The menstrual cycle is the correct term for the cycle (usually monthly) in which a woman’s body releases an egg, prepares itself for fertilization of the egg by sperm and creates an environment in the womb in which the fertilized egg could implant and form a developing embryo (baby). If the egg is not fertilized, the lining of the womb is shed from the body in what are commonly known as a woman’s ‘periods’.
Girls start to have their periods (menstruate) around the age of 11-13, usually about 2 years after the breasts first start to develop, and will continue having periods until the menopause, which occurs, on average, at about the age of 51.
The length of the menstrual cycle can vary from a short cycle of only 21 days to a long cycle of 40 days. The length of the cycle is calculated by counting the first day of bleeding as day 1 and then counting until the very last day before the next bleed (period). The length of the menstrual cycle is commonly described as 28 days, although this may be true for only one in 10 women.
• The menses (bleeding or periods): this commonly lasts from day 1 to day 5.
During this phase, if fertilization of the egg hasn’t happened, the lining of the womb or uterus, which is called the endometrium, comes away from the uterus wall and the blood and tissues pass out via the vagina. Most women bleed for between 3 and 5 days. The lining of the endometrium will end up about 1 mm thick at the end of the period. As well as the loss of the endometrial tissue, about 35 to 50 mL of blood is lost from the broken endometrial blood vessels in a typical period. This blood does not usually clot unless bleeding is very heavy.
• The follicular phase: this phase is so-named because it is when the follicles in the ovary grow and form an egg. About 3 to 30 follicles grow. Each follicle contains an egg, but one follicle will overtake the rest and reach the correct stage of maturity.
During the next few days, the lining of the uterus is repaired and builds up to be thicker. This is why this phase is also known as the proliferate phase. This is stimulated by estrogen secreted from the ovaries. The lining of the uterus will now be about 3 mm thick and is also more velvety again.
• Ovulation: A surge of luteinising hormone stimulates the mature follicle in one of the ovaries to release its egg (ovulation). The other follicles over-ripen and break down. Estrogen also peaks during this surge. Some women can feel a pain on one side of the abdomen around the time the egg is released. This is known as ‘mittelschmerz’ – a German word translating as ‘middle pain’. An egg is released from the right or left ovary at random and takes about 5 days to travel down the fallopian tube to the uterus.
• The luteal or secretory phase: This phase follows ovulation and lasts until the menses. After the follicle ruptures as it releases its egg, it closes and forms a corpus luteum. The corpus luteum secretes more and more progesterone, which acts on glands in the endometrium and causes them to make a secretion. The purpose of this secretion is to feed the embryo for a few days until a placenta has formed. Even if the egg is not fertilized and pregnancy has not happened, the secretion is still produced.
The progesterone secreted by the corpus luteum causes the temperature of the body to rise slightly until the start of the next period (see diagram). This rise in temperature can be plotted on a graph and gives an indication of when ovulation has occurred.
If the woman has not become pregnant the corpus luteum starts to break down. This is when progesterone production rapidly drops and the estrogen level decreases. This lack of hormones causes blood vessels in the endometrium to go into spasm and they cut off the blood supply to the top layers of the endometrium. Without oxygen and nutrients from the blood, the endometrial cells begin to die, tissue breaks down and there is bleeding from the damaged blood vessels and so this is how the new menstrual cycle begins.
Possible Ovulation Sensations
This is thought to be caused by swelling of numerous follicles in the ovaries as the eggs race for dominance and ultimate ovulation. It is typically felt as a general abdominal achiness, since both ovaries swell with growing follicles as the woman approaches ovulation.
A sharp pain:
This could be the actual moment that the egg bursts through the ovarian wall and is usually felt on only one side.
This is probably the result of irritation of the abdominal lining caused by leakage of blood or follicular fluid released from the ruptured egg follicle. It could also be due to contractions of the fallopian tubes around ovulation.
Cervical Fluid is the mucus that is secreted from the cervix. It is produced by the hormone estrogen in the first phase of a monthly cycle. Cervical fluid is an essential element to conception due to its ability to keep sperm alive for up to five days (in fertile quality fluid), protects it from the acidity in the vagina and transports the sperm to the outer third wall of the fallopian tube where fertilization takes place.
What Does Cervical Fluid Look Like?
Cervical Fluid will range in abundance, consistency, color and fertile quality due to the increasing level of estrogen within the first phase of your cycle. Typically the changes in fluid will fall into the following pattern.
Dry or Light Moisture - INFERTILE
After menstruation for a period of 3 - 5 days you may experience no fluid at all or a small amount of moisture. Color of any existing fluid is clear or slightly white but will dry immediately on your fingertips. Overall sensation is not wet at this time.
Sticky or Gummy - INFERTILE
Cervical Fluid then changes to feeling sticky for a period of 2 - 3 days. When rubbed between your fingertips it may give a small amount of resistance, feels slightly gummy or may even crumble. The color will range from clear to white and although you may feel a small amount of moisture the fluid is still dry and does not feel wet at this time.
Creamy, Milky, Lotion Like - FERTILE
Cervical fluid now becomes much more abundant and will feel wet from 2 - 4 days. It can appear either thick and creamy or like hand lotion and will form peaks in your fingertips when pulled apart or can be thinner and look milky. Color of the fluid is white or yellow and the overall vaginal sensation is wet.
Eggwhite Cervical Fluid - VERY FERTILE
Cervical fluid now reaches its most fertile stage for 1 - 5 days. The fluid will look and have the consistency of eggwhites. It is slippery to the touch and if pulled between the fingertips will stretch 1 - 10 inches! The color can be clear or iridescent and the overall sensation is extremely wet.
Dry, Moist or Sticky - INFERTILE
Cervical fluid will now change drastically due to the drop in estrogen and the surge of progesterone following ovulation. It can be dry, watery, moist or sticky and will remain in that stage until the end of your monthly cycle - which is the day before your menstrual period begins. Any fluid at all will dry up quickly upon your fingertips, can range from no color to white and your overall vaginal sensation will be dry at this time.
The cervix is at the back of the vagina. If you feel something at the back of your vagina that stops your fingers, then you have found your cervix. If you apply gentle pressure you will notice that it feels smooth, round and firmer that the surrounding vaginal tissues. you are approaching ovulation, your cervix will be high and soft (like your lower lip) and may feel more open. When you are not fertile, your cervix will feel lower, more firm and closed. If you choose to check your cervical position as an indicator of fertility here are some guidelines:
* Position: Your cervical position changes throughout your cycle. It heightens and becomes harder to reach as you approach your most fertile time. It may take a few cycles for you to get to know your own pattern.
* Low: This is the position where it is easiest to feel and reach your cervix. This is when you are least fertile.
* High: When it is hardest to reach (you may not even be able to reach it). It will feel more wet, soft and open. This is when you are most fertile.
* Firmness: Again, the issue is to notice the changes in the texture of your own cervix throughout your cycle. It also may take you a few cycles to notice your own pattern. If you feel bumps that do not seem to be related to your fertility pattern, tell your doctor.
* Firm: At your least fertile time, your cervix will feel similar to the tip of your nose. It will likely be low and easy to reach at this time.
* Soft: At your most fertile time, it will feel soft like your lower lip. It is when you will have eggwhite-like cervical fluid and will feel high and you may be able to notice that it also feels open. It may be hard to reach.
* Openness: Not everyone can tell this one, but you may be able to feel if your cervix feels more open when you are most fertile. Women who have already given birth may notice that their cervix always feels slightly open. Women who have never given birth, may not notice the change at all or may notice that the cervix only opens slightly at their most fertile time. If you can't tell, don't worry about this one.
It is important to use a special Basal Body Temperature thermometer. Take your temperature before getting out of bed at the same time every morning. Temperatures can be taken orally or vaginally but must be taken in the same place throughout the cycle since the temperatures of the different parts may vary.
*First Phase Temps
The first phase (Preovulatory) before ovulation has occurred, temps will normally be between 97.0 to 97.5. Right before ovulation occurs the hormone estrogen is produced causing lower temps. Just remember, your temps can rise and fall multiple times before a dip making it difficult to know when the lowest point will be. It is important to also know that your lowest temperature is most likely NOT your peak day and unless you are charting other indicators you may miss your most fertile time completely.
*Second Phase Temps
In the second phase (Luteal Phase) which begins after ovulation temperatures generally will rise between 97.6 and 98.6. The increased temperatures are due to the hormone progesterone which is released from the corpus luetum - the follicle that hold the egg. The temps will remain high for a period usually 12 to 16 days until they drop again (either the day before or the day of) when your cycle ends and menstrual period begins. If conception occurs temperatures will remain high during the entire pregnancy.
*Third Phase Temps
Many women experience a third phase (Triphasic Phase) which is temperatures climbing to yet another level that is approximately 3/10's - 4/10's over the Luteal Phase high. This is due to the HCG (Human Chorionic Gonadotropin) hormone that is produced if conception has occurred and when implantation takes place.
Detecting ovulation by charting your temperatures can easily be seen after you have ovulated. A dip in temperature followed by a rise (at least 2/10's of a degree) higher than all temps the previous six days and staying at or beyond this level for at least 3 consecutive days shows that ovulation has occurred. Your coverline is usually drawn at this point. Remember - BD has to take place BEFORE you ovulate to enhance your chances for conception. Charting your cervical fluid and position along with your temperatures will give you a much clearer picture as to when you are most likely ovulating and when your peak time is.
*Identifying Anovulatory Cycles
A anovulatory cycle means that no ovulation occurred during that particular cycle. This can be identified by charting your waking temperature. When viewing charted temperatures that appear to have peaks and valleys (many low and high temps) throughout the entire month with no clear separation of a rise in level of temps (rising from first phase / pre-ovulation Phase to second phase / luetal phase) this is a good indication that ovulation did not occur. Many women who are able to conceive may have months that no ovulation takes place.
*Low Estrogen Levels
Estrogen is a hormone that is produced by the follicles that hold an egg. Estrogen plays a large part in the ability to conceive. It is the hormone needed for women to ovulate. It also plays a part as to the amount and quality of cervical mucus which is crucial for the sperm to travel up to the outer third part of the fallopian tubes for conception. An indication of low levels of estrogen would be a nonovulatory cycle along with low amount or poor quality of cervical fluid.
*Low Progesterone Levels
Progesterone is also an important hormone within our cycle. It comes from the corpus luteum. When an egg is released the follicle that held it collapses and becomes a yellowed bodied mass called the corpus luteum. The corpus luteum sticks to the ovarian wall and starts producing progesterone. Its life span is about 12 to 16 days. Progesterone insures that all maturing eggs (15 - 20 within a cycle) are not released, it thickens the uterine lining, and causes the fertile signs - dip and temp, egg white cervical mucus, and high cervical position to return to a non fertile state.
Low Progesterone levels can be indicated by seeing temps close to, on or below coverline after ovulation through the end of a cycle. Even if ovulation was achieved, low progesterone levels make it very difficult to obtain successful conception. Low progesterone levels can be treated by seeking help from an OBGYN. Progesterone shots, pills, and suppositories are some of the ways doctors may prescribe to increase this hormone.
*Indication of Possible Pregnancy
Ovulation day is not necessarily the same day month to month making the first phase of a cycle vary. The luteal phase (second phase after ovulation) usually is the same every month. After ovulation has occurred you can indicate a pregnancy by watching for the passing of your normal luteal phase. For example if you always have 13 days past ovulation (DPO) from when you ovulate to when your period comes and its now 16 DPO, there is a very good chance you are pregnant! 18 DPO with high temps usually guarantee's that you have conceived. Seeing a sustained third phase (triphasic phase) will also put you on the red alert to a possible success!
*Indication of Possible Miscarriage
Miscarriages are heartbreaking and unfortunately not a rare occurrence! An astounding 1 out of 3 pregnancies end in miscarriage. Many early miscarriages happen so early that if not charting, one probably would never know it occurred. Sometimes it happens so early that it could be confused with a late period. Passing your normal luteal phase date combined with a third level of temps only to be followed with a steady decline or sudden drop in temp and bleeding may indicate a miscarriage has occurred. If you suspect you are miscarrying, please contact your doctor.
*Don't Temp Alone!
Your waking body temperature is a great tool to use in fertility awareness. But temp readings are much better served when charted along with cervical fluid and cervical position. Using the three indicators together will give you the best indication of when your most fertile and peak time is which will greatly enhance your chances for conception. When you are most fertile, your cervical position is very high, your cervix gets soft and the slit becomes open. Your cervical fluid becomes abundant, clear and stretchy (consistency of egg whites). In using all three indicators you will be amazed at the information you will gain about your cycle and what your own body can tell you about your own fertility!