I began using a temperature-only Fertility Awareness Method about 7 years ago after experiencing a migraine with auras while taking hormonal birth control. I was introduced to the concept of Fertility Awareness a year or so beforehand, but both of those pieces are stories for another time. It wasn’t until a year later that I read Taking Charge of Your Fertility and began tracking my cycle through a sympto-thermal method. Three years later, I began charting with the Justisse Method as I trained to become a Holistic Reproductive Health Practitioner and Fertility Awareness Educator…and that’s when I really began nerding out about the menstrual cycle as our body’s fifth vital sign.
In 2004, the New York Academy of Sciences hosted a forum for a group of leading women’s health experts where they discussed and acknowledged the value of the menstrual cycle as a health tool. They stated that, “The menstrual cycle is a window into the general health and well-being of women, and not just a reproductive event.” Additionally, they discussed the importance of further research to help “determine the impact of menstrual suppression and its potential side effects on future fertility and long-range health” – i.e. the Pill. Eleven years later, the American College of Obstetrics and Gynecology established a committee opinion (academic jargon for "this is what we think as a group of practitioners with lots of social, academic and political power”) stating that, “Identification of abnormal menstrual patterns in adolescence may improve early identification of potential health concerns for adulthood.”
Charting the menstrual cycle is not just a tool for those who want to optimize their health and learn more about their body. It should be used as a valuable diagnostic measure from early on in the reproductive years.
This means that suppressing the menstrual cycle with synthetic hormones for a decade or more, only a few years after beginning one’s period, deprives us of valuable information that can help to identify or prevent health concerns in the future.
I see this day in and day out as a Holistic Reproductive Health Practitioner. When I am working with a client who is learning how to chart their cycles, I am always zooming out to get a bird’s eye view. What is this person’s body telling them? How are they managing stress? Are they consuming foods that are causing a low grade (or acute) inflammatory response? How is their thyroid function? What is their relative hormone balance or ratios? Are they at risk of anemia or have any endometrial dysfunction?
The charts don’t lie and are often full of valuable information.
As I work together with clients I teach them how to observe and gather this data. Then, I take it a step further by helping them understand what the expected parameters of the menstrual cycle are, and how to interpret what they see on their charts. It’s my goal for them to become confident in both observing and interpreting their menstrual cycle…eventually working myself out of a job!
What Charting Unveils…
Blood volume loss
endometrial dysfunction, endocrine dysfunction
Range of days between menstruation + onset of cervical mucus
FSH / HPO axis function
HPO axis / thyroid function
Cervical mucus pattern, characteristics + frequency
HPO axis, progesterone/estrogens, cervical health, inflammation, food sensitivities, cortisol levels, thyroid function
thyroid function, inflammation/ stressors
Luteal Phase range
progesterone function, cortisol balance, thyroid function, evidence of (in)sufficient follicular development
Luteal Phase BBT
progesterone function, cortisol balance, inflammation, food sensitivities
So what are these key elements that provide so much information? The first, and typically easiest to assess, is the volume of blood loss during menstruation. On average, we expect people to lose anywhere from 25-80mL throughout their period. For reference, a fully saturated regular pad or tampon would absorb around 5mL of blood. If someone is bleeding much more or less than this, it may be an indication of an endometrial (the lining of the uterus) or endocrine (hormone) dysfunction.
Next, we look at how many days there are between the end of your period (which should last about 3-7 days) and when you begin to notice cervical mucus. This is called the Follicular Phase. Additionally, we want to know what the characteristics are of that mucus. Yes, I actually want you to look at and touch (!!) that goopy or creamy stuff. Doing so gives us information about the HPO (hypothalamus-pituitary-ovarian) axis function, relative responsiveness of one’s ovaries to FSH (follicle stimulating hormone), cervical health, relative estrogen/progesterone levels, cortisol imbalance, inflammation responses, and food sensitivities.
Next, and most importantly, we want to identify if someone is ovulating regularly. If they are not, this gives us a warning sign that there may be underlying health conditions like hypothyroidism, hypothalamic amenorrhea, or Polycystic Ovary Syndrome.
Simply bleeding every month or so is not enough information to determine whether or not someone is ovulating regularly.
Sometimes our bodies will have anovulatory cycles followed by, what we call, withdrawal bleeds. (This is also what happens each month with hormonal contraceptives) It simply resets the hormonal process, and can sometimes look like a normal period, but it doesn’t come with the health benefits of ovulation. With that being said, if you’re going more than 35 days between periods, that’s also a warning sign that your body may not be ovulating regularly and it requires further testing.
Once we can determine whether or not someone has ovulated, we have a lot more information to work with. We can assess relative progesterone levels, follicular development, cortisol balance, thyroid function, and inflammation and food sensitivities through the number of days between ovulation and your period, the characteristics of any mucus that might be present, and the range of waking basal body temperatures during this second half of the cycle (called the Luteal Phase) - phew!
Before I learned about the Fertility Awareness Method, I had no idea that there was anything to be aware of other than when I got my period. I would have loved to learn about my food sensitivities earlier on, or the way that my body expressed chronic stress (outside of the panic attacks, frustration and exhaustion). Most of the people that I work with have had the same perspective. And almost every single one has come from our sessions together saying, “Why has no one told me this before?!” I don’t have a simple response for that question. In fact, it may be one of my future musings, but let’s leave it at: the f’ing patriarchy.