How Do I Track My Cycle For Pregnancy Or Contraception?

Variations in your cycle actually tells you a lot about your overall health. I therefore encourage everyone recovered from Hypothalamic Amenorrhea to track their cycle. So how do I track my cycle you ask yourself. In this post I walk you through the basics around the menstrual cycle and the hormones involved. You will also learn how to track your cycle, either for contraception or for pregnancy.

Your cycle has four phases

It is a bit misleading that the cycle always is illustrated as 28 days. The length of the menstrual cycle varies from woman to woman and from cycle to cycle but everything from 23 to 35 days is considered normal. The follicular phase varies the most in length. If we see that this phase is growing longer (>23 days), if we have anovulatory cycles and/or that the luteal phase is getting shorter (<11 days), it is a warning sign that something is not quite right. If you see this it might be advisable to reflect, slow down, eat more or exercise less. You can always reach out to me, then we can have a look together.

In/after Hypothalamic Amenorrhea recovery, it is common that the first cycles are outside of the "normal" range or anovulatory. The most important thing is that the trend is positive, by that we get confirmed that we are on the right track.

Menstruation

What: Your cycle starts with menstruation on day 0. During menstruation, blood from the previous cycle from inside the uterus is shed through the cervix and vagina. The uterine lining (the endometrium) is thinnest during this phase.

Duration: A typical period lasts about five or six days but may last up to eight days.

Hormones: Levels of estrogen and progesterone are typically at their lowest in this phase. This causes the top layers of the uterus lining to release and leave the body.

Follicular phase

What: The follicular phase starts on the first day of your period and lasts until ovulation. Throughout the menstrual cycle, there are multiple follicles (fluid filled sacs containing eggs) at different stages of development in both ovaries. One follicle in one of the ovaries becomes the largest of all the follicles. It is called the dominant follicle and is about 1-2 cm in size. This follicle is the one prepared to be released at ovulation. In addition to maturation of the egg, our uterus lining thickens in preparation for pregnancy during this phase (so a potential fertilized egg can implant and grow).

Duration: The follicular phase lasts about 10-22 days, it will vary from cycle-to-cycle.

Hormones: The pituitary gland (a small area at the base of the brain that makes hormones) produces Follicle Stimulating Hormone (FSH). FSH tells the ovaries to prepare an egg for ovulation. The dominant follicle produces estrogen as it grows, which peaks just before ovulation happens. This signals the uterine lining to grow.

Ovulation

What: Now the dominant follicle reaches about 2 cm. When it bursts an egg leaves the ovary and enters the fallopian tube towards your uterus. This occurs about 13 to 15 days before the start of the next period. Once the egg is released, it will survive up to 24 hours. If sperm reaches the egg during this time, you may get pregnant. Since sperm can survive for about five days under the right conditions, it is possible to get pregnant in the five days before ovulation and on the day of ovulation.

Duration: Ovulation can last from 16 to 32 hours.

Hormones: The dominant follicle in the ovary produces more and more estrogen as it grows larger. The high levels of estrogen is detected by the hypothalamus. As a response, the hypothalamus sends very frequent pulses of GnRH, which tells the pituitary gland to dramatic increase the production of Luteinizing Hormone (LH). This spike is what causes the release of the egg. Estrogen levels drop right after ovulation.

Luteal phase

What: The Luteal phase lasts from ovulation until the start of the next period. After ovulation, the follicle that held the egg turns into something called a corpus luteum. It makes the hormones progesterone and estrogen to support pregnancy. If pregnancy does not happen, the corpus luteum breaks down between 9 and 11 days after ovulation and after that the uterus lining sheds and the period begins again. Hence we ideally want this phase to last > 10 days. If not, it is difficult for a fertilized egg to implant in the uterus. If you do become pregnant after ovulation, a short luteal phase may result in an early miscarriage.

Duration: Ideally it should last 12-14 days, but between 9 and 16 days may occur.

Hormones: Progesterone rises. This causes the uterine lining to stop thickening and prepare for a fertilized egg. If no pregnancy happens, progesterone will peak and then drop. A drop in progesterone and estrogen causes menstruation, and and the cycle starts over. If too little progesterone is secreted, the uterine lining doesn't properly develop. This is demonstrated by a short luteal phase.

How to track your cycle

As I mentioned at the beginning of this post, cycle tracking is not only helpful for pregnancy or contraception, it also provides valuable information about your overall health. How awesome isn't that? Every month you get confirmed black on white if you are on the right track.

There are thousands of tools that help you document your tracking. I am personally a fan of FertilityFriend, but you go with the provider you like the most. You can also go old-school and track your cycle with pen and paper if you prefer.

I recommend you to use the Cervical Mucus (CM) method to predict your ovulation, your Basal Body Temperature (BBT) to confirm it. In addition, you can use ovulation test stripes alongside with BBT and CM to give you more assurance, but it is not necessary.

Cervical mucus can predict ovulation

The hormones that control your menstrual cycle also make your cervix produce mucus (the discharge that comes out of your vagina). Your cervical mucus changes in color, texture, and amount during your cycle. This can be used to predict ovulation. The different phases of mucus that you typically will observe throughout the cycle are:

• Dry days or tacky, white or yellow-tinged mucus This is seen the first few days after your period ends. These days are non-fertile days.

• Sticky, slightly damp and white mucus After the dry phase your mucus will get more sticky (you can role bolls out of it). These days are non-fertile days.

• Creamy, wet and cloudy, yogurt-like mucus While the body is getting closer to ovulation, the mucus gets more creamy; it reminds a bit of yogurt. These days are semi-fertile days.

• Slippery and very wet, stretchy, raw egg white-like mucus Right before and during ovulation you have the most mucus. It’s clear and it feels slippery, quite similar to raw egg whites - hence Egg White Cervical Mucus (EWCM). This mucus can easily be stretched between your fingers. These “slippery days” are your fertile (or unsafe) days, when you’re the most likely to get pregnant. These days last about 4 days, leading up to (and including) ovulation.

• Dry days until menstruation occurs After ovulation you will have less mucus, and it’ll get cloudy and sticky again. Eventually it will dry out until you get your period again. These days are non-fertile days.

The EWCM seen when approaching and during ovulation plays a crucial role in fertility. The EWCM acts as lube, guiding the sperm up from the vaginal canal and cervix into the uterus. Within the EWCM, sperm can survive for up to 5 days due to its texture and pH, which are protective for sperm. Thus, it is possible to get pregnant in the five days before ovulation and on the day of ovulation. These are the days to have intercourse if you try to conceive, or to use protection if you don't want to get pregnant. Getting pregnant after ovulation is limited to the 12-24 hours after your egg has been released. This is because the egg can only live for 24 hours.

To track your cervical mucus there are a few things to pay attention to:

• Use toilet paper, wipe the opening of your vagina before peeing and check the color and texture of the cervical mucus on the paper

• Be aware of the color and texture of the cervical mucus on your underwear

• Having a bowel movement will also move some of the cervical discharge down, so it might be easiest to check after having a bowel movement.

But how do I track my cycle if I have Hypothalamic Amenorrhea? If we start observing mucus in HA recovery, it is a great sign we are on the right track! Sometimes clients see patches of EWCM that then dries up (without ovulation) and come back again about 14 days later. As if your body needs a few attempts before really following through with ovulation.

Basal Body Temperature (BBT) can confirm ovulation

Your Basal Body Temperature (BBT) is the temperature of your body when you’re completely at rest. As you can see in the chart on the top of this page, your BBT will shift upon ovulation. This is due to the rise in progesterone happening in the luteal phase. This means, if we can detect this shift, we can confirm that ovulation did occur. Prior to ovulation the temperatures will vary in a lower range, post ovulation they will vary in a higher range. Usually the temperatures post ovulation will be around 0.2-0.5°C higher. A good rule of thump is that once we see thee consecutive temperatures that are higher than the previous six we can be confident ovulation took place.

To track your BBT there are a few things to pay attention to:

• You need a special two-digit thermometer

• Take the temperature first thing you do in the morning after waking up (before you get out of bed)

• You should measure the temperature on the same time every day

• Ideally you should measure the temperature after > three hours of consecutive sleep

• I recommend you to have the thermometer in your mouth for a few minutes before turning it on - in my experience this will give more accurate results

There are a few things that might give false values (alcohol, sickness, moving prior to measuring, not enough sleep, ...) but don't stress too much about this. Your temperature will vary and there will be outliers, but we are looking at the overall trend.

In Hypothalamic Amenorrhea recovery, it is a good sign if we see an increase in your BBT. This signals that your body is ramping up its metabolism, a really good sign that we are getting closer to having a period again.

Ovulation test strips

Ovulation test stripes works by detecting Luteinizing Hormone (LH) in your urine. This surge typically happens 24 to 48 hours before ovulation. But as explained above, your fertile window is longer than that (as soon as you start observing EWCM you are fertile). So if you would rely solely on the test stripes, you would miss up to four days of fertility. In addition, these test stripes can be quite pricey. You could also have an LH surge, but still not ovulate (in Hypothalamic Amenorrhea Recovery, this is not uncommon). My advice would therefore be to only use this method alongside with the other two. You don't have to test the whole cycle, it is enough to start testing once you observe EWCM and stop once ovulation has been confirmed.

There are more tools out there that might help you with your cycle tracking (position of cervix, measuring of CO2 in exhalation, ....). You need to find an approach that fits your taste. For all during HA Recovery, your charts might be far from the classical text book example. Feel free to reach out to me for help with interpretation of charts and/or actions on how to improve your cycle.