Fertility Awareness is gaining popularity with teens and single women who want to go off “the Pill.” Among teen prescriptions for the Pill, 17% are for PMS, acne, and dysmenorrhea. It is my hope that naturopathic physicians will become a driving force in teaching Healthy Body knowledge and fertility literacy, thus rendering obsolete the prescription of the oral contraceptive pill (OCP) for menstrual discomfort. As part of my approach to women’s health, I invite my patients to integrate menstrual cycle charting and fertility awareness. Charting one’s cycle helps identify days of both fertility and infertility, which helps couples naturally regulate their fertility. Charting also helps predict hormonal triggers for PMS and seizures, and point to patterns associated with PCOS, endometriosis, and miscarriage.
Naturopathic philosophy blends itself seamlessly with fertility awareness, which appeals to couples that want to naturally regulate family planning without using chemical contraception. As more OCP side effects come to light, patients want information on other ways to balance hormones.
How Does Charting Work?
I teach women how to chart their cycles by making observations as they wipe throughout the day. At night, they record on their Cycle Chart what they feel (sensation); what they see on the toilet paper (observation); and whether the mucus can stretch (“finger test”). The fertile days, or “cervical fluid days,” are days when the woman’s cervix discharges sperm-friendly mucus that is rich in fructose and glucose and which is alkaline in nature. This cervical fluid is biochemically identical to seminal fluid.
The discovery that specific types of cervical fluid correlate to the precise timing of fertility was elucidated by 2 Australian physicians, John and Evelyn Billings. Fertile cervical fluid is produced in response to rising blood estrogen levels. The key factor in determining whether a woman’s cervical fluid is fertile is its sensation. When wiping it off, the sensation is slippery. The last day of this slippery fluid is called the Peak Day and correlates highly with ovulation and the highest blood estrogen levels. The day after the Peak Day, the cervical fluid is no longer slippery, and has much resistance. This sensation is so easily detected that even blind women can determine their fertility.
Day 21 No More
The usual protocol is to order blood work on Day 21 for luteal-phase function. This is based on the assumption that ovulation always occurs on Day 14. When you consider that only 13% of cycles have a Day-14 ovulation, one can appreciate the unreliability of testing on this day.
Using the Peak Day, charting clearly identifies the end of the follicular phase. Post-peak days represent the true luteal phase, based on the woman’s individual physiology. Blood work is done on “Peak Day +7,” not on Day 21.
I like to order post-Peak blood work on Peak +1, +3, +5, +7, +9, and +11. A healthy cycle will have a crescendo-decrescendo pattern in the levels of both progesterone and estrogen.
The next step, after 3 months of charting, is to order an estrogen blood-work series, beginning on the mucus days on Peak -5, -3, and -1, and around the Peak. Again, you want to see a crescendo-decrescendo pattern. A follicular ultrasound series will also use the mucus days as a timing strategy.
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