A doctor answers your fertility questions: Understand your fertility better now

December 14, 2021

A doctor answers your fertility questions: Understand your fertility better now

We asked Dr Alicia Thompson questions about menstrual cycles, fertility, and women's health. Dr. Alicia Thompson is a board-certified obstetrician gynecologist (ob-gyn) practicing in the United States (and Tempdrop Fan). Here she responds: 

I am not currently trying to conceive; why should I be interested in my period and cycle health? 

Woman speaking with her female OB/Gyn discussing women's health

In short, abnormalities in the menstrual cycle can indicate abnormalities in other areas of your health. The menstrual cycle can be viewed as a marker of overall health. Disruptions or abnormalities in the cycle can be early indicators that something is wrong.

Does taking hormonal birth control regulate cycles?

No, hormonal contraceptives (hormonal birth control, or HBC) do not regulate menstrual cycles. 

The menstrual cycle is a complex process to recruit an egg for ovulation and prepare the lining of the uterus for possible implantation of an embryo. HBC, commonly referred to as the pill, turns off the process of ovulation (so does the contraceptive injection, implant, vaginal ring, and patch). 

A normal and regular menstrual period should indicate to women that

  1. ovulation has occurred.
  2. she is not pregnant.
  3. she is beginning the egg recruitment phase of her next cycle.
  4. she shed the menstrual lining and will begin development of the new.

Conversely, the bleeding a woman experiences while on HBC, which is most often caused by simply no longer receiving the hormone, does not indicate those same things. Instead, it simply tells us that if a woman taking a HBC stops it, her uterus will bleed.

How can tracking my cycles be useful if I need to seek the help of a fertility doctor?

Image of a cycle charted in Tempdrop

Keeping track of menstrual cycles can provide very useful information to fertility specialists. Short cycles, long cycles, irregular cycles, abnormal bleeding, and other markers can help guide to the correct diagnosis and treatment options. Furthermore, if a woman has been documenting acts of intercourse consistently in her fertile window, often called “appropriately timed intercourse,” she may be offered earlier diagnosis and testing, for example after 6 months rather than the commonly used 12 month standard.

If I start fertility treatments, should I keep charting my cycles, or will that information not be useful? 

Yes, charting should be continued during fertility treatments if possible. First, it can elucidate if the treatments are manifesting the desired effects. Second, it can help to reveal possible unwanted side effects of the treatments. 

When it comes to hormone testing, are the standard recommended times of CD3 and CD21 going to suit all women? 

Calendar

No, the standard CD3 and CD21 will not suit all women. 

First, some hormone levels are remarkably different at different times of the cycle (learn more about hormones in the follicular phase and luteal phase), so it is important to know where in the cycle the patient is.

Second, CD3 assumes that the bleeding a woman is experiencing is a normal period. Not all bleeding is a period. For women who experience abnormal bleeding, it can be difficult to distinguish what is the true period from what isn’t. Menstrual charting with biomarkers of fertility (cervical mucus production, cervical changes, basal body temperature, urinary hormones, etc.) can help distinguish the actual period from abnormal bleeding events. This will help her know when CD3 actually is.

Third, CD21 is meant to be a test of hormones in the middle of the luteal phase (post-ovulation). While CD21 may be useful for many women, for those with irregular cycles (a very common problem in those with subfertility and infertility) or just longer cycles, CD21 can be done too early or too late in the luteal phase - or miss it all together. Fertility awareness charting can be used to target the labs at the appropriate time.

If I don't see evidence of ovulation in my chart but am now bleeding, does this start a new cycle count? 

This depends on the entire picture of the cycle. Sometimes, especially when learning a new method, it is possible that the signs of fertility have been missed or were not identified with confidence. Some women can bleed or spot at the time of ovulation, which is a common phenomena. For many, the bleeding is not a period and is rather an episode of abnormal uterine bleeding. In general, bleeding that does not follow clear signs of ovulation does not represent the start of a new cycle and should not be counted as such - it should be considered anovulatory. Abnormal bleeding should be annotated in the chart and may warrant an evaluation by a medical professional.

My cycle is extremely long, and I haven't ovulated yet; will taking progesterone restart my cycle? 

For most women, taking progesterone will induce what is called a “progesterone withdrawal bleed” which is similar to the bleeding experienced by women taking HBC. In most circumstances, the bleeding can be charted as the beginning of a new menstrual cycle. However, a significant number of women do not bleed after taking the progesterone. This should be addressed with the medical professional who prescribed the medication.

I don't seem to be producing cervical mucus. Is it important? 

Cervical mucus on a chart in the Tempdrop app

Cervical mucus is very important. The cervical mucus helps to filter out sperm with abnormal shape and motility. The vaginal pH is inhospitable to sperm, so the mucus acts as a nutrient medium that not only protects the sperm, but also capacitates and activates them to facilitate travel through the uterus and tube and to fertilize the egg. 

How can I increase my cervical mucus production?

Drink plenty of water in the fertile window. Avoid antihistamines and decongestants, which can dry-up cervical fluid. A few supplements have shown benefit in limited studies, including B-complex vitamins taken daily; guaifenesin in the fertile window; FertileCM, taken daily. Here is a great article with a list of suggestions. Otherwise, it is important to discuss low mucus with a FABM-knowledgeable healthcare provider as this may indicate an underlying problem that may warrant further investigation.

I use LH test strips, is that enough to confirm that I am ovulating? 

No, LH test strips do not confirm ovulation. If an LH surge is detected, it simply means that the pituitary gland is trying to initiate an ovulation event. However, this does not mean an egg was ready for ovulation. Nor does it indicate a ready egg will be released appropriately. Some conditions, especially PCOS, can be associated with abnormal LH surges.

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Do you have any more questions to ask a doctor about fertility and cycles? Go find us on Instagram!

 

Dr Alicia Thompson, board-certified OB/GynDr. Alicia Thompson, is a Board Certified Obstetrician Gynecologist (FACOG), practicing in the United States of America. Dr. Alicia, has a particular interest in natural family planning and has seen the personal benefits of using Tempdrop.

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