5.Be sure to check when you are not sexually aroused.
6.Both before and after using the toilet, take a tissue and fold it flat. Separate your vaginal lips and wipe from front to back.
7.Focus on how easily the tissue glides across your vaginal lips. Does it feel dry, smooth, or lubricative?
8.Now lift the secretion off the tissue to feel it with your thumb and middle finger. Focus on the quality. Again, does it feel dry? Sticky? Creamy? Lubricative like eggwhite?
9.Look at it while slowly opening your fingers to see if it stretches.
10.Check your underwear throughout the day. Notice if you see a fairly symmetrical wet circle.
11.To differentiate between cervical fluid and basic vaginal secretions, try the glass of water test: true cervical fluid usually forms a blob and sinks to the bottom or remains distinct in the water.
12.Note the quality and quantity of the cervical fluid (color, opacity, consistency, thickness, stretchiness, and most important of all, slipperiness and lubricative quality).
13.The best time to observe fertile cervical fluid as it flows out will be after bearing down while using the toilet.
14.Around your most fertile time, look in the water for a ball which sinks to the bottom.
15.Other times when it’s easy to observe cervical fluid are after exercising or doing Kegels.
16.Be aware that as you get closer to ovulation, your cervical fluid may become so thin that it gets harder to finger test, leaving only a lubricative sensation.
17.Learn to tell the difference between semen and fertile-quality cervical fluid. Eggwhite tends to be clear, shimmering, and often stretchy, whereas semen sometimes appears as a rubbery whitish strand or slippery foam. Mark any ambiguity with a question mark in the cervical fluid row.
Charting Your Cervical Fluid
1.Day 1 of the cycle is the first day of red menstrual bleeding.
2.Use the notations in the chart below to record your cervical fluid.
3.Record the most fertile- or wet-quality cervical fluid of the day, even if you are dry all day except for one single observation.
4.Record the wettest vaginal sensation you notice throughout the day.
5.Treat all signs of semen or residual spermicide as a question mark in the Cervical Fluid row.
A typical cervical fluid pattern.
Identifying Your Peak Day
1.Your Peak Day is the last day of either:
•Eggwhite
•Lubricative vaginal sensation
2.If you don’t have eggwhite, you would count the last day of the wettest-quality cervical fluid you do have.
3.The Peak Day is the last day of eggwhite or lubricative vaginal sensation, even if you have an additional day or two of creamy cervical fluid after.
4.The Peak Day is fairly easy to identify because the cervical fluid tends to dry up very quickly.
5.Once you have identified the Peak Day, be sure to write “PK” in the Peak Day row of your chart.
Taking Your Temperature
1.Take your temps first thing upon awakening.
2.You should take them about the same time every morning, give or take about an hour.
3.If using a digital thermometer, wait until it beeps, usually about a minute. If using a glass basal body thermometer, leave it in for five minutes.
4.Take your temps orally. (If you find that you don’t get a clear pattern, you may want to switch to taking it vaginally—just be consistent!)
5.If using a digital thermometer in which you still don’t see a clear thermal shift, try consistently leaving it in for a minute or two beyond the beep.
Charting Your Temperature
1.You can record your temps at any time that day.
2.If the temperature falls between two numbers on a glass thermometer, always record the lowest temp.
3.Record and connect the temps with a pen.
4.Unusual events such as stress, illness, travel, or moving should be recorded in the Notes row of the chart. Temps taken earlier or later than usual should be noted under Time Temp Taken.
5.If your temps seem confusing or erratic, try taking them vaginally for at least a full cycle from period to period.
6.If you think a temp is outside the normal range, apply the Rule of Thumb by waiting until the next day to draw the connecting line. Omit any aberrant temps by drawing a dotted line between the normal ones on either side.
Drawing the Coverline
1.After your period ends and once you start noticing wet cervical fluid, begin watching for a temp that is higher than the cluster of 6 preceding temps.
2.Identify the first day your temperature rises at least two-tenths of a degree above the highest in the cluster of the preceding six temps.
3.Look back and highlight the last six temps before the rise.
4.Draw the coverline one-tenth above the highest of that cluster of six highlighted days preceding the rise.
Barbara’s chart. A standard temperature pattern with coverline. Note that the first day that Barbara noticed a temperature shift was Day 15, so she counted back six days and highlighted that cluster of temperatures. Then she drew her coverline on 97.8, which was 1/10th above the highest of the cluster, which was 97.7 on Day 9. This cycle length was 27 days.
Observing Your Cervix
1.Begin checking your cervix at least once a day after menstruation has ended.
2.Make sure your fingernails are trimmed, and always wash your hands with soap first.
3.Try to check about the same time each day.
4.The most effective position in which to check is squatting.
5.Insert your middle finger and remember the mnemonic SHOW as you observe the following conditions of the cervix:
6.Women who have vaginally delivered children will always have a slightly open cervix.
7.The best time to begin observing cervical changes is when the wet-quality cervical fluid starts to build up in the days before ovulation.
8.Don’t be surprised if you feel nabothian cysts on your cervix.
9.You should not check your cervical position if you have genital sores or vaginal infections.
10.You may prefer to check your cervix for only about a week, from the first day of fertile-quality cervical fluid through to your thermal shift.
11.You may want to focus on just one or two of the characteristics of the cervix.
Charting Your Cervix
1.Use a circle to represent the cervical opening.
2.Typically, the cervix will progress from low, closed, and firm before ovulation to high, open, and soft around ovulation, as seen in the chart below.
NOW THAT YOU KNOW
Congratulations! If you understood this chapter, you are ready to apply your newfound knowledge toward avoiding pregnancy naturally, getting pregnant, or simply taking control of your gynecological health.
OTHER WAYS TO MASTER CHARTING
If you have had any trouble internalizing the basic concepts taught in this book, I would highly encourage you to take a class in the Fertility Awareness Method or find a qualified Fertility Awareness counselor.
In addition, there are other types of master charts which you can download from tcoyf.com. They are summarized on the last page of the book.
CHAPTER 7
Anovulation and Irregular Cycles
None of us are Barbie dolls. As much as Madison Avenue tries to convince us that all women should be 5'9" and supermodel thin, the reality is that there is tremendous variety among women. And, of course, you should know by now that the conventional wisdom that all women should have 28-day cycles and ovulate on Day 14 is simply not true.
Not only can a woman’s cycle lengths vary—but they may be different depending on what phase of life she is in. So you may find that you’ll go through months with only intermittent ovulation, such as during adolescence, just coming off the pill, breastfeeding, or approaching menopause. And your cycles may also fluctuate due to temporary situations such as illne
ss, travel, stress, or exercise. The beauty of charting your cycles, though, is that you can take control and understand what is transpiring in your body on a daily basis, regardless of your particular circumstances.
So what defines an irregular cycle? As you know by now, cycles that vary between about 21 to 35 days are considered normal, unless you have other troubling symptoms. In general, you should see your doctor if they fall outside of that range or are accompanied by inconsistent amounts of bleeding. The quality of menstruation following ovulation is usually fairly consistent, and thus, if your cycles are irregular with bleeding that is sometimes light, sometimes heavy, sometimes red, sometimes brown, sometimes with clots, and sometimes without, it’s often an indication that you are not ovulating normally, if at all.
There are differences in the way your fertility signs are reflected over time, depending on whether you are experiencing:
A typical cycle: In a normal cycle, your body prepares for the release of an egg in a fairly timely, predictable manner. After your period, under the influence of rising estrogen, you’ll usually have several days of possibly no cervical fluid or maybe sticky, followed by days of building up to a progressively wetter fertile-quality cervical fluid. After the egg is released, your cervical fluid will rapidly dry up until you start the pattern over again the next cycle.
An anovulatory phase (low body weight, breastfeeding, premenopause, etc.): This refers to those periods of time when women take longer to release an egg. In such special circumstances, your body could theoretically take up to a year or longer to finally build up a high enough level of estrogen to trigger ovulation. It’s almost a twosteps-forward, one-step-back situation, in which your body may make many attempts to ovulate before it finally is able to do so, as seen in the graphic below.
During this time, you may notice what are referred to as “patches” of cervical fluid. Instead of the classic buildup typical of normal cycles, you may see a series of patches of wetness interspersed with drier days.
This chapter is devoted to what transpires in your body during these special circumstances when you don’t ovulate or you do so very sporadically. Chapter 9 discusses ways you can try to balance your hormones to start ovulating again. And Appendix J discusses how to use FAM for birth control during such times.
DIFFERENT PHASES OF ANOVULATION OR IRREGULAR CYCLES IN WOMEN’S LIVES
Adolescence
American girls typically start to menstruate between 12 and 14 years old. But the onset of periods doesn’t necessarily mean the release of an egg every cycle. In fact, one of the factors that characterize menstrual cycles in teenagers is irregularity due to fluctuating estrogen levels, and thus cycles don’t automatically start out predictably. It’s a gradual process that can take several years while the hormonal feedback system matures. During this time, then, an adolescent’s cycles may vary considerably, with many anovulatory ones dispersed throughout.
Coming off the Pill
One of the greatest motivations for women to learn about FAM is the frustration they feel with the numerous side effects they often experience while on the pill, both subtle and overt. If it isn’t headaches and weight gain, it’s breakthrough bleeding.
But probably the biggest concern I have as a women’s health educator is the fact that women are routinely prescribed the pill to help “regulate” their cycles. The problem with this approach is that the actual cause of the irregularity is never addressed, such that when they go off of the pill, their cycles usually revert back to what they were before. So if a woman was prescribed the pill to regulate her cycles when she was say, 23, and decides to go off at 33 to try to get pregnant, she may be stunned to discover that not only did her cycles return to their pre-pill irregularity, but it’s now 10 years later and she may be confronted with the reality that she has a condition such as PCOS that was never treated when its symptoms were first revealed.
The insidious problem of the pill masking potential fertility issues is so troubling that I think women should always be apprised of this potential drawback before they begin to take it. In any case, if you are just coming off the Pill or other hormonal birth control and starting to chart, I discuss what to expect here.
Pregnancy and Breastfeeding
If you were to take a survey of pregnant or breastfeeding women, one of the things they would probably tell you they enjoy about their condition is that their periods have stopped. Of course, it makes sense physiologically for the woman’s body to be incapable of getting pregnant again following conception. Once a woman becomes pregnant, she won’t ovulate until after the baby is born.
And if she is breastfeeding “on request,” that is, virtually every time the baby cries to be fed, she may not resume ovulating again for many months to even a year or so after the baby’s birth. This is because every time a baby suckles, it stimulates prolactin, a hormone that indirectly suppresses the FSH and LH that are imperative for ovulation. But in order for breastfeeding to efficiently prevent the release of eggs, the baby must suckle consistently throughout the day and night.
A breastfeeding woman could go a year or more without ovulating and experience the same Basic Infertile Pattern (BIP), whether it be dry, sticky, or a combination, day after day. The reason she usually won’t initially see wet-quality cervical fluid is that the low estrogen levels, which are indirectly caused by the hormone prolactin, will also keep fertile-quality cervical fluid from being produced. The trick is for breastfeeding women to be attentive to the Point of Change in the quality of cervical fluid that indicates that ovulation will be resuming soon. Because cycles while breastfeeding can be either nonexistent or quite confusing, you should read Appendixes I and J if you plan to use FAM for birth control during these times.
Premenopause
Menopause is the time in a woman’s life when she ceases ovulating and having menstrual periods altogether. It typically occurs around age 51. But the time leading up to menopause can take up to about a decade, with fertility actually starting to significantly diminish about 13 years before her last period. During premenopause, her cycles may start appearing unlike anything she is used to. Cycle lengths tend to initially decrease due to shorter luteal phases. Eventually, though, the cycles become longer and longer as the number of times an egg is released becomes less frequent. Finally, cycles cease altogether. A woman is generally said to have completed menopause if she has gone for one full year without a period.
As with breastfeeding, cycles while approaching menopause can be fairly tricky. You should therefore read Chapter 22 and Appendix J carefully if you plan to use FAM as contraception during the premenopausal years.
THE DIFFERENCE BETWEEN AN ANOVULATORY CYCLE AND BEING ANOVULATORY
An “anovulatory cycle” is somewhat transitory, occurring now and then in most women at some point in their lives. For example, you might have developed a fever just before you were about to ovulate, which prevented the egg from being released. Or perhaps you tried a completely nutso diet of cotton balls (no joke—some have!), which basically told your body that it was full but that until you get your act together, ovulation’s not gonna’ happen. Or you traveled to, say, Vladivostok for seven weeks, and didn’t resume ovulating until you got back.
“Being anovulatory,” on the other hand, is a longer period of time lasting perhaps months on end, and may or may not resolve itself. This is caused by everything from breastfeeding or being underweight to having a medical condition such as PCOS or hypothyroidism.
AN OVULATORY RIDDLE FOR YOUR CYCLE-SAVVY FRIENDS
What is the difference between cycles in which the woman ovulates but doesn’t get her period, and one in which she gets her period but doesn’t ovulate? Pause for a moment while you think about it.
Sabrina’s chart. A typical temperature pattern for pregnancy. Note that Sabrina almost certainly ovulated by Day 17 as seen by the next morning’s thermal shift. Her chart shows more than 18 high temperatures following the shift, a sign that likely confirms her pregnan
cy, as seen in Chapter 13.
Skylar’s chart. A typical temperature pattern with anovulation. Note that Skylar did not have a thermal shift reflecting ovulation, and thus the “period” that follows on Day 40 is actually anovulatory bleeding, which is technically not menstruation.
In the former case, the woman is almost certainly pregnant. In the latter case, she has had an anovulatory cycle. The two charts below show how very different these scenarios look on paper.
ANOTHER GREAT REASON TO CHART
In anovulatory cycles, non-charting women may assume they are menstruating normally. So why would they continue to experience bleeding if ovulation has not occurred? This type of bleeding results when estrogen production continues to develop the uterine lining without reaching the threshold necessary to trigger ovulation. In such a case, one of two things may happen that lead to what appears to be a menstrual period:
•The estrogen builds up slowly to a point below the threshold and then it drops, resulting in “estrogen withdrawal bleeding.”
•More commonly, the endometrium builds up slowly over an extended period of time, eventually to the point where the resulting uterine lining is so thickened it can no longer sustain itself. Since it doesn’t have progesterone to maintain it, the uterine lining is released in what is known as “estrogen breakthrough bleeding.”
In either case, if you weren’t charting, you might think you were simply menstruating, though you may notice a difference in the type of bleeding. Specifically, the flow can be either unusually light or heavy, and of course, the timing can result in cycle lengths all over the map, or the chart, as it were.
COMMON CAUSES OF TEMPORARY ANOVULATION OR IRREGULAR CYCLES
The following are other common reasons why women may not ovulate, either temporarily or for extended periods of time:
Illness
Being sick does not necessarily affect your cycle, but if it does, its impact is usually influenced by which phase you are in when you get sick. If your illness occurs before ovulation, it may delay it, or even prevent it altogether. If it occurs after, it will rarely affect your cycle, because the luteal phase usually has a consistent life span of 12 to 16 days that is typically not affected by factors such as sickness, travel, or exercise. For each individual woman, the luteal phase is even more consistent and its length will usually not vary more than a day or two.
Taking Charge of Your Fertility Page 12