Taking Charge of Your Fertility

July 13, 2011
OBGYN.net Staff

This is the title of an excellent book by Toni Weschler, MPH, and is the perfect resource for the subject of this column. I feel every teen and young woman should receive this book once she starts having menstrual periods.

Taking charge of your Fertility

This is the title of an excellent book by Toni Weschler, MPH, and is the perfect resource for the subject of this column. I feel every teen and young woman should receive this book once she starts having menstrual periods. There are also many other resources available for teens and women, and links will be provided at the end of this article. Among the list are some great charts and articles that explain this issue in greater detail.

Where do we learn about menstrual cycles and fertility? Back when I was a pre-teen, we had special classes about "the starting of your menstrual cycle.' This was very basic, just the facts. Schools also started to offer "Sex Ed" classes. In the 50's these were a joke. The teacher was very uncomfortable discussing the topics, and of course the students gave her a bad time. Perhaps you can tell me what your classes are like.

So many times in high school sex education classes, students are given just the basics. This is partly because the topics are uncomfortable for the teachers to discuss, and partly because some parents do not feel this education should occur in schools. I do not share either of these views. I feel the more information available to all of us the more we can choose a healthier path for our lives. If women truly understood how their body works, and the changes that occur, this would lead to better decision making about sexual activity, birth control, and planning a pregnancy.

Here are some guidelines for you:

Learn about the hormones that control your menstrual cycles.
Learn about the hormones that affect how you feel before and during your period.
Learn about the signs of ovulation.
Learn about what is normal and what is abnormal in regards to menstrual cycles.
Learn how to prevent or achieve pregnancy using the signs of ovulation as a guide
Find a practitioner with whom you can talk and share your concerns. Look for classes or courses in your area that might provide you with more information.
Learn about the Hormones that control your Menstrual Cycle

This may seem a bit technical at first, but and I am just going to introduce the topic. Science is learning more and more about the hormones and interactions of hormones, but some of the basics have been established.

I. The four major hormones involved with ovulation are:

Follicle Stimulating Hormone (FSH)
Estrogen (E)
Luteinizing Hormone (LH surge)
Progesterone (P)


If any of these hormones are out of balance, then women usually notice other changes. For example, If ovulation doesn't occur, the levels of progesterone usually are lower. If estrogen levels are very high, sometimes women don't ovulate. Sometimes the LH levels are inadequate. The 'normal' menstrual cycle is based upon how these hormones interact, either in harmony or balance, or out of harmony or out of balance.

Each hormone has specific function, and you can find more information about these functions throughout the resources below at the close of this article. The more you understand these functions and the effect they have upon you, the more you will understand why you feel the way you do, how you are feeling, and what happens when one or the other of these hormones is in lesser or greater supply. These hormones will affect you all of your life, from your very first menstrual period until well into menopause. Many birth control methods are based on how these hormones work. Synthetic hormones have been created to mimic your natural hormones.

Additional Glands and hormones that play a role in your menstrual cycles are the Pituitary Gland and the Hypothalamus.

"Stress can affect hormonal secretions, but this is difficult to assess. Stress seems to affect ovulation. The most common cause of delayed ovulation is both physiological and psychological stress. This is because stress can dramatically affect the functioning of the hypothalamus, that gland in the brain responsible for so much of the reproductive system. It is the hypothalamus that is responsible for the regulation of appetite, temperature, and most important, emotions. It also regulates the pituitary gland, which in return is responsible for the release of FSH and LH. When stress affects the hypothalamus, the end result can be a delayed emission of these reproductive hormones, which are necessary for the release of a mature ovum."(p162, Taking Charge of Your Fertility)

II. Learn about the hormones that affect how you feel before and during your period.

These are some of the effects of the two major hormones involved in your menstrual cycle. See if any of these signs and feelings are familiar to you:

Estrogen: (has about 300 known functions). Some of the most important are:

Rise before puberty causing the changes we see in adolescents. (growth of breasts, pubic hair, and changes associated with womanhood. Stimulates breast tissue.
Levels vary throughout the cycle.
Promote and help thicken the uterine lining.
For successful ovulation, estrogen levels need to be at a consistent level for a period of time.
Regulates sleep centers
Improves pain tolerance
Helps to soften the skin

Higher or lower levels seem to be related to food cravings, breast tenderness, and moodiness. This is difficult to assess as there are many other hormones such as progesterone and prostiglandins that impact the menstrual cycles.

Progesterone:

Prevents the release of all other eggs in that cycle
Causes the uterine lining (endometrium) to thicken and sustain itself until the corpus luteum disintegrates 12 to 16 days later.
Causes the three primary fertility signs to change. These signs are: waking temperature, cervical fluid, and cervical position. (p 47: Taking Charge of Your Fertility by Toni Weschler.

These hormones also impact you if you were pregnant. They have very specific functions for maintaining a pregnancy. That is a topic for another column.

III. Learn about the signs of ovulation.

Start tracking your menstrual cycles as you read and learn about what is a normal cycle for you, and what are variations from normal. The more observant you are the clearer this all will be for you. The following are the primary and secondary signs that ovulation is about to happen, or happening.

A. Primary Signs of Fertility:Waking (Basal Body) Temperature: this is a graphic and objective sign to facilitate charting of your ovulation. "A woman's preovulatory waking temperature typically range from 97.0 to 97.5 degrees Fahrenheit, with postovulatory temperatures rising to about 97.6 to 98.6 degrees. After ovulation they will stay elevated until her next period, about 12 to 16 days later. If she were to become pregnant, they would remain high throughout her pregnancy. Temperatures typically rise within a day or so after ovulation, and are the result of the heat0inducing hormone progesterone….the key…is to look for a pattern of lows and highs…see the whole. (p 53)

Cervical Fluid: this is what seminal fluid is in a man. On fertile days the mucus becomes very stringy, somewhat like egg white. This improves the transport of sperm through the cervix and into the uterus. At other times not during menstruation, or while on the birth control pill, the consistency of any discharge is much thinner and less sticky.

Cervical Position: Around ovulation the cervix becomes soft, high, open and wet. At the other times of the month the cervix is firm, low, closed and nonwet.

B. Secondary Fertility Signs:

Midcycle spotting: Mild to intense Pain or achiness near the ovaries (Mittelschmerz) and appears to be related to the swelling of the ovarian follicles, release of the egg and irritation of the abdominal lining caused by the leaking of blood or follicular fluid from the ruptured egg follicle.Increased sexual feelingsFuller vaginal lipsAbdominal bloatingWater retentionIncreased energy levelHeightened sense of vision, smell, and tasteIncreased sensitivity in breasts and skinBreast tenderness


Not all of these signs are experienced by every woman every month. Some women never experience many of these things. In my experience as women become more aware of these signs they notice them. Following a pregnancy sometimes women notice these signs either more specifically or sometimes less specifically. This is why Charting your menstrual cycles can be very challenging--Things seem to change frequently.

Not experiencing some of these signs does not mean there is anything wrong. However by charting the presence (or absence) of these signs will help you and your partner track your cycles, and if the signs are totally absent, you have some visual facts to discuss with your provider. I you are on the Birth Control Pill, or have had the Depo-Provera shot, you might not experience some of these signs, as these two methods of birth control change your hormonal balance. For example, you will not experience the mid-cycle pain as you will not be ovulation. And, the cervical mucus will be different because of the changes in hormonal stimulation.

Technology is providing us with Ovulation Kits which simply provide additional information for you. Learning these basics is key for understanding your menstrual cycles.

Source: Chapter 5: Taking Charge of Your Fertility by Toni Weschler.

You will find many more details about these chances and signs in this book. This article is intended to provide you with an introduction to the signs. The following three areas are what you can do with this information once you begin collecting your data. As you can see you can evaluate the many phases of your life using these basic signs. This book also has some excellent charts you can copy and use for reference. As fertility awareness becomes an understood topic, you will see more and more aids to assist you. I've seen some great charts and fertility booklets. Childbirth Graphics makes a handy item called a "Conceptidater: A Personal Record for Pregnancy Planning"

IV. Learn about what is normal and what is abnormal in regards to menstrual cycles.V. Learn how to prevent or achieve pregnancy using the signs of ovulation as a guide

Find a practitioner with whom you can talk and share your concerns. Look for classes or courses in your area that might provide you with more information.