If you’re planning on having kids in the future — be it tomorrow, or five years from now — learning about fertility is an important part of your female health journey. In case you needed reminding, the female body is a masterpiece, and the more we understand our own (phenomenal) bodies, the more we can make decisions that empower us.
Fertility and your menstrual cycle are linked. Which is why, it’s important to understand how our periods work and what they could be telling us.
Understanding your menstrual cycle is empowering whether you are thinking of getting pregnant (or not) or even if you are in a relationship (or not).
When a woman clearly understands her menstrual cycle she:
Is in a great position to use this information to either avoid or achieve a pregnancy
Can accurately predict (to the day) when to expect her period. (Menstrual charting can also be used to confirm pregnancy and more accurately predict a baby’s due date from conception date)
Can link her cycles to other symptoms she might be experiencing (mood swings/increased libido/funny aches and pains/energy levels, migraines) and allow her to plan her weeks accordingly.
Can be alerted to unusual symptoms which may be indicative of a medical condition or increased stress. For example, a woman with heavy, painful periods as a young girl may be given the pill with no further investigation as to the underlying cause. This may essentially mask symptoms of endometriosis and other issues relevant to fertility until she’s ready to conceive. It’s at this point she then uncovers these underlying health issues extending the time it takes for her to conceive. Had she had better knowledge around what to expect from a healthy menstrual cycle, she may well have addressed her health issues a lot earlier.
Has valuable information on her reproductive health that may assist doctors in diagnosing and addressing causes of subfertility as well as other underlying hormonal imbalances in the body
Is not concerned by symptoms that she has come to understand are part of her biological make-up and natural and healthy.
Like any health tracker - there is comfort in monitoring how your body is responding on a day to day level and understanding your menstrual cycle is no different.
Below, we interview Monica Cook, a sexologist and fertility awareness educator about this link. If you would like to know more (which we encourage) click through to Monica’s website.
Interview with Monica Cook
Monica Cook | Sexologist & Fertility Awareness Educator
MScMed(SRH), GDipScCommun, PhB(Sc)(Hons)
Menstrual Cycle 101
Can you tell us how the menstrual cycle works?
The first thing to be aware of is that most women’s menstrual cycles are not 28 days and can vary from person to person. A menstrual cycle starts at the beginning of a bleed (or period) and ends the day before the next cycle begins. It is divided into three phases:
The Pre-Ovulatory Phase - this includes the days during your period (menstruation) and is the number of days it takes before your body moves into the fertile phase.
The Fertile Phase - this is where your body starts to change in preparation for the release of an egg. Oestrogen starts to increase and the maturing follicle prepares to release the egg. When the egg is finally released it survives 12-24 hours before it breaks down and disappears (unless it is fertilised). Even though an egg only survives for a short time, a couples ‘fertile phase’ (time in which a pregnancy is possible) is extended because of how long sperm can survive after ejaculation (see picture below).
The final phase is the Post-Ovulatory phase. If no fertilisation results, the upper lining of the uterus that has been built up ready to receive the embryo starts to break down and you get your period which is the beginning of a new menstrual cycle. On the other hand, if the egg is fertilised, it continues to travel down the fallopian tube and into the uterus to implant in the lining of the uterus (also known as the endometrium) which can take 3-4 days. The embryo continues to grow here.
The menstrual cycle can also be explained through hormonal profiles and various signs and symptoms, but this is a very easy way of initially understanding it.
It is also important to realize that if you’re on a hormonal contraceptive such as the pill, it disrupts the normal pattern of a menstrual cycle suspending it in a ‘post-ovulatory’ phase indefinitely.
Visual Representation of a Menstrual Cycle
Male: A male is fertile all the time
Female: The first few days of a woman’s cycle involves menstruation (represented as 5 days worth of ‘red lines’). At some point the body may release an egg (represented by a blue line) which survives 12-24 hours.
Together: Thankfully a couple does have 12-24 hours in which to have sex to try for conception. As sperm survives for 3 even up to 5 days in the right environment, a couple is fertile for a number of days before ovulation meaning that even if they have had sex before the egg is released, sperm may still be around when the egg is finally released to still fertilise it.
How can you track your cycle?
These days many women use menstrual trackers and phone apps with varying success. The challenge with many of these trackers is that they use an algorithm that is often based on what your menstrual cycle has done in the past. This is great for women who are regular but does not fully account for the variability possible in healthy women or those that do not have regular cycles. This makes using a tracker like this to either avoid/achieve a pregnancy potentially risky or misleading. There are also ovulation kits available such as Clearblue that help to identify your most fertile days by measuring hormone rises related to ovulation.
The simplest (and cheapest) way to track your cycle is to start to understand your body’s own natural signs and symptoms associated with various phases of your menstrual cycle. These signs and symptoms include tracking your basal body temperature, cervical fluid and if you’re particularly keen, you can also learn to feel for your cervical position, Once you become accustomed to reading your body, you will be able to more accurately track your cycle which is especially useful at times where cycles are disrupted such as post-partum or during peri-menopause.
Can you tell us what we should pay attention to with cervical fluid?
Cervical fluid is the one thing I think every woman should be taught at school but isn’t. As a result so many women go through their lives thinking they are abnormal, dirty or have an infection when in actual fact, they are as healthy as can be. Cervical fluid is indicative of which of the three phases (mentioned above) you are in.
During the pre-ovulatory phase, every woman has a basic pattern of cervical fluid which may not be particularly remarkable and the same from day to day. However, as she enters the fertile phase things begin to change. The fluid starts to change in colour, quantity and consistency. Fertile cervical fluid resembles egg-white in that it is clear, stretchy and slippery. This cervical fluid is a crucial part of the conception process as it protects the sperm from the acidic environment of the vagina and assists it in moving toward the egg.
In the post-ovulatory phase the fluid changes again moving away from stretchy and slippery and towards a new (often stickier) quality. The pattern of cervical fluid is unique for each woman which is why it’s so important to be aware of what it looks like for you.
What is the role of hormones in fertility?
Hormones are everything when it comes to fertility. They mobilise the menstrual cycle and impact different parts of the body to do what they need to do to allow all the processes we have discussed above to occur. For example, oestrogen is what impacts the cells of the cervix to begin the production of slippery egg-white like fertile fluid and a cocktail of hormones are responsible for the eventual development and release of the egg itself. They also impact on the lining of the endometrium. Progesterone is another important hormone central to the latter part of the menstrual cycle and required for sustaining a pregnancy. These shifts in hormones are often responsible for secondary symptoms in the body during the menstrual cycle such as bloating, aches and pains, mood swings, sore breasts etc.
What is the effect of different forms of contraception (or what should people consider in choosing a birth control if they do want to have biological kids one day)?
Contraceptives work in various ways to prevent a pregnancy. There are reversible methods of contraception such as barrier methods, hormonal methods and intrauterine devices as well as more permanent forms of contraception such as vasectomy (for men) and tubal ligation (for women).
I strongly suggest to all my clients that they understand exactly how their contraception of choice works, contraindications (any conditions that may prevent them from using it), how to use it correctly and to be aware of possible side effects. There are always advantages and disadvantages to each contraception that are beneficial to consider. They can do this by asking their GP or going online to a reputable website (such as Family Planning NSW) to find out more.
It is also important for people taking hormonal contraceptives (such as the Pill) to realise that it may take some time for menstrual cycles to kick in or contraceptive medications to wear off. For example, women who have used injectable contraceptives tend to experience a delay (which can vary from 3 months up to a year) when it comes to the return of their fertility.
Tips for menstrual cycle, tracking, and wellbeing- what is one thing you want everyone to know?
We tend to emphasise other aspects of our health such as diet and exercise, whilst missing an equally as important element - sexual and reproductive health. Upskilling in this space and taking an interest in what your body is doing on this level can also open up a whole new level of appreciation and foster a healthy body image as you realise that certain processes exist for a reason.
Like anything, menstrual cycle tracking takes motivation and consistency. However, after some time it becomes like any other habit and can easily become part of a person’s routine.
If someone is interested to start planning on getting pregnant what should their first steps be? (diet, vitamins, planned intercourse effect on relationship dynamics).
If you are planning on getting pregnant - here is a brief list of things you may want to consider:
1. Preconception check-up with an experienced GP. This often involves a brief look at your medical history, mental health, current health, medications/supplements that you should or should cease taking (and how long you may need to wait before these medications are no longer present in the body) as well as immunisation status. You may also want to get a Cervical Screening Test at the same time if you’re due for one in the next year.
2. Optimize health - you may want to have a close look at your diet (increasing wholegrains, fruit and vegetables and reducing inflammatory foods such as sugar or processed foods), body mass index and exercise habits (all of which can impact on fertility) as well as consider giving up or minimizing smoking, alcohol or recreational drugs.
3. Your GP will most likely recommend a pre-natal multivitamin at least a month before you start trying to conceive to ensure levels of folate are sufficient for healthy neural tube formation.
4. Start getting a sense of when they are fertile in their cycle by monitoring cervical fluid
5. Be prepared that it may take up to 7 months to conceive and that this is a normal amount of time to wait and try. If you have been having sex at the fertile time for more than 12 months and are still not pregnant it is best to see your GP. If you are in your mid to late 30’s I would suggest seeing someone earlier.
6. Plan plenty of intimacy time together with your partner that isn’t intercourse oriented. So many couples fall into the trap of shifting their focus from sex-for-enjoyment to sex-on-a-mission which can lead to anxiety and sexual dysfunction in the long-run.
Further Resources:
Books- Taking Charge of Your Fertility, by Toni Weschler
Apps- (ovulation trackers) Kindara
Websites- airrm.org.au, nfs.org.au, modernfertility.com, naturalwomanhood.org, factsaboutfertility.org
Scientific studies-
Duante, M Contreras A, Jensen ET, White, A (2016) The Performance of Fertility Awareness-based Method Apps Marketed to Avoid Pregnancy, Journal of the American Board of Family Medicine, 29 (4) 508-511
Frank-Herrmann P, Heil J, Gnoth C, et al. The effectiveness of a fertility awareness method to avoid pregnancy in relation to a couple’s sexual behaviour during the fertile time: a prospective longitudinal study. Hum Reprod. 2007; 22:1310–9. [PubMed: 17314078
Thikssen A, Meier A, Panis K, Obmelet W (2014) Fertility Awareness Based Methods and subfertility: a systematic review. Facts, Views and Visions in Obstetrics and Gynaecology, 6 113-123