MYTHBUSTER - Spontaneous ovulation

The moment when the egg gets released from the ovary

   I have heard it from different people that "Yeah, yeah, this Fertility Awareness Method sounds very good for contraception, but what about when ovulation happens spontaneously and therefore the egg does get fertilized?".
   The fact is that the ripening of the follicle and the releasing of the mature egg is the result of a very long and complex process. When, at the end of the cycle, the progesterone level drops and bleeding begins, in the brain the hypothalamus starts producing GnRH (Gonadotropin Releasing Hormone) that activates the Pituitary gland. The Pituitary gland releases FSH (Follicle Stimulating Hormone) that travels with the blood circulation to the ovaries where it kicks in the process of ripening the follicles and the eggs inside. The follicles produce estrogen that is responsible for the occurring fertility signs (cervical mucus, changes in the position of the cervix) and for building up the uterine lining. 
   There is continuous connection and communication between the ovaries and the brain via hormones. As the estrogen produced by the ripening follicles (and later the dominant follicle only) reaches a certain level in about 1-2 weeks' time, this will give green light to the Pituitary gland to release LH (Luteinizing Hormone). Ovulation happens 12-24 hours after the LH level peaks, we see this exact moment in the picture above. (The light purple in the background on the left is the ovary, the pink is the protrusive ripe follicle and the red is the egg.)
   We have discussed before that whatever has an effect on the brain (grief, travelling etc.) can influence the hormone production, causing ovulation to occur earlier or later than usual, but this does not happen in a minute. The process is so long and so complex that a long awaited meeting with a loved one, a good sex, a huge orgasm, a big fright, an argument etc. will not cause spontaneous ovulation out of the blue. And in case the process has already started, estrogen level is rising, cervical fluid is being produced, it will show up on the cycle chart immediately and those who use the method for contraception avoid unprotected vaginal intercourse in this period anyway, so an accidental spontaneous ovulation (if such thing exists at all) will not cause unplanned pregnancy!

   I hope we have managed to clear any doubts in this topic. The Natural Family Planning Teachers' Association (where I was trained) does not accept the existence of spontaneous ovulation but the theory could be proven or refuted only if we could examine each and every woman's each and every cycle in the world.
   I leave it up to you to decide if you believe in it or not. Nevertheless, the Fertility Awareness Method is a very effective and safe solution for contraception! 😉

The different types of vaginal bleeding

Human blood as seen through microscope

   I believe it is important to discuss the different types of vaginal bleeding because not everything is menstruation!

1. Spotting: As the name shows, this is not a proper flow but few drops of blood that we can find occasionally in the urine, on the toilet paper or in the panties. Generally it has brownish (old blood) or light pink color or it might make the cervical fluid streaky with red. Spotting can occur for 1-2 days around menstruation, it can also be a result of ovulation or the implantation of a fertilized egg. In every other case or if it lasts more than 2 days it is considered abnormal and should be examined. Abnormal spotting can have various reasons, like insufficient progesterone production, cyst, injured cervix, ectopic pregnancy, miscarriage etc.

2. Menstruation: Menstruation occurs when ovulation is not followed by fertilization and therefore the corpus luteum withers, the progesterone level decreases, the thickened uterine lining sheds and exits through the vagina, causing bleeding. The flow usually lasts for 3-5 days, varies between light and heavy, during which we loose about 25-80 ml of blood. If any aspect is out of the ordinary there might be some problem in the background, it is advised to get it looked into (taking contraceptive pill is not a solution!!)

3. Breakthrough bleeding: We are talking about breakthrough bleeding when, for some reason, ovulation does not happen in a cycle and, due to the lack of progesterone to support it, the uterine lining cannot hold itself and sheds, leaving the body with blood flow. Those who do not chart their cycles often mistake it to be menstruation but that is incorrect. Menstruation is always preceded by ovulation! In case of breakthrough bleeding the cycle does not end yet, new cycle starts with true menstruation.

4. Withdrawal bleeding: When taking contraceptive pills, the blood flow in the 4th week is called (hormone-)withdrawal bleeding. As we already know, the pill shuts the system down completely, stops all the natural hormone production and makes the cycle non existent (that the doctors 'forget' to tell us about, otherwise there would not be such a huge market for it), therefore we obviously cannot talk about menstruation in this case. Bleeding occurs because they withdrew the artificial hormones from the 4th week's pills to make the endometrium shed and exit, imitating menstruation and therefore making women believe that they have normal cycles. (The first versions of the pill provided hormones continuously, not causing any blood flow, but this made women doubtful about the efficacy.)
Many people ask about tricks to make the bleeding happen earlier or later to avoid collision with the vacation or the honeymoon etc, but I believe that those who have been following this blog so far can clearly see that there is no natural way to do that. The only solution is the pill, you will bleed when you take the ones without hormone. But let me ask you this: is it really worth it??

5. Postpartum bleeding: This bleeding occurs postpartum, as the name shows, in case of vaginal birth it can last for weeks but it might stop sooner after Cesarean section. Lot of different aspects together determine when fertility will return but we can talk about menstruation only after ovulation starts happening again. 

+1. Vaginal bleeding in case of abortion or miscarriage: I don't think this category requires too much explanation, these events can also cause extensive, heavy blood flow. It is always advised though to ask the doctor how long is normal and when we might start to suspect some underlying problem. In these cases fertility returns quite soon but there might be changes in the cycles compared to the ones preceding the pregnancy: different length, cervical fluid pattern, different symptoms occurring in certain phases.

   I hope you learnt something useful today, ask questions or share comments on the topic, subscribe with your e-mail address and sign up for the course, it's really worth it! 😉

"Thanks, doc but no, thanks!"

   I hope you will find this article very useful and you will be motivated to start charting your cycles and therefore avoid mistreatment.

  
   We start with the fact that the majority of doctors count with 28 days cycle length and ovulation on the 14th day (or in case of long cycles 14 days luteal phase length), they don't know (?) what cervical fluid is and they are not willing to dig deep to find the source of a problem. Now let's see why this attitude might be dangerous and how Fertility Awareness can help us get the proper treatment:

1. "White flow": Probably the most common misapprehension (I, myself have experienced it several times and heard the same from others also) is when you go to the gynecologist in your fertile window and s/he tells you that "Unfortunately you have some white flow" and immediately writes a prescription for fungicide. This can happen either because s/he is not aware of the existence and function of the cervical fluid and thinks it is a sign of vaginal infection; or because s/he assumes that you have no idea whether it is cervical fluid or vaginal discharge caused by infection, so why even ask, it is easier to prescribe the medicine just to be sure.
       What can you do? You can try saying "Yes, I am fertile right now" after the diagnosis, if s/he understands, then good. If s/he ignores what you said and prescribes the fungicide anyway, you can thank her/him politely but not buy the medicine because you know perfectly well that you do not need it.

2. Blood test on the 21st cycle day: This is also based on the theory of 28-14 cycles. Every hormone has an optimal day within the cycle for getting its level checked. Most of them can be examined in the first few days of the cycle which is not an issue because it is very easy to tell when a cycle starts. The problem is when they call you in on the 21st day to check your progesterone. The progesterone level is the highest on the 7th day post ovulation, if conception did not occur then it starts decreasing after that. We already know that ovulation rarely happens exactly on the 14th day, therefore a blood test on the 21st day (14+7) will show an accurate reading just as rarely and a false result can lead to unnecessary hormone treatments.
       What can you do? In a cycle chart the basal body temperature shows when your ovulation happened (just before the shift) so you will be able to tell which day is the 7th after. This way you will be able to get your progesterone level tested on the correct day and you will always get an accurate reading.

3. Determining the time of conception: This is probably the most dangerous mistake someone can make because it does not affect only you but also the embryo growing inside. When your pregnancy test turns positive and you go to the doctor for the first time, s/he asks the first day of your last period. S/he then adds 14 days to it (the assumed time of ovulation and therefore conception) and based on this s/he checks if your baby is growing at an appropriate pace. But what if your ovulation was late for some reason and it happened, say, on the 21st day? Then the doctor says that the embryo is not growing properly and s/he prescribes some medication or suggests abortion, believing that there is something wrong with the baby and it would probably die soon anyway. When in reality there is nothing wrong at all, only conception happened a week later.
       What can you do? If you are charting your cycles properly then, before you start trying for a baby, it is advisable to find out whether your doctor believes you regarding the day of ovulation. If s/he does then it is an easy case, you can just tell her/him during the first examination exactly when the baby was conceived and s/he will calculate accordingly. If s/he doesn't believe you then the simplest thing you can do is to count back 14 days from the ovulation day and say that that is when your last period started. (One of my friends did this, resulting in a worry-free pregnancy.) S/he will not be able to verify your statement anyway but this way at least, because s/he counts with ovulation on the 14th day, the age of the foetus will be calculated accurately. 

4. "You cannot conceive? Take hormones!": Unfortunately this comes from a personal experience, when, after several months of trying, I was still not pregnant and we visited the doctor to find out what to do. The doctor only asked how many months we have been trying and whether I have any unusual symptoms or complaints and then she immediately prescribed hormone treatment. She told me to take it as advised and keep trying, it will solve the problem, the baby will come. Luckily at that time I had already been charting my cycles and could clearly see that there was nothing wrong with my hormones at all, I had proper ovulation each month, so why take medication to fix something that is not broken?
       What can you do? Again I would say you might try to convince your doctor that you know exactly what is going on in your body and when. If s/he doesn't believe you, then you might want to find another doctor. Naturally I did not take any of the prescribed hormones because they were not necessary. (And to prove this, right after that our first baby conceived without any external 'help'.)

5. Progesterone for bleeding during pregnancy: Again personal experience that when our first baby conceived and I had spotting at the end of the 5th week, we called the doctor that something is wrong. Without asking anything she told us to go to the clinic so she can give me progesterone injection, it will solve the problem. I was shocked that she did not even want to try to figure out the cause of the bleeding, no examination at all, only immediate artificial hormone treatment once again. As we found out later, the spotting was caused by the pregnancy being ectopic (the egg implanted in the Fallopian tube instead of the uterus), so injecting progesterone probably would have made the situation even worse. You could read in the previous blog post how dangerous ectopic pregnancies can be and how important early diagnosis is.
       What can you do? In a case like this it is better to visit another doctor who does not treat blindly but examines first. We, instead of her clinic, went to a nearby hospital where they did not mind the time they spent to figure out the cause of the symptom and do the proper treatment, therefore the situation did not end in tragedy. 

   With all this I do not intend to judge or criticize doctors, I respect them, they have enormous professional knowledge, I, myself have already trusted them with my life once. But they are not omniscient, not unerring, they generalize and average because they do not have the time and capacity to pay special, personal attention to each individual which can cause the above seen mistakes and mistreatment. Let's help them (and ourselves!) by dedicating 2 minutes of our time each day to chart our cycles so we can avoid being falsely diagnosed and treated unnecessarily because, after all, we are the 'suffering' party, not the doctors!
   Feel free to share your experiences or ask your questions in the comment section below, and once again, let's take care of ourselves! 😉

What you need to know about ectopic pregnancy

   Even though today's topic does not have the closest connection to Fertility Awareness I think it is important to talk about it because it happens to more people than we would imagine and cycle-charting can help with the early diagnosis. It is the ectopic pregnancy.

   When the fertilized egg implants not into the thickened uterine lining (endometrium) but some place outside the uterus, it is called ectopic pregnancy. Statistically it occurs in 2% of all pregnancies and it can be fatal for the mother therefore early diagnosis is extremely important. Different types are recognized according to the place of implantation.

   Telltale signs could be vaginal spotting or bleeding, abdominal cramps, even fainting. In any case you must contact your doctor immediately! Unfortunately the embryo has no chance for survival but early diagnosis can reduce the damage caused in the mother's body.
   Treatments can vary depending on how forward the pregnancy is and where the egg implanted. It might be possible that the egg moves forward after getting temporarily stuck in the tube (without actually implanting), in this case a regular ultrasound examination can be enough, no need of intervention, but this is rare. In most of the cases it implants there and starts growing. With an early diagnosis, when the wall of the tube is not affected yet, this can be solved by taking medication that makes the egg die and get absorbed, there will not be permanent damage.
   The problem is that the tube is not very flexible, as the embryo grows it can crack. This time it might still be possible to suck the egg out but the remaining wounds increase the chances of another ectopic pregnancy. Another solution is to remove part of the Fallopian tube that contains the embryo which will decrease the chances of getting pregnant again by 50% because that side will never work properly any more. (However, it is still possible that the egg is released from the ovary towards the stomach and the other side's tube picks it up, so the situation is not that hopeless.)
   In the worst case the wall of the Fallopian tube breaks completely, causing internal bleeding in the abdomen. In this case surgery is immediately needed because it can cost the mother's life if not acted upon. Fertilized eggs implanted elsewhere also cause internal bleeding if they do not get removed in time.
   Risk factors that increase the chance of ectopic pregnancy:
       - previous ectopic pregnancy
       - tubal surgery
       - pelvic inflammatory disease
       - smoking
       - advanced maternal age
       - miscarriage
       - abortion
       - history of infertility
       - intrauterine device

   So, once again, an ectopic pregnancy can be fatal for the mother, early diagnosis is extremely important! Cycle-charting helps in realizing pregnancy at an early stage and therefore noticing the occurrence of abnormal symptoms in which case one must visit the doctor as soon as possible!
   Let's take care of ourselves, Ladies!