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  • Nadine Mulder

Understanding YOUR menstrual cycle.


We spend our entire lives trying NOT to fall pregnant. Often having a slight pang of anxiety if our period is a day late. Then when the time comes when we are ready to start a family, it can be quite perplexing when it doesn’t happen straight away. And many women assume that there must be something wrong. But what if you’ve been “trying” to fall pregnant all this time outside of your fertile window? For some women, their fertile window and ovulation don’t actually match up! And they’ve been having intercourse a few days too late or too early. This is why it is so important to understand YOUR cycle.

Aside from fertility indicators, your menstrual cycle is so inherently reflective of your health status that it is considered as the 6th vital sign. Alongside temperature, blood pressure, respiratory rate, heart rate and pain and is a very clear representation of a women's general health. So even if you are not trying to fall pregnant, understanding YOUR cycle can be extremely useful in identifying any hormonal issues that have the potential to impact all systems of your body. This can manifest as issues related to:

  • Sleep;

  • Moods;

  • Libido;

  • Ability to concentrate;

  • Inflammation; and

  • Digestion/Metabolism….just to name a few.

Top agenda: Pregnancy.


Did you know that your body is geared towards pregnancy every single cycle, whether you like it or not. And there are so many tricks and techniques she will use in the lead up to ovulation to entice you into having sex when you are most likely to conceive.


If you pay attention to your body and know what to look for, you will discover many signs that can be used as fertility indicators which you can use to increase your chances of pregnancy or to avoid it altogether! And as every woman is different, tracking your cycles and monitoring your body’s signals is the best way to know exactly when you’re ovulating and how to take advantage of it.

Tracking your cycle signs also lets you know whether or not your period is just a normal cycle ending or a miscarriage (which is more common then you think). This is very useful information because it shows you that you are actually ovulating. Which means that you’re maturing and releasing eggs, your Fallopian tubes are open, cervical fluid is optimal and sperm count and mobility is normal. And can point you in the right direction as to how to make appropriate changes to enhance your chances of a successful pregnancy.



Some anatomy


Before you start tracking your cycles, it’s important to understand how the process all works.

After menstruation, follicular stimulating hormone (FSH) causes about 15-20 eggs to start maturing in both ovaries. Each egg is inside an individual cocoon (follicle) and each follicle produces estrogen as it matures. The dominant follicle causes levels of estrogen to climb, thickens the uterine lining and stimulate glands in the cervix to produce mucus – more about that soon!


The race to egg maturity takes between 8 - 22 days and varies considerably from woman to woman and hence contributes to the high variability of cycle length.



This follicular phase can be affected by alcohol, stress, weight gain or loss, travel, supplements, exercise etc. and can all impact whether your period is "early or late, light or heavy, short or long, painful or pleasurable." (Maisie hill.) 

Once the dominant egg reaches the estrogen threshold this will trigger the release of luteinizing hormone (LH). This hormone will cause that egg to burst out of the follicle and through the ovarian wall into the pelvic cavity where it is swept into the Fallopian tubes.


Amazing fact: if one fallopian tube is not viable, the other healthy fallopian tube can sweep up an egg released from the ovary on the opposite side of your body!!


The now empty follicle that originally encased the egg will now collapse, develop it’s own blood supply and turns itself into a temporary gland (called the corpus luteum) that produces a hormone called progesterone. The corpus luteum lives for 12-16 days and is less impacted by environmental factors – unlike the pre-ovulation phase. So the post ovulatory phase is much more fixed in length. Therefore, if you know when you ovulate, you can predict when your period will start by counting forward 14 days. OR, you can count back from the first day of your period 14 days to figure out on which day you ovulated, combined with other ovulatory signs.



Progesterone is the dominant hormone of the second half of your cycle. It is PRO-GESTATION and enhances the likelihood of pregnancy by:

  • Preventing any more competing eggs from being released;

  • Thickening the uterine lining for an egg to burrow into; and

  • Triggering changes in your basal temperature, cervical fluid and cervical position to assist successful sperm mobility.

Other fun facts about progesterone:

  • It reduces inflammation;

  • Calms the nervous system;

  • Soothes your mood;

  • Improves sleep or may be the reason why you may need more naps post ovulation;

  • Stimulates bone tissue generation;

  • Regulates estrogen; and

  • Reaches peak levels 7 days after ovulation.

Progesterone slows you down, makes you more cautious and more likely to want to rest, essentially keeping you safe just in case you are pregnant. It also slows down your bowels so you have more time to extract vitamins and minerals from the food you eat. Again, this is in case you have to support a developing embryo and can lead to constipation. This is the same reason why you may find your appetite increases in the latter half of your cycle. So during this phase, if you don’t eat regularly, unstable blood sugar will make you more likely to get “hangry”.


The first day of your cycle is the first day of a full blood flow. Spotting lightly before your period starts is the tail end of a previous cycle. Even if it continues for several days before your proper period begins and can be a sign of inadequate progesterone which causes the lining to shed early. This can happen at any stage of your cycle. 
You can also get spotting at ovulation or during implantation as the embryo embeds in the lining of your uterus. This is normal spotting. 


If the egg released is fertilised, it will burrow into the uterine lining and begin producing HGC (the hormone pregnancy tests detect). This hormone tells the follicle to continue producing progesterone longer than the 14 days to sustain the lining of the uterus long enough for the placenta to take over progesterone production when it develops.

Just before your period comes, if there has been no fertilisation, the corpus luteum will die which causes levels of oestrogen and progesterone to fall dramatically. This triggers the release of prostaglandin which cause the blood vessels in the lining of your uterus to constrict, cutting off the oxygen supply to the cells and causing them to die. Dead cells are then swept out down your vagina.

Other interesting information about your cycle:

  • Cramps and "period poos" are thanks to the effects of prostaglandins on your smooth muscle;

  • The lining of your womb begins it’s remodelling 3 days after your period starts;

  • Female babies inside their mother’s womb already contain ALL the eggs she will possess for the rest of her life. So when your mother was still inside your grandmother, she had already developed the egg containing the genetic material that would eventually become you;

  • Men produce 100-300 million sperm a day; and

  • A human egg is the largest cell in the body. A sperm cell is the smallest.


Signs of Ovulation


As a woman, you are only fertile within a 5-6 day window every cycle. Outside of this time, it is impossible to fall pregnant. An egg only survives for 12-24 hours after it has been released (ovulation). And even if you release 2 eggs in one cycle (yes that is possible), the second egg can only be released within a 12 hour period of the first, thanks to the clever hormonal orchestration that is your cycle.


The reason that you can be fertile for 5-6 days however, is that sperm can live for that long within the woman’s body, waiting for the egg to be released. But only if they have the right kind of cervical mucus to protect and sustain them. This brings me to the first (and in my humble opinion the most important) fertility indictor to watch for…CERVICAL MUCUS.


“A woman can have sex on the Tuesday but fertilisation of the egg may not occur until the Friday morning.”


CERVICAL MUCUS.



You may not have ever paid any attention to your cervical fluid qualities, so this may seem like quite a bizarre thing to be analysing. However, once you start, you’ll be amazed at what this moisture can tell you about where you are within your cycle.


Cervical fluid is the normal discharge that comes from your vagina and is responsible for the wet patch in your undies. As your body gears up towards releasing an egg, your cervical fluid changes to adopt qualities that assist in the successful fertilisation of your egg.

It does this by:

  • Becoming more alkaline to protect the sperm from the acidic nature of your vagina;

  • Providing nourishment and energy for the sperm; and

  • Changing its texture to actually assist the sperm to swim up towards the awaiting egg.

But cervical mucus has another important objective. To make you want to mate!


Midway through the first half of your cycle, you may notice your cervical mucus becomes more like a creamy lotion that is white and opaque, this signifies the start of your fertile fluid. It is wetter in nature and you can start to feel wet without arousal – which can lead to arousal (I told you your body was tricky!)


The most fertile cervical fluid that usually shows up just before an egg is released and resembles raw egg white. It is slippery, stretches between your fingers, can be clear/streaked with blood/yellow/pink or red. There is a slippery vaginal sensation throughout the day (which can be even more arousing) and the normal mark on your undies has a rounder, wetter appearance – as opposed to a streaky white mark.


NB: This fluid can resemble semen and if you are trying to conceive, it can get confusing to discern what is semen and what is fertile cervical fluid. Semen is thinner, breaks apart easily and dries very quickly on your finger. Fertile cervical fluid is slippery and stretchy and does not dry as quickly. Semen will also absorb into toilet paper whereas fertile cervical mucus will sit on top of it without being absorbed. 

Other normal types of cervical fluid you may experience throughout stages in your cycle may appear as crumbly, thick, sticky or gummy and rubbery. It may even form small peaks when you separate your fingers. These cervical fluid types tend to trap the sperm and are not conducive to conception and are therefore typical of your post ovulatory phase.


If you’re trying to conceive, you want to be having sex by the time milky lotion arrives and during “egg white” mucus. It can keep sperm alive for up to 5 days which is why it shows up in the days BEFORE ovulation. Some sperm will be stored in little pockets surrounding the cervix before being permitted to continue on to the fallopian tubes where they will wait within the lining for the egg. Then when the egg is ready, some sperm will be released and allowed to approach. This is very different to the old visual of the sperm racing towards the egg.

The take home message here is that you MUST BE HAVING SEX IN THE LEAD UP TO OVULATION WHEN CERVICAL MUCUS IS OPTIMAL. DON’T JUST WAIT FOR DAY 14 TO ARRIVE.


SIDE NOTE: This is often why fertility tests can be so misleading. If you’re waiting for the smiley face to appear on your fertility test (which picks up a hormone called luteinising hormone LH), you may have missed your only opportunity to get sperm to where it needs to be. This is due to:


  • Some women only have minimal amount of LH which can be undetectable;

  • Some women have mini LH surges throughout their cycle, especially women with PCOS; and

  • Some women may only have a couple of days of fertile fluid 2 days before ovulation, which for them is the only time that the sperm would be able to travel through their vagina successfully. If she was to wait until ovulation – her fluid may have dried up. Remember sperm can live up to 5 days in optimal cervical fluid.

How to check your cervical mucus


When wiping yourself after doing a poo or wee is a great time to check your cervical mucus. The slippery nature of the egg white mucus will mean that your hand may speed up and glide over your vaginal opening as you wipe. Non-fertile fluid will cause a rougher drag against your skin.

Another tell-tale sign is the wet patch in your underwear – most fertile mucus has higher water content which leaves a more symmetrical patch that stays moist your undies. Non-fertile fluid tends to dry quickly and leaves a streaky mark.

If you have low cervical fluid or are unsure of it’s nature, another way to check your mucus is to go in and collect it yourself. This may be something that makes you uncomfortable if you are unaccustomed to touching yourself, however the best way to check for cervical mucus if you’re unsure is to insert 1 or 2 fingers inside your vagina. And as Maisie Hill says “if you want to be a parent, you may as well get used to dealing with body fluids now.”

Summary:

  • Begin checking your CF the day after your period ends;

  • Focus on your vaginal sensations during the day;

  • Try to check it every time you use the bathroom;

  • Try to avoid checking it when you’re sexually aroused;

  • After urinating, check how easily the toilet paper glides while wiping;

  • Use your fingers to collect a sample and move it between your fingers identifying its texture;

  • Note your underwear throughout the day; and

  • Check the toilet bowl especially after opening your bowels as it can flow out quite quickly and form a blob in the water or sink to the bottom.




Your peak day is the last day of a slippery vaginal sensation or wet cervical fluid. (If you don’t experience this type of fluid just note the last day of the wettest fluid you do have.) This can also correspond with any mid cycle spotting – this is a very good sign of ovulation! 


Note: Vaginal discharge should not have a strong odour or cause pain/burning or itchiness. If you find this to be the case, please contact your doctor.


Factors that may impact your cervical fluid include:

  • Infections;

  • Dehydration;

  • Smoking;

  • Low oestrogen caused by being underweight or over exercising;

  • Not eating enough healthy fats;

  • Thyroid imbalance;

  • Arousal fluid; and

  • Antihistamines and other medications.

Vaginal dryness can be caused by low oestrogen, getting older, having a baby, breastfeeding, all of which reduces blood flow to the ovaries.


Factors that can cause low oestrogen include:

  • Disordered eating;

  • Being under weight;

  • Over exercising;

  • Medications;

  • PCOS;

  • Gluten intolerance; and

  • Thyroid problems.

Symptoms of low oestrogen include:

  • Dry vagina;

  • Painful sex;

  • Disturbed sleep;

  • Hot flushes;

  • Bladder leaking or infections;

  • Poor memory;

  • Emotional fragility;

  • Joint pain;

  • Depression; and

  • Dry skin and eyes.

Increase oestrogen by eating regularly, exercise less strenuously, include lots of healthy fats likes avocado, pasture raised eggs, salmon, olive oil, grass fed butter, coconut milk. Avoid alcohol, coffee and other stimulants and acupuncture can also we very helpful.


TEMPERATURE


Your basal body temperature (BBT) is the lowest temperature your body reaches during complete rest. Tracking your daily BBT is very important because it gives you information regarding whether:

  • Ovulation has occurred;

  • The 2nd phase (progesterone phase) is long enough for the egg to implant;

  • Pregnancy has been achieved. More than 18 consecutive days of elevated temperature readings suggest that pregnancy has been achieved. This can be useful in differentiating between a period and a miscarriage.

Prior to ovulation, your temperature is lower; around 36 – 36.5 degrees Celsius. After ovulation, temperatures rise by 0.2 degrees Celsius or more due to the heating effects of progesterone. Some people (but not everyone) will also find that their temperature falls slightly before they ovulate which can be a helpful heads up before it happens. As progesterone falls in the absence of conception, your temperature will drop just before your period starts. If your temperatures remain high, this is suggestive of pregnancy.

Temperatures below 36 degrees Celsius is suggestive of poor thyroid function which can be detrimental to fertility. Post ovulatory temps that take a while to climb or which dip in the luteal (post ovulatory) phase can indicate progesterone deficiency – both of which would warrant investigation.


Factors that can influence your temperature and give you an inaccurate reading are:

  • Fever;

  • Alcohol consumption the night before;

  • Less than 3 hours of consecutive sleep prior to taking your temperature;

  • Inconsistent time of reading;

  • The use of a heating source such as an electric blanket;

  • A Restless night;

  • Stress;

  • Sudden increase physical activity

  • Illness or infection; and

  • Dramatic weight changes.


How to chart BBT


Temperature must be taken under the tongue at the same time every day (give or take an hour) prior to any activity such as getting up, drinking, looking at your phone and using the toilet.

Temperatures rise gradually throughout the day until about 2.00 p.m. So if you have to take your temperature at a different time than usual, make sure your note this in your chart.


There are lots of wonderful free apps available to help you easily chart your BBT readings but if you’d like to chart them on paper, just ask me and I will email you a template.


You must be using a basal digital thermometer which provides 2 decimal places. Eg 36.78. You can buy them in most chemists and pharmacies.



CERVICAL POSITION


Have you ever noticed that on one occasion, a particular position during intercourse feels pleasurable and on another day, that same position causes quite a bit of discomfort? This is because your cervix (the opening between the uterus and vagina) actually moves and changes in the lead up to ovulation.


It softens and moves upward towards the top of your vagina to shorten the distance sperm have to travel to get to the egg. It is also more open and wet thanks to the work of the glands at the cervical opening. This assist the sperm motility toward the egg.


You can check the position of your cervix as another indicator of pending ovulation. If you would like more information about this, just ask.


OTHER SIGNS THAT MAY INDICATE IMPENDING OVULATION

  • Mid cycle spotting;

  • A pain or ache over one ovary;

  • Increased libido;

  • Swollen volva or fuller vaginal lips;

  • Bloating;

  • Increased energy and confidence;

  • Heightened vision/smell/taste;

  • Breast and nipple sensitivity; and

  • Breast tenderness.

OTHER FACTS ABOUT MENSTRUATION.


Women often say that they got pregnant straight after coming off the pill. This is most likely due to the release of excess oestrogen they have been storing in their fat cells causing continuous fertile quality fluid. However, it can take several months for your hormones to recover after a prolonged time on the pill so it’s advised to come off the pill at least 3 months prior to wanting to conceive and use other methods of birth control during this time.


If you’re on the pill, you’re not having periods, you’re having withdrawal bleeds which occur as a result of a lack of hormones when taking the sugar pills. You do not ovulate when taking the pill.

Rising oestrogen causes an increase in blood flow to the genitals which actually makes your clitoris swell, and is why you can catch yourself thinking about sex at work and why you’re more likely to orgasm around ovulation - your body is doing everything it can do get you in the mood for procreating.

In your ovaries are dormant follicles, each containing immature eggs. It takes over a year for them to mature for ovulation. 190 days before ovulation, they develop a blood supply and begin to respond to their environment. So taking care of your health ideally starts 6 months prior to conception.


Hormone disrupters


These are chemicals in our environment that can disrupt or mimic hormone behaviour in our bodies. This can be extremely disruptive to our normal reproductive cycle function and regulation. And as you’ve read above, it takes a unique and intricate orchestration of hormones to successfully release an egg and to enhance all the factors surrounding it for fertilisation.


These chemicals include:

  • Phthalates. These are found in cheap personal care products like deodorants;

  • Fragrances, candles, air fresheners, fabric softeners;

  • Hand wash, nail polish, cleaning products;

  • Parabens in soaps and shampoos;

  • Soy products;

  • BPA and other plastics;

  • Non-organic tampons and other sanitary items; and

  • Insecticides and fungicides. Go organic where you can or look into the “dirty dozen” which will tell you which fruits and vegetables have the highest pesticide content.

Why stress is so detrimental to pregnancy and hormonal health.

There are 3 important hormonal pathways that occur in your body.

1) The hypothalamic-pituitary-ovarian (HPO) axis. This system stimulates and regulates all the hormones that are responsible for the healthy workings of the female reproductive system. It is thanks to the HPO axis that we mature eggs, make fertile cervical fluid, build up and sustain the lining of the uterus when needed and shed the lining if no fertilisation occurs. As well as all the other intricate jobs that occur in the background that make your menstrual cycle function optimally.


2) The hypothalamic-pituitary-thyroid (HPT) axis. This system stimulates and regulates thyroid function. Poor thyroid function can interfere normal ovulation, severely impacting fertility.

3) The hypothalamic pituitary adrenal (HPA) axis. This system controls and orchestrates our stress response.

If your body perceives your environment to be stressful, the HPA axis causes the release of stress hormones into your system which gets your body ready to fight or flight! To do this, your muscles need more accessible blood and energy to meet the physical demands of either running away from danger or fighting a perceived threat. To give you the best chance of survival, your body will also turn down or inhibit other body systems that are not crucial at that time. These include your digestive and reproductive systems. And chronic stress can have detrimental effects on your mental, immune, metabolic and reproductive health.

The problem is, your body cannot decipher what it is you’re feeling stressed about. It doesn’t know that you’re feeling anxious about a work deadline, an argument with a friend or not being pregnant for the 6th month in a row despite doing everything you can to fall pregnant! Your body just interprets this as an inappropriate time to bring a baby into the world. Other factors that your body perceives as stressful is overly strenuous exercise, inadequate food intake (starvation), poor sleep and dehydration. Food for thought.



This blog was based on resources collected from many sources. However, two books made up the bulk of the information. Period Power by Maisie Hill is an incredible resource and should be read by all women who are sexually active. "Taking charge of your fertility" by Toni Weschler is also very comprehensive.

Images 1 and 2 are by @eugeniedbart, 2 and 10 by Duvet Days, 4 by @kegg_tech and 5 by@sabinatenn.