Tuesday, March 10, 2015

Frequently Asked Questions on a Womans Cycle

I have put together a FAQ for reference, as these are the most common questions I get asked from time to time about a Woman's cycle.

When does the cycle start is it still during my period? CD1 and where it all begins is the first full day of your period. Don’t count it until it is in full flow for you. This means there should be enough blood to require sanitary protection.

What's the process of ovulation? Fertility is a complicated process and hopefully I will help you to understand the importance of each and every hormones to help you in order for you to successfully conceive, and sustain the pregnancy. It is possible that at this stage you have been for some blood tests at your doctors. For those of you who are effectively in the ‘dark’ about the fertility; It all starts with sex hormones. Hormones are complicated. I’m amazed on a daily basis how these wonderful substances manage to build up and then pass on the mantle so to speak to the next phase. As such, I see it in women as a relay race to the finish. Different hormones will come into the race when each in turn reaches a certain point. In some women when their fertility is less than optimum they will have weaker runners at different stages, but ultimately the race will always run. The organiser is always the main organ the hypothalamus and his second in command is the coach – the  pituitary gland, who ultimately grooms the hormones to ensure they are ready and brings on new runners at different stages. The second coach is also the ovaries themselves, who listens to the pituitary and responds on the ground. The cycle for a woman is cut into 2 main phases. The Follicular  ( building) and the Luteal phase ( sustaining). Fertility can be a complicated process, particularly for women as there are some hormones that are vital messengers during your cycle and in order to build the messenger, as well as the major hormones, it is vital the ‘machine’ ie your body produces the right effect in your reproductive system in order for the egg to meet sperm and for fertilization to happen. Hopefully you will have been to your doctor prior to reading this, to check everything is in working order.If you haven’t now’s the time to order a few blood tests.

In the early stages of the cycle the important hormones are: Follicular – (day 1- 16 approx)1.Follicle Stimulation Hormone (FSH) 2.Oestrogen  (E2 or Oestradiol) 3. Luteinising Hormone (LH) Testosterone. and in the Luteal phase ( after ovulation day 12- 28/30 aprox) 4. Oestrogen ( E2 ) 5 .Progesterone  (P4) *Testosterone a) Follicle Stimulating Hormone (FSH) is produced by the pituitary gland located just behind the eyebrows in the brain/ This gland is super important as it stimulates the development of a follicles and eventually a primary follicle. (b) follicles cells produce oestrogen which in turn increases FSH in a positive feedback loop. (c) oestrogen will thicken the lining of the uterus in preparation for a fertilised egg. (d) oestrogen production peaks at day 12  (aprox) causing the pituitary to release a surge of LH. This loosens the now mature egg from the dominant/Primaryfolicle which is released at ovulation.




LH reduces the secretion of Oestrogen
LH stimulates the empty follicle to develop into the corpus luteum
(e)Progesterone and oestrogen together stop any more LH and FSH being secreted from the pituitary. (negative feedback)
This prevents further follicle development or ovulation.
(f) Progesterone maintains the lining of the thickened endometrium in preparation for the implantation of a fertilised egg. (g) If implantation does not take place then the Corpus luteum falls apart. The progesterone production stops and from day 28 ( approx) a drop in progesterone triggers:

The endometrium breaks down and the 'menstrual period' begins
FSH and LH begin their secretions again
A new cycle has begun

What is the LH surge?The LH surge (seen in the top diagram) is luteinizing hormone which is responsible for the trigger of ovulation. As you can see it comes in fast and leaves fast! I like to see it as the needle that pierces the follicle to allow ovulation! This only lasts a very short time a well, a few hours tops, so once you see this surge its high time to get busy making a baby as you will only have a day at most – however this can vary from person to person.  Some women find that they get a fait line for LH or none at all. Its hard to nail this hormone down, and just because you get it it doesn't mean you are releasing an egg. Many women get quite obsessed with OPK sticks to measure this. What I would advise is rather than using them is getting to know your cycle through charting first. Then use OPK, as the body will ' try a few rounds' of LH to get the follicle to trigger and burst, and if you have PCOS there may be a few highs of this hormone as it tries to balance out during the cycle, so OPK isn't the best measure, all it means is that it is trying to burst the follicle, not that you have actually ovulated. Ovulation can only be confirmed by an ultrasound and pregnancy!

I am charting my cycle and noticed I ‘ peak’ early, is this normal? Most women are snowflakes, we all ‘peak’ or ovulate at different times. Also this won’t always be on a set day each month as we all have months where things change our hormones. We are all told if we have a 28 day cycle we ovulate on day 14. Not always true. Some women can ovulate on day 6, others on day 18. However a more healthier ovulation where the follicles have time to build up to around 18mm is at least 12 days if it is later than 18 days also it can mean that the th hormones have 'hung on' longer often this is seen with PCOS, where the body will try to mature the follicles to allow them to burst and release and egg. Its all about the follicular and luteal phase, which we will talk about in a moment! Its all about the timing as is everything in life!

If I get to know my cycle, when is the best time to have sex to make a baby? Start charting your cycle to understand your phases. I recommend you use something like http://www.fertilityfriend.com/ - although it isn’t designed to show you when you can have sex to conceive, it is a fabulous tool to help you to get to know your cycle, so you are more ‘ body aware’ Once you have followed your cycle for around 2/3 months you will have a bit more of a clue as to your ‘fertile window’. Some ladies find they have a short Luteal phase by doing this, which can have implication to sustaining a pregnancy.

The best time to make sure egg meets sperm is to have sex 2 days before ovulation, the day before. Then have it the day of ovulation. I’ve had clients who assumed they were a classic ‘ 14 day ovulater’  and they were in fact not ovulating until day 16, so were missing it every time!

Cervical mucus – sounds gross, and I have seen this jelly like stuff before, what the heck is it?As we build and sustain you will have noticed over the years that there are, well some changes in your pants! This isn’t anything to worry about, in fact its perfectly normal. There are on average 5 different types of CM to look for.

Dry – a sign your body might be low in oestrogen or you could be very badly dehydrated!

Sticky – not fertile at this time, has a sticky consistency but not stretchy

Creamy – not fertile at this time, and looks like lotion!

Watery - Fertile.  Usually clear to touch, feels cold as a pose to menstruation wetness which is warm.

Egg White (EWCM) - This is the most fertile CM. looks and feels like raw egg white and is very stretchy. If you touch it between your thumb and finger it will stretch without breaking. This stuff feeds the sperm and projects it to the egg faster. EWCM is mostly clear.

As oestrogen builds in your system you will  see changes in our CM as it gets more watery and then more like egg white.

How can I see this happening in me, now I know what to look for? Some women will see obvious signs of CM but unless you have super tight vaginal muscles that expel it outwards, you may not get to see it on your pants. One way to check, is by putting 2 fingers into your vagina and drawing out some of the CM.

I have never seen any fertile types of CM, does this mean I am not ovulating? No. Some women just never see the changes in their CM but it doesn't mean it's not there, they may be up further in the pipes so to speak!

What happens to CM after I have ovulated? After ovulation CM will usually return to an infertile state straight away.

What is the difference between the follicular and luteal phases, I keep hearing about having a ‘ Luteal phase defect!
As mentioned above in ‘ what’s the process of ovulation’  your egg builds based on a concoction of hormones and the follicle will grow to a max of 18mm - 25mm. During the final days before ovulation there will be a ‘fight’ for dominance between 1 or 2 follicles.This is very different if you go for IVF, as the drugs you will be on there will push your body to produce sometimes up to 10 follicles, which can give you up to 20 eggs in some cases! Under normal circumstances you will have 1 follicle which will produce 1 egg. ( or if you are lucky enough, naturally you can produce two eggs to have non identical twins!) When you ovulate your hormonal signals will switch from FSH and LH and Oestrogen to Progesterone and Oestrogen. Progesterone is the hormone that will start to flow as soon as we ovulate. It is produced from the site of the corpus luteum ( where the follicle has burst.) – so on the collapsed follicle, progesterone will start to flow. We have now moved from Follicular phase ( building) to luteal ( sustaining) If we haven’t fed our body adequately nourishing the production of progesterone, this will be a ‘weak’ hormone.  This is often indicated by spotting in the luteal phase or a shorter time from ovulation to period after charting for a few months. Anything less than 11 days, is seen as an indication of low progesterone. However this needs to be confirmed by a blood test and I would say one of the most important tests to go for, so ask your reproductive specialist to order this of you have had problems conceiving. If you do indeed become pregnant if the uterus is not stocked full of Progesterone from many moons of making good levels, when the body switches the ‘tap’ from the corpus luteum to the uterus to produce progesterone, from week 7 – 10, this is often the time when early miscarriages happen, as the growing embryo is feeding from the uterus for progesterone and not like in the early days fed from the corpus luteum and it isn't strong enough to keep it flowing.