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Safeguarding Reproductive Health Understanding what is normal
Safeguarding Reproductive Health Understanding what is normal
| Understanding what is normal |
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 The normal ovulatory cycle can be divided into four phases:1. The bleeding phase or menstruation – this is a convenient marker of the beginning and end of the cycle. 2. The early infertile days – the time of the Basic Infertile Pattern (BIP) – which occur for a variable number of days in any cycle. There may be many days, or even weeks or months of the BIP in a very long cycle. In a short cycle there may be only one or two, or even no days at all of the BIP. 3. The fertile phase – during this time the cervix produces mucus in response to the oestrogen produced by the follicles developing in the ovary. The length of the fertile phase can vary for different women, but is typically five to seven days. The fertile phase ends when the woman has counted three days after recognising the Peak: the Peak being the last day of the slippery sensation, preceded by a variable number of days of a changing developing pattern (getting progressively wetter and then slippery), and followed by an abrupt change. The Peak can only be recognised in retrospect - the next day - when the sensation is no longer slippery. 4. The late infertile days – the luteal phase. Infertility resumes after ovulation and the death of the egg cell and continues for the remainder of the cycle. In a fertile cycle, the length of the luteal phase (from the Peak day until the beginning of the following menstrual bleeding) is within the range 11-16 days. There are many circumstances when the cycle may be considerably longer than the average 28-32 days. A cycle is still considered to be within the normal range if it is between 21 and 35 days. However, if the FSH (Follicle Stimulating Hormone) production is arrested at the intermediate stage – after the follicles have commenced development, but before the dominant follicle has been selected – the follicles remain in a state of chronic minimal stimulation which may lead to the appearance of mucus and episodes of bleeding without a Peak having been recognised. Ovulation is delayed until there is a further rise in FSH. This situation of delayed ovulation occurs in some cycles due to stress or illness, and is common towards the end of breastfeeding, after coming off chemical contraceptives and when approaching the menopause. In each of these circumstances the long cycle is a natural response to emotional and/or environmental factors and can be easily explained by your Billings Ovulation Method™ tutor. You will be reassured that by applying the Early Day Rules until a Peak is recognised you can confidently manage your fertility whether you are wishing to become pregnant or avoid a pregnancy. There are also four normal types of bleeding: 1. Menstruation – which is caused by the withdrawal of the hormonal support of the lining of the uterus (endometrium) as the oestrogen and progesterone levels fall following ovulation when there has been no conception. 2. Oestrogen withdrawal bleeding – when there has been some growth of the lining of the uterus, due to raised oestrogen, but no ovulation because the FSH has been arrested at the intermediate stage, the endometrium is shed with bleeding when there is a subsequent fall in the level of oestrogen. 3. Breakthrough bleeding may occur in some cycles as oestrogen levels rise. The bleeding will usually be accompanied by other symptoms of fertility such as a feeling of wetness and the appearance of mucus. This can occur in any cycle, but is most likely when there has been a delay in ovulation. 4. Implantation bleeding – may occur about a week after conception, as the fertilised ovum is implanting into the lining of the uterus. Your Billings Ovulation Method™ tutor will usually be able to help you identify all these normal types of bleeding by what else is recorded on your chart.
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