USING NATURAL FERTILITY & PERIMENOPAUSE
What happens to our fertility during peri-menopause?
As a female, Peri-menopause is the ‘little unknown about’ topic that sits somewhere between our childbearing years and the end of our reproductive life. We can sail through this phase without really realising that we are fast approaching menopause, to suffering from the debilitating effects of insomnia, weight gain, mood swings, anxiety, scanty to heavy and irregular bleeding, loss of libido to the reappearance of acne - aggghhhh, not so great right?
Typically peri-menopause arrives somewhere between the age of 40-48.. and even as young as 35. Symptoms can occur up to 10 years before menopause (the complete cessation of menstrual periods) or a few years prior - each and every individual experiences their own journey.
What I think we tend to not pay too much attention to… or rather, not consider, is that although we are not yet infertile, we are not particularly fertile anymore either… we are somewhere in-between. The ovarian reserve declines with advancing age. There is still a chance of conception occurring, however, with statistics and rates showing too much of a variance, I’ve chosen to not include here to avoid confusion.
So, as our age advances - so do our health risks when continuing to take the oral contraceptive pill (particularly over the age of 40). Cardiovascular health/risks are at the top of the list, to an increased risk of breast cancer (as per research/studies). With these risks.. what are our contraceptive options?
The copper IUD and Mirena IUD are 2 very popular options - particularly (not all) in females who have completed their family, are in long-term relationships and like these hassle-free long lasting contraceptive devices. But what if you can no longer take the OCP (combined or mini-pill), find condoms irritating, suffer heavy bleeding with the copper IUD, feel the hormonal effects of the Mirena IUD or hormonal implants such as Jadelle? How many more options are there to consider?
As mentioned, our fertility declines fairly rapidly as we age - especially over the age of 40. When we are younger we usually choose an OCP to prevent pregnancy and/or help with irregular/heavy menstrual bleeding and help clear acne. Out of those, the MAIN reason for seeking the OCP is to PREVENT pregnancy during our fertile years. If we understand that our fertility declines and we have a very, very, small chance of conception each cycle are we more likely to take risks by having unprotected intercourse?
In my experience, the answer is NO!
Clients still express their fear of falling pregnant with their 2 top fears: experiencing a difficult pregnancy & having birth complications to having a premature baby with complicated health needs. Therefore, with these in mind, those in their early to mid forties tend to be extremely careful about avoiding conception.
So here is what is on offer to help you through this time - no gimmicks, hormones or weird stuff. Just good old human physiology! By using the Sympto-thermal method you are able to establish and track when you are fertile and when you aren’t. But how if your periods are irregular or your hormones are all over the place? Don’t you need a regular, monthly cycle to be able to use natural fertility to avoid conception?
NO YOU DON’T - Here is how it works:
Your body produces signs of fertility which we are able to recognise via our basal body temperature, our cervical mucus and changes in our cervix. When taught by an accredited NFNZ Fertility educator, you are able to learn and understand the times that you are either fertile or infertile to avoid conception. Our teaching has been adapted to understand and recognise the changes in hormones as we age and to make charting your fertility a very real possibility. If you are already a seasoned charter - great! If not, you can still learn and make it work for you. You can still even carry on using a fertility/period app (*note of caution - never rely on an app to avoid pregnancy as it is simply ‘guessing’ your fertile window - an app cannot distinguish when you are about to or have ovulated).
In a nutshell……You learn about your OWN Basic Infertile Pattern (BIP). This is an interpretation of your cervical mucus. There are 2 patterns, either dryness or unchanging mucus and sensation. Once you learn your own BIP - typically within 3 weeks of charting, a set of ‘rules’ are followed to avoid conception. While it seems simple…. it isn’t UNLESS you are taught by an educator who understands the Sympto-thermal method in it’s entirety and has undertaken additional training in peri-menopause. There are certain factors to consider such as bleeding or spotting and basal body temperature differences. Our teaching adapts as your reproductive cycle changes - you do not have to do away with using natural fertility as your chosen method of contraception. Your educator works with you to ensure that you understand the method and continues to check in with you/be available for queries as your body is going through changes. All NFNZ Accredited educators are able to write to/liaise with your GP/Specialist if required.
Want to learn more? Would you like to use this method for yourself? Head over to my website to learn more: https://www.bespokebirths.co.nz/natural-fertility
Book/Website Recommendations:
This Changes Everything - Niki Bezzant
Hormone Repair Manual - Lara Briden
Peri-menopause Power - Maisie Hill
The Peri-menopause Solution - Emma Bardwell
Breastfeeding & Natural Fertility - As a contraceptive? Is it really possible?
I wrote a quick Instagram post on breastfeeding and fertility a while ago and got so many queries, I thought it was timely to write a blog and answer those most frequently asked questions.
So if you haven’t seen or read by now and somehow just landed on this page, then I shall introduce myself as a mutli-modality trained holistic health/educator and birth support practitioner. Part of my role is working as an Accredited Natural Fertility Educator with Natural Fertility NZ. I offer fertility awareness and for couples wishing to achieve conception or avoid conception, I teach them the sympto-thermal method. I went on to complete further training in teaching perimenopause guidelines and breastfeeding & fertility. Here is what I have to offer specifically for those who are pregnant and considering contraception already (yes - you do need to think ahead!), or for those with a new baby and considering what may be the best option for them.
QUICK ANATOMY & PHYSIOLOGY LESSON:
Prolactin - A hormone secreted by the anterior pituitary gland. It increases during pregnancy, and acts together with progesterone in particular, to promote alveolar growth as well as playing a major role in milk production. Oestrogen, the growth hormone, and corticosteroids are the major hormones involved in the growth duct tissue. Prolactin is high in late pregnancy, but high oestrogen blocks its release.
After the birth, oestrogen levels drop and the prolactin is released in pulses 24hrs a day. Prolactin levels remain high for the first three months after birth. Prolactin is an important hormone in the initiation of lactation. Once the baby starts suckling, the nerves are stimulated and signal the hypothalamus, which in turn signals the anterior pituitary gland, to release prolactin.
Frequent suckling maintains adequate milk production and release the stored milk. Prolactin levels decline gradually after birth and return to normal levels 2-3 weeks after birth in the non-breastfeeding woman.When suckling is reduced, for example, when solid foods are introduced, or baby sleeps through the night, prolactin secretion returns to normal and menstruation and/or ovulation resume.
LAM OR LACTATIONAL AMENORRHEA METHOD:
Relies on EXCLUSIVE breastfeeding (Exclusive breastfeeding is: no formula/water given and no solid foods (but medictions if required), not having a bleed after 8 weeks and a baby that is less than 6 months of age. This method requires no charting, but a commitment to exclusive breastfeeding while using it. This method also works if you are expressing as well as breastfeeding e.g. express during the day and breastfeed at night.
Quick check list if LAM is right for you:
Is your baby less than 6 months old? If yes, then:
Are you amenorrhoeic? No bleeding OR spotting since 8 weeks? If yes, then:
Are you exclusively breastfeeding? If yes, then:
GREAT! Exclusive breastfeeding provides at least 98% protection from pregnancy and YES you can use this method.
If you answered NO to any of the above, the answer is NO as your chance of pregnancy is increased and you cannot rely on LAM for contraception.
BREASTFEEDING CHARTING:
Based on charting cervical mucus signs, vulva sensation and baby’s feeding and sleeping pattern to recognise infertility and the signs of returning fertility. This method requires detailed and thorough charting. This is an option for those who do not intend to exclusively breastfeed, those who return to work early, plan to introduce solids early, do not meet the LAM criteria as above.
If you do not meet the LAM criteria you may be eligible for Breastfeeding charting. This is a daily commitment which includes charting:
Date
Babys age
Number of breastfeeds in 24hrs
Longest time between feeds
Solids - How much/how often?
Bottle/supplement cups
Cervical mucus (colour, amount, texture)
Vaginal sensation (dry/damp/moist/wet/very wet)
Further notes e.g illness, medications etc
Further appointments with your educator include:
Help you to establish a BIP (basic infertile pattern), teach you how to check changes in your cervix (when you reach 12 week’s postpartum - called cervical palpation), guidelines to follow, things to look out for and when to contact your educator.
When your baby reaches 6 months of age, we switch you to a partial breastfeeding chart which includes daily temperature taking. A partial breastfeeding chart can be used by those who are not exclusively breastfeeding, by breastfeeding clients who are already breastfeeding charting but are showing signs of returning fertility.
When bleeding resumes, we switch you to a STM chart (using sympto-thermal method).
Your fertility educator will choose the appropriate method for you, support you while you are learning, help you with any queries and keep you informed about your charting along your journey.
QUICK FACTS:
Exclusive breastfeeding generally results in a delayed return to fertility. MOST (not all) women who exclusively breastfeed in a ‘cue based and responsive way’ will not have any menstrual periods or ovulate in the first 6 month’s postpartum
A publication printed in the British Medical Journal (BMJ) 2012 showed that menstruation on average occurred at 7 and a half months’ postpartum with ovulatory cycles ocurring at 8 and a half months
The maximum birth spacing effect of breastfeeding is achieved when a mother ‘fully” or nearly ‘fully’ breastfeeds and remains amenorrhoeic (bleeding before the 56th postpartum day being ignored). When these two conditions are fulfilled, breastfeeding provides more than 98% protection from pregnancy in the first six months. At six months, or if menses (period) returns, breastfeeding ceases to be full, or nearly full before the sixth month, then the risk of pregnancy increases.
References:
Contraceptive Technology & Reproductive Health Series, Lactational Amennorrhea Method (LAM), retrieved from: https://www.fhi360.org/sites/default/files/webpages/Modules/LAM/s1pg14.htm (October 12, 2021)
Natural Fertility NZ Incorporated - Advanced Practice Manual 2020
Panzetta S, Shawe J, Lactational amenorrhoea method: the evidence is there, why aren't we using it? Journal of Family Planning and Reproductive Health Care 2013;39:136-138.