviest day.

Menstrual cycles that fall outside of these ranges are considered clinically “irregular” — as are periods that are very long, heavy or painful. These types of cycles can signal a serious medical condition. If a woman in your life has irregular cycles, they should talk to their healthcare provider and find out why. Learn about polycystic ovary syndrome (PCOS) or endometriosis to know more.

6. A woman is only fertile for about 7 days every month.

Remember what you were taught in school, that sex on any day can lead to pregnancy? It’s not true, but it’s the safest thing to say when kids can’t stop giggling long enough to understand the details. Even now, you may be surprised to learn that the seven-day timeframe when intercourse can lead to pregnancy (called the “fertile window”) is seven days long because that’s how long your sperm can live inside her body (6). While her egg only lives for up to 24 hours, she can still get pregnant if you have sex six days before her egg is ready (ovulation). Don’t know what ovulation is? That’s ok, neither did 64% of the people we asked. Watch this handy video to learn about it.

Tip: Don’t stop reading without looking at number 7.

7. Figuring out when those 7 days are requires more than counting days.

The day of ovulation often happens around mid-cycle, but this is different for everyone and can fluctuate by ±8 days cycle-to-cycle. That variability means the times when someone can get pregnant from intercourse will also move around. And it is possible (although unlikely) for someone to be fertile during their period (7). This is especially true for anyone who has a highly variable or short cycle. If you’re trying to stay child-free, counting days is not much better than guessing. This is why there are “surprise periods” and why there are surprise pregnancies. The latter has higher consequences than a bloody pair of undies.

So why is it so hard to know when the fertile window is? The first part of the cycle (pre-ovulation) fluctuates in length more than the second part (post-ovulation), meaning if you wanted to determine the day of ovulation with relative accuracy by counting days, you could only do it by counting backwards from the first day of her next period, after the cycle is complete. Getting a more accurate idea of ovulation timing requires methods like ovulation tests, tracking basal body temperature (BBT), or blood tests. And those methods still just determine when ovulation has happened in the past, which is too late if you’re trying to use this information to avoid pregnancy.

More data is needed to predict ovulation before it happens. Fertility awareness methods (FAM) of family planning, involve tracking things like BBT and changes in cervical position and fluid. Monitoring those changes allows you to predict, to some extent, when ovulation is approaching.

Tip: Counting days to determine ovulation can create risks of pregnancy when that’s not wanted, or make it harder to get pregnant if you’re trying.

8. How to avoid unintended pregnancy (…and STIs).

In 2011, nearly half of the pregnancies in the United States were unintended (45%)(8). Nearly half. For men, the simple answer for contraception is to use a condom every time and use it correctly. Find a condom that fits you well and use a bit of lube on the tip, before putting the condom on. This can help condoms be less of a turnoff (the lube allows the condom to move against your skin for greater sensitivity). Chafing from condoms goes both ways. It’s also good for you to learn where she needs lube when using condoms. After figuring out what works, having those tools available will mean that spontaneous sex with condoms is more possible and comfortable for both of you.

Besides condoms, reliable contraceptive options for men are limited. They include getting a vasectomy, only engaging in nonintercourse sex play or just never having sex. Those are the few methods that a man can be completely in control of. The “pull-out” method (aka withdrawal) fails 18% of the time and day-counting (aka “rhythm method”) fails 25% of the time — not reliable enough for what’s at stake.

Although many women use hormonal birth control, these don’t protect against sexually transmitted infections (STI). Even if you and your partner agree to have unprotected sex, if you’re not in a committed relationship, you still need to prevent transmission of an STI. This brings you back to condoms.

Tip: Find condoms and lube that work well for you and always have some available. Put some lube on the tip to make condoms more comfortable. If you’re in a relationship, explore other options together.

9. There is a huge amount of unacknowledged stress, and risk, for women who are sexually active.

The stress, and risk, that comes from being a woman with an active sex life goes largely under-acknowledged. Beyond worrying about pregnancy, unprotected sex and condom failure can result in a physical burden that falls exclusively on women — taking big doses of hormones (emergency contraceptives), waiting for a possible miscarriage or making the choice between unintended pregnancy and birth or abortion. As men, none of that can happen to us. We go through our own experience related to unintended pregnancies, but the consequences are dramatically different, because nothing happens to our bodies. Men can be supportive partners through this and we can also be 100% responsible for prevention, if we choose to.

The burden of STIs also tends to fall disproportionately on women. They have more screening for STIs and undergo a higher number of treatment procedures for infections like human papillomavirus (HPV), the most common STI in both men and women. Women are also more susceptible to contracting certain STIs and are more likely to have severe long-term health consequences because of them (10).

Tip: You can help to offset stress and prevent unintended pregnancies by always having condoms available. Boys and young men can help by getting vaccinated for HPV — vaccination is available for men under the age of 26.

Hopefully this information was helpful. If you’ll never have a period, you’ll also never know what it’s like to feel menstrual cramps, or any of the 100+ premenstrual symptoms. You won’t experience the anxiety that comes with unexpected periods, unintended pregnancies or the physical consequences of things like hormonal birth control, abortion or labor, birth and breastfeeding. But if you’re lucky, some of the women in your life may be willing to talk about how those things affect their lives and that can be a great thing for their health and for your relationships.

Feel free to respond, ask questions or share your experiences on Twitter, @MikeLaVigne. For medical questions, please ask a healthcare professional.

References

  1. Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. Am Fam Physician. 2014 Mar 1;89(5):341–6.
  2. Lucky AW. Quantitative documentation of a premenstrual flare of facial acne in adult women. Archives of dermatology. 2004 Apr 1;140(4):423–4.
  3. Ader DN, South-Paul J, Adera T, Deuster PA. Cyclical mastalgia: prevalence and associated health and behavioral factors. Journal of Psychosomatic Obstetrics & Gynecology. 2001 Jan 1;22(2):71–6.
  4. Lee KA, Rittenhouse CA. Prevalence of Perimentrual Symptoms in Employed Women. Women & health. 1991 Aug 9;17(3):17–32.
  5. Bernstein MT, Graff LA, Avery L, Palatnick C, Parnerowski K, Targownik LE. Gastrointestinal symptoms before and during menses in healthy women. BMC Womens Health. 2014;14:14.
  6. Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual intercourse in relation to ovulation — effects on the probability of conception, survival of the pregnancy, and sex of the baby. New England Journal of Medicine. 1995 Dec 7;333(23):1517–21.
  7. Wilcox AJ, Dunson D, Baird DD. The timing of the “fertile window” in the menstrual cycle: day specific estimates from a prospective study. Bmj. 2000 Nov 18;321(7271):1259–62.
  8. Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008–2011. New England Journal of Medicine. 2016 Mar 3;374(9):843–52.
  9. Madkan VK, Giancola AA, Sra KK, Tyring SK. Sex differences in the transmission, prevention, and disease manifestations of sexually transmitted diseases. Archives of dermatology. 2006 Mar 1;142(3):365–70.