%% #update → add cervix anatomy image%% # Monitoring Your Cervix >[!example] 10 Feb 2023 #articles %% [[the cervix is a precision organ as complex as the eye]] %% When you start tracking your menstrual cycle, it’s always best to [[The Beginners Guide to Menstrual Cycle Tracking|start with the basics]]. However, after a while I recommend that you deepen your awareness of your cycle using advance tracking techniques in order to [[Why Ovulation Is the Key to Optimal Health|understand ovulation]]. These techniques include: 1. [[Observing Your Cervical Mucus|observing your cervical mucus]] 2. [[Tracking Your Basal Body Temperature|tracking your basal body temperature]] 3. monitoring your cervix position In this article I will discuss the anatomy of the cervix and it's functions. I will also discuss how the cervix changes position throughout the menstrual cycle, how to monitor your own cervix and how to determine ovulation using changes within the cervix. Erik Odeblad said "the cervix is a precision organ as complex as the eye" and after researching for this post, I really think he may have been on to something. >[!Example] Contents > > - [[#What is the cervix?|What is the cervix?]] > - [[#The word cervical has multiple meanings within human anatomy|The word cervical has multiple meanings within human anatomy]] > - [[#The anatomy of the cervix|The anatomy of the cervix]] > - [[#The functions of the cervix|The functions of the cervix]] > - [[#The functions of the cervix#1. The cervix acts as a barrier|1. The cervix acts as a barrier]] > - [[#The functions of the cervix#2. It produces cervical mucus|2. It produces cervical mucus]] > - [[#The functions of the cervix#3. The cervix plays an important role in conception, pregnancy, and childbirth|3. The cervix plays an important role in conception, pregnancy, and childbirth]] > - [[#How the cervix position throughout the menstrual cycle|How the cervix position throughout the menstrual cycle]] > - [[#Monitoring your cervix|Monitoring your cervix]] > - [[#How to tell if you’ve ovulated using your cervical position?|How to tell if you’ve ovulated using your cervical position?]] > - [[#Final Thoughts|Final Thoughts]] ## What is the cervix? Before we get into how to monitor your cervix, we need a basic anatomy lesson. What the majority of people refer to as the vagina, is in fact, called the vulva. This means that all of the external genitalia is called the vulva and *not* the vagina. (FYI...I only learnt this when I was 30! The vagina is in fact only the internal tube which connects the external genitalia (your vulva) with the uterus (your womb). The cervix, which is the entrance to the uterus, is at the top of the vagina and changes position throughout the menstrual cycle. ## The word cervical has multiple meanings within human anatomy %% - [[the word Cervical has multiple meanings within human anatomy]] - [[the Latin for cervix is cervix uteri, which literally translates as “the neck of the uterus”]] %% Along with a basic anatomy lesson, I also think it's important that we understand the etymology of the word. The word cervix in Latin means 'neck'. And it's for this reason that the word 'cervical' refers to different areas in the human body where there are neck-like structures, the two main ones being: 1. Referring to the neck of the uterus 2. Referring to the cervical vertebrae in the spine[^1] The Latin term for cervix is cervix uteri, which literally translates as “the neck of the uterus”. ## The anatomy of the cervix %% - [[cervix anatomy]] - [[the cervix is held in place by paired ligaments on either side]] %% The cervix is the cylindrical, lower, narrow part of the uterus that connects the uterus to the vagina. Around 3-4 centimetres long and composed from connective and muscular tissue, the cervix consists of 2 main parts, the ectocervix and endocervix.[^2] The ectocervix is the portion of the cervix projecting into the vagina where as the endocervix is the inner part of the cervix that forms a tunnel. The internal os is the term used to describe the opening of the cervix within the uterus and the external os is the term used to describe the opening of the cervix into the vagina. Paired ligaments on either side hold the cervix in place, the uterosacral and the cardinal (transverse cervical) ligaments.[^3] ## The functions of the cervix There are three main functions of the cervix: 1. it acts as a barrier 2. it produces cervical mucus 3. it plays an important role in conception, pregnancy, and childbirth ### 1. The cervix acts as a barrier %% [[the cervix acts as a barrier]] %% The cervix acts as a barrier that separates the uterus from the vagina. This is important to allow for the transmission of menstrual fluid and other secretions from the uterus to the vagina whilst preventing the transmission of pathogens from the vagina into the uterus. It also plays a part in allowing or preventing the passage of semen from the vagina to the uterus depending on menstrual cycle phase. ### 2. It produces cervical mucus %% [[cervical mucus is produced by the cervix]] %% The cervix also creates cervical mucus, a normal body fluid that changes throughout our menstrual cycle in response to fluctuating hormones. Cervical mucus plays a key role in the female reproductive cycle as it helps to fertilise the egg and transport sperm to the fallopian tube. It also acts as a barrier, providing a defence by recognising and preventing pathogen entry. ### 3. The cervix plays an important role in conception, pregnancy, and childbirth %% - [[the cervix plays an important role in conception, pregnancy, and childbirth]] - [[the cervix is the door to the female reproductive system]] - [[during pregnancy, the function of the cervix is to retain and protect the growing baby]] - [[the cervix must undergo a dramatic process of remodelling to allow for passage of the foetus]] %% This goes without saying but the cervix is involved in conception, pregnancy, and childbirth. Or as Martyn et al, (2014) put it so beautifully, the cervix is the door to the female reproductive system. During conception, it must allow sperm to passage into the uterus through the endocervical canal. Throughout pregnancy the cervix must "remain closed despite multiple forces acting upon it". Simply put, it must retain and protect the growing baby. Then during labour, in order to allow for the baby to be born, the cervix must undergo a dramatic process of structural and mechanical change. ## How the cervix position throughout the menstrual cycle %% [[the cervix changes throughout the menstrual cycle]] %% According to Nott et al, (2016) the cervix "demonstrates a considerable amount of anatomic (and physiologic) variation throughout the menstrual cycle". Firstly, the cervix changes to either promote or prevent the passage of sperm. Secondly, it changes in order to facilitate the shedding of the endometrium during menstruation.[^4] Let me explain... During menstruation, the cervix is firm and low, with the external os (the opening of the cervix) being open as it releases blood. Once all the blood has been shed, the external os closes with the cervix remaining firm and low. ![[Cervix Low.excalidraw.png]] As ovulation approaches, the cervix cervix begins to 'SHOW', which is an acronym for it becoming soft, high, open and wet. It may also change in the angle or tilt as it moves into more of an upright position.  ![[Cervix High.excalidraw.png]] Once ovulation has occurred there is often a dramatic shift as the cervix moves low, closes and becomes firm once again. The angle or tilt of the cervix may also change, usually to a backwards facing position. ## Monitoring your cervix %% [[Fertility Awareness Mastery Charting Workbook by Lisa Hendrickson-Jack]] %% Monitoring your cervix is simple to do. That said, we need to remember that this is all subjective. Which is we you need to get to know our own cervix each and every day of our cycle because we are all so different.  - Choose a time of day that makes sense to you such as in the shower in the morning. Your cervix can change position throughout the day due to activity which is why you need to take at the same time every day.  - Wash your hands (for obvious reasons). Again this is why checking in or after a shower works well. - Insert your middle finger into your vagina. Your cervix is located at the end of your vagina and will feel similar to the end of your nose or your puckered lips. - If you can't find it or reach it, try squatting. Alternatively you could try placing one foot up on the sink. Just make sure to lock the bathroom door! - Notice the height, how open it is, how firm it feels and it’s tilt. Make a note of it on your [[Free Menstrual Cycle Tracking Templates & Guide|chart]].[^5] > The key is to check every day so you can feel the relative differences from day to day; cervical changes can be very subtle. Check your cervix in the same position and at the same time each day (i.e. in a squat before showering in the morning), so you’re comparing apples to apples – or cervices to cervices, as the case may be. ~ [The Beautiful Cervix Project](https://www.beautifulcervix.com) ## How to tell if you’ve ovulated using your cervical position? %% [[identifying ovulation with cervix]] %% Getting to know your cervix and how it changes throughout your menstrual cycles means that you may be able to use this to identify ovulation. ![[Cervix High & Low.excalidraw.png]] When oestrogen is high and ovulation is approaching, your cervix will be SHOWing. Again this means that the cervix will be soft, high, open and wet. Any other time the cervix will be firm, low and closed (except during menstruation).[^6] This is especially the case during the luteal phase when, under the influence of progesterone, the cervix may also be lying against the wall of the vagina. One thing I would say is that checking your cervix in order to predict or confirm ovulation should be used alongside [[Tracking Your Basal Body Temperature|tracking your basal body temperature]] and [[Observing Your Cervical Mucus|observing your cervical mucus]] observing your cervical mucus, not on it's own.And in all honesty, it really is not a necessary step to understanding ovulation, it is more about confirming what your cervical mucus & BBT have told you.  ## Final Thoughts I mentioned at the beginning of this article that Erik Odeblad said "the cervix is a precision organ as complex as the eye". And honestly, I have only covered the basics of what the cervix does. But just as with every other part of the female anatomy, the understanding of the cervix is still in it's infancy. Even so, we can appreciate that the cervix is a vital part of the female reproductive system, which not only plays a plays an important role in conception, pregnancy, and childbirth but also in providing protection from pathogens. By monitoring our cervix and understanding how it changes day to day, we can gain greater insight into the menstrual cycle and ovulation. >[!Example]- Sources > - [Fertility Awareness Mastery Charting Workbook by Lisa Hendrickson-Jack](https://www.amazon.co.uk/Fertility-Awareness-Mastery-Charting-Workbook/dp/199942803X) > - %%[[(Martyn et al, 2014)]]%% Martyn, F., McAuliffe, F.M., Wingfield, M., 2014. The role of the cervix in fertility: is it time for a reappraisal? Human Reproduction 29, 2092–2098. [LINK](https://doi.org/10.1093/humrep/deu195) > - %%[[(Nott et al, 2016)]]%% Nott, J.P., Bonney, E.A., Pickering, J.D., Simpson, N., 2016. The structure and function of the cervix during pregnancy. Translational Research in Anatomy. [LINK](https://doi.org/10.1016/j.tria.2016.02.001) > - %%[[(Odeblad, 1994)]]%% Odeblad, E., 1994. The discovery of different types of cervical mucus and the Billings Ovulation Method. Bulletin of the Natural Family Planning Council of Victoria. Available at": [LINK](https://www.factsaboutfertility.org/wp-content/uploads/2017/01/Odeblad_DiscoveryZofZCervicalZMucus_1994.pdf) > - %%[[(Parenteau-Carreau, 1988)]]%% Parenteau-Carreau, S., Infante-Rivard, C., 1988. Self-palpation to assess cervical changes in relation to mucus and temperature. Int J Fertil 33 Suppl, 10–16. [^1]: There is much debate as to how to pronounce these terms. Personally I (and many of the therapists that I know) pronounce 'sur-vi-kl' when referring to the neck and 'sur-vuh-kl' when talking about the cervix of the female anatomy. [^2]: "Although studies of cervical length in non-pregnant women are few, it is acknowledged that the size and shape of both the cervix and the external os differ in women and vary with age, hormonal changes, parity and surgical treatments to the cervix." (Martyn et al, 2014) [^3]: "It is thought that the uterosacral ligaments help to maintain the uterus in its typically anteverted state" (Nott et al, 2016). [^4]: The endometrium is the mucous membrane that lines the uterus. It grows and thickens during the follicular and luteal phase thanks to the hormones oestrogen and progesterone. If pregnancy does not occur it is shed during menstruation. If pregnancy does occur it sheds along with the placenta during childbirth.%%[[endometrium#^8e08cc]]%% [^5]: With regards to height, a low position will usually mean that you don’t need to inset your finger as far whereas when your cervix is high you may not even be able to reach it. [^6]: After having a birth, miscarriage or abortion your cervix may never be fully closed again and may always be a little bit dilated. (Unlike before when closed should feel fully closed). However you should still be able to notice changes in your cycle which again is why it’s important to get to know what your cervix feels like.