When I first got my period at age of 14, I did not have a clue how much information our menstrual cycle can tell us. I only knew that this is a natural process for girls and has something to do with our fertility. My period was always painful and crampy that I felt it is more a curse than a blessing. I visited my gynecologist to find a “solution” for my painful period, and this is when I was prescribed birth control pill (Yasminelle). Obviously, side effects of the pill came right away – migraines, moodiness, being wired, losing sex drive etc. – but it made my period painless and smooth like never before.

If I knew then what I know now, I would have made a different life choice and would have never started on birth control pill and stayed on it for 12 years. Birth control pill is a medicine full of synthetic hormones which are completely unidentical to our body. The birth control pill industry created a false narrative about menstrual cycles that made women believe ovulation is not necessary to overall health, unless you want to make a baby. Anything that suppresses ovulation also suppresses metabolism. In 2019, American Cancer Society included combination birth control pill as a known human carcinogen. It is scary, right? Then, why take the chance of developing annoying symptoms or even cancer, if women have a better choice?

Understanding and tracking your menstrual cycle is the way forward in making empowered decisions and leveraging all the information our body is telling us. Tracking my cycle taught me how my hormonal blueprint appears in my life from month to month – food preferences, level of sex drive, mood, activity preferences (yoga vs weight lifting), productivity, sharpness, creativity, or sleep – that using this pattern allowed much more predictability in my everyday life. Cycle self-awareness is the foundational step in learning to listen to our body and how it is doing.

Your sixth vital sign

Your menstrual cycle is a vital sign, just like your body temperature, pain, pulse/heart rate, respiration rate and blood pressure. As your sixth vital sign, menstrual cycle is a monthly reflection of overall health. It tells you about whether you are ovulating or when you are ovulating, and it determines the relationship between your symptoms and hormones. It can help you to know when the best time is to conceive or avoid pregnancy depending on your family planning goals. It also gives you a clear picture on whether you are entering peri-menopause or menopause phase of your life. It guides you through your cycle giving you clues of when you can expect your bleeding. A healthy menstrual cycle is a reflection of healthy and balanced hormones. Health does not exist without happy hormones. For example, if you are not ovulating, then your ovaries do not produce progesterone leading to infertility, PCOS, moodiness, early menopause and so on.

Tracking your own cycle can empower you by providing deeply personal information on your health. Every women has a different cycle rhythm, so tracking yours is the way to learn what is your unique cycle rhythm. If you have an irregular cycle, it can help you to get a better understanding of what is going on.

Facts to know

Before we deep dive into the methods of fertility awareness, I find it important to lay down some factual foundation about ovulation and fertility. Skip this part if you already know them.

• You only ovulate one egg each month and it lives for about 24 hours.
• Day 1 is the first day of your period, when you get a full bleed, not just spotting. The average menstrual cycle is 28-30 days, and ovulation happens around day 14 due to LH surge (luteinizing hormone).
• Women are born with 1-2 million eggs but release only 300-400 eggs during their lifetime. One at a time during each ovulation. When the egg is released it travels through the fallopian tube and reaches the uterus where it can be fertilized by the sperm. If the egg is not fertilized then it dissolves.
• Sperm can live up to 5 days in the vagina depending on the conditions such as pH, cervical mucus, and the quality of the sperm.
• Your fertility window is the 5 days leading up to and including ovulation. This is when you can try to conceive or avoid pregnancy.

Fertility Awareness aka tracking your cycle

Fertility Awareness method often called natural family planning which describes it all. FAM is a natural, non-hormonal, non-invasive method to track and understand your cycle. It involves monitoring and recording different fertility signals during the whole menstrual cycle to determine when the chance of pregnancy is high.

There are three methods involved in tracking your menstrual cycle, all are part of Fertility Awareness Method. They can be used either individually or together – while you are still familiarizing yourself with this new process, it is best to use all three methods. Later with some practice and experience you can use only two out of three.

Lets dive into the magical wonderful world of your menstrual cycles.

Method 1: Menstrual Cycle Charting

Some call this method as Calendar rhythm method or simply Calendar method. Basically, you document when you are getting your period (day 1) and how long it lasts. You are also suggested to record your symptoms and how you feel emotionally and physically throughout the cycle. Your chart starts on day 1 when you get your period and extends to the last day before your next period begins.

What signs to pay attention to and record on the chart?

• First, you document the first day of your period and its lengths (up to 7 days) on the chart/calendar.
• Then, each day, you check for emotional signs: mood, energy, creativity, socializing, relationships, self-esteem, ambition, mood to dress up, emotional shifts.
• After, each day, you record the physical signs: bloating, breast tenderness, fatigue, food cravings, migraines, sleep quality, sex drive, exercise/movement (type), blood clots, cramps, blood color, pain, cervical mucus, blood flow (heavy, mild, light), pelvic pain, basal body temperature.

Method 2: Tracking your Basal Body Temperature (BBT)

I have been tracking my basal body temperature every day for years (except on holidays), because not only it gives a clue when you ovulate and will have your period, but it also a great indicator of how your metabolism is doing (especially thyroid). Your temperature fluctuates during your menstrual cycle, and it is beautifully visible on the chart/calendar. In general, if your metabolism is strong and healthy, then your BBT will be in a range from 36.5 °C to 36.8 °C. Considering those natural monthly fluctuations, this range will be a little bit broader. Here is why.

Before ovulation (follicular phase), your estrogen level continually increases to support the maturing process of the egg (follicle). High level of estrogen triggers an LH surge (luteinizing hormone) leading to your ovary to release an egg and this is called ovulation. During this short period of time, your BBT drops (36.1-36.4°C). The egg moves up through the fallopian tube and waiting to be fertilized. This egg lives only 24 hours after egg release. After ovulation (luteal phase), your BBT will increase, and progesterone will become the dominant hormone. Progesterone is produced by the egg sac left after the release of the egg. This egg sac alias corpus luteum is a temporary endocrine organ producing plenty of progesterone, and little bit of estrogen. The body temperature tends to go up as high as 36.8 – 37 °C and stays up for about 10-14 days during the luteal phase.

When and how to track BBT?

• To record your BBT, you only need a thermometer that record two decimal points like 36.65°C. It is cheap and easily available at any pharmacy.
• First thing in the morning, you need to take your temperature while you are still in bed and have not moved/eat/drink. Your temperature is very sensitive to any of these, and it influences the accuracy of the collected data.
• Place your thermometer next to your bed or on your phone to remember.
• If your BBT does not go up during luteal phase, then it is a sign of non-ovulatory menstrual cycle. It is a great starting point to have your hormones checked (full thyroid panel).

Method 3: Tracking your Cervical Mucus

After recording your menstrual cycle and basal body temperature, you can also track your cervical mucus aka cervical fluid. Cervical fluid is a very reliable indicator of ovulation and fertility. It is produced by your cervix, and it changes in color, texture and amount throughout the whole menstrual cycle.

• Follicular phase: During and right after your period, you barely produce any fluid, and mostly unnoticeable. Then as we move toward ovulation, our estrogen level increases which prepares your body for ovulation. Your cervix starts to produce mucus, which is thick, creamy and yellowing in color. Not stretchy or elastic at all.
• Ovulation: During ovulation, you will notice an egg white kind of discharge, and it will be plentiful, stretchy and clear. This is a peak fertile mucus and the best time for conception.
• Luteal phase: After ovulation, your corpus luteum start to produce progesterone. Your cervical fluid will get thicker and dryer in order to plug the cervix and create a barrier for closing the sperm out. It indicates a low level of fertility.

There are several ways to check your cervical mucus and get a clearer picture of your cycle and fertility. If you have missing periods or irregular cycle, it is a great way to sense changes and make a better prediction of your next period. This method requires you to evaluate cervical secretion in one of the following ways:

• Check, then record the color and texture of the discharge on your underwear each day.
• Wipe the opening of your vagina with a piece of toilet paper and check the color and texture of the mucus. Touch it with your finger.
• To go even further, you can insert your index finger into your vagina and feel the texture and check the color.

Whatever you choose, you will have a great deal of information on your status of cervical mucus. These three methods described above will give you a full picture on your fertility and overall health. It definitely takes some practice, so I suggest to take 3 months to learn, gain insight, and tune into your body, while still using condoms.

An optional method: Position of your Cervix

It is an additional, but warmly recommended method to get to know your cycle even better. Close to and during ovulation, when estrogen is the dominant hormone, your cervix is higher in the vaginal canal, softer to touch and its opening is wider. A cervix that is high, open, and soft indicates fertility. After ovulation, when progesterone is produced and takes over, your cervix sits lower in your vagina, firmer to touch and its opening is more closed. This is an accurate sign of non-fertile period.

How effective is the FAM?

This method if followed correctly, it is 99% effective to either avoid pregnancy or get pregnant depending on want you desire. It takes commitment and practice to excel at getting the most out of this method. Most importantly, both partners have to be on board when you choose this method. It is suggested to use condoms during fertility days to avoid unwanted pregnancy. Also, you have to know that it does not protect you from the transmission of STDs (Sexually Transmitted Diseases).

Can I use Fertility Tracker App?

I understand if you feel overwhelmed by all of this information, and you have to know that it takes a few cycles to gain experience and feel confident. While you are learning about your cycle, you might use Fertility tracker app, which was created based on the FAM method. It is easy to use and effective, but in my opinion it does not replace the traditional self-checking method. In other words, I would not solely rely on this technology, even if it has been proven to be as effective as 99.3%.

There are over 100 apps on the market claiming to be effective in tracking fertility, but only a handful delivers their promises and can be trusted. The two most popular fertility monitors on the market are Daysy and Natural Cycles.

They both are non-hormonal and non-invasive solutions for managing your fertility and cycles in general. They have a little computer built in which contains millions of data on women’s cycles. The technology works by gathering, then comparing your personal data with the database. After a few months of use, the computer will have enough data on your menstrual cycle rhythm that it can start to compare your new cycle with previous ones. The app predicts your fertility window and ovulation using green/red/yellow/purple color signals. Each color indicates what to expect on that day. These technologies use only the BBT method, which is then applied as the basis of prediction/calculation.

Take away

At the beginning of your journey, I recommend to use all three methods to really get to know your cycles and gain confidence. After a few months, maybe a year, you will realize that it is so natural to tune in your body and you might feel to rely only on two methods out of the three. Personally, I use basal body temperature and cervical mucus methods daily to check my fertility state. If your goal is not to get pregnant then during your fertile window use another safe contraception like condom.

References

Lisa Hendrickson, 2019, The Fifth Vital Sign: Master your cycles and optimize your fertility, page 79-156.

Lara Briden, 2015, Period Repair Manual: Natural Treatment for better hormones and better periods, page 45-99.

Dr Jolene Brighten, 2019, Beyond the pill: a 30-day program to balance your hormones, reclaim your body and reverse the dangerous side effects of the birth control pill, Part III – Take back your body.

Dr Aviva Room, 2021, Hormone Intelligence: The complete guide to calming hormone chaos and restoring your body’s natural blueprint of wellbeing.

Sarah J., Lorrae M., Michael Z. Can apps and calendar methods predict ovulation with accuracy?, 2018, PMID: 29749274