Temps typically rise within a day or so after ovulation and are the result of the heat-inducing hormone, progesterone. Progesterone is released by the corpus luteum (the follicle that previously housed the egg before it passed through the ovary, as discussed in the last chapter). So, usually, the rise in temps signifies that ovulation has already occurred. Waking temps within a cycle typically look like Ruby’s chart below.
Ruby’s chart. A typical waking temperature pattern. Note her rise in temperature starting on Day 17, which means that for this particular cycle, ovulation most likely occurred about Day 16. This cycle was 30 days, since she got her next period on Day 31.
When interpreting temps, you’ll want to train your eyes to “see the forest through the trees.” The key to doing so is to look for a pattern of lows and highs. In other words, you’ll find that your temps before ovulation will go up and down in a low range, and the temps after ovulation will go up and down in a high range. The trick is to see the whole, and not focus so much on the day-to-day changes.
I learned how helpful this concept was when I first taught at a women’s clinic years ago. Within a few weeks of the first class, I would inevitably start getting calls from clients who were convinced they must not be ovulating. But when they read me their temps over the phone (back in the Paleolithic Era, before e-mail), the pattern seemed perfectly evident. I couldn’t understand why they didn’t see what I saw. Then it dawned on me. They were not seeing the pattern, because they were focusing instead on the fact that on Monday it was up, on Tuesday it was down, then back up, and so on. Remember to stand back and see the whole picture. If you find that your temps are not obvious, I would encourage you to chart several cycles before you depend on FAM as a method of birth control.
Preovulatory temps are suppressed by estrogen, whereas postovulatory temps are increased by heat-inducing progesterone. In fact, one of the ways to remember that the second phase of the cycle is the “progesterone” phase is to think of it as the “pro-gestation” phase. In other words, this is the phase of the cycle that is warmer, as if designed to act as a human incubator to nurture an egg that may have just been fertilized.
I want to stress here again that the rise in waking temps almost always indicates that ovulation has already occurred. It does not reveal impending ovulation, as do the other two fertility signs, the cervical fluid and cervical position. In addition, you should also be aware that in only a minority of cycles will women ovulate at the lowest point of their temperature graph. Because a pre-ovulatory temperature dip is so rare, women should not rely on its occurrence for fertility purposes. Rather, they should use the cervical fluid and cervical position to anticipate approaching ovulation.
You should be aware of certain factors that can increase your waking temps:
•having a fever
•drinking alcohol the night before
•getting less than three consecutive hours sleep before taking it
•taking it at a substantially different time than usual
•using an electric blanket or heating pad when you normally don’t
However, as you will see in the following chapter, you needn’t worry about the occasional erratic temps that may result. This is because you can discount them without compromising the accuracy of the method. In any case, FAM gives you two other daily signs to cross-check your fertility.*
Temps, Stress, and the Dreaded Late Period
Waking temps can be extremely helpful in projecting how long a cycle will be, because they can identify if you’ve had a delayed ovulation that would cause your cycle to be longer than normal. Remember, once the temps rise, it’s typically a set 12 to 16 days until your period. And after you’ve charted for several cycles, you will be able to determine your particular postovulatory range even more precisely. (As previously discussed, for most women the phase after ovulation doesn’t vary more than a couple of days.)
I myself experienced a classic delayed ovulation during a cycle when I was moving from one home to another. Three things were happening in my life during that cycle, any one of which would have been enough to delay ovulation.
I was 31 years old, and my cycles were typically between 26 and 32 days or so. It was November, and I had all the signs that I was approaching ovulation. My cervical fluid was getting wet, and my cervix was rising and becoming more open and soft. On Day 16 of my cycle, though, I had to completely move out of my old home and into the new one, meaning that every speck of dirt had to be washed off the walls of my apartment, and all of my boxes moved into my new house. In addition, I had to lecture at a midwifery school across town before catching a plane during rush hour to lecture at a conference in another state the next morning. So what was going on? I was moving, traveling, and totally stressed out.
My body basically said, “Tell ya what. I think I’ll just put your ovulation on hold until you’re good and ready.” In the end, as you can see from my chart below, I didn’t even ovulate until about Day 24, and ended up with a 38-day cycle! Had I not been charting, I probably would have been completely panicked, thinking I was pregnant, since I had never in my life experienced such a long cycle.
The author’s chart. A temperature pattern showing a delayed ovulation. Note how my temperature shift didn’t occur until Day 25, confirming that I had a delayed ovulation due to the stress in my life at the time. My cycle ended up being 38 days!
This example illustrates an important point. Women who don’t chart are continually fearful when their periods seem “late,” not realizing that long cycles are usually simply due to ovulating later, a phenomenon that is very easy to identify through waking temps. (If you are truly concerned that you might be pregnant, there is an extensive discussion about pregnancy tests and charts that reflect pregnancy in Chapter 13.)
I used my own experience to exemplify the point that there are numerous things that can delay or even prevent ovulation, including stress, travel, moving, illness, medication, strenuous exercise, and sudden weight change. But, by charting your temps, you can accurately determine when you might be having a delayed ovulation. Whether you are trying to avoid or achieve pregnancy, knowing this information is invaluable, sparing you needless anxiety and confusion.
Even Dow Jones has a thermal shift!
CERVICAL POSITION (OPTIONAL SIGN)*
Have you ever noticed that intercourse is occasionally uncomfortable in certain positions? Maybe you have sweet memories of a lazy Sunday morning with your partner. You woke up that day feeling particularly amorous, and slid on top of him. But a week later, when you wanted to relive that wonderful day, you noticed that, instead of experiencing the same delicious feeling, you felt a deep pain inside. What was going on? Why the discomfort this time?
Or perhaps you’ve noticed that there are times when it is quite easy to insert your diaphragm or cervical cap, but other times it seems almost impossible to find your cervix to insert it properly. Or, worse yet, it may seem like there is not even enough room to insert it. Or has your health practitioner ever commented on your appearing to be fertile during a pelvic exam, even though she had done nothing more than insert a speculum?
All of this has to do with the fact that your cervix, the lower part of the uterus that extends into your vagina, goes through some fascinating changes throughout your cycle, all of which can be fairly easily felt. Your cervix can give you a wealth of information about your fertility, literally at your fingertips.
As with cervical fluid, the cervix itself prepares for a pregnancy every cycle by transforming into a perfect “biological gate” through which the sperm can pass on their way to finding the egg. It does so by becoming soft and open around ovulation in order to allow the sperm passage through the uterus and on to the fallopian tubes. In addition, the cervix rises due to the estrogenic effect on the ligaments that hold the uterus in place.
After your period and under the direct influence of estrogen, your cervix typically starts to change. One of the easiest ways to remember how your cerv
ix feels as you approach ovulation is the acronym SHOW, as seen in the illustration below.
Let’s take each facet in the order listed above. The cervix is normally firm like the tip of your nose, and only becomes soft and rather mushy, like your lips, as you approach ovulation. In addition, it’s normally fairly low and closed, feeling somewhat like a dimple, and only rises and opens in response to the high levels of estrogen around ovulation. And finally, it’s the cervix itself that emits fertile-quality wet cervical fluid when the egg is about to be released. Lola’s chart below shows how the changes look when recorded.
Lola’s chart. A typical cervical position pattern. Note how the circles represent how open her cervix is and their position in the box represents how high it is. The letters below the circles stand for the firmness of the cervix—firm, medium, and soft. This cycle was 27 days.
SECONDARY FERTILITY SIGNS
Many women are lucky enough to notice other signs on a regular basis, all of which are very helpful in being able to further understand their cycles. These are referred to as secondary fertility signs, because they do not necessarily occur in all women, or in every cycle in individual women. But they are still very useful for giving additional information to women to identify their fertile and infertile phases.
Secondary signs as ovulation approaches may include:
•ovulatory spotting
•pain or achiness near the ovaries
•fuller vaginal lips or swollen vulva
•swollen lymph gland
•increased sexual feelings
•abdominal bloating
•water retention
•increased energy level
•heightened sense of vision, smell, and taste
•increased sensitivity in breasts and skin
•breast tenderness
The first sign on the list above, ovulatory spotting, is thought to be the result of the sudden drop in estrogen just before ovulation. Because progesterone has not yet been released to sustain it, the lining may leak a small amount of blood until the progesterone takes over. Spotting can range in color from a mere tinge to a bright red and may be mixed with slippery fertile cervical fluid, and it’s typically more common in long cycles.
Courtney represented the classic example of a woman not understanding the distinction between different causes of bleeding. She called saying she wanted to use FAM for birth control, but thought she might not be an appropriate candidate for the method because she had “such short cycles.” When I questioned her about them, she said they were “literally every two weeks, but alternated heavy, light, heavy, light.”
Of course, what she was experiencing was probably a cycle of typical length with classic ovulatory spotting. I encouraged her to take my Fertility Awareness class. I don’t know if she still uses FAM for contraception, but she certainly understands her body a lot better than before.
As for the various pains that women often notice midcycle, there are several theories as to their causes. The important point is that you cannot say with certainty whether they are occurring before, during, or after you’ve ovulated.
Dull achiness: This is thought to be caused by the swelling of numerous follicles in the ovaries as the eggs race for dominance and ultimate ovulation. It’s typically felt as a general abdominal achiness, since both ovaries swell with growing follicles as the woman approaches ovulation.
A sharp pain: This could be the few minutes during which the egg passes through the ovarian wall and is usually felt on only one side.
Crampiness: This is probably the result of irritation in the abdominal lining caused by leakage of blood or follicular fluid released from the ruptured egg follicle. It could also be due to contractions of the fallopian tubes around ovulation.
Because there are several pains that may occur, none of them is considered a primary fertility sign that can be depended upon alone. But ovulatory pain in general is an excellent secondary fertility sign to corroborate the three primary signs. Usually referred to as mittelschmerz (midpain), it is felt by many women around ovulation, typically lasts anywhere from a few minutes to a few hours, and is usually felt on the side where ovulation occurs.
One of the more interesting secondary fertility signs is that of a swollen vulva just before ovulation. As their cervical fluid becomes slippery and wet, some women notice that their vulva becomes puffier on one side (the side on which they are ovulating). And there is another secondary fertility sign that is particularly intriguing because it, too, can help you determine on which side you will ovulate.
If you are especially attentive as you approach ovulation, you may be able to feel a small lymph gland swell to about the size of a pea. This is the lymph node sign, and as seen in the illustration below, can be felt by lying down and placing your hand near your groin. By positioning your middle finger just over the pulsating artery of your leg, your index finger may be able to feel the tender and enlarged lymph gland. This usually indicates the side on which ovulation occurs. It’s certainly not necessary to chart, but it’s fun to have yet one more sign to observe.
Checking the lymph node as you approach ovulation
In addition to those signs previously listed, you may find through charting that you yourself have some unique secondary fertility signs. I’ve certainly heard of many in my years of counseling women:
Jessica gets hiccups as ovulation approaches. The skin on Georgina’s thumb cracks in a somewhat painful lesion every cycle around ovulation. But through learning to chart, she was able to at least identify what caused it. And Emma develops such a heightened sense of smell around ovulation that, as she describes it, if her chef-husband cooks something in their house during her fertile phase, she can smell it for days after, and no amount of open windows relieves her nausea. Likewise, if she eats potato chips, or anything with mustard on it, even though she practically sterilizes her hands afterward, she can still smell the residual effect! But if she is outside her fertile phase, she can whip up an onion-garlic casserole, and she’s not the least bit affected by it.
When women learn that all this is happening inside their bodies on a regular basis, they are often amazed. And to think that all they were taught about their menstrual cycles in the fifth grade was whether to opt for tampons or sanitary napkins during their periods!
CHAPTER 6
How to Observe and Chart Your Fertility Signs
When women first hear about observing fertility signs, their reaction is typically:
“You’ve got to be kidding me. Too much bother.”
“There’s no way. Take my temperature every day?”
“What a hassle. Who’d do it?”
I, too, had a similar response when I first heard about charting cycles 34 years ago. But once I learned how simple it really was, I was chagrined. Today, I have a different attitude. Quite simply:
Charting is a privilege, not a burden.
How could I have been so oblivious about such a fundamental aspect of my body before I learned to be so aware? A cynic might question the time involved in checking every day. But I think many would agree that it’s infinitely more appealing to take one’s temperature in the morning before getting up than to stop lovemaking to insert a diaphragm or cervical cap, or to contend with the numerous side effects and inconveniences of other methods. And for those frustrated in their desire to get pregnant, the time involved is minuscule compared to the inevitable office visits and procedures for those not educated in FAM.
To show how simple charting really is, let me make an analogy. If someone were to ask you to describe how to tie your shoelaces, you might begin:
Let’s see. Well, you take your right shoelace, and place it over the left one. Then take the left shoelace and twist it under the right, pulling both shoelaces away from each other to form a twisted knot. Then make a loop with the right shoelace, which was originally the left. Take the left shoelace and . . .
I’m exhausted just trying to write the rest of the directions. If y
ou had to learn something as simple as tying your shoes through following directions, you’d probably never get it right. Observing and charting your fertility signs is really no different. Once you learn the basic principles, it becomes second nature. When reading this chapter on how to observe and chart fertility signs, refer to the sample Birth Control Chart and Pregnancy Chart in the color insert. Trust me. It’s not as involved as it initially appears.
Two versions of blank master charts are printed on the last pages of the book: one designed specifically for birth control, and the other for pregnancy achievement. You can copy and enlarge them by 125%, or better yet, download them at tcoyf.com.
FERTILITY AWARENESS APPS
The Internet is flooded with dozens of beautifully designed apps to monitor a woman’s menstrual cycle. But beware! Most of them are nothing more than a high-tech version of the ineffective Rhythm Method. So if it predicts when you will be fertile based on only the first day of your last menstrual period, simply delete it!
In order to judge whether an app is reliable, at a minimum, it should allow you to input your cervical fluid and basal body temps and, ideally, other secondary fertility signs as well, such as ovulatory pain. Remember, apps that only use temps cannot indicate when ovulation is about to occur, but only confirm that ovulation has already happened. To know on a daily basis whether or not you are fertile, you need to observe and record your cervical fluid, which is crucial for both pregnancy avoiders and pregnancy achievers.
Regardless, an app alone can’t possibly provide you with the class instruction and personal counseling that is often necessary to be able to understand how to rely on your primary fertility signs. Apps should be used only as a convenient way to have your charts always with you, or to share them with a clinician or others. However, they are certainly not a replacement for proper education about your body, fertility, and cycles. In fact, and to be clear, apps should never be exclusively relied upon to interpret FAM for contraceptive purposes.
Taking Charge of Your Fertility Page 8