# The Fifth Vital Sign: Master Your Cycles & Optimize Your Fertility by Lisa Hendrickson-Jack >[!Abstract] Description > **MENSTRUATION ISN'T JUST ABOUT HAVING BABIES** Your menstrual cycle is a vital sign, just like your pulse, temperature, respiration rate, and blood pressure. And it provides you with essential information about your health.The Fifth Vital Sign: Master Your Cycles and Optimize Your Fertility brings together over 1,000 meticulously researched scientific references in a textbook-quality guide to understanding your menstrual cycle. In this book you’ll learn: –What a normal cycle looks like; –The best way to chart your cycle and increase your fertility awareness; –How best to manage critical aspects of your health, including better sleep, exercise and a healthier diet; –Natural methods for managing period pain and PMS; –How to successfully avoid pregnancy without the pill; and –How to plan ahead if you do want to get pregnant. The Fifth Vital Sign aims to better connect women with their menstrual cycles, to break the myth that ovulation is only important when you're ready to have a baby. READ THE FIFTH VITAL SIGN TO BETTER UNDERSTAND YOUR HEALTH AND FERTILITY Whether children are a part of your future plans or not, your health matters. Start learning more now, and take control of your health. ABOUT THE AUTHOR Lisa Hendrickson-Jack is a certified Fertility Awareness Educator and Holistic Reproductive Health Practitioner. She teaches women to chart their menstrual cycles for natural birth control, conception, and overall health monitoring. In her work, Lisa draws heavily from the current scientific literature and presents an evidence-based approach to fertility awareness and menstrual cycle optimization. In the book Lisa Hendrickson-Jack also goes through natural methods for managing period pain and PMS, how to successfully avoid pregnancy without the pill and how to plan ahead if you do want to get pregnant. Aiming to better connect women with their menstrual cycles, the book works hard to break the myth that ovulation is only important when you're ready to have a baby. The book is simple to read and understand which is surprising seeing as it is has so many scientific references. A textbook quality guide that is also really enjoyable to read with so many pieces of information that I have not come across in any other books. ## Notes - progesterone mitigates effects of oestrogen - why ovulation is the key to optimal health - regular ovulation is a sign of health - ovulation is the main event - fertility awareness - observing your cervical mucus - 32 books - every woman's menstrual cycle varies - the rhythm method assumes that all cycles will be the same length - the symptothermal methods monitors bbt, cm & cervix position - there are a variety of fertility awareness charting systems and methods - unopposed oestrogen causes problems > “The biggest gift fertility awareness has given me over the years is the ability to trust my intuition. By paying attention to my fifth vital sign, I have gained the courage, confidence, and audacity to question the status quo, advocate for myself, and make informed decisions about my health - and now it’s your turn.” > >\- [[Lisa Hendrickson-Jack]] %% ## Notes ## Introduction - MC not exclusively related to having babies - MC is a vital sign - That changes in response to the state of your overall health - Most women have no idea how their MC work ## The Fifth Vital Sign - Intro - Your MC is a Vital Sign - What is a vital sign? - Vital sign = is a bodily response you can monitor to measure how your body is functioning - 4 most common vital signs - Heart rate - Body temperature - Respiratory rate - Blood pressure - The value in learning your fifth vital sign - Other than avoiding pregnancy naturally - And optimising your chances of conceiving - You are fertile for a maximum of 6 days per cycle - Ovulation only happens on 1 day - Once egg is release it disintegrates within 12-24 hours if not fertilised - Cervical mucus appears before ovulation - Extends the window of fertility to 6 days - CM can keep sperm alive for up to 5 days - Outside of this window - pregnancy is not possible - Monitors overall health - Compare vitals to a well-established normal range for each sign - Help identify if cycles are healthy - Underlying health issues - Present as - Delayed ovulation - Mid-cycle spotting - Abnormal cervical mucus patterns - Irregular periods - Amenorrhea - Period stops completely - The fifth vital sign - MC is normal and healthy - Many healthcare practitioners don't believe women need to have regular periods - Menstrual suppression through HCPs - Treat MC as an illness - Women with long irregular periods - Eg PCOS - Exposed to unopposed oes for weeks/ momths - These women 3x more likely to develop endometrial cancer compared to general pop - Women with irregular cycle s <26 or >34 days - Nearly twice a s likely to develop breast cancer in their lifetime - Regular ovulation followed by sufficient progesterone (and oes) production - Associate with building and maintaining optimal bone density in women - Irregular ovulation - Increased risk of osteoporosis - diabetes - Cardiovascular disease - High blood pressure - infertility - Maintaining healthy ovulatory MC is important for preserving optimal health ### [[ovulation is the main event]] - [[you can only experience a true menstrual period after ovulation]] - [[regular ovulation is a sign of health]] - [[ovulation is necessary for the production of progesterone]] - [[progesterone mitigates effects of oestrogen]] - [[Unopposed oestrogen causes problems]] > - Not your period ^kkxxz > - You can only experience a true menstrual period after ovulation > - Regular ovulation is a sign of health > - only possible when endocrine & reproductive systems functioning normally > - Crucial for maintaining optimal health during reproductive years > - Progesterone is important > - Progesterone mitigates effects of oes > - Unopposed oes known to promote cell growth in breast cancer and endometrial cancer ## What does a normal period look like? - Is my period normal? - You only experience a true menstrual period after ovulation - 1st half of cycle - Ovaries release oes - Oes rebuilds your endometrial tissue & restores the base - 2nd Half of cycle - Progesterone is produced - Takes the functional layer and makes it receptive to implantation - Causes uterine lining to mature - Mc is a continuous proces - Proliferation - Which is what oestrogen is doing - Differention - Which is the job of progesterone - Tissue degeneration - Period marks the beginning of the MC and represents tissue degeneration - Is this actually my period? - Your period will arrive 12-14 days after ovulation - Thats how you know its true menstrual period - You can confirm ovulation with the advanced tracking - Variant of red - Bright red to deep burgundy - The first day of your period is the day that requires some action on your part - Even if preceded by few days of spotting - Where you'll need a pad/ tampon/ cup - How many days should I bleed? - Normal period lasts 3-7 days (4-5 on average) - Flow pattern that starts heavy & gradually tapers off - Expect 90% of total blood loss will be in first 3 days of period - How much should I bleed? - Total bleeding 25-80 ml - Less than 25ml - Hormone levels are too low - Struggle to stimulate normal endometrial growth and development - More than 80ml - More likely to develop iron deficiency anemia - Associated with imbalance of oestrogen & progesterone - Specifically too much oestrogen in relation to progesterone - [[_Archive/Archive/menorrhagia]] - Measuring how much you should bleed - Is it normal for my periods to be painful? - Painful periods are not normal - Though common moderate to severe pain is not normal - Normal = no cramping or very mild cramp or discomfort - Extreme pain with periods - School / work / life/ normal daily activities - Need to use painkillers - Sign that something is wrong - may be associated with endometriosis - abnormal growth of endometrial like tissue outside of the uterus - 20-90% of women who suffer specifically with pelvic pain - Modern medicine minimises experiences of women as a whole - Endometriosis diagnosis - Just under 8 years in UK - Just under 12 years in US - Standard treatment for pelvic pain - Painkillers or HCPs - Neither address underlying cause - Impression that menstrual pain is normal - Part of being a woman - What is Physically happening during menstruation? - Normal reproductive processes are all inflammatory events - Ovulation - Menstruation - Implantation - labour - Involves cyclical tissue injury & regeneration - When process is disrupted - Could lead to excessive bleeding and/ or pain - What's normal for you? - Sudden change in flow - Significantly heavier or lighter than before - See the bigger picture - If one thing falls outside the 'normal' parameters does not mean there is a problem - Look at MC as a whole - Consider how all pieces fit togethr - No such thing as a perfect period ## Cervical Mucus - What is CM? - CM is the key to understanding your fertility as it relates to your MC - Critical for fertility - Sperm depend on it for survival - Produced by cervix - Cervical crypts - Folds & creases within the lining of your cervical canal - About 100 in your endocervical canal - Produce 20-60mg CM per day (together) - During fertile window = produce 10-20x that amount - Cervix = biological valve - Either open or closed depending on where you are in your cycle - Cervix decides - who can enter - When they can enter - When to close the doors - Affected by oes & prog - Oestrogen stimulates cervical crypts to produce E type mucus ((Estrogenic mucus) - Women produce CM on 2-7 days of their MC - This is called their fertile window - CM can keep sperm alive for up to 5 days - Pregnancy possible when have sex on any day you produce CM (prior to ovulation) - Possible for sperm to survive until ovulation - Produce CM in response to changing levels of oes & progesterone throughout the cycle - After ovulation - Progesterone surpasses further CM production - Directs cervical cells to produce thick gelatinous mucus plug - = dry infertile days - Your cervix is filled with a mucus plug on your dry and fertile days - G-type mucus - What makes cervical mucus "fertile"? - 3 reasons - Perfect PH for sperm - Keeps sperm alive for up to 5 days as you approach ovulation - Prepares sperm to be able to fertilise an egg (oocyte) - Vaginal microbiome - Ecosystem of diverse microorganisms - Lactobacillus = most abundant of these - Work hard to keep ph of vagina acidic - Offers protections against - BV - Yeast infections - STIs - UTSs - Other foreign invaders - Sperm can't survive inside of vagina for more than a couple of hours - They need more alkaline (higher ph) - Peak Mucus Vs Non-peak mucus - Peak mucus is like raw egg whites - Clear, stretchy, and / or lubricative - Optimal for conception - Non-peak mucus is like creamy hand lotion - Doesn't stretch - Why distinguish between peak and non-peak mucus if both are fertile? - Achieving the high efficacy of fertility awareness-based methods of birth control - Highly effective - 99.4% effective - Birth control - Optimising your chance of conception - Sex on days of peak mucus... - Closer to ovulation - Peak CM sperm friendly qualities - Confirming ovulation - Peak day = last day of peak CM - After ovulation P rises - Shift CM to dry days - Monitoring MC health - Infections - Abnormal cervical cells - Doesn't vaginal discharge mean I have an infection? - Not necessarily - 5 Types of vaginal discharge you should be aware of - CM - normal - Specifically related to fertility - Vaginal cell slough - Crumbly white or yellow discharge - May also appear as shiny film - May see most days - normal - Shedding of vaginal cells - Vagina cleans, rejuvenates and replaces dead cells - Arousal fluid - Released when sexually aroused - NOT produced by cervix - When sexually aroused = veins and capillaries fill with blood - Similar to an erection - Pressure forces arousal fluid through vaginal tissues - Vagina = wet & slippery - May be produced any day of cycle - Rapidly dissipates when you touch and stretch it - May also be produced when breastfeeding - Discharge related to infections - STIs - Yeast infection - Continuous = does not stop after ovulaton - White/ yellow/ greenish discharge - Yeasty or fishy smell - Irritation / itchiness & discomfort - See GP - Discharge related to abnormal cervical cells - And/ or cervical dysplasia - Abnormal cell growth on surface of cervix - May release watery discharge - Oestrogen, progesterone & your cervical mucus - Cervical crypts sensitive to O & P - O = stimulates cervix to produce E-type (Estrogenic) mucus - P = dries up E-type CM - P = stimulates cervical crypts ro produce G-type CM (gestagenic) - G-Type mucus (gestagenic): your infertile (dry) days - Don't actually see - Forms a thick mucus plug inside of cervical canal - Acts as a barrier between vagina & uterus - Sperm can't penetrate G-type mucus plug - Biological valve is closed - Dry days are infertile for 4 reasons... - Sperm can't penetrate G-type mucus - Can't swim through your cervix - G-type mucus = naturally acodis - Creates environment that sperm can't live in - Your O levels are too low to trigger ovulation - P suppresses E-type mucus production - E-type (Estrogenic) mucus: your fertile (mucus) days - Non-peak mucus - Peak mucus - How does CM help make a baby? - Your CM contains channels for sperm to swim through - Also filter out abnormal sperm - Prepare them for fertilization - Guide them to Fallopian tubes just in time for ovulation - How does my CM change with age? - You'll see and production gradually declines with age ## What does a healthy MC look like? ## 24-35 days (average 29 days) Most women learn that normal MC = 28 days - Contraceptive pills? - 4 weeks Study - Published in 1967 - Largest study conducted on MC - International journal of fertility - 1934-1961 - 2700 women were examined - Identified 3 distinct phases of a woman's reproductive life - Postmenarche - Average cycle length 32 days - Range 23-90 days - Middle life - Average cycle length 29 days - Range 23-38 days - Premenopause - Average cycle length 33 days - Range 22-148 days - Info was collected just before first birth control pill put on market - 1960 ## MC variation 5-7 years post-menarche - MC takes several years to mature - And fall into normal cycle pattern 10 years before menopause - MC begins to wind down - Perimenopause - Significant fluctuation in MC - Not uncommon to ovulate early - = Shorter MC - Especially in the beginning of this phase - As MP approaches this shifts - MC begin to lengthen - Esp in 1-2 years before cycle stops HCPs - 1-2 years of MC irregularity after discontinuing use All women regularly experience minor fluctuations MC length more stable in middle life phase - After MC has matured - Fewer variations in 'middle life' ## Perfect cycle? - No such thing - Every woman is unique - Reflects - Health - fertility - Life situation - Cycles responds to... - stress - Illness - Look at cycle as information - Be an objective observer - Record what you see - Without judgement - Jumping to conclusions - MC responding to its environment - Cycles fall outside 'normal' range? - Your body is not broken - MC simply giving you info about your overall health ## Irregular cycle? - = when length consistency varies by more than 8 days from cycle to cycle - Means that we can have a cycle fluctuate between 27-37 days - And is still not classed as irregular - Problematic cycles? - Regularly fall outside 24-35 days - Or vary in length by more than 8 days from cycle to cycle - Note the word regularly - Everyone has an outlier every now & then - If cycles daily consisten - But one month your MC is way off - Don't assume there's a huge problem - Its about looking for patterns - If something to worry about - Will regularly show up in your cycle - Irregular examples - 24 days - 42 days - 60 days - Fewer than 9 periods per year - Consistenly irregular cycles - Need to be monitored aloofly - Often earlysign of a deeper issue ## Normal MC Several aspects determine a Normal MC - Period - Total length of your cycle - Cervical mucus patterns - Ovulation - Length of luteal phase ###### 2 main phases of MC Follicular phase - preovulatory - Ranges from 10-23 days - Ave 15 days Luteal phase - postovulatory - Range 10-16 days - Ave 13 days - Length determined by life cycle of your corpus luteum - And its ability to produce adequate amounts of P - Analogy - P gives a plastic bag its sttength - P holds up uterine lining - Prevents from shedding long enough for implantation to occur - Low P = bag splits and contents fall out - = premenstral spotting - Short luteal phase - P levels peak in middle of luteal ohase - O has peak aroud the same time - Peaks coincide with small window when a fertilise egg is able to implant - into endometrial lining ## Long or short cycle determined by the preovulatory phase - Follicular phase is variable - Luteal phase is fairly consistent - Which means date of ovulation shift from cycle to cycle - Ovulation occurs on day 10-23 of cycle (average day 15) ## Light expose has a known impact on the MC - Studies - women with long & irregular cycles - Slept with light on during days 13-17 - Simulating natural moonlight around presumed ovulation - Average MC length went from ave 45 days to 33 days - Mid cycle light exposure decreased ave MC length ## Small percentage on women regularly cycle with the moon - Study 826 women between 16-25 - 28.3% menstruated around new moon ## Factors that delay ovulation - stress - Stress has a direct impact on the MC - Delays ovulation in preovulatory phase - May lead to double peak - Body's way of protecting you - Or shortens the luteal phase - Illness - Travel ## Your MC as a diagnostic tool? ###### MC disruptions - Often the first sign of an underlying health condition - MC = vital sign - Monitor for overall health - Beyond ability or desire to have children ###### Thyroid disorders on of most common causes - Identified through - Low BBT - Cycles that are longer (or shorter) than normal - Abnormal bleeding patterns - Abnormal CM patterns ###### PCOS - How does it show up in my MC? - A note on ovulation predictor kits and PCOS - Clinical features of PCOS - MC disturbances - Polycystic ovaries - hyperandrogenism - Insulin resistance - inflammation - Metabolic disturbances - Disrupts the normal pattern of ovulation - Typically causes long irregular MC - Higher risk of developing CV disease & Diabetes ###### Hypothalamic Amenorrhea - 3 main types - Related to Weight loss - exercise - Stress - Most women with HA have all 3 types - HA for long time - Higher risk of developing Osteoporosis ###### Additional health issues - Can affect MC in subtle & obvious ways ## The pill and your fertility Fake menstrual bleed - Added to original design of the pill - Get women to go along with it - Leading to artificial 28 day pill Long term HC use - Associated with higher rates of - Cervical cancer - Breast cancer - Liver cancer - Reduced rates of - Ovarian cancer - Endometrial cancer - Colorectal cancer You have a right to make informed choice - About the medications you use A brief history of the pill What are HCPs so effective? - Interfere with ovulation - Interfere with implantation - Prevent cervix from producing fertile quality CM Side effects - Increase risk of DVT - Increase risk stroke - Lower libido - Dramatically decrease T level - Shrink the clitoris and surrounding vulva tissues - Especially the vaginal opening - Increase risk of painful sex - Increased risk of anxiety & depression - Alter your choice of an intimate partner - Change the way you perceive their 'scent' - Cause nutrient deficiencies - Disrupt normal balance of vitamins & minerals in the body Does the pill mess with your libido? - Lower your T levels - Orgasms, vaginal lubrication & painful sex Does the pill mess with your mind? Do healthcare practitioners warn women about the risks? What if a similar drug caused men to experience anxiety & depression? Will the pill cause you to choose the wrong partner? Does the pill cause nutrient deficiencies? - intro - Folate B9 - Pyrodoxine B6 - Other vitamin & nutrient deficiencies Does the pill cause cancer? Are you saying we shouldn't ever use the pill? ## Coming off the pill Starting a family? - Allow a transition period of 18-24 months - Allow cycles to normalise - Can take 9-12 cycles HCs shrink ovaries & suppress ovarian reserve parameters - Allow 6-7 months pos HCs to return to normal Normal fertility - Temporary delay in return to normal fertility - 3-18 months - Depending on what HC and how long Coming off Hc equally important when not planning children Seek professional help - Period not returned urge 4-6 months - Cycles not normalised within 12-18 months When should I come off the pill? Will my period come back right away? HCPs & your ovaries Delayed return of fertility post HCPs Coming off HCPs when you don't want to get pregnant Post pill recovery - intro - Post pill recover phase - Replenishing nutrients - Supporting natural hormone production - Restoring gut health - Supporting liver Know when to seek support ## The wisdom of your MC Body is an intelligent source of info - Tune into it's wisdom - Pay attention to & understand your MC MC connects to deeper source of wisdom & power - A force that wants you to become vibrant - Authentic version of yourself - Mentally - Physically HC interfere with inner guidance of MC Give yourself permission to retreat when menstruating Compare phases of MC to seasons of the year - Each phase has changes in - Mood - creativity - energy MC = opportunity to examine your life - What you need to pay attention to - Period = tension is released - New cycle begins ## Charting your cycle Successful charting - Daily habit - Check fertile signs - Stay consistent with it - Ensure adequate support Avoiding pregnency/ birth contol - Know how to identify when fertile - Decide how to manage fertile window - Opting for (protected) sex during fertile window? - Relying on effectiveness of chosen birth control method - Eg condoms Trying to conceive - Best days to have sex are peak CM - Optimise sperm concentration - If issue with sperm quality/ count - Ensure accurate timing Using fertility awareness to avoid pregnancy - intro - Your times of fertility - Your times of infertility - Checking for mucus the day after sex - Managing your fertile window - What is perfect use? - intro - Condoms - Cervical cap / diaphragm - Withdrawal - What is my risk tolerance? - Using fertility awareness to get pregnant - intro - Optimising sex for conception - Addressing poor sperm count or quality ## Improving cervical mucus production Drugs that interfere with CM production - HCPs - Antihistamines - Fertility drugs like clomid & tamoxifen Cervical dysplasia, HPV & cervical surgery - Can I reverse abnormal cells without surgery? Additional factors that negatively impact your CM production How to improve your CM production ## Nutrition for healthy cycles Incorporate specific nutrient dense fertility foods - Maximise nutrient intake - Contain high density of vitamins & minerals that support fertility Nature's original multivitamin - Contain the micronutrients you require - In their most absorbable forms - For optimal MC health & fertility Vitamin A - Essential role in optimal reproductive health - Best sources - Liver Dairy products - Opt for high quality , minimally processed, full fat milk & dairy products Brighly coloured fruits & vegetables - Contain wide array of phytonutrients - Support optimal MC health & fertility --- - Real food Nutrient dense fertility food - Grass fed & pasture raised animal products - Liver and organ meats - intro - Is it safe to eat? - Doesn't it contain toxins? - What other nutrients are found in liver and organ meats? - Cod liver oil - Minimally processed, full fat dairy products - A2 vs A1 - Full fat vs low fat/ non-fat - Grass fed vs grain fed - Unhomogenised vs homogenized - Raw (unpasteurised) vs pasturised - Eggs - Pasture raise free range - important source of ket nutrients - Support MC health & fertility - Fish & other seafood - important source of long chain omega 3 fatty acids - Shellfish - important source of zinc - Seaweed - important source of iodine & other trace minerals - Bone broth - Provides key nutrients that support gut health - Immune function - Reduce oxidative stress - Lacto-fermented foods - Builds and diversifies gut flora - Optimise gut health - Nutrient absorption - Immune function - Fruits & vegetables - Saturated fat vs vegetable oil for cooking ## Lifestyle choices for healthy cycles Avoid over-exercising - Cause cycle irregularities Practical ways to manage stress - Rediscover what brings you joy Sleep hygiene - Sleep in complete darkness - Minimize your (blue) light exposure at night time - Get some sunlight first thing in the morning - Limit your caffeine consumption - Get to bed early - Get some exercise during the day - Create a restful night-time routine - Create an ideal sleep environment Reduce xenoestrogen exposure - Skip the HCPs - Switch to pasture raised grass fed meat (and organic dairy products) - Eat organic when possible - Switch to natural scent free beauty products - Switch to non-toxic and/ or organic menstrual products - Clean up your household cleaning routine - Reduce your BPA exposure - Get rid of your non-stick cookware - Filter your drinking water - Limit processed soy products Avoid the junk - Processed foods - Industrial see oils - caffeine - Artificial sweeteners - alcogol - Cigarettes Balance your blood sugar Identify & address food sensitivities Support your liver - Reduce processed foods Exercise smarter (not harder) Manage your stress - intro - Cultivate a mindfulness practice - Reconnect with what makes you happy - Spend some time in nature - Practice gratitude - Ask yourself some big questions [[Managing period pain]] [[Managing PMS naturally]] ## Restoring normal menstrual cycles Thyroid disorders - Replacement thyroid hormones - Additional thyroid supplements - Work with functional medicine doctor for best results With a thyroid discorder - intro - Iodine - selenium - zinc - iron - magnesium - Vitamin A - Additional nutrients that support thyroid function Dietary changes to Stabilize blood sugar - Effective to reduce IR - Support weight loss - Normalise MC PCOS - Associated with certain nutrienal deficiencies - Supplements With PCOS - intro - Stabilise your blood sugar - Address nutrient deficiencies - Address insulin resistance - Address inflammation Women with HA - Improve eating patterns - Modifying exercise practices - Reduce stress Restoring normal cycles with HA ## Planning ahead for pregnancies Preconception nutrition - Nutrient dense fertility foods - Is it safe to eat foods high in vitamin A? - How much fish is safe to eat? HCPs & pregnancy Age related fertility decline - Improving egg quality Navigating fertility challenges - intro - Improving sperm quality - Lifestyle factors for healthy sperm - Key nutrients for sperm quality Fertility treatments - intro - Intrauterine insemination IUI - Home insemination - IVF - Fertility preservation ## Getting the support you need - Your doctor's perspective on the pill - Finding a practitioner who will support you - Who's on my team? - Choosing a practicioner - Do your research - Find a practitioner who specialises in the issue you have - Consider seeing a functional practitioner in addition to your doctor - Interview your practitioner - Know when its time to move on - Where do I go from here? ## Chapter 5: What Is Fertility Awareness? ### [[fertility awareness]] > Fertility awareness (FA) allows you to determine which days of your cycle are fertile and infertile. FA involves tracking your three main fertile signs: cervical mucus (CM), basal body temperature (BBT), and cervical position, and together, these signs help you identify your fertile window. One side benefit of FA is that it has no impact on your fertility. There’s no transition period when you’re ready to start a family; you simply start having unpro­tected sex on your fertile days. In that way, FA preserves your fertility. ^pl5b1 [Link](yomu://content/annotation/E515E69F-70F1-4E9F-83D9-5347A78E9772) ### [[there are a variety of fertility awareness charting systems and methods]] > There’s no one universal fertility awareness-based method. Instead, there are a variety of charting systems and methods of FA tracking that use one or a combination of the main fertile signs: CM, BBT, and cervical position. ^k8on6 ### [[the symptothermal methods monitors bbt, cm & cervix position]] > I teach women to monitor all three fertile signs — often referred to as the symptothermal method.The “sympto” in symptothermal refers to mucus and cervical position, and the “thermal” refers to the thermal shift that occurs after ovulation. One study of 900 women who contributed 17 638 menstrual cycles worth of data found the symptothermal method to be 99.4 percent effective in preventing pregnancy when used correctly.138 The rate of unintended pregnancy was 0.43 percent for women who abstained from sex during their fertile window and 0.59 percent for women who used barrier methods during their fertile window. In other words, with perfect use, FA results in less than one pregnancy per 100 women per year (though typical use varies widely, from 66.4 percent to 98 percent effectiveness, depending on the user and their chosen method).139 All of the women in the above study were taught the symptothermal method by qualified instructors. ^n29-u [Link](yomu://content/annotation/99E23471-CC4E-4722-A8CA-66E1DF6A8794) ### [[the rhythm method assumes that all cycles will be the same length]] > The rhythm method involves estimating when ovulation will take place based on the average length of your past cycles. It’s based on the assumption that your cycles will always follow the same pattern, and it is therefore restricted to women with exceptionally regular cycles. ^7nal8 > > In the calendar rhythm method, a woman makes an estimate of the days she is fertile based on past menstrual cycle length. She does this with the expectation that the current length of her cycle, and thus the timing of her fertile phase, will not vary greatly from previous menstrual cycles. [Link](yomu://content/annotation/28354304-23B8-4AE5-B721-053220574FFD) ### [[every woman's menstrual cycle varies]] > However, menstrual cycle variability is the one thing all women have in common. In one study of 2316 women (contributing a total of 30 655 cycles), only 30 percent of the study participants had cycles regular enough to use the rhythm method. ^ae-u7 [Link](yomu://content/annotation/89FDBAF6-3857-4B56-B610-C87DD3D18399)