For most of my menstruating life, I thought my cycle was normal, great even. It came like clockwork at almost the exact time every month. I made note of the first day of my period and counted until when I would approximately have it again. Easy.
I was never sexually active before marriage. As part of our pre-marriage prep, we attended sessions on fertility awareness methods (FAM) at the recommendations of friends who were using it. FAM is aimed at having an understanding of your body to either achieve or avoid pregnancy. I assumed I already had it all figured out and could assess when I would ovulate. Turns out, I was totally wrong: My cycle was not normal, and counting the days until my next period was not charting.
When it came time to put the sessions we learned into practice, all of my preconceived notions about fertility were completely altered on what really goes on in the female body between days one and approximately twenty-eight. First of all, how I was keeping track of my cycle is not the same as charting to track your full reproductive health. What I was doing is called calendaring—or, as your parents may have called it, the rhythm method. In essence, it is guesstimating when ovulation will occur and when Aunt Flo will come again based on your menstrual history.
Luckily, there are more science-based charting methods as well. I landed on the Creighton Model Fertility Care System (CrMS). It seemed the most well-rounded and suitable to my needs (though it does require training to do properly). The basis of CrMS is recording biomarkers, such as bleeding and vaginal mucus observations—the color, consistency, stretchiness, and feel of your mucus—throughout your cycle. What I found is that not only did charting help me pinpoint my peak fertility, but it also helped my doctor diagnose other underlying health issues I was facing. Here’s what I learned from charting.
01. Know When You’re Fertile
Yes, I know. This one is a given. But it’s still pretty awesome. Almost all fertility awareness methods provide insight as to when you’re ovulating (and thus, fertile). This is particularly helpful if you’re trying to get pregnant—or avoid that altogether.
Personally, I like that I can use this system of tracking my cycle to avoid or achieve pregnancy in a natural way that works with my body.
02. Diagnose—and Relieve—PMS
Using CrMS helped me to better understand that there is a reason behind the menstrual madness. Many women mistakenly believe it is “all in their head.” But low progesterone could also be a determining factor in your premenstrual mood swings.
When I chart, in addition to keeping track of cervical mucus, I take note of my mood changes on the record I keep. Because I was charting, my practitioner determined that I just needed a little tweak of estrogen and progesterone to help mitigate some minor symptoms of PMS.
03. Diagnose Underlying Issues such as Infections and PCOS
Mary Caprio, a fertility care practitioner and registered nurse for the past twenty-nine years, points out that some women may miss that they have issues such as infections.
“For women who do not use a natural system such as the Creighton Model, there may be several subtle health concerns that they may miss during their reproductive years,” she says. “One of the most common would be what practitioners term ‘tail-end brown bleeding’ (TEBB). Many women view this phenomena as normal. It is characterized by two to three days of brown bleeding at the end of a woman’s menstrual period. This could be an indicator of a lower-than-normal progesterone level and is easily spotted when using the Creighton Model System.”
I, too, had this tail-end brown bleeding for the past twelve years and thought it was normal to have on my chart. It was not. My OB-GYN thought it might be a common bacterial infection, and lo and behold, an antibiotic prescribed did in fact clear it up.
There are several other underlying conditions that charting can help identify: polycystic ovarian disease, cancer, anovulatory states (when ovulation does not occur), and limited fertility due to limited mucus cycles, among others. Charting and biomarkers could also help you and your doctor find out why you may have missed your period or why you may have heavy bleeding.
04. Identify Risk of Miscarriage
Caprio also highlights another common reason for brown bleeding: low progesterone. If very light or brown bleeding “occurs for at least three days before moderate or heavy bleeding begins, it could be an indicator of low progesterone.” Progesterone is the predominant post-ovulatory hormone, which, among other things, provides uterine lining support during pregnancy. A low progesterone level during pregnancy puts women at risk of miscarriage. Knowing this before a pregnancy could prevent the loss of an unborn child.
I have experienced how my low progesterone has affected my husband and me. We lost our first child due to a miscarriage. My progesterone level was 12 ng/ml when I found out I was pregnant at four weeks. The ideal level is around 20 ng/ml. I knew that my progesterone had always been low because of my chart and confirmation from tests of my progesterone blood levels. As a result, my doctor immediately prescribed me oral progesterone as soon as I found out I was pregnant. Research confirms our rocky start. A study published in the Journal of Obstetrics and Gynecology reports that “91 percent of pregnancies with progesterone lower than 15 ng/ml will end in miscarriage.” There is no way to pinpoint exactly what causes miscarriages. Progesterone was likely not the sole reason for our miscarriage. But it definitely had an effect on the loss of our priceless gift.
05. Plan for a Healthy Pregnancy
Kathryn A. Karges, M.D., OB-GYN, who is fellowship-trained in the Creighton Model Fertility Care System and NaProTechnology, shares, “Charting NFP allows us to accurately pinpoint ovulation and therefore an accurate date of conception and due date. So much of what happens during pregnancy is based on accurate dating of the pregnancy and the due date. While early pregnancy ultrasounds can help us figure out the correct due date, often times the NFP chart is more accurate.”
Doctors look for signs such as the average length, weight, and heart rate of the baby based on weeks since conception. Anything that appears abnormal can help your doctor determine if there will be any complications or risks for your or your baby’s health. For most OBs, a lot of decisions can be made or strongly suggested about your care based on your due date (inducing labor, for example). As a nurse who has worked in labor and delivery units, I have definitely seen firsthand how inaccurate due dates have harmed preterm babies by induced labor. The overall goal of using charting for prenatal care is to monitor the progress of a pregnancy and to identify potential problems before they become serious for either mom or baby.
06. Determine the Source of Infertility
As couples who have struggled with infertility can tell you, determining why you can’t get pregnant can be tricky. For instance, if you have endometriosis, you might have a regularly occurring period—but no mucus. Mucus production is one example of how our biomarkers can detect fertility abnormalities.
According to The NaProTechnology Revolution: Unleashing the Power in a Woman’s Cycle by Thomas W. Hilgers, M.D., a helpful book on knowing the irregularities we face, among women who have “regular cycles and a diagnosis of endometriosis (through a laparoscopy), 77.6 percent of them will have either dry cycles or what we refer to as limited mucus cycles. . . . If one relies on ovulation test kits to get information regarding abnormalities and the presence or absence of fertility, they will be gravely missed.”
A doctor can confirm hormone levels with a few simple blood draws. If hormone levels match up with the chart, it is easier for the doctor to diagnose and treat the problem. After I started charting, I found out that I have mostly dry cycles. No mucus equals no fertility. This could be caused by stress or other physiological conditions (endometriosis, low hormones, etc.). My charting alerted my doctor that I should get my hormone levels tested, which confirmed that the dry cycles I was observing on the outside were from hormone deficiencies. Both estrogen and progesterone deficiencies can result in a dry cycle, whereas having optimal levels ensures mucus production.
Whether you’re having sex or not, charting to get a baseline of what your regular cycle looks like is hugely beneficial to your reproductive health. This way, you know if you are deviating from your normal or have patterns that point to hormone imbalances. Charting has empowered me to be proactive about caring for my reproductive and overall health in conjunction with my doctor. A growing awareness of my fertility brings me peace of mind because I know that I’m doing the best I can do for my body’s unique needs. I have the record to prove it.