Читать книгу Moody Bitches: The Truth about the Drugs You’re Taking, the Sleep You’re Missing, the Sex You’re Not Having and What’s Really Making You Crazy... - Julie Holland, Julie Holland, MD Julie Holland - Страница 10
ОглавлениеSome days you feel like a rock star. Some days you feel like a rock.
This has a lot to do with where you are in your monthly cycle.
Your mood is likely at its best during the first half of your menstrual cycle, called the follicular phase, where the ovary nurtures a developing egg. This is when estrogen levels climb and dominate progesterone levels. Estrogen helps you feel alluring, nurturing, and forgiving—all qualities that help you attract and entrance a mate, as your egg matures and becomes ready for ovulation. Because estrogen acts as a stress hormone, little difficulties slip away like water off a duck’s back. Who wouldn’t want to be with you? You’re so easy to be with!
The second half of the cycle, the luteal phase, is the two weeks between when the egg is released from the follicle and when your period starts. This is where mood complaints will occur, when progesterone dominates estrogen. Progesterone can make you feel sluggish and cranky, and it peaks at day twenty-one. Right before your period, estrogen levels drop hard and fast, and so does your goodwill toward others. If you get a little bitchy like clockwork every month, blame low estrogen and high progesterone. Welcome to PMS, premenstrual syndrome.
PMS is natural. Not fun, but normal. But in the “bible” that psychiatrists use to diagnose illness, the Diagnostic and Statistical Manual of Mental Disorders, premenstrual dysphoric disorder (PMDD), an extreme form of PMS, is listed as a pathological state, implying that it requires psychiatric treatment. Somewhere between 3 and 8 percent of women of reproductive age meet the criteria for PMDD. About 15 to 20 percent of women have horrendous PMS or none at all; the rest of us fall somewhere in between, and where we lie can shift from month to month and, more important, from menarche (the beginning of monthly periods in adolescence) to perimenopause, the two phases of our lives where PMS tends to worsen due to more erratic hormone fluctuations.
Crying at the drop of a hat, having a short fuse, feeling overwhelmed and underappreciated, craving chocolate, and not being able to get off the couch are all fair game during the days leading up to your period. Lower estrogen levels cause serotonin levels to drop precipitously a few days before menstruation, which may be the biological basis of many PMS symptoms. Low levels of serotonin are implicated in depression, panic disorder, and obsessive-compulsive disorder (OCD), so don’t be surprised if you feel a bit like a psych patient (or three) before your period starts. Less serotonin is like less insulation available to protect you from the outside world. You’re even more physically sensitive to pain than usual, and more emotionally sensitive to criticism. You’re less resilient in the face of stresses and feel sadder, hungrier, and more scared, tearful, and angsty. When you stack up PMS symptoms against those of a major depressive episode, there is a massive overlap. The big difference is that PMS goes away once your period starts. Major depression persists for weeks or months.
Typically PMS arises in the three or four days before your period starts, but a handful of my patients report their PMS symptoms starting a day or two after ovulation. They become terribly depressed, hopeless, and despairing. They get into fights more easily with family members and coworkers. They have trouble getting to sleep or staying asleep and feel bloated and crabby. A few of my patients assure me their PMS is mild, but pretty much everyone notices that “the period before their period” does bring some significant and noticeable changes in mood. Because it is perfectly normal to have mood fluctuations throughout your monthly cycles, you don’t necessarily need to medicate PMS away, but you do need to educate yourself about it. I also strongly recommend that you keep track of your cycle, jotting down when your period starts and when you ovulate. If you keep track of when certain mood symptoms occur, not only will it help you to plan your monthly calendar but it might help to keep certain family members, and maybe even coworkers, in the loop on what to expect.
Besides getting a good sense of when you’re fertile, keeping track of your cycle will give you a heads-up about when you’re going to be more emotionally sensitive and reactive. You can plan to take on more challenging assignments at the beginning of your cycle right after your period, when your resilience is higher. The peak estrogen levels seen toward the middle of your cycle mean improvement of verbal and fine motor skills, so plan your business presentations and sewing projects for that time of the month. You should definitely leave the tasks best suited to someone with OCD, like cleaning out your closets, for during the PMS part of your cycle. Also, your pain tolerance is at its lowest point during PMS. Not a great time to go to the dentist or get waxed. Schedule those appointments during the first half of your cycle.
Commonly my patients tell me that it’s easier for them to cry during the few days before their period. There is a phenomenon called rejection sensitivity that is often seen in clinically depressed patients. When your serotonin levels are bottomed out in depression, you’re more sensitive to everything, and it takes less of an insult or slight from someone for your feelings to be hurt. It’s no different in the days leading up to your period. Hurtful comments are going to hit you harder. Women cry more easily during PMS, and it’s not just the mean things that others say. There is an increased sensitivity to schmaltzy television commercials and corny country songs on the radio. If I get a lump in my throat when I see anything poignant on the streets of New York—a homeless schizophrenic rooting through the garbage, a businessman stopping to help tourists fumbling with a map—I know just where I am in my cycle.
Our emotional lives revolve around our own internal clockwork, and understanding that schedule requires attention. Keep track of when you’re horny, when you’re bitchy, when you’re flirty, and when you want to kick ass and take names. Becoming intimate with your rhythms will allow you to use natural fluctuations to your advantage, and establishing a baseline is the only way to accurately identify changes. This becomes especially important when starting or stopping a medication, especially those—such as oral contraceptives or SSRIs—that provide an unnatural stability. Their potential impact on mood, libido, and more is real, and you may find that that they’re taking more than they’re giving.
Learning from PMS
Being a crybaby is one thing, and maybe you could say that it is an endearing exacerbation of womanly empathy and vulnerability, but it hardly ends there. This increased sensitivity, especially to criticism, can cause explosive reactivity. My patients with PMS notice that they get snappy and easily irritated by things they would typically let slide the rest of the month. They become more unpredictable in their responses, and they can let loose with utterances or actions that are not in their repertoire the other three weeks of their cycle. This has to do with the frontal lobes inhibiting the emotional centers, which require solid doses of serotonin. Closer to PMS means lower serotonin levels, so for some of us, the closer we get to our periods, the more likely it is that the “bitch switch” is on. But it’s not that we’re getting upset over nothing.
We are getting upset over real things, it’s just that we usually hide our sadness and anger better. Thanks to high estrogen levels, we are usually more resilient. Breezy, even. We allow for others’ needs better and can remain detached more convincingly. Natural cycles of caring less and more correlate with our menses. A good way to think of estrogen is as the “whatever you want, honey” hormone. Estrogen creates a veil of accommodation. Designed to encourage grooming and attracting a mate, and then nurturing and nourishing our family members, estrogen is all about giving to others: keeping our kids happy and our mates satisfied. When estrogen levels drop before our periods, that veil is lifted. We are no longer alluring and fertile; we are no longer so invested in the potential daddy sticking around. It’s time to clean house. During the rest of the month you put up with all kinds of bull that you won’t tolerate the week before your period.
I say, let it be a lesson to you. Perhaps you should be putting up with less all month long. The dissatisfaction that comes on a monthly schedule is a gift to you, a chance to make some much-needed changes in how you’re living your life and how much you’re giving, bending, and stretching to meet everyone else’s expectations. What I stress with my patients is this: the thoughts and feelings that come up during this phase of your cycle are real; they are genuine. If you’re feeling overwhelmed or underappreciated, that you’re taking on more than your partner, or that things are out of balance, chances are it’s all true.
Remember that our animal imperative is to reproduce. Every cycle is a chance to propagate the species. Just as your hormones allow your uterus to fluff up and prepare for a new embryo, they also push you to “nest.” When a woman is in the later months of her pregnancy and progesterone levels are at their highest, there is a frenzy that overtakes her to clean the house and prepare for the arrival of her baby. Every month, when your body prepares for a possible embryo implantation, progesterone levels are building and causing a smaller form of nesting. Toward the end of the cycle, a woman might become dissatisfied with her environment and obsessive about making changes in order to make sure the setting is appropriate next month for the burrowing of the embryo into the uterine lining. PMS is a time of psychological inventory, to take stock and make sure you are where you want to be in your life. Every cycle is an opportunity for a fresh start, to make your life over the way you want it. Pay attention to that critical eye, to those judgmental thoughts. They are probably more valid than you’d like to believe, and I bet they’re actionable, too.
Women’s empathic skills can be a great source of useful information and strength, and there is some evidence that they are highest during our premenstrual days. PMS is a great time to tune in to intuition. Because of lower serotonin levels, we are more “raw” and less emotionally blanketed before we menstruate. It is a time to rest and reflect and to honor deep feelings. Sensitivity is dismissed in our culture, but it really does have its advantages. PMS is an opportunity to listen to your body and to honor your feelings. Trust your PMS bitchiness. And put it to good use the rest of the month. Harness the knowledge you garner when you’re more critical, write it down, and put it into action when you’re more genteel and diplomatic, as soon as your period ends. Try this for a month or two and see if you don’t have some “new month’s resolutions” of your own.
Chocolate and Other Treatment Options
In both depression and PMS, food cravings, typically for carbohydrates, are common. The usual suspects are comfort foods like breads, pastas, and desserts, particularly those of the chocolate persuasion. I’m not typically a dessert person, but if I find myself scrambling through the cabinets for leftover Halloween candy, I know my period is exactly two days away. There are studies that claim that craving chocolate during PMS is specifically American and therefore a learned cultural phenomenon and not related to anything physiological. The theory is that we have been taught that it’s okay to eat chocolate during PMS and we’re taking advantage of that accepted behavior by indulging when it’s our time of the month. I don’t buy that for a minute. First, your body requires more calories when you’re premenstrual, and sweets and carbs can provide them quickly. Second, your magnesium levels are low (premenstrual migraines are a reflection of this), and chocolate can boost magnesium levels.
The most important piece of the puzzle is again serotonin. In depression and in PMS, when serotonin drops, your body tries to fix that imbalance. It begins to want carbs, specifically sugar, and particularly chocolate. Eating carbs is known to boost serotonin levels, but try to stick with complex carbs like whole grains instead of sugary concoctions to avoid the insulin surge and crash of blood sugar levels that follow. Tryptophan is the amino acid your body uses to create serotonin, so it makes sense to eat foods high in tryptophan specifically, instead of carbs in general. One thing I tell my patients about chocolate cravings is that they can sometimes be satisfied by eating bananas, which are high in tryptophan. Milk, lentils, and turkey are also high in tryptophan, especially the dark meat, so the truth is, you’d be better off pulling a King Henry and munching on a turkey leg than scarfing down all those Oreos.
Here’s an even lower-calorie way to boost serotonin levels: the amino acid supplements L-tryptophan and 5-hydroxytryptophan (5HTP), the building blocks for making your own serotonin, are available in any health food store. Nutritional supplements, vitamins, minerals, and amino acids can offer significant symptom relief, but you’ll need to do more legwork to educate yourself about what’s recommended and how to take it. Because of aggressive lobbying, these supplements are not regulated by the FDA to the same extent that prescription medicines are; there can be tremendous variability among brands and even within brands. Enlisting the assistance of an herbalist or naturopath would be wise in many situations.
Vitamin B6 is also helpful for PMS, as it is a cofactor for serotonin synthesis. Adding a magnesium supplement, which can lower anxiety and prevent insomnia, is also a good idea in the days leading up to your period. Magnesium is a diuretic, so it’ll also help with your swollen boobs and bloated pelvis. Calcium can also lessen irritability and help with insomnia, so a calcium-magnesium supplement would work nicely. Sometimes caffeine (or pineapple or asparagus, natural diuretics) can help to get rid of some degree of the bloating and fatigue. Omega-3 fatty acids found in oily fish or fish oil supplements may also help cut down on reactivity and irritability.
Here’s the biggest tip I can give regarding PMS: regular exercise. Cardio, in particular, can help to reduce many symptoms of PMS and moodiness in general. It has been shown to be as effective as antidepressants in improving mood and energy level and reducing feelings of malaise. In many situations, daily cardiovascular exercise can do as much for you as SSRIs, without the weight gain and deadened libido.
Your diet also matters. Estrogen dominance can lead to heavier periods. Hormones in processed meat and certain chemicals in plastics, soaps, and pesticides can mimic estrogen, as can soy, which is added to many processed foods. If you do eat meat and poultry, make sure it’s organic, or at least labeled “hormone-free,” as the hormones used in the meat industry can potentially cause heavier periods. My patients who have switched to a vegetarian or vegan diet are enjoying lighter, less crampy periods. Also, keeping your weight at an optimal level can make a big difference in your monthly symptoms. The more body fat you have, the more estrogen your body is going to make, so aim for a leaner frame if you have significant PMS symptoms or especially heavy periods.
Timing is everything. When you do and don’t have sex can affect a slew of things. For instance, when you started having sex, and how often you have it, can affect fertility. If you started earlier and engage in it weekly, your cycles are more likely to be regular. Weekly sex, with its regular dose of pheromone exposure, also means you’re less likely to have heavier, painful periods, your fertility will more likely stay on track, and your menopause may even arrive later. One more important timing tip: abstaining from intercourse and from orgasm may be just what your uterus needs during menstruation. In a group of women with heavy periods, 83 percent reported sex during menses, compared with 10 percent in the group with lighter periods.
For severe PMS that affects functioning (missing work or school, being unable to perform household chores, having huge, regular blowups with everyone around you), there are prescription medication options. Psychiatrists will commonly prescribe SSRIs or SNRIs (serotonin and norepinephrine reuptake inhibitors like venlafaxine, desvenlafaxine, and duloxetine; see the appendix for details). You can take these pills all month long or just during the week before your period. The shorter-half-life medicines, like paroxetine and venlafaxine, are not good choices here, as coming off them tends to be uncomfortable; you don’t need to deal with antidepressant withdrawal every month. I prefer to use escitalopram, which starts working quickly and is easier to taper. I have quite a few patients who used to take antidepressants every day but now take only 5 milligrams of escitalopram for the four to seven days before their period every month, and this can be perfectly effective.
Another treatment option is to go on oral contraceptives, which create steady hormone levels. For many women, PMS is markedly reduced, as are cramping and heavy bleeding. Often, the longer you’re on the Pill, the lighter your periods are. There is also the option of taking oral contraceptives continually, where you stop the hormones only three or four times a year to have withdrawal bleeding. More gynecologists are recommending continual use of the Pill, especially in patients with endometriosis (a condition that causes extremely painful menses). Just how often you need to come off the hormones in order to shed the uterine lining is a subject of some debate, but the FDA has approved the use of Alesse and Levlen, which allow only four periods a year. And I certainly have patients who are enjoying fewer than that.
However, I have a few complaints and caveats about oral contraceptives, so I’d prefer that you don’t rush to use them to treat PMS until you read on.
The Pill’s Dirty Little Secrets
Using oral contraceptives to manage PMS is not an option for everyone. Flatlined hormone levels have the potential to throw things off dramatically; it’s not what’s natural for us. It is extremely hard to predict who is going to do well on the Pill versus who won’t. I have some patients who are typically very moody and erratic, seemingly tossed about on a stormy sea of hormones throughout the month. Those patients often do better on the Pill, having fewer mood swings and minimal PMS once they get past the first few months of taking oral contraceptives. For them, the Pill ends up being stabilizing, providing steady levels of the same hormones day in and day out, which is what they need to manage their moods and minimize PMS.
But many of my patients find that they cannot tolerate how emotional the Pill makes them, and after trying several different brands over the years, they abandon the idea of using oral contraception for birth control. For these patients, the Pill is destabilizing. I have heard this sentence countless times when first meeting a patient and asking about contraception: “The Pill made me crazy.” Those exact words. It’s not clear why so many women in my office are reporting this phenomenon, except that many are coming to me for complaints of depression, not just PMS. In one study of women who started oral contraceptives, 16 percent noted that their moods had worsened, while 12 percent noted improvement in their moods and 71 percent had no change in their moods. Women who had PMS prior to the Pill reported significant improvement in their PMS on the Pill, while those with a history of depression, not just PMS, had worsening moods.
Some women are simply more sensitive to hormones affecting their moods than others are. The Pill works by presenting just enough estrogen and progesterone to the pituitary that it thinks ovulation has already occurred and so won’t trigger the follicle to release an egg. Estrogen and serotonin regulate each other in a complicated dance, like so many things in the brain and body. Anything that affects estrogen is going to have an impact on serotonin. One possible reason the Pill may make some women a bit bonkers: estrogen causes the manufacture of a serotonin receptor called 5HT2A. This is the receptor that mediates the effects of hallucinogens like LSD and is the target of some antipsychotic medications. About a third of women have variations on this receptor that may cause problems when estrogen levels are higher.
But the bigger culprit is likely the progesterone. Synthetic progestin is horrible for your mood, and about 10 percent of women really can’t tolerate it at all. The oral contraceptive Yaz is preferable when it comes to mood effects, perhaps due to one component, drospirenone, which is more similar to natural progesterone than other synthetics are, or due to the fact that it acts more like a diuretic, lessening water retention during the premenstrual phase. (Being bloated does bad things to your brain.)
Another reason oral contraceptives may worsen mood is that synthetic hormones seem to interfere with tryptophan metabolism and vitamin B6 levels, both of which are necessary to make serotonin. If you’re on the Pill, you should supplement with B6.
You could say that the Pill basically tricks your body into thinking it’s pregnant already, so that no egg gets released. Also, the cervix becomes plugged up with thick mucus, the way it does in pregnancy. Because there is no thinner cervical mucus flowing, the Pill can make your vagina drier, and sex may become painful. If you’re not on the Pill, your cervical mucus is an easy way for you to track your cycle and fertility. Midcycle, the mucus is runny like egg whites. When you’re fertile, nature ensures you’ll be naturally more lubricated when you need it. On the Pill, you’re not fertile, so there is less mucus and you’re not well lubricated.
For many women, the Pill makes their skin clearer; estrogen does help give you that peaches-and-cream complexion. Your breasts tend to get a bit larger on the Pill, just as they do in pregnancy, likely due to the steady progesterone levels the Pill provides. So lighter periods, less acne, and lovely boobs sound great, I know, but there are some downsides to being on the Pill. First, there is the issue of weight gain, but, more accurately, a change in weight distribution. Estrogen dictates where fat gets placed in the body. It makes you put on weight in your hips and thighs, and also in the backs of your arms. There is a logical reason for this. Women of childbearing potential need a different center of gravity. If you’re going to carry a baby in your belly, you need ballast in your backside; estrogen tends to make your stomach flatter because that’s not where fat distribution is needed. (FYI, when you’re perimenopausal, your belly starts to store fat because your estrogen levels are waning. Beware the menopot.)
Second, oral contraceptives can really cut into your sexual desire. I tell my patients this is the “dirty little secret” of the Pill. For some women, being liberated from the fear of unwanted pregnancy may allow them to relax and experience sexual pleasure more, but a slew of other women are unhappy to discover that their desire for sex and their ability to achieve orgasm are muted by being on the Pill. There are two factors at work here. The first is, the longer you’re on the Pill, the lower your testosterone levels become, and the less horny you are over time. Taking extra estrogen orally increases levels of something called sex hormone binding globulin (SHBG), a protein in the blood that binds up testosterone, so you end up with lower circulating levels of “free” testosterone, one-tenth to one-twentieth of normal. If the hormone is bound up, it doesn’t hit the receptor, so it’s useless to your brain. It gets worse: a research study showed that women who’d been off the Pill for four months still had SHBG levels four times that of normal. When I spoke with one of the investigators, he told me it never returns to normal. Another gynecologist told me, “It should be a warning on the box,” but instead it’s something no one seems to talk about.
Testosterone, while twenty times more prevalent in men, is also present in women, and it is the primary hormone responsible for sexual drive and desire. Part of every woman’s monthly cycle includes testosterone levels that rise and fall, peaking just as fertility peaks, midcycle. Normal testosterone levels not only vary throughout the cycle but also go up and down throughout the day (higher in the morning in most women) and in response to various circumstances and behaviors (rising after vigorous exercise, success at work, and having regular sex). Women’s testosterone levels tend to be highest in their early twenties and fall after menopause, after all the other hormones have declined. So not only is there a peak in testosterone midcycle but there may also be one during a brief, magical time right around age forty, a woman’s “sexual peak,” where testosterone levels are relatively higher than those of the other hormones. When you’re on the Pill, you miss out on all of that.
Ovulation and Pheromones: Choosing a Cad or a Dad
Many women have significant shifts not just in their hormones but in their horniness all month long. It wasn’t until my forties that I became aware of how much my libido, and, more important, my feelings about my husband, varied from week to week. When I read about this in a book called Sexy Mamas, I felt validated: “My husband knows that my monthly cycle provides me with about a week of feeling romantic, a week of lust, a week of slowing down, and a week of no desire. We work around that.”
Fertility increases gradually up to ovulation and rapidly decreases afterward. Your desire to have sex naturally follows that pattern. While most primates have a period of “heat,” it is generally assumed that the human female doesn’t have such a cordoned-off time frame and is sexually available all month long, called “extended sexuality.” As you may have experienced, there are a few days in your cycle when you’re more up for sex than at other times, and, logically, Mother Nature has been smart about when that is. Women are more likely to be horny midcycle, during peak fertility, in the day or two leading up to the egg being released, when their testosterone levels are at their highest. The perfect storm of ovulation, optimum fertility, and peaking testosterone levels creates one red-hot mama (to be).
The baboon’s backside turns bright red when she is in heat (called estrus), signaling to nearby males that she’s ready for love. Humans are not quite so overt, though our midcycle high estrogen levels do cause a subtle dilation of blood vessels in our cheeks, enhancing our natural blush. Studies show that men are more sexually attracted to women wearing red than other colors. Also, men are more likely to assume that a woman is sexually active and receptive if she is wearing red. This may be partly cultural and partly biological. Perhaps unconsciously, women know this, as we are more likely to choose to wear red when expecting to meet and chat up an attractive man.
Ovulation is the only time every month when you’re pretty much guaranteed to be horny. Your desire is easier to arouse, and your sexual response is heightened. Greater feelings of attractiveness also peak during this time. All kinds of important things happen midcycle, when you ovulate. Oxytocin peaks, which means increased rates of orgasm and wanting to bond with others. Also, testosterone and estrogen levels are higher, which puts you in an ultrareceptive and horny place. Your pupils even dilate more in response to seeing your sex partner when you’re midcycle, but not if you’re on the Pill.
We have a repertoire of not-so-covert behavior that makes it clear we’re fertile. Women who are ovulating are more likely to feel sexually attractive and to choose provocative, clingy clothing. They dress more fetchingly, wear more jewelry and perfume, and go out more when they’re midcycle and fertile. They’re also more likely to casually hook up, and less likely to use condoms. Women feel more attractive around ovulation, and men are able to tell which women are closer to ovulation and trying to look more attractive by examining their photos. In studies, men pay strippers who are ovulating more money than those who aren’t, and they rate the voices of women who are ovulating as sexier than the voices of those who aren’t.
For that day or two when you have a viable egg, your body is being told by your hormones (especially testosterone) to go out and find a sperm donor. And not just any sperm donor. Our evolution dictates that we find the finest, fittest mate to donate his genetic material to our lineage. Introducing the alpha male—the best hunter, but not necessarily a good sharer. Women are also more likely to choose “bad boys” when they’re ovulating—the kind of guy with a five o’clock shadow and a motorcycle, who’d most likely arouse you but maybe won’t stick around and help you raise your kids. This dual sexuality is called conceptive and not conceptive. Some sex researchers call this dilemma “cad versus dad.” We want cads when we’re fertile, and dads when we’re not.
In my office, the younger gals tend to go for men who excite and intrigue them, who have an edge and are hard to pin down. Women prefer men with a lower voice (more testosterone and likely more infidelity prone) for short-term mating but not for long-term relationship building. I’ve had countless heart-to-hearts with these patients about their choices in men. Often, as they mature, I remind them that the criteria need to change; they are shopping for a husband now, not a boyfriend.
When women are ovulating, their mate selection focuses on masculine traits that signal good genetic material, the alpha-male DNA. When not fertile, women still seek out men, but are more attracted to “non-genetic material and assistance”—those with resources who’ll stick around to help with child rearing. Women, regardless of their own wealth, may still seek out men with adequate resources and social status. I know you have a job and a good credit rating and you don’t need a man for anything, but your brain is still more like a cavewoman’s than you’d like to admit. There have been no major changes to our genetics since we were hunter-gatherers. We’re naturally attracted to men who not only have money, power, and social rank but also have shown they will share it. Just not all month long.
Women find classically masculine faces more attractive around the time they ovulate, choosing less chiseled-looking guys when not fertile. Fertile women are also more attracted to men acting in dominant, competitive ways. When we’re fertile, it’s all about genetic material, not social graces, which means if you’re in a relationship with a dad, you may still end up flirting with a cad midcycle. Like men, it’s natural for us to seek out the best genetic donor for our offspring. And also like men, even with a bird in the hand, we still go poking around the bush. Partnered women are more likely to choose the scent from a dominant man, while single women respond to the scent of men who are nurturing and willing to commit. It may be that even when a woman is partnered with a good provider (a dad), she can’t help but still be attracted to a man midcycle who could lend his exceptional genes to her next offspring (a cad).
So what happens with women who are on oral contraceptives and never have a fertile phase? Just what you’d expect with static hormones. There’s no midcycle peak in oxytocin to push bonding and orgasms, and no surge in estrogen or testosterone stoking desire. As far as the brain is concerned, the deed is already done. If there’s a bun in the oven, there’s no need to attract a baker, and so the midcycle preference for the chiseled cad is gone. Women on the Pill act like women who are already pregnant, where the focus is to attract someone with other things to offer and share besides their manly genetic virtues. Pill users show weaker or no preferences for facial and vocal masculinity.
The biological drives for food, drink, and sex ensure first our own survival and then the survival of our progeny. Clearly, women and men go about this differently, focusing on separate attributes we deem important. When searching for the best possible genetic donors, men follow their eyes and women follow their noses. Men are actually more likely to fall in love at first sight, and neuroimaging of men in the early stages of romantic love show increased brain activity in the visual centers. Men are swayed by facial symmetry, glowing skin, and a particular waist-to-hip ratio. These help to signal that a woman is healthy and able to bear children.
When it comes to mating, women are influenced by scent. The sense of smell is the oldest and least mediated sense in our brains and processes information more quickly than the other sensory systems. Because the brain cells for smell are only one synapse away from the amygdala, our emotion center, we have no real control over liking or being repulsed by an odor. Women have a more sensitive sense of smell, and more brain space devoted to processing smells and pheromones, thanks to estrogen. Estrogen helps us to detect pheromones, the signature scent of a potential mate, more adroitly than men do, especially during ovulation, when estrogen levels are highest. For optimal mating, we need someone who’s in the Goldilocks zone of different but not too foreign: genetically similar and compatible, but not family. Pheromones from the male sweat glands allow us to make this determination. Women prefer the smell of a stranger’s armpit over that of family members, which is an ageless signal to prevent inbreeding.
When it comes to mate selection, so much happens unconsciously that we don’t really have much control over. Pheremones are a good example. When a patient tells me she has a new boyfriend, I usually ask her if she likes the way he smells. I don’t mean his cologne or deodorant, and I definitely don’t mean his stink when he walks off the basketball court, but rather his scent, his natural odor. “If you stuck your nose in his armpit, would you be happy?” You’d be surprised how often this question is met with a resounding yes. When I hear “I could live there!” then I know they’re a good match. How someone smells to you matters tremendously. This is one of the reasons I’m not a huge fan of online dating. Pheromones help us to pick ideal mates for ourselves, and this process is based primarily on genetics, not on Photoshopped selfies.
In 1995, Swiss researcher Claus Wedekind performed a study that has come to be known as the sweaty T-shirt experiment. He asked women to sniff T-shirts that men had been donning for three days without showering or using cologne. Wedekind found, and further research has confirmed, that most of the women were attracted to the scent of men whose major histocompatibility complex (MHC) was markedly different from their own. The MHC indicates a range of immunity to various disease-causing agents. When you’re mating, you want someone with different immunities than you have, so that your offspring can benefit from the variety. Optimally, children will have more disease-fighting capacity than either of their parents. Too-similar immune systems of potential parents can lead to complications in fertility and pregnancy. Also, if a woman partners with a man whose genetic makeup is too similar to hers, she’s more likely to cheat on him. The more genes they share, the more likely she’ll be attracted to other men.
Pheromones are typically processed unconsciously, but lately this issue has come to the fore, and there have been more sweaty T-shirt parties going on around the country, a riff on the Wedekind experiment. Male invitees are told to bring a T-shirt they’ve worn for twenty-four hours (including overnight). They are assigned a number and the shirt is placed in a Ziploc bag. Women smell the shirts, choose the one they like the best, and find their lucky date through his number. “Pheromone party” organizers say they have created lasting pairs in this way. Follow your nose to marital bliss. Being attracted to someone’s pheromones can help carry you through some significant bumps in the relationship. Taking in another’s scent helps with bonding. Primates are prosocial, and they solidify bonds in their community by grooming, which involves sitting close to each other and breathing in each other’s scent, never mind picking and eating bugs off each other’s fur. The next time you’re mad at him, smell your man’s armpits or T-shirts, and see if that doesn’t help you feel a bit better about who he is and what you have together. If and when you have them, smell your kids, too. There’s research on mother-infant bonding via pheromones as well.
Men rate not just a woman’s visible sexual attractiveness as highest when she’s midcycle; they like her scent more then, too. If she’s on the Pill and not ovulating, she doesn’t have the same “cyclical attractiveness of odors” that naturally cycling women do. A much bigger deal: being on the Pill affects the way women process pheromones in terms of these important genetic compatibility issues. Women on the Pill don’t seem to show the same responsiveness to male scent cues. They tend to pick mates who are more similar to them, and less “other.” Scottish researcher Tony Little found that women’s assessment of men as potential husband material shifted drastically if they were on oral contraceptives. In a replay of the sweaty T-shirt experiment, women who were using birth control pills chose men’s T-shirts randomly or, even worse, showed a preference for men with similar immunity to their own. One study remarked that a woman on the Pill might go off it only to realize she is with someone who is more like a brother than a lover.
The good news is that she will probably pick a dad and not a cad. Women on the Pill favor less masculine men, which could mean he will stick around for child rearing. But do you want him? Women who were on oral contraceptives when they chose their mates scored lower on measures of sexual satisfaction and partner attraction. If there was a separation in their relationship, they were more likely to have initiated it than the men were, and more likely to complain of increasing sexual dissatisfaction. But they were also happier with how their partners provided for them, and often ended up having longer relationships.
These days, I actually recommend to my patients who are on oral contraceptives that they go off them for three or four cycles to make sure the man they met when they were on the Pill is still the man they want to bed down year after year and create a family with when they’re off it. Once you’re already in a relationship, it gets mighty complicated to stop your birth control to reassess the man you’ve already chosen. Better to do your mate selecting while not under the influence of any other hormones besides your own, which means finding a nonhormonal form of birth control—such as condoms, an IUD, a diaphragm, or a cervical cap—while you’re on the lookout for the man of your dreams. I also recommend spending some time in his armpit to make sure he’s the one. I’m not kidding. The body, undisrupted, is powerfully intuitive and worth listening to.
