FERTILITY SIGNS - Cervical position

   Although the cervical position is one of the main fertility signs, many people do not observe it for various reasons. The cervix is the part of the uterus that reaches into the vagina, connecting the two. It looks like a doughnut with a small opening in the middle. To observe it you have reach up inside your vagina to feel it with your fingertips around the same time every day, in the same position (squatting, lying on the bed etc.).
   In 1962 Dr Edward Keefe american gynecologist was the first one who described the changes in the cervical position during the menstrual cycle. He encouraged women to observe it themselves so that they would know when they are fertile and when they are not.
   In the infertile phase of the cycle the uterus has the shape of a pear upside down. The cervix reaches longer into the vagina therefore you feel it being lower, it is firm and dry and the opening in the middle is closed. In the fertile phase, however, due to the increasing level of estrogen the shape of the uterus becomes more apple-like, the cervix moves higher, it becomes softer and wetter. It also opens up to let the cervical fluid flow into the vagina and to let the sperms reach inside the uterus to fertilize the egg. The cervix is highest, softest, wettest and most open at the time of ovulation. After the egg is released, due to the progesterone hormone produced by the developing corpus luteum, the uterus quickly returns to its upside down pear shape, the cervix becomes low, firm, dry and closed once again. (The picture does not show the changes in the shape of the uterus properly.)

   Those who have read the previous article might have noticed that the changes in the cervical position are very much in synch with the changes in the cervical mucus, both can help us determine the fertile phase in the menstrual cycle. Their reaction to estrogen and progesterone are very similar and if you note them in a cycle chart you will see that they create a spectacular curve. This is the reason, however, that many people choose not to observe the cervical position. The basal body temperature and cervical fluid chart is enough to determine the fertile and infertile phases of the cycle. The cervical position serves as double-check to confirm what the mucus has already told us.

   It can also happen that someone wants to observe the changes of the cervix but for some reason she cannot reach it inside the vagina in any position in any phase of the cycle. That is absolutely normal, no need to be worried, in this case she must rely on the cervical fluid to identify the onset of fertility. 

   Checking the cervix can be especially useful for those who are not sure they understood the cervical fluid sign properly or they have issues with the mucus production due to some medication or hormonal imbalance. In this case the cervix along with the temperature will help them determine the fertile phase. 

   With this we have reached the end of our fertility signs. There is a fourth "sign" also but it is not observation, it is simply counting days and analyzing previous data, during the course I explain it in details but here I do not feel it necessary to write a full article about. 

   I hope you have learnt something useful today but I have to tell you that to be able to chart your fertility signs and use the Fertility Awareness Method properly you must learn it from a qualified educator, reading the articles will not be enough! Here, on the blog I speak of things generally, but the method itself is much more complex, it requires more detailed knowledge!

   For the next article I have a lighter topic, I hope you will enjoy, stay with me. 😉

FERTILITY SIGNS - Cervical mucus

   Cervical mucus (CM) is the one fertility sign that everyone comes across at some point, only they have no idea what they see. When you go to the gynecologist in your fertile window s/he will say "You have a bit of a flow" and s/he will immediately prescribe anti-fungus medicine, not knowing (?) that it is absolutely normal. This is that sticky or creamy white discharge that you sometimes find in your panties and this is what sometimes creates slippery feeling when you wipe yourself after peeing. But what is this exactly?

   The cervical mucus or cervical fluid is an alkaline substance containing electrolytes, glucose, amino acids, proteins, enzymes and 90-99% water. It is produced in the cervical crypts in the first half of the cycle due to the increasing level of estrogen. Thanks to gravity it travels from the cervix down through the vagina and can be observed at the vaginal opening. Being alkaline it changes the normally acidic environment of the vagina that would kill the sperms, it nourishes the sperms and creates a path for them to travel towards the uterus while filtering out the deformed ones and this is what can keep the sperms alive up to 5 days in the cervix while waiting for the egg to come. 

   The colour, consistency and amount of the mucus changes during the follicular phase, from yellowish rubbery or sticky through white creamy or milky to opaque stretchy and slippery (like raw eggwhite) and all these are natural and normal! As we are approaching ovulation the mucus becomes more and more stretchy and slippery, providing optimal environment for the sperms to live, feed and travel in. After ovulation due to the progesterone hormone it dries up or returns to the initial sticky or creamy state. It is important to know that prior to ovulation, for the reasons mentioned above, as soon as any type of mucus appears, we are considered fertile, this is the sign that tells us when our fertility begins in the cycle.
   Felix Pouchet was the first to define the cervical fluid in 1847 and in 1954 Dr John Billings described it as the primary sign to indicate potential fertility. Billings, along with his colleagues categorized the different types of cervical mucus and their impact on fertility and developed the Billings Method that determines the fertile phase in the menstrual cycle. 
   Observing cervical fluid is pretty easy for western people: you have to wipe your vaginal opening with a piece of folded toilet paper before and after peeing and check if there is anything on the paper (pee gets absorbed, mucus stays on the surface). Whoever is not experienced in identifying the different version of mucus I encourage them to touch it and take it between the fingers, rub it to see if it is sticky or lotiony or slippery, try to pull it to see if it is stretchy. I know it sounds gross at first, but believe me it is not horrible at all once you get used to it and it provides you with a huge amount of information about your health and fertility. After a couple of weeks it becomes part of the routine of using the toilet and you won't even need to touch it any more because you will be able identify it and note it in the chart by just looking at it.
   Another reason why it is important to observe and chart cervical fluid daily is that everyone has their own mucus pattern during the cycle. Once you get to know yours you can avoid the above mentioned misunderstandings and unnecessary treatments at the doc's but you will also know if something is wrong and should be checked. Natural cervical mucus is odorless, does not cause irritation or any other symptom, the colour can be pale yellowish, white, opaque, or pinkish (in case of spotting) and all this means is that you are fertile at the moment. But if you have dark yellow, brown or greenish, possibly lumpy discharge with a strong, unpleasant smell that often causes irritation at the vulva then it is probably caused by some vaginal infection and you must see your doctor and get it treated!

   In the next post we will talk about the third fertility sign, the cervical position. I hope you found this article useful and I haven't put you off charting, trust me, it's really worth it! 😉

FERTILITY SIGNS - Basal body temperature

   The first fertility sign that we have to discuss is the basal body temperature (BBT) or waking temperature.
   Probably all of you have already learnt in biology class that the normal body temperature of humans is between 36-37 degree Celsius. This, however, keeps changing during the day according to our activity, obviously while we are working out it will be higher, while we are at rest it will be lower. The waking temperature can be taken in the morning when we wake up after at least 3 hours of consecutive sleep. This is the time of the day when it is the lowest. As soon as we get out of bed and start our daily activities it will rise, but we are not talking about big differences, only few tenth or hundredth degree changes.
   The fact that the basal body temperature changes during the menstrual cycle, in the first half it stays in a lower range, in the second half it rises to a higher range was first discovered in 1868 by Dr W.Squires, but he could not figure out the reason behind it.
   Van de Velde was the one who realized the connection between the mid-cycle temperature shift and ovulation in 1904. In 1928 he also figured out that the reason for the higher temperatures is the progesterone hormone produced by the corpus luteum after ovulation. However the field studies and researches took place decades later by Dr John Marshall British neurologist who published the proof of this theory in 1968.
   But why is this an important part of Fertility Awareness? Because the woman who takes her BBT daily and notes it in a chart will be able to differentiate between the pre-ovulatory (follicular) low temperatures and the post-ovulatory (luteal) high temperatures. This will tell her if ovulation happened and she can also estimate its day. It can happen that ovulation does not occur for some reason but the temperature chart will show this, the temperatures will remain low throughout the cycle. Also whoever is trying to conceive can save money on pregnancy tests because the production of progesterone hormone is continuous while expecting a baby, the temperatures will stay high for 9 months.
   The only problem with the basal body temperature is that it is very sensitive, there are numerous factors that can throw it off balance and cause a false reading (bad sleep, consuming alcohol, illness, travelling etc.) If you join a course and learn the Fertility Awareness Method though, you will be able to identify these factors and know what to do about them. Also I have to tell you that the BBT is not taken in the armpits because that place is unreliable when we are talking about so small changes. It has to be taken in the mouth under the tongue, in the vagina or in the rectum (always the same place). There are basal body thermometers available that were developed specially for this cause and show hundredths of degrees compared to the general thermometer that was designed to indicate fever and shows only tenths.
   As I have said it is very useful to chart your waking temperatures but it will tell you only when your fertile phase ends since it rises 1-2 days after ovulation.

   In the next post we will see which sign shows us the onset of fertility and determines the length of the fertile window in the cycle. Stay with me! 😉

The phases of the menstrual cycle

   I have already mentioned before that the cycle is not only about menstruation, now let us see what the different phases of the cycle and their characteristics are.

1. Menstrual phase
   This is the part of the cycle that is the easiest to identify and the most obvious. The fist day of the cycle is the first day of menstrual bleeding. If conception did not happen in the previous cycle then the thickened endometrium sheds and leaves the uterus in form of bleeding through the vagina. This lasts for about 3-5 days with changing intensity during which we normally loose 25-80 ml of blood. We can talk about true menstruation only if it is preceded by ovulation. (I will have a separate post about the different types of bleeding.)

2. Follicular phase
   This part is about the ripening of the follicle and the egg inside. The brain produces FSH (Follicle Stimulating Hormone) which starts the ripening of multiple follicles in both the ovaries but after a few days one (or two) follicle becomes dominant, the others whither and get absorbed. The ripening follicle produces the main hormone of this phase, estrogen, that is responsible for the developing of the secondary female characteristics and the fertility. Estrogen induces multiple procedures in our body that would redound fertilization (more about this later). The length of this phase varies, it can differ from month to month. The reason for this is that the brain plays a central role in the process. Whatever can influence the working of the brain (stress, grief, travelling etc.) can also influence the production of the hormones and therefore the length of this phase.

3. Ovulation phase
   This is the most important part of the cycle in terms of fertility and health as well. Ovulation is when the ripe egg gets released from the ovary and starts its journey in the Fallopian tube towards the uterus. When the amount of estrogen, created by the ripening follicle, reaches a certain level it makes the brain produce LH (Luteinizing Hormone) that will cause the follicle (12-24 hours later) to break and release the egg. The level of this hormone is what ovulation predictor kits can show from urine. The egg lives for 12-24 hours after ovulation and can only be fertilized in the first 6-12 hours. In case there were two dominant follicles, the second egg gets released maximum 24 hours after the first one. The length of this phase is about 3 days, from the LH surge to the death of a possible second egg.

4. Luteal phase
   This part was named after the corpus luteum. When the egg gets released, the broken follicle remaining in the ovary turns into corpus luteum and starts producing the main hormone of this phase: progesterone. Progesterone blocks the production of FSH and estrogen thus preventing the ripening of new eggs. It also prepares the endometrium for a possible implantation. If fertilization has not occurred, the corpus luteum lives for 10-16 days, determining the length of the luteal phase for each woman individually. It is the same number of days in every month (+/- 1 day maximum). As the corpus luteum dies and the production of progesterone suddenly stops, the endometrium sheds and leaves the uterus through the vagina in the form of menstrual bleeding, a new cycle starts. So if you chart your cycles, as soon as ovulation happens you will be able to tell exactly which day your next period will come.

   So these are the phases of the menstrual cycle, I hope you found this article useful, you can ask questions or tell your opinion in the comment section below. In the next posts we will discuss the fertility signs, stay with me! 😉

MYTHBUSTER - About the Fertility Awareness Method

   In today's article we will dispel the misconceptions about the Fertility Awareness Method (FAM).

Myth #1: Fertility Awareness Method is the same as Rhythm Method.
Fact: The Rhythm Method is about guessing and predicting. It is based on the false theory that all cycles are the same, if the previous one was 28 days long then this one will be as well and ovulation always happens in the middle of the cycle. FAM is based purely on biology, it has a strong scientific background. It always concentrates on the current day in the current cycle by the observation of the hormone-induced fertility signs (basal body temperature, cervical fluid, cervix).

Myth #2: Fertility Awareness is not an effective method for contraception.
Fact: As we have discussed before, FAM is backed up by scientific researches, always concentrates on the present. The person who learns to observe and chart her fertility signs on a daily basis will always be able to tell if she is fertile or not on a given day. Based on this information and their family planning intention (whether they want to have a baby or not) she can decide about having sexual intercourse. For those who obey all the rules and abstain from sexual intercourse on the fertile days this method works with a 99.6% efficacy. For those who choose to have protected sex in the fertile window this rate gets reduced to the efficacy of the barrier method (condom, diaphragm, spermicide etc) they use.

Myth #3: Fertility Awareness works only for those who have regular cycles.
Fact: We have seen above that the biggest advantage of FAM is that due to daily observation it always concentrates on the present - the current day in the current cycle. This is why it works for everybody, regardless of age, or situation (coming off hormonal birth control, postpartum, nursing, approaching menopause). The user will always know exactly what is going on in her body and which phase of her cycle she is in. 

Myth #4: Fertility Awareness is only good for achieving or avoiding pregnancy.
Fact: There is a separate post ('The fifth vital sign') already on this blog that confutes this statement in details. The cycle chart (the notes on the daily observations of the fertility signs) provides you with a broad and very detailed picture of your hormone production and reproductive health. It tells you whether everything works properly in your system. If you get to know your own fertility cycle pattern from your charts then you can avoid running to the doctor all the time or taking unnecessary treatments because you will be able to distinguish between normal and abnormal events. You might not use the method for contraception or getting pregnant but still it is very reassuring to have proof in your hand about your body working perfectly. And if something is wrong you can find a solution, you have the time and the opportunity to change your ways and the positive effect will be visible in your upcoming charts.

   I hope that by now you see why Fertility Awareness is good and worth learning. It might take 1-2 cycles for you to gain confidence in charting your fertility signs but the observation itself is not more than 2 minutes daily and the information it gives you is very valuable and useful.
   If you are interested in learning contact me here, in e-mail or on my Facebook page, I guarantee that you will not be disappointed. 😉