Blog of the Society for Menstrual Cycle Research

Coming off Depo-Provera can be a woman’s worst nightmare

August 28th, 2014 by Laura Wershler

re-blogging re:Cycling

In celebration of our fifth anniversary, we are republishing some of our favorite posts. This post by Laura Wershler originally appeared April 4, 2012, and has received nearly 600 comments. To avoid confusion, we have closed comments on this re-post.

 

Need proof that women are sometimes desperate for information and support when it comes to quitting hormonal contraception? You need look no further than the 100 plus comments in reply to an old blog posting at Our Bodies OurselvesQuestions About Side Effects of Stopping Contraceptive Injections.  The comment stream – a litany of woes concerning women’s discontinuation of Depo-Provera – has been active since Nov. 2, 2009.

On March 29, 2012, Rachel, author of the post, wrote a follow-up piece in which she laments: “Although a quick internet search finds many women complaining of or asking about post-Depo symptoms, there isn’t much published scientific evidence on the topic.” Beyond research about bone density and length of time to return to fertility, little is known about the withdrawal symptoms women have been commenting about.

Depo-Provera is the 4-times-a-year birth control injection that carries an FDA “black box” warning that long-term use is associated with significant bone mineral density loss.  Never a fan, I made a case against this contraceptive in a paper for Canadian Woman Studies, published in 2005. The comments on the OBOS post indicate that many women took Depo-Provera without full knowledge of the potential for serious side effects while taking it, or of what to expect while coming off the drug.

Considering that Depo-Provera completely suppresses normal reproductive endocrine function, it is not surprising that many women experience extreme or confusing symptoms once stopping it. Take Lissa’s comment for example, posted on February 21, 2011:

Omg I thought I was tripping. I have been on depo for a year and stopped in jan. My breasts constantly hurt, I put on weight, have hot flashes, and sleeping problems. I pray everyday my cycle returns and stops playing with me. I only spot lightly.

Two and a half years after publication, the original article continues to garner monthly comments. I’ve read most of them and have yet to see one that offers concrete advice or a referral to resources that provide information and support to women looking for both. One such resource is Coming Off The Pill, the Patch, the Shot and Other Hormonal Contraceptives, a comprehensive, clinical-based guide to assist women transition back to menstruation and fertility, written by Megan Lalonde and Geraldine Matus.

Lalonde, a Holistic Reproductive Health Practitioner, and Certified Professional Midwife, helps women establish healthy, ovulatory cycles after using hormonal contraception. She says that women who’ve used Depo-Provera generally experience the most obvious symptoms and have the hardest time returning to fertility.  She finds that every client’s experience is different and will be affected by the status of their cycles before taking the drug, and their overall health. “It can take time to regain normal menstrual cycles, from a few months to 18 months, in my experience,” says Lalonde. “Some women have minimal symptoms while their own cycles resume, while others might have significant symptoms, including mood changes, unusual spotting and breast tenderness.”

The comments to the Our Bodies Ourselves blog post demonstrate that many women are not finding the acknowledgement and support they need to understand and manage the post-Depo transition. Some are disheartening to read, like this comment by Judy from April 12, 2011, and this recent one posted by Melani on March 21, 2012.

In my last re: Cycling post, I asked for input on the Coming Off the Pill Mind Map I created. I’ll be making a few revisions thanks to the thoughtful feedback readers have provided. I had assumed that this guide would be applicable to all methods of hormonal birth control but, after reading these women’s comments about their Depo-Provera experiences, it appears this contraceptive may require its own branch on the mind map.

Waiting

August 20th, 2014 by Heather Dillaway

re-blogging re:Cycling

In celebration of our fifth anniversary, we are republishing some of our favorite posts. This post by Heather Dillaway originally appeared October 28, 2010.

I’ve been thinking a lot lately about the words we use when we’re talking about menstruation or reproductive experiences more generally. I’ve been noticing lately that we use the word “waiting” quite a bit. I have a friend who is “still waiting” for her menstrual cycle to be “normal” again after her second child, and several other friends who are either “waiting” to figure out whether they will get pregnant, “waiting” to be done with their pregnancies, or “waiting” before they can have their last and final kid. I just had my basement waterproofed and one of the basement repairmen told me that his wife had been “waiting” ten months to get a menstrual period and that they were worried about her (this is information he volunteered after I told him I studied women’s health). I started thinking more about how the menopausal women I interview always talk about “waiting” to figure out whether they are really “at menopause,” or “waiting” to figure out if this is really their last menstrual period. Or how so many girls/young women who are sexually active are “waiting” to get their periods so that they can be relieved to know they are not pregnant. Or how women with painful periods, endometriosis, or migraines are waiting until those days are over each month. What does all of this reproductive waiting (waiting for menstruation, waiting for menstruation to be over, waiting for pregnancy, waiting for birth, waiting for menopause) mean?

In all of these instances of reproductive waiting, waiting seems a negative connotation and that seems to stem from the fact that we do not feel in control or in charge of this reproductive time. When I think of the other situations in which I might use the word “waiting”, the same holds true. I tell my kids to “wait their turn” and they don’t like it. And none of us really like waiting in line. Fast food restaurants, frozen dinners, and ATM machines are all in existence because we don’t have time or don’t like to wait. Phrases that we use like “worth the wait” also connote negativity about waiting. So, I finally looked up the actual definition of waiting. Depending on which online dictionary you visit, definitions of “waiting” include: “pause, interval, or delay,” “the act of remaining inactive or stationary,” or “the act of remaining inactive in one place while expecting something.” While some of these definitions do not automatically lend themselves to negativity, waiting is defined mostly as a passive activity that we are forced to participate in, perhaps against our will.


All of this makes me think further about whether women really dislike the waiting or the time that comes with menstruation or other reproductive experiences, and whether women really feel out of control as they engage in their experiences. Is this just a word we use or are we really impatient about menstruation and reproduction? When I think about alternative words that are sometimes used, like “tracking,” other words seem much more agentic in that they put women back in control of their cycles and other reproductive experiences. So, is it just the word “waiting” that has the negative connotation or is that word signifying some larger impatience that we have about reproduction these days? I have a colleague who writes about the “inconveniences” of reproduction and how, in so many ways, we try to avoid the reproductive waiting or reproductive uncertainties we face. For instance, instead of waiting to see when a baby is born, we might plan a c-section so that we can know when we’ll get that baby. Or, now we’re told that if we’re “waiting” more than 6 months to get pregnant that we should probably start taking fertility drugs to shorten our wait or get rid of some of that uncertainty. Or now we can find out that we’re pregnant a couple weeks after conception instead of waiting to see whether we menstruate a few weeks later. We attempt to cut out some of those reproductive waits these days. Menstrual suppression is at least partially popular because then women won’t have to be surprised by their periods or wait to know what bad day their period might fall on.


I think perhaps we do need to be more conscious of the words we use to describe our own and others’ reproductive events. Is “waiting” the correct word to use? Is “tracking” a better word to use because of the agency/active control it implies? Is “experiencing” a broader, less value-laden word to use? What do we really mean when we use these words?

Obvious Child: The Other Taboo

June 18th, 2014 by Holly Grigg-Spall

cervical mucus

 The recently released rom-com ‘Obvious Child’ has been discussed far and wide for its mature, sensitive and funny approach to the topic of abortion and yet I have not seen one comment on the fact that this movie also makes mainstream (and yes, funny) the topic of cervical mucus.

In the opening scene stand-up comedian Donna (played by real-life comedian Jenny Slate) is performing on stage at her local open mic night. She wraps up with a joke about the state of her underwear and how, she describes, her underpants sometimes look like they have “crawled out of a tub of cream cheese.”

She claims that they often embarrass her by looking as such during sexual encounters, something she feels is not sexy.

Of course, by “cream cheese” I immediately assumed Donna meant cervical mucus. Unless she is supposed to have a vaginal infection – which seeing as it is not discussed amongst the other myriad bodily function-centric conversations in the movie, I doubt to be the case – then it’s clear she is detailing her experience of cervical mucus.

Later on that night, when Donna meets and goes home with a guy, has sex and then wakes up in bed with him the following morning, she sees that her underwear is laying next to the guy’s head on the pillow. Not only that, but this is one of those situations she finds embarrassing as the underwear is actually covered in the aforementioned “cream cheese” or cervical mucus. She cringes, retrieves the underwear and hastily puts it back on under the covers.

At this scene we can assume that the presence of visible cervical mucus indicates that the character is in fact fertile at this time during the movie. Even if we didn’t know this movie was about unplanned pregnancy, perhaps we would know now. Apparently Donna is not on hormonal birth control, and she’s not sure if, in their drunkenness, they used a condom properly. So, I speculate, if Donna had known she was fertile and that the “cream cheese” in her underwear was actually one of the handy signs of fertility her body provides, then she may have taken Plan B and not had to worry about an abortion. But, then, of course, we wouldn’t have had the rest of this movie. We would have had a very different movie – a movie someone should also make.

But it goes to show how some body literacy might go a long way in helping women make more informed choices. The abortion sets her back $500 and causes some emotional turmoil. A dose of Plan B is cheaper and easier to obtain, although not without some side effects. Maybe even, we can speculate, if Donna had known she was fertile she might have avoided PIV sex that night.

It’s great to see a movie approach the choice of abortion as though it really were, well, a choice. But isn’t it interesting that in doing so it shows how women can be hampered in their choices by a lack of body literacy?

We often see women in movies discussing their “fertile time” in regards to wanting to get pregnant – and so meeting their husbands to have sex at the optimum time in usually funny, crazy scenarios. Sometimes we have seen women taking their temperature or using ovulation tests and calendars to figure this out. However, I think this might be the first mention of cervical mucus in cinema.

I had the honor of seeing this movie with longtime abortion rights and women’s health activist Carol Downer and getting to discuss it with her after. Carol pioneered the self-help movement and self-examination, adding much to our collective knowledge of our bodies.  

This is what she had to say:

The Many Faces of Cervical Fluid

May 7th, 2013 by Elizabeth Kissling

Guest Post by Kati Bicknell, Kindara

It has been brought to my attention several times that not all women’s cervical fluid matches the usual descriptions of sticky, creamy, egg white, or watery. This means some women are having a hard time charting their fertility, because they don’t know how to categorize their cervical fluid for their chart.

So today I’ll give you very detailed descriptions of the different types of cervical fluid, and how to classify them.

I’m going to be incorporating vaginal sensation into the mix here. Vaginal sensation is the way your vagina *feels* when different types of cervical fluid are present. You know how you can tell if the inside of your nose is wet, like when you have a runny nose? And you know how you can tell if the inside of your nose feels dry, like when you are in a dusty desert? You can tell the same things about your vagina as well, if you pay attention. The way your vagina feels can give you a lot of insight on the state of your fertility and what kind of cervical fluid you’re likely to find.

One thing to keep in mind when it comes to cervical fluid is that there is a baseline level of moisture that will always be present in the vagina. After all, it’s a mucus membrane, like your mouth. If you touched the inside of your cheek, it would be damp — same thing with the vagina. Don’t let that normal vaginal moisture confuse you. Unless there is a physical substance on your fingers or toilet paper, it doesn’t count as cervical fluid. (The exception here is watery cervical fluid: sometimes the water content is so high that there is nothing that will hold together, and it’s just plain wet. But in those cases there is usually so much of it that there is no question about whether or not it’s cervical fluid.)

Cervical fluid is measured above that baseline level of moisture. It tends to start out on the drier end of the spectrum, and it increases in water content as a woman approaches ovulation. Generally, the higher the water content, the more fertile the cervical fluid. After ovulation the water content will decrease.

Note: all cervical fluid is potentially fertile. If you are charting to avoid pregnancy, any cervical fluid you notice before ovulation means that your fertile window has begun. But for women who are trying to achieve pregnancy, there are definitely types of cervical fluid that are more optimal for getting pregnant. So, shall we launch our boat onto the sea of cervical fluid exploration? Lets!

These are the different categories of cervical fluid.

None:

  • What it feels like (vaginal sensation): dry, or like “nothing’s going on.”
  • What it looks like: nothing! Maybe a slight dampness on your fingers that will quickly evaporate.
  • What it feels like on your fingers: a slight dampness.
  • What it looks like on your underpants: nothing. Squeaky clean. You could wear those underpants again tomorrow if you wanted to (ain’t no one gots to know about it!).

Sticky:

  • What it feels like (vaginal sensation): dry, sticky, or like “nothing’s going on.”
  • What it looks like: whitish or yellowish, tiny bits of clear gummy bears, tiny pieces of drying rubber cement, grade school paste, wet Elmer’s glue, wet wood glue, crumbly off-white Play-doh, thick white or yellow cream, clumpy, pasty, tacky, gummy.
  • What it feels like on your fingers: springy, sticky, crumbly, dry, pasty.
  • What it looks like on your underpants: white or yellowish lines or areas that tend to sit on the top of the fabric, as opposed to soaking in. When it dries it forms a crust that can hard to wash out on laundry day.

Creamy (similar to sticky, but with a higher water content.):

  • What it feels like (vaginal sensation): cool, slightly damp, or may not feel like anything.
  • What it looks like: milky, cloudy, like hand lotion, yogurt, whole milk, or heavy cream.
  • What it feels like on your fingers: smooth, creamy.
  • What it looks like on your underpants: white or yellowish lines or areas that tend to sit on the top of the fabric, as opposed to soaking in. When it dries it forms a crust that can be hard to wash out on laundry day.

Eggwhite:

  • What it feels like (vaginal sensation): slippery, lubricative.
  • What it looks like: raw egg whites, wet rubber cement, clear, stretchy.
  • What it feels like on your fingers: slippery or lubricative or stretches an inch or more between thumb and forefinger.
  • What it looks like on your underpants: slippery, wet, may sit on top of the fabric, or soak in slightly.

Watery:

  • What it feels like (vaginal sensation): water rushing, dripping or gushing out of your vagina; cold, wet sensation.
  • What it looks like: clear or milky/clear, about the consistency of water or skim milk.
  • What it feels like on your fingers: wet, slippery.
  • What it looks like on your underpants:  leaves round wet patches that soak into your underpants.

I’m sure I left out some possible descriptions of cervical fluid here. If I didn’t name one that you’ve personally experienced, let me know in the comments. I’ll add in more descriptors as needed, so we can make the most thorough cervical fluid compendium known to humankind!

Cross-posted at Kindara, February 20, 2013.

Does it matter that hormonal contraceptives are endocrine disrupting chemicals?

March 6th, 2013 by Laura Wershler

I’ve been wading through State of the Science of Endocrine Disrupting Chemicals – 2012. The 289-page report was prepared by a group of experts for the United Nations Environmental Programme and World Health Organization.

It is dense and complex, but what I’ve been looking for is any acknowledgement that hormonal contraceptives are endocrine disrupting chemicals (EDCs).

Hormonal contraceptives clearly act as EDCs according to the definition used in this report:

An endocrine disruptor is an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects in an intact organism, or its progeny, or (sub) populations. A potential endocrine disruptor is an exogenous substance or mixture that possesses properties that might be expressed to lead to endocrine disruption in an intact organism, or its progeny, or (sub) populations.

Adverse health effects would include, in this context, anything that disrupts the reproductive systems of humans (and wildlife) or contributes to other health problems such as hormone-related cancers, thyroid-related disorders, cardiovascular disease, bone disorders, metabolic disorders and immune function impairment. Hormonal contraceptives certainly disrupt the reproductive system and have been associated with increased risk of cardiovascular events, loss of bone density, decreased immune function and, in some studies, increased risk for breast cancer. Metabolic disorders? Recent research suggests that long-acting progestin-based birth control may increase risk in obese women for Type 2 diabetes.

The only mention I could find of specific contraceptive chemicals is in section 3.1: The EDCs of concern. In a table under the sub-heading Pesticides, pharmaceuticals and personal care product ingredients, two key components of hormonal contraceptives are listed: Ethinyl estradiol, the synthetic estrogen used in most oral contraceptive formulations, and Levonorgestrel, a synthetic progesterone used in combined oral contraceptive pills, emergency contraception, the Mirena IUD, and  progestin-only birth control pills. Levonorgestrel is considered of “specific interest.”

The concern with these chemicals is not the effects they may have on women taking them, but on the possible reproductive impact on wildlife from the excretion of these chemicals into the aquatic environment. It seems ethinyl estradiol and levonorgestrel are considered safe contraceptive drugs when taken by choice to disrupt fertility, but EDCs worthy of concern when such disruption is unintended.

How would it change our perception of hormonal contraceptives if we acknowledged them as endocrine disrupting chemicals? Would we wonder why there is no discussion of how these EDCs might contribute to the health issues considered in the report? Would we ask why hormonal contraceptive EDCs are routinely used to “treat” (meaning only to alleviate symptoms of) endometriosis, fibroids and PCOS – conditions potentially caused by other EDCs?

Another relevant concern addressed in the report is the effect of “estrogenic agents, and their role in breast cancer.” The report states there “is good experimental evidence that estrogenic chemicals with diverse features can act together to produce substantial combination effects.” I have to wonder how hormonal contraceptive EDCs fit into this mix.

Here’s something to ponder. Last week news stories reported that the incidence of advanced breast cancer among young American women, ages 25 to 39, has risen steadily since 1976. Lead researcher Rebecca Johnson was quoted as saying, “We think it is a real trend and, in fact, it seems to be accelerating.” The increase is small in relative numbers, only 850 cases in 2009, but the “trend shows no evidence for abatement.”

Researchers can’t explain the increase. Lifestyle changes, obesity, sedentary lifestyle and toxic exposure to environmental chemicals are offered as possible factors. But what about the hormonal contraceptives many women of this generation have been taking since they were 15 or 16 years old? Surely these EDCs must be considered as potentially contributing factors.

How to Check Your Cervical Fluid When You Feel Like You Just Don’t Have Any

February 12th, 2013 by Kati Bicknell

In an older post I wrote, I talked about how to check your cervical fluid with a folded piece of toilet paper or your clean fingers.

BUT! What if you’re doing that and not finding anything? What if you, like many women I talk to, think that they don’t have any cervical fluid?

Well, you’re in luck, because I’m about to explain how to measure your cervical fluid, even if it seems like you don’t have any! Are you ready for this? You’re so ready.

Adapted from a photo by Lamerie // Creative Commons 2.0

Things you’ll need:

  • Hand mirror
  • Clean towel
  • Soap and water

So … it goes a little something like this — CRAM YOUR FINGERS IN YOUR VAGINA! Just kidding. Not really. Kind of. Kidding about the “cramming” thing, but not about the “in your vagina” thing.

First things first, wash your hands. You don’t want to introduce any foreign bacteria into the vagina — it’s got a whole host of its own friendly bacteria that keeps things running smoothly, and you don’t want to upset the balance.

Now that your hands are clean … wait a minute! Okay, a lot of you reading this are probably very familiar with your vagina, where it is, how it looks, and every little nook and cranny inside and out. But some of you may not be. For those of you in the second camp, there is an extra step.

Grab a hand mirror!

Okay, was that hand mirror very dirty? Did you take it out of the woodshed or something? Is it your husband’s shaving mirror? If any of the above are true, wash your hands again.

Now get naked from the waist down — think gynecologist’s office, but significantly less unpleasant. You can leave your socks on. No cold stirrups (hopefully). Now sit or squat on a clean towel on the floor, and hold the hand mirror between your legs so you can actually get a good look at your vulva (external genitalia). As women, our genitals are positioned in such a way that they are very hard to get a clear look at without the aid of a hand mirror, so unless you’ve done this before, you may be surprised at what you see. Look at how beautiful you are! So many little folds of soft delicate skin, so many different shades of color. Vulvas come in all shapes and sizes and colors, and each are perfect and beautiful and packed with nerve endings, so don’t you even dare consider labiaplasty, even if the vulva you see in the mirror doesn’t look like the ones you may have seen in certain adult movies (or Canadian strip clubs). Yours is perfect. I promise.

Have a look and a feel around! Gently spread your inner labia apart and take a peek at what’s in there. You’ll see your clitoris, vaginal opening, and, if you have keen eyesight, the urethral opening. Neat, huh? You may even see some cervical fluid at the vaginal opening.

Now see where your vaginal opening is? Gently slide one clean finger inside, see how that feels? Okay, now you know WHERE to stick your finger when checking your cervical fluid internally.

Crouch in a squatting position, and place one or two (if they fit) fingers in your vagina, until you feel something like the tip of a nose (if you are fertile it might be much softer). This is your cervix! The place from whence all cervical fluid hails! The motherland!

Now draw your finger(s) gently out of your vagina and have a look at them. They will be slightly damp, because the vagina is a mucus membrane, like the inside of your mouth, so wetness is a given. Other than that, is there any “substance” on them? Anything that looks like grade school paste, or hand lotion, or raw egg whites? If so … there is your cervical fluid!!!! You found it! Hooray!

If not, you may be a) on the pill, b) in the pre-ovulatory infertile phase of your cycle, before you’ve started to make cervical fluid, or c) in the post-ovulatory infertile phase of your cycle, after ovulation, and your body may have stopped making cervical fluid for the remainder of your cycle.

If you don’t notice any, check again later in the day, and several times tomorrow, and every day after that! Soon you’ll have something to record on your chart!  :-)

Now you can stand up, wash your hands (again), pull up your pants (this step is critical), and go about your day!

Wheeee!!! Any questions on that? Ask me in the comments.

Cross-posted at Kindara, February 5, 2013

Getting Over The Pill

January 15th, 2013 by Kati Bicknell

Here’s a notion: Birth control pills are not the only way manage your reproductive health.

The pill came out more than 50 years ago, and at the time, it was a symbol of liberation and freedom for women. Suddenly, they no longer had to worry about unplanned pregnancy. It was great. But now that 50-year-old technology is starting to lose much of the appeal it once had.

Adapted from a photo by Jess Hamilton // Creative Commons A-NC-SA 2.0

Today many women get on the pill as teenagers to “regulate” irregular cycles, and they get off the pill in their late 20s or early 30s when they want to get pregnant. The unfortunate reality is many women find it’s not as easy as they thought it would be to get pregnant. Ten or fifteen years of being on oral contraceptives doesn’t “fix” an irregular cycle; it just kind of pushes the pause button on your reproductive system.

When you come off the pill in your late 20s or early 30s because you finally want kids, your body has to pick up where it left off when you were a teenager. Often women at this stage of their lives find it takes longer than expected to conceive and wind up on the assisted reproductive technology track — reproductive endocrinologists, expensive and annoying tests, procedures, hormone injections ,and all that jazz. And, heartbreakingly, after several years and thousands of dollars, that doesn’t always work.

The side effects of the pill are a real pain in the ass for many women, too. Weight gain, depression, loss of libido, and “not feeling like myself” (AKA “I seem to have gone insane”) are some of the more common complaints cited. In fact, a CDC report on contraceptive use states that 10.3 million women have stopped taking the pill due to side effects, or fear of side effects.

All women need a way to have children when they want them, and to not have children when they don’t. And they need to feel good about the whole thing — not freaked out, bloated and crazy. Imagine how the world would be different if this was a reality.

This reality is possible thanks to the wonderful simplicity of the Fertility Awareness Method — the technology behind Kindara. Instead of women’s reproductive reality being like this:  “Oh my god,  I don’t want to get pregnant” during her twenties, followed by “Oh my god,  I want to get pregnant NOW!” in her thirties, the Symptothermal Method makes it one question: “When do I want to get pregnant?”

Charting your cycle using the Fertility Awareness Method can help you achieve your reproductive goals without pills, side effects, or stress, whether you want to have kids in the next few years, in 10 years, or never. By charting your cycle, you will see if and when you are ovulating, and you will know when you are fertile, which is the trick to knowing when you can or cannot pregnant. Charting your cycle could help clarify issues that need to be remedied before you can get pregnant too. You can even confirm pregnancy with your chart. Exciting!

If women were taught the basics of Fertility Awareness as soon as they entered their reproductive years and knew that they could avoid or plan for pregnancy by charting their primary fertility signs (temperature and cervical fluid), they would save a lot of time, money, and stress.

What a different world we would all be living in if each woman shifted her thinking from “I need this pill so I don’t have unplanned pregnancies, and I need my doctor to prescribe this pill” to “I know just what is going on with my cycle at all times. I am calm, confident, and empowered. I manage my own fertility thank you very much, and I don’t need pills to do it.”

Now I’m not saying that oral contraceptives have no place in the world. They are a wonderful invention. Thanks to the pill, women today can take it as fact that pregnancy can be prevented easily and effectively. But because this is now a forgone conclusion, we are free to look for even better options — options like the Fertility Awareness Method that can prevent pregnancy easily, effectively, autonomously and without side effects.

Originally published at Kindara.com on December 15th, 2012

Fertility Charting Is the Way of the Future!

August 29th, 2012 by Kati Bicknell

The Quantified Self is the idea that by tracking things about your body you can live a happier and healthier life. Hardware devices like the Fitbit and Withings scale measure your daily activity and weight respectively so people can set and reach activity and weight goals. Apps like Lose It are tapping into this idea using a software-only approach: Lose it helps you lose weight, not by putting you on a diet, just by having you keep track of everything you eat. Every day you enter all the foods you eat into the app, and it tells you how many calories you consumed. You can also put in how much, and what type of exercise you did each day, and Lose It tells you how many calories you burned.  The result is you can see the amount of calories you burned, relative to the amount of calories you took in.

I have several friends who swear by this app. Lose it isn’t telling you anything you don’t know (eat less, and exercise more if you want to lose weight), but what it is doing is making it very easy for you to see how your actions are affecting your weight in a specific way on a daily and even moment by moment basis. In addition to achieving goals, quantifying the self leads to a sense of confidence and control where before there was confusion. And in doing so it makes us feel better.  This is the crux of the quantified self movement. Recording and analyzing everyday data can help us win at the game of life!

As my friend Lauren Bacon has pointed out, fertility charting fits right in to the Quantified Self movement. Women who chart their fertility record their waking body temperature, cervical fluid viscosity, and other data each day, and over the course of each menstrual cycle get a detailed picture of their reproductive health, and sometimes more!

Kindara Screen Shot © Kindara 2012

Cervical fluid viscosity is a proxy for estrogen level. Basal body temperature is a proxy for progesterone.  And as any high school student can tell you, hormones are powerful influencers of how we feel, think and act, and why our bodies do the things they do.  Just imagine if your menstrual cycle, and all the fluids, feelings and fluctuations that went along with it were no longer a mystery.  Imagine knowing just what was going on, and why.

By recording your daily fertility signs a whole world of possibility opens up for you! While it’s true that fertility charting can be, and often is used to achieve or prevent pregnancy, the benefits of it don’t stop there. Fertility charting can answer important questions about our ovulation, luteal phase, cycle health, thyroid function and more.  I have friends who have finally figured out the root of several food allergies, from charting their fertility.  I myself have learned that a diet high in animal fat keeps my cycles regular. One reason I’m so excited about what we’re doing at Kindara is that as more and more women start quantifying their fertility, we’ll start to generate new knowledge about fertility for the benefit of humankind, creating a virtuous feedback loop that will help each woman feel calm and confident with her fertility in her specific situation.

I envision a future where more and more women are taking an active role in their own health care with fertility charting.  How about you? If you’re currently charting your cycle, tell us in the comments what you’ve learned so far, and how it’s changed your life!

In a fertility flap? Five things you need to know

August 22nd, 2012 by Laura Wershler

Your fertility is not a deep, dark mystery only your doctor can unravel. It’s yours to own, understand and manage. Forget the ticking biological clock, it’s the wrong metaphor. Fertility ebbs and flows, like the phases of the moon. It’s about the cycle – not the clock.

Are you wondering about your fertility status? Will you be able to have a baby when you want to?

Seems these questions are on the rise for 20- and 30-something women who are finally getting the message that putting off motherhood may not be a good idea. Recent news stories report that young adults don’t know the facts of fertility decline and overestimate the success of reproductive technologies.

But as the message gets through, the response makes my eyes roll.

Judith Timsom, one of my favorite columnists, recently pondered the fertility fears many young women are having.  Among them:

A third woman, turning 30, with a committed partner and a great job, made fertility sound like the new “f” word as she glumly remarked to a friend ,“My doctor told told me my fertility just dropped 50 per cent. Crap.”

This is crap. It misrepresents how fertility works. Timson writes that “young women – and men – are crying out for more factual, emotionally neutral information on how their fertility works.”  Forgive me if I, and at least 700,000 others – the number of people who have purchased Toni Weschler’s  Taking Charge of Your Fertility since it was first published in 1995 shake our heads in frustration.

What women need is body literacy, the know-how to observe, chart and interpret our menstrual cycle events so that we – not the doctor, not the lab tech – can confirm our fertility status. Yes, it’s called fertility awareness, and, since the late 60s, millions  of women world-wide, including me – a bonafide pro-choice feminist, have used this life skill to both avoid and achieve pregnancy.

If you’re worried about your fertility, here are five things you need to know:

  1. You can learn to observe and chart three key signs of fertility: a) fertile cervical mucus b) basal body temperature shift  c) adequate luteal phase, or number of days from ovulation to next period.
  2. If you use hormonal contraception (HC), you have been infertile for as long as you’ve been using it. When you stop HC, your body has to establish healthy ovulatory menstrual cycles before you become fertile. Health and environmental factors may impact this process. Factor recovery time into your baby plans.
  3. If you began using HC as a teenager for heavy bleeding, painful periods  or irregular cycles chances are your reproductive system has not fully matured. When you quit HC this maturation process will resume. Depending on the method you used, it could take months before you have ovulatory, fertile cycles. Be patient. Holistic Reproductive Health Practitioners can assist in recovering fertility.
  4. If you began using HC for PCOS or endometriosis, expect symptoms to resume when you stop. The Centre for Menstruation and Ovulation Research describes treatments that manage PCOS  and endometriosis while helping to preserve fertility.
  5. Fertility is individually, not statistically, determined. It can ebb and flow from cycle to cycle. Diet, stress, travel and trauma can result in anovulatory, or infertile, cycles. When it comes to getting pregnant, the more you know about your own menstrual cycle, the better.

Fertility awareness is empowering, but Toni Weschler says that in her decades long experience she has repeatedly seen the sense of excitement that women feel evolve into anger. “Women want to know why they weren’t taught this when they were teenagers.”

The young women Judith Timson writes about have yet to acquire this knowledge. When they do, will they be angry enough to teach their own daughters? Weschler has a book for them, too - Cycle Savvy: The Smart Teen’s Guide to the Mysteries of Her Body Fertility isn’t a mystery if you know where to look for the clues.

I’m sick of being special.

August 2nd, 2012 by Alexandra Jacoby

I’m sick of being special. I am.

I want to be ordinary.


What brought this on? ​

I was clicking through some of the July 28th Weekend Links (thank you, Liz!), and the article about birth control advice for women over 40 caught my eye, and while reading it, I became curious about the source quoted there, Jennifer McCullen, a physician at Ob/Gyn Women’s Centre of Lakewood Ranch. That led me to the Lakewood Ranch Medical Center, The Women’s Center:

“Caring for the special needs of women at every stage of life is the focus of The Women’s Center at Lakewood Ranch Medical Center. Separate from the main hospital. Private and with easily-accessible parking, the center’s experienced team of medical professionals coordinate care in areas of obstetrics and gynecology, labor and delivery and urology, with special attention to childbirth and breast care.”

 

Special needs just stopped me in my tracks.
​Really? 

As far as I know, human reproduction has been happening more or less the same way forever.

In whatever way the moments of conception and birth were reached, whatever the stories of the people involved, they did include a fertile woman’s body ready to hold, to carry, and to nourish through all its phases a zygote, embryo to a fetus, and to eventually deliver, a human baby.

So, why are body-experiences as relate to reproduction, or to the menstrual cycle, considered special situations like in the quote above describing The Women’s Center’s services, or “special” in another way — embarrassing, inappropriate to mention, to-be-hidden, as Fit Chick reminds us is more often than not the case, in her blog post, Breaking the Curse?

​Actually, today, I don’t care so much about the whys – but go ahead and add to the comments: because that could help us to understand ourselves, our collective story of how we got here, and that may help us to move beyond this space where our common body-experiences as potentially child-bearing, menstruating humans is treated as other​, rather than ordinary.

Deeply and widely quality-of-life​ affecting, ordinary.

And yet, managing our experiences, just talking about them….these are still special situations.

Special situations – at every stage of our lives?

​​I’m sick of being special.

I want to be ordinary.

 

Bring on the Fat!

July 31st, 2012 by Kati Bicknell

I’ve been doing research on my own menstrual cycle for almost four years, charting my cycle using the Fertility Awareness Method.

 

Photo by Pete&Brook // CC 2.0

My cycles have always been wacky. I got my period when I was 11  but bled only a couple times a year, until, at my doctor’s suggestion, I went on the pill at 18, to “regulate” my cycle.  At 26 I learned that the birth control pills didn’t actually regulate my cycle, they just covered up the real issue.  I was determined to let my body find its own natural cycle, so I went off the pill. I wanted the option to have my own children someday, and with my dubious state of fertility, I needed to give myself a head start on having a healthy cycle.

I didn’t find much information about cycle health for a while, but when I was finally introduced to Toni Weshler’s book, Taking Charge of Your Fertility, I felt that  I had found the key!  I was fascinated to learn that with just a few simple actions each day I could get a clear picture of my cycle health. I started charting right away and did my best  give my body a shot at having a “normal” healthy cycle, exercising, eating healthy, trying different herbs and foods. But nothing seemed to make a lasting difference.  I would still only get around four periods a year.

This year in February I went to China, so Kindara could take part in the Haxlr8r start-up accelerator program. I was shocked when within two weeks of arriving in China, I ovulated, after not having my period for six months. I don’t generally ovulate in the winter, so I thought maybe this was just the end of that drought, being as it was March. But then I ovulated again in April, and in May, and in June.

The only thing I could point to that I was doing differently from what I had ever done before was eating lots of weird meat. In China it seems that no part of the animal is wasted. I had countless meals consisting of mostly bones and/or animal fat. In fact the regular “meat” that I was used to in the States didn’t seem to exist.  Everything was either bones, organs, or fat. This was pretty unnerving to me at first, but I slowly got used to it. So I kept it up. When we came back to the states in mid-June I made an effort to eat meat at least several times a week, the fattier and weirder the meat, the better!  And that’s hard to find here. But my efforts seem to be working, I ovulated in July as well!  This makes five months of regular cycles, for the first time in my life.

This is incredible, and I never would have had such a front row seat on the action if I wasn’t charting my cycle. I seem to have cracked the code on what my body was missing. And this means that I should have an easier time getting pregnant, if and when I decide I’m ready. My procreative power is now in my own hands, and I love it!

Adventures in Building a Fertility Awareness Charting App

June 20th, 2012 by Kati Bicknell

I’m obsessed with fertility charting, and in my search for a Fertility Awareness app that met my needs, my husband and I created one.  The most important thing to us are our users, and their feedback is gold. We learned the hard way that women want to chart on their phones, not their computers. We want to avoid the mistake of thinking “we know best” again.  So what our customers say to us is taken very seriously. But sometimes they ask for things that we don’t want to give them!

I received a question from one of the women who downloaded our app, asking me if there was a way to enter temperatures measured to the 1/100th of a degree, (like 97.34).  She didn’t want to round to the tenth of a degree (97.3)  and risk throwing off her chart.  We thought we understood her concern.  If you’re taking your temperature every morning, you want that exact temperature to go in your chart! Rounding seems like it might throw off the chart. Right?

Well that depends on if you’re measuring in Fahrenheit or Celsius.  If you’re measuring in Celsius you must measure to .05 of a degree to catch the temperature shift.  In Fahrenheit you only need to measure to tenth (0.1) of a degree. Measuring to the hundredth (.01) of a degree is too small of an increment to make any important difference on your chart.

When charting basal body temperature (BBT), the bi-phasic temperature pattern over the course of your cycle tells you if you’re ovulating, when you’re ovulating, and the length and health of your luteal phase.  Post-ovulatory temperatures are usually around 0.3 degrees Fahrenheit higher than the preovulatory temps.  0.3 is larger than 0.01 by a factor of 30. This means that measuring to hundredths of a degree is not necessary to catch the temperature shift.

Typical Rounding Scenario

This graph shows a typical bi-phasic temperature pattern, clearly confirming ovulation.  The red line was graphed using temperatures that were accurate to the 1/100th of a degree.  The blue line is graphed using those same temperatures rounded to the 1/10th of a degree.  As you can see, the difference between the two lines is not enough to obscure a temperature shift on a chart.

We had a moment of deliberation… do we tell our user to just get a different thermometer?  Do we tell her to round her temperatures?  That didn’t seem like great customer service.

We realized that the solution is not to simply tell this woman why what she was concerned with didn’t matter.  From her perspective, rounding temperatures is a pain in the ass and she doesn’t want to do it!  THAT “pain in the ass” factor is the problem that we have to solve.  So, with this realization we decided to add the ability to chart in hundredths to our development plan.

Even though measuring to this accuracy isn’t necessary, if adding the second decimal place on our data screen makes it easier for women to get their data into the chart, we’ll do it!  We want all women to have access to the yummy benefits that are to be had from charting one’s cycle, and we are committed to removing the barriers to that, however it must be done.

 

Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.