The Spice of Life: Variations in Female Anatomy
As you can see below, there is an endless variety of shapes, sizes, and fullness of vaginal lips. There are also different hair patterns, with many women choosing to fully or partially remove their hair. Regardless, these illustrations should dispel any concerns women may have about whether or not they are normal! All vaginal lips are unique.
© 2015 Sheila Metcalf Tobin.
Birth Control Chart
Pregnancy Chart
“Where do I come from?”
A New Perspective on a Timeless Question
Every one of us started life in our maternal grandmother’s womb before our own mother was even born! How is that possible? Because every female fetus, including your mom, produced all the eggs she will ever have while still inside her mom. Of course, one of those eggs ultimately developed into you!
APPENDIX A
Troubleshooting Your Cycle
After you start to chart, you may come across situations in which you need more clarification or guidance. What follows is a list of what I believe to be the most likely problem areas, based on my decades of practice. They are categorized both by symptom or fertility sign, and by when it occurs in the cycle.
I hope these pages serve as a valuable resource that addresses any additional concerns or questions you may have.* In addition, I encourage you to either take a class or consult with a certified Fertility Awareness counselor, both of which can be found through the websites listed here.
CATEGORIZED BY SYMPTOM OR FERTILITY SIGN
Bleeding
Spotting before menstruation (at the end of the luteal phase)
Very light or heavy periods
Dark brown or blackish spotting at tail end of period
Unusual bleeding
Midcycle spotting
Spotting anytime from week after ovulation to expected period
Spotting after intercourse
Cervical Fluid
Continual sticky cervical fluid day after day (Basic Infertile Pattern)
Continual wet-quality cervical fluid day after day
Absence of any eggwhite-quality cervical fluid or only watery-quality
Patches of wet cervical fluid interspersed over long cycles
Wet cervical fluid well after ovulation
Wet sensation or eggwhite before menstruation
Infection masking cervical fluid
Wet cervical fluid found at the cervix but not at the vaginal opening
Waking Temperatures
High temperatures during period
Higher- or lower-than-average waking temperatures throughout cycle
Ambiguous thermal shifts
Temperature dip before the rise
Temperature below coverline well after ovulation
Drop in temperature day before period begins
Fewer than 10 days of high temperatures above the coverline
18 or more high temperatures after ovulation
Two levels of high temperatures after ovulation (triphasic pattern)
Dropping temperatures after either 18 high temperatures or a positive pregnancy test
Temps That Cause Tricky Coverlines
Because women occasionally have thermal shifts that make it difficult to draw their coverlines, Appendix H addresses the following:
No thermal shift
Outlying temperatures
Erratic temperatures
Weak thermal shift whose 3rd temp does not reach 3/10ths above coverline
Temperatures that rise one-tenth degree at a time (slow-rise pattern)
Temperatures that rise in spurts (stair-step pattern)
Temperature that drops on Day 2 of the thermal shift (fall-back pattern)
Fever
Cervix
Cervix that can’t be found
Cervix that never fully closes
Bumps on the surface of the cervix
Pain or stinging during intercourse
CATEGORIZED BY WHEN IT OCCURS IN THE CYCLE
During Menstruation
Very light or heavy periods
Dark brown or blackish spotting at tail end of period
High temperatures during period
Midcycle
Midcycle spotting
No thermal shift
Ambiguous thermal shifts
Temperature dip before the rise
Temperatures that rise one-tenth degree at a time (slow-rise pattern)
Temperatures that rise in spurts (stair-step pattern)
Temperatures that drop on Day 2 of the thermal shift (fall-back pattern)
Absence of any eggwhite-quality cervical fluid or only watery-quality
Cervix that can’t be found
After Ovulation (Luteal Phase)
Spotting before menstruation (end of the luteal phase)
Spotting anytime from week after ovulation to expected period
Temperature below coverline well after ovulation
Fewer than 10 days of high temperatures above the coverline
18 or more high temperatures after ovulation
Two levels of high temperatures after ovulation (triphasic pattern)
Wet cervical fluid well after ovulation
Just Before Next Menstruation
Spotting before menstruation (end of the luteal phase)
Spotting anytime from week after ovulation to expected period
Drop in temperature day before period begins
Wet sensation or eggwhite before menstruation
Anytime in Cycle
Bleeding
Unusual bleeding
Spotting anytime from week after ovulation to expected period
Spotting after intercourse
Waking Temperatures
Erratic temperatures
Outlying temperatures
Higher- or lower-than-average waking temperatures throughout cycle
Fever
When taking accurate temperatures is not always possible
Cervical Fluid
Continual sticky cervical fluid day after day (Basic Infertile Pattern)
Continual wet-quality cervical fluid day after day
Absence of any slippery eggwhite-quality cervical fluid
Patches of wet cervical fluid interspersed over long cycles
Infection masking cervical fluid
Wet cervical fluid found at the cervix but not at the vaginal opening
Cervix
Cervix that never fully closes
Bumps on the surface of the cervix
Intercourse
Pain or stinging during intercourse
Spotting after intercourse
SPOTTING BEFORE MENSTRUATION (AT THE END OF THE LUTEAL PHASE)
Premenstrual spotting accompanied by high temps before dropping on the day of red bleeding is usually indicative of poor ovulation leading to low progesterone, or a luteal phase insufficiency. In essence, the corpus luteum starts to break down too soon, which in turn causes a premature shedding of the uterine lining. Either way, Day 1 of the cycle is considered the first day of a true red menstrual flow.
If the spotting consistently occurs before the 10th day of your thermal shift or lasts three days or longer, you should see your doctor to rule out a number of other conditions, including thyroid issues, fibroids, endometriosis, and endometrial polyps. Assuming you don’t have any of these, you can hopefully resolve it with some of the natural approaches discussed in Chapter 9.
For those wanting to get pregnant, if natural remedies don’t work, it may be a potential problem requiring further medical intervention, since normal-length luteal phases of at least 10 days are necessary for implantation of the egg. One of the most common medical treatments is to prescribe Clomid to be sure that the ovulation is optimal. You can read more about insufficient luteal phases in Chapter 14.
Premenstrual spotting
VERY LIGHT OR HEAVY BLEEDING
Exceptionally light or heavy periods can
be the result of an anovulatory cycle—that is, a cycle in which an egg was not released. (This type of bleeding is especially common for women with long and irregular cycles and those approaching menopause.) You can determine if you ovulated by whether you had a thermal shift or Peak Day about 12 to 16 days before this type of bleeding. If there wasn’t, you can be fairly certain that the period you experienced is anovulatory.
Technically, this is not a true menstrual period, since it didn’t follow the release of an egg. However, to maintain a point of reference, you would still consider it Day 1 of a new cycle. Regardless, whether you are using FAM for birth control or to get pregnant, it is necessary to differentiate between anovulatory bleeding and ovulatory spotting. If you are trying to get pregnant, you will probably want to see a doctor if you have any of the following:
•consistently heavy periods, which may be due to fibroids or endometriosis, among other conditions
•three days or more of premenstrual spotting or postmenstrual spotting beyond Day 5, which may be a sign of a luteal phase insufficiency
•very light periods, which may be due to an inadequate endometrial buildup
You can see that anovulatory bleeding and ovulatory spotting look very different on paper, as seen by Paige’s and Daisy’s charts below.
Anovulatory bleeding. Note how Paige continues to have patches of cervical fluid as her body attempts to ovulate this cycle. But the lack of a thermal shift indicates that she did not ovulate, so the “period” she had after such a long cycle is actually anovulatory bleeding. She therefore repeated Day 35 on a clean chart as Day 1 of a new cycle.
Midcycle (ovulatory) spotting. Daisy tends to have long cycles with midcycle ovulary spotting. Were she not charting, she would maybe think that her cycle length was 22 days with very light “periods” of only two days.
DARK BROWN OR BLACKISH SPOTTING AT TAIL END OF PERIOD
This may be due to inadequate hormonal support of the uterine lining caused by a luteal phase deficiency from the last cycle, or possibly endometritis, which is an infection or inflammation of the cells lining the uterus. If it continues beyond two days, click here for other possible causes.
Lindsey’s chart. Dark brown spotting. Lindsey tends to have several days of dark brown or blackish spotting following her period, in addition to a short luteal phase with a few days of spotting premenstrually. This is often an indication of a deficient luteal phase, which affects the uterine lining pre and post-menstrually. In this case, as seen on the top line of the chart, her luteal phase was only 8 days.
UNUSUAL BLEEDING
Once you know your cycle well, you won’t need to be concerned if you occasionally get spotting in the day or so before your period or around ovulation. But if you have red blood or days of brown or black spotting at confusing times, you should probably be checked by a doctor. Chapter 19 discusses possible causes of unusual bleeding.
Bleeding that requires medical attention. Note the number of days and where it occurs in the cycle. It wouldn’t be considered ovulatory spotting because it starts about a week after the Peak Day. However, it could theoretically be implantation spotting if the woman were pregnant (see page 367). If she were not pregnant, this type of bleeding would require medical attention.
MIDCYCLE SPOTTING
Some women will notice that they occasionally have a day or two of spotting about midcycle, right around ovulation. In fact, they may even notice that the fertile cervical fluid (especially eggwhite-quality) is tinged with brown, pink, or red. This is a result of spotting mixed with cervical fluid, and is considered extremely fertile. It’s usually due to the sudden drop in estrogen that precedes ovulation and is nothing to be concerned about. If anything, it is a good secondary sign to record on your chart. It’s typically more common in long cycles.
You can tell that it is ovulatory spotting because it occurs within a couple days of a thermal shift (see Chart A below). If, however, the spotting lasts more than a couple days, is bright red, or you notice spotting at other times in the cycle that do not coincide with ovulation or the approach of your period, it could be an indication of any number of problems requiring medical attention, some of which are discussed in Chapter 19 (see Chart B below). One exception is the spotting that is sometimes an early sign of pregnancy, as seen in the Implantation Spotting chart later on.
A. Midcycle (ovulatory) spotting
B. Spotting that requires medical attention
SPOTTING ANYTIME FROM WEEK AFTER OVULATION TO EXPECTED PERIOD (IMPLANTATION SPOTTING)
If you experience spotting anytime from about a week after your thermal shift to the expected date of your period, it may be a sign of pregnancy. When the fertilized egg burrows into the uterine lining, it can cause implantation spotting. If you have reason to think you might be pregnant, pay special attention to your temperatures to see whether they remain above the coverline for at least 18 days, or even continue to rise into a third level right around the spotting, called a triphasic pattern. This is discussed here.
If you prefer to take a pregnancy test, be aware that even the most sensitive ones probably won’t be valid until you’ve had at least 10 post-ovulatory high temperatures. And store-bought tests generally require a few more days than blood tests because they are not as sensitive to the minute amounts of HCG that the embryo initially produces.
Implantation spotting
CONTINUAL STICKY CERVICAL FLUID DAY AFTER DAY (BASIC INFERTILE PATTERN)
Some women notice that they never have any dry days following their period, and instead have a continuous unchanging secretion. You may want to initially get it checked to rule out an infection or cervical issue. But if your cervix is healthy, you should consider such cervical fluid as part of your Basic Infertile Pattern (BIP).
With a BIP, you will usually experience day after day of sticky or unchanging cervical fluid leading up to a Point of Change which signifies impending ovulation in a few days. In order to establish a Basic Infertile Pattern, you must observe your cervical fluid very carefully by abstaining for up to two consecutive weeks following your period, without the interference of semen, spermicides, douches, or anything else that may make your observations difficult.
Once you have established your BIP, any days with this pattern are treated as if they were dry, whether you are trying to avoid or achieve pregnancy. The trick is to learn to detect the Point of Change to a wetter, fertile-quality cervical fluid. For complete instructions on how to use FAM for birth control while you have a BIP with normal ovulatory cycles, click here.
Basic Infertile Pattern (BIP) of sticky
CONTINUAL WET-QUALITY CERVICAL FLUID DAY AFTER DAY
If you notice continuous wet or eggwhite-quality cervical fluid that extends for possibly weeks at a time, it could be an indication of excessively high levels of estrogen due to, among other conditions, PCOS or thyroid dysfunction.
Another fairly common condition that may cause a prolonged phase of wet cervical fluid, often with a delayed Peak Day, is an ovarian cyst. They are follicles in the ovary that stop developing before ovulation, forming fluid-filled cysts on the ovarian wall that usually last for a few weeks before disappearing on their own. Although they often have no symptoms, they can cause a chronic dull ache (usually on just one side), painful periods, or even pain during intercourse. Fortunately, physicians can usually diagnose them through a pelvic exam or ultrasound, and in most cases, they can be easily treated through a progesterone injection that disrupts the estrogen dominance, dissipating the pain and allowing bleeding 5 to 10 days later.
Prolonged wet cervical fluid could also be caused by stress. But the classic stress-induced pattern usually consists of patches of wet cervical fluid as your body keeps attempting to ovulate. Of course, a thermal shift will confirm when you ultimately do ovulate. If you are breastfeeding, your body could be making numerous attempts to start ovulating again, thus extending your normal fertile pattern for longer than usual.
Regardless what the c
ause is, if you are using FAM for birth control, see Appendix J on how to chart with these patches of cervical fluid.
Finally, you could have a vaginal infection. If you have any of the following symptoms in addition to continual wetness, you should see a health practitioner for a proper diagnosis:
•abnormal discharge
•unpleasant odor
•itching, stinging, swelling, and redness
•blisters, warts, or chancre sores
Excessively wet cervical fluid
ABSENCE OF ANY EGGWHITE-QUALITY CERVICAL FLUID OR ONLY WATERY QUALITY
You may find that you rarely if ever have eggwhite. Or maybe you notice only an occasionally gushing watery secretion that sometimes resembles nonfat milk. Regardless, you should consider it fertile. Remember that cervical fluid is on a continuum from dry to wet, with clear, stretchy, or lubricative the ideal for getting pregnant.
You should fill in the “eggwhite” row, but then be sure to record the actual consistency in the Cervical Fluid Description row, such as watery, clear, or milky. In fact, occasionally women notice this type of cervical fluid immediately after their last day of slippery or stretchy cervical fluid. In any case, it’s still considered eggwhite, and would be the Peak Day if it is the last type of wet before drying up.
Women who have had cryosurgery or cone biopsies taken from their cervix may find that they don’t produce much cervical fluid at all. This is because many of the cervical crypts that normally produce it may be removed during these procedures. In addition, the Pill may damage the crypts as well, and even cervical infections may compromise cervical fluid production.
For those trying to get pregnant, this watery secretion may be sufficient—though it may not have the viscosity necessary to allow sperm to swim. In the end, if you are trying to get pregnant and don’t produce enough cervical fluid to conceive naturally, you would still have several options as discussed in Chapters 14 and 15, including the use of intrauterine insemination.
Taking Charge of Your Fertility Page 37