USING NATURAL FERTILITY & PERIMENOPAUSE

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

Your Menstrual Cycle - A window into your reproductive health

A healthy menstrual cycle does not have to be a perfect 28 days, just as your bleed every cycle does not need to be a set number of days. So, what does a healthy menstrual cycle look like?

There is a huge variation in normal which varies from woman to woman, and all comes down to age, lifestyle factors and general overall health. Normal is what is normal for YOU.

What is important to know is to be in tune with your cycle or at least have some understanding of your menstrual cycle, so that if variations occur, you can be aware of the changes and look to investigate further if you suspect something is not quite right.

What is a normal menstrual cycle?

When we first menstruate during puberty, our cycle length can be all over the show, from 23 days up to 90 days apart. It can take some time for our cycles to become more ‘regular’ and predictable. During our late teens to late 30’s, typically our menstrual cycles are anywhere between 24 days to 36 days – but again, can vary. What we do know with menstrual cycles and our health is that during times of stress, over exercising and under eating, our periods can be put on ‘pause’.  Following childbirth our cycles can vary, and likewise, when we creep into our early to mid 40’s (roughly) we begin to enter another phase – peri-menopause: where our cycles typically shorten over time. It is also normal for your cycle to vary and change from month to month…..but, what is considered ‘not normal’ is a CHANGE or several changes that don’t settle. For example, mid cycle spotting, bleeding or discomfort during intercourse, cycle lengths that shorten with new heavier bleeding or cycle lengths that lengthen with new heavier bleeding, cycles that come with marked emotional changes, such as anxiety, feelings of anger or rage, tearfulness or new physical complaints such as sore breasts, painful cramps, headaches/migraines and insomnia. These are some and not all suggestions that may warrant you to investigate your health further.

Bleeding should typically be between three and seven days in length, with the heaviest flow on day two (but can vary). Normal blood loss is anywhere between 30 to 80mls over a course of a period (Romm, 2021). Using no more than six pads or tampons a day is a normal amount of bleeding (Romm, 2021). A bleed or period is considered heavy when it lasts 8 or more days, you are soaking through pads and or tampons regularly, you have to change pads throughout the night or you experience large blood clots, experience fatigue or suffer from anaemia due to frequent blood loss (Romm, 2021). Although with the introduction of menstrual cups and period underwear, how can we know for sure what our flow is like, and are we checking?

The four stages of a menstrual cycle:

Menstruation:

Days 1-6 of your cycle. Day 1 is considered the FIRST day of your new cycle. This is the time when your endometrial lining is shed (bleeding). The hormones estrogen and progesterone are at their lowest at this time in your cycle, although estrogen begins to slowly rise. Tiredness and the desire for rest rather than exercise is common through at this time (but you should not be feeling so fatigued that it interferes with your everyday life).

Follicular phase (proliferative phase):

Days -13 of your cycle (including menstruation). The uterine lining is beginning to proliferate or build (hence the name proliferative phase), follicles are ripening inside the ovary in preparation for ovulation and glands in the cervix begin the production of cervical mucus. Following your bleed, your cervical mucus is either dry or damp, white in appearance and feels pasty or crumbly. As you approach ovulation, your cervical mucus changes in appearance and texture to clear, stringy, slippery and even egg white. This is fertile cervical mucus which helps sperm to survive until ovulation has occurred. Therefore, conception can occur 5-7 days before ovulation – your cervical mucus nourishes the sperm! Estrogen rises, follicle stimulating hormone (FSH) rises (peaks at ovulation) and testosterone increases. This is also a time of good energy, motivation and a good time to get new projects started or finished!

Ovulation:

Days 14-18 one egg (sometimes two) is released from the ovary. Estrogen peaks stimulating the luteinising hormone (LH) to surge. The egg is released when the dominant ovarian follicle ruptures. No surprises that this is a time in your cycle where you feel the most ‘tuned in/switched on’ and very keen…if you know what I mean!

Luteal phase (Secretory phase):

Days 14-18 (includes ovulation) – From ovulation to the start of your next period. This is the phase where if pregnancy does not occur, your body prepares for menstruation and if you do conceive, your body is preparing to implant the potential pregnancy into the uterus. Progesterone is produced and dominates the luteal phase. After the mid-luteal phase, if conception did not occur levels of progesterone and estrogen drop causing the endometrium to shed, and with this, your next cycle begins. If you did conceive, the body continues to produce progesterone (from the corpus luteum) to support the pregnancy until the placenta takes over (between 10-12 weeks).

Trying to conceive?

Using an app is handy – But observing your cervical mucus is even better! After your period ceases, start to observe your cervical mucus several times per day. When you are not yet fertile, you will produce very little mucus or a little which is creamy or white. The texture can feel flaky or crumbly to the touch. As you head towards mid cycle or ovulation, your cervical mucus changes and becomes more wet, clear or stringy (egg white). After ovulation, your cervical mucus changes back to less fertile again – the white/pasty/crumbly and you produce less of it.

How to check? Use 2 clean fingers and touch the entrance of your vagina to observe what you see. It is as easy as that! Notice how it may change throughout the day.

Changes in the cervix: Following your period, use 2 clean fingers and insert high into the vagina to feel your cervix. When you are not fertile your cervix will feel like the tip of your nose (firm). When you are heading towards ovulation or mid cycle, your cervix will feel soft (like your bottom lip). During ovulation, you may not be able to feel it at all. Following ovulation and when you are no longer fertile, your cervix will feel firm like the tip of your nose again. Clever! Please note when you do check your cervix it only needs to be once per day, at the same time, and not after a bowel movement or intercourse. Easy! See more here: https://www.bespokebirths.co.nz/natural-fertility

Avoiding conception?

Just as for trying to conceive - you would avoid intercourse during your fertile times instead. Best taught by an accredited fertility educator and in conjunction with taking your basal body temperature daily, you have what is known as the Sympto-thermal method – 98% effective when taught by a qualified teacher (and of course used as taught!). See more here: https://www.bespokebirths.co.nz/natural-fertility

When our cycle goes AWOL or is unpredictable, troublesome or causing concern?

Always start with your GP/Gynaecologist to rule out anything serious. A registered Naturopath, Homeopath or acupuncturist are great places to start. They will take a full case history and look at your overall health – rather than one thing in isolation. Supplements, herbs, vitamins/minerals may be prescribed and will be to meet your own individual needs – hence, why seeking help from a professional is always better than taking tons of different supplements from over the counter.

Seeing changes takes time and commitment – so stick it out as the improvements are worth it.

Wishing you healthy and happy menstrual cycles for years to come….!

 References

Romm, A. (2021). Hormone Intelligence: The complete guide to calming hormone chaos and restoring your body’s natural blueprint for well-being. Harper Collins.