Tag: body literacy

Can I get pregnant on my period?

Many people think that having sex during menstruation cannot lead to pregnancy, but the answer is much more nuanced than that. It is possible to get pregnant during bleeding episodes, some of which may not be menstruation!

Was the bleeding truly menstruation?

Charting evidence-based fertility signs like cervical mucus, basal body temperature, and urinary tests are the best way to determine if you are ovulating. True menstruation should follow about 10-16 days post ovulation as indicated by a temperature shift or positive PdG test.

If you are not charting your cycle with a fertility awareness based method, your bleeding may not really be menstruation. Estrogen breakthrough bleeding may appear very similar to menstruation and is often indistinguishable without charting. This bleeding can be fertile, and pregnancy could result.

Day one of a true menstruation marks the beginning of the cycle.

Day 1 is true menstruation because it followed a proven luteal phase. The current cycle confirms the next bleed will be menstruation because of the positive progesterone tests. This app is Read Your Body.

How long are your cycles? Better yet, approximately when do you usually ovulate?

If your cycles were 26 days or longer for the last year, it is unlikely you will become pregnant with sex during the first five days of the cycle.

Dr. Josef Roetzer monitored 5,807 cycles. He observed only one pregnancy before day 6 of the cycle. Her cycles were 22-27 days long.

Dr. Roetzer estimates that using the first five/six days is 99.8% effective for avoiding pregnancy. It is important to note that all of his cycles monitored had a temperature shift preceding menstruation. If you do not have proof that you ovulated before a bleed, it becomes more likely to conceive during bleeding.

Another way to determine the last infertile day at the beginning of the cycle is to use Dr. Doering’s rule. Dr. Doering subtracted 7 from the earliest first high temperature in the last year. For example, Sarah’s earliest first high temperature was day 13. Day 13 – 7 = Day 6 as the last infertile day of the cycle. This rule is always crosschecked with cervical mucus. Sperm may survive up to 5 days in cervical mucus, and any presence that has not been determined to be infertile through instruction should open the fertile window. The Doering rule is more personalized than automatically assuming the first five/six days are infertile.

In Dr. Frank-Hermann’s double-check sympto-thermal study from 2007, all three method failures were from day 5 intercourse. This study used the first five day rule and Doering rule. This study yielded an efficacy of 99.6%.

So am I safe to have sex during my period? Ask yourself these questions.

  1. Did you confirm ovulation with basal body temperature, PdG strips, or a blood draw in the previous cycle?
  2. Are your cycles longer than 26 days on average? Have you ever had a peak day before day 13 of the cycle?

If the answer to both of those is yes, you can probably have safe sex up to day 5 of your cycle.

If your answer is no, then you have a possibility of pregnancy.

What if I want to be more conservative?

Some methods like Billings, FEMM, and Creighton suggest not having sex during heavy days of bleeding when cervical mucus cannot be observed.

If you have a history of short cycles (less than 26 days) or want to add an extra layer of protection onto the beginning of the cycle, I recommend beginning observing vulva sensation and cervical mucus as soon as your bleeding has lightened enough to no longer need a tampon, cup, or regular pad. If you need only a panty liner or are only experiencing light spotting, you should beginning checking your cervical mucus and sensation throughout the day. At the end of your day, if you have observed no cervical mucus or sensation outside of your determined infertile pattern, this day is safe for sex. (DO NOT DO THIS WITHOUT LEARNING A METHOD. THIS BLOG IS NOT ENOUGH INFORMATION TO AVOID PREGNANCY WITH ALONE).

What if I bleed for more than 5 days?

If your menstruation lasts longer than five days, you should follow the instructions from the paragraph above. It is NOT safe to consider past day 5 automatically available if you are bleeding. You need proof by using cervical mucus or urinary estrogen tests that your fertile window has not yet opened past day 5 of the cycle.

What if I randomly have a short cycle?

Checking cervical mucus is your best back up. Cervical mucus should appear when the fertile window is opening for most charters. Many methods suggest no longer considering menstruation safe once you enter peri-menopause (can occur up to 10 years before menopause) because cycles may shorten at this time. If you notice that your cycles have grown shorter than 26 days, you may want to become more vigilant and stop automatically considering the first 5 days safe.

Conclusion

For the majority of people menstruating, using the first five days of a true menstrual cycle will not result in pregnancy. For a very small percentage, it may. I recommend charting with a real fertility awareness method (Sensiplan, SymptoPro, FEMM, Billings, Marquette, etc) to determine if your bleeding is actually menstruation!

Works Cited

Boetze, Iosef. “Further Evolution of the Sympto-Thermal Methods.” International Review of Natural Family Planning 1 (1977): 139-150.

Raith-Paula, Elisabeth, et al. Natürliche Familienplanung heute. Springer Medizin Verlag Heidelberg, 2008.

Which method of fertility awareness is right for me? A decision making tool

It can be hard to choose the right method for you. In this graphic, I have simplified the main signs, times of intimacy, and efficacies for the four methods that I am most familiar with.

As part of my charting journey, I have personally compared and charted with Billings, sympto-thermal, and Marquette. You can view my charting comparisons here.

The graphic is intentionally simplified. Method rules will vary, particularly if you are using a different protocol of the method or combination of signs. My Marquette example is for monitor-only rules.

Time of day for intimacy is very important to consider as a part of the decision making process. If you and your partner’s schedules don’t mix well, this may sway you towards another method!

Some couple like intimacy to feel spontaneous. If you never want to worry about time of day, Marquette is likely the best method to choose.

On the other hand, if you want your fertile window to be defined by cervical mucus, you may want to sacrifice any time of day sex for the flexibility of opening the fertile window that may come with using alternative evenings of the basic infertile pattern in Billings.

I recommend interviewing an educator and telling them your unique situation before committing to a method.

To find an instructor, I recommend using the Read Your Body Educator directory linked here. You can use it to find an instructor based on the fertility signs you want to chart, your location, price range, and more!

No dry days? You may qualify for a basic infertile pattern!

After menstruation, the majority of women will experience dry days. For these women, their basic infertile pattern is dry. Other women may experience a pattern of unchanging mucus, sensation, and discharge after menstruation. For women who experience this same UNCHANGING discharge, mucus, sensation pattern for three cycles in a row following menstruation, they may have a non-dry basic infertile pattern. The keyword here is unchanging; any changing pattern would not indicate a basic infertile pattern. This type of pattern should only be established under an instructor if someone is seriously avoiding pregnancy. For women who establish this pattern with a mucus-only instructor (either Billings or Creighton are options), this pattern has the same level of efficacy for avoiding pregnancy as a dry pattern. Some examples of this pattern may be continuous moist days, continuous sticky days, continuous white mucus, or others!

DO NOT try to use these days for unprotected sex without establishing it for a minimum of 3 cycles with an instructor (it may take longer than this). When using these days, intercourse should be rotated to every other day in the evening before bed. 

What causes this pattern? In cycles less than 35 days, it is caused by bits of the G mucus plug breaking off. While the plug is breaking off, it causes the visible mucus or sensation. However, the rest of the plug is still blocked. This means this time of the cycle can be considered infertile if an instructor works with you to make sure it is the G mucus plug breaking off. In cycles longer than 35 days, it can be caused by a combination of the G mucus plug breaking off and estrogen’s effect on the vaginal walls causing a sloughing effect. Read more about the types of mucus here.

Sympto-thermal methods like Taking Charge of Your Fertility also mention a “sticky” dry basic infertile pattern. Methods like SymptoPro claim that women do take on an elevated pregnancy risk when using these days. As sympto-thermal methods are not as strenuous on mucus observations as mucus-only, consider this risk when deciding to utilize this pattern. Again, ideally if someone is avoiding pregnancy, they should reach out to an instructor before using these.

In either of these cases, experiencing any dry days following menstruation means that you do not qualify for a basic infertile pattern of non-dry in regular cycles. This pattern needs to be re-established with an instructor following hormonal birth control usage or pregnancy. 

Irregular Cycles

For postpartum, perimenopausal, or people with cycles longer than 36 days, it is also possible to have a basic infertile pattern of non-dry after 14 days of the same UNCHANGING discharge, mucus, sensation. In addition, a combined basic infertile pattern is possible in the Billings Method. This should only be established with an instructor. For these transitions, the Billings Method is highly recommended. 

In both regular and irregular cycles, working with an instructor can help you get more safe days for unprotected sex if you are experiencing a non-dry pattern.

An Honest Review of Fitbit for Menstrual Cycle Tracking

You may know that the Fitbit app has some built in menstrual cycle tracking features, but many people do not know that it has other features that may be useful for menstrual cycle tracking. In this article, I will review the pros and cons of the Fitbit app as it relates to cycle tracking for people who ovulate. For context, I use a Fitbit Charge III.

The most basic feature that Fitbit offers for cycle tracking is recording bleeding dates of menstruation and then displaying a predicted fertile window based on average cycle length.

The pink bar represents the length of menstruation. The blue bar represents a predicted fertile window. The flower symbol represents predicted ovulation.

The user needs to remember to input menstuation each cycle. Once it is inputted, Fitbit will generate the blue fertile window. This fertile window should NOT be used for avoiding pregnancy, as it is only based on cycle length and not real-time fertility signs like cervical mucus or basal body temperature.

Once menstruation is entered, it will also begin a countdown until your next predicted menstrual cycle.

Countdown until menstruation in the app.

Unfortunately, I do not find this basic feature very useful for anyone who has any cycle variation. Even though my cycle length has increased over the last year, Fitbit has not automatically updated my cycle lengths. The app does not appear to be very adaptive without user input.

In addition to tracking bleeding the app offers options for:

  • Mood
  • Plan B (morning after)
  • Ovulation tests (better called luteinizing hormone tests)
  • Cervical mucus (Taking Charge of Your Fertility categories)
  • Cyclical symptoms like acne

It is rather disappointing that the app does not include options to mark pregnancy when it occurs, especially since we know that this changes daily calories burned and heart rate, to name just two effected areas of the app.

Screenshots of other features.

A really cool feature that I do like is the ability to show cycle trends like flow intensity and cramps. The same screen that displays this will also let you scroll through all past cycle lengths.

In the settings of this screen, you can also decide to toggle off predictions. For people avoiding pregnancy, I do recommend either ignoring or toggling off predictions in the Fitbit app. The app allows you to choose your current birth control method as well.

Outside of the designed menstrual cycle tracking features, I want to highlight resting heart rate as a potential exciting thing to track for those who are not taking hormonal contraception. Why do you need to not be taking hormonal contraception to utilize the heart rate feature for menstrual cycle tracking? Hormonal contraception suppresses ovulation, and ovulation changes our heart rate charts!

To learn more about resting heart rate and the menstrual cycle, read my previous post here.

You can see my heart rate falling during menstruation around April 10th, and then rise during my fertile window and luteal phase.
Menstruation began when my heart rate dipped below 70 on this chart. Ovulation likely occured around the third raised heart rate in this close-up.

Heart rate in people who are ovulating is at its lowest point during menstruation, rises during the fertile window, and continues to be elevated in the luteal phase.

When heart rate begins to drop again, this is an excellent way to predict menstruation will soon occur. For example, I have been tracking my heart rate in Fitbit for 2 years, and I always bleed when my heart rate dips back down to 70 beats per minute after my luteal phase!

I do think this feature is worth tracking for anyone interested in a more precise period prediction than cycle length. If you have Fitbit premium, you can also find a setting for sleeping heart rate under restoration. This may be more steady than resting heart rate for some individuals.

The red line is sleeping heart rate converted to fit on a charting graph, and the blue line is resting heart rate. They rose near the time of possible ovulation as indicated by the positive LH tests on the chart.

Lastly, I want to address Fitbit temperature for menstrual cycle tracking. Unfortunately, wrist temperatures are not a compatible parameter for fertility awareness when it comes to avoiding or achieving pregnancy. It can be incredibly erratic. When we track temperature, we want the temperature as closest to the core as possible.

Fitbit does not give precise temperatures, instead it gives deviations from a range. I likely ovulated near 18, 19, or 20 on the photo above. While Fitbit did detect a slight shift, it is not particularly clear, and it dropped back down.

As depicted above, my luteal phase the previous month was extremely undefined, and I could not determine a confirmed temperature shift with it.

For now, I do not recommend Fitbit for precise temperature tracking. Instead, I recommend a basal body thermometer.

Conclusion

Fitbit offers some really unique options for cycle tracking, but it should not replace your birth control or fertility awareness method. The heart rate feature may be useful for identifying cycle phases, but the temperature readings are not suitable for tracking cycle phases.

6 Cycle Comparison: Marquette Versus Billings Versus DOT Fertile Windows

Have you ever been curious what your fertile window would look like in multiple methods?

In this blog, I show 6 cycles with various fertility signs and method interpretation including: the sympto-thermal method (Sensiplan rules), Marquette method, the Billings Ovulation Method, and DOT (a calendar method that was recently purchased by Clue app and is a new FDA approved birth control). I chose to include representation for only studied methods of fertility awareness: sympto-thermal, sympto-hormonal, mucus-only, and calendar method.

All charts are from the Read Your Body app, a flexible app for all methods that I highly recommend!

Some things to know before reading:

  • Marquette allows sex any time of day within their rules. My calculation rule lasts until the end of day 7.
  • Sympto-thermal method allows sex any time of day during first 5 days of menstruation, but the first safe day in the luteal phase must be used in the evening. My calculation rule is day 5.
  • Billings Ovulation Method allows sex in the evenings only and on rotated days in the pre-ovulatory time of the cycle. Days of bleeding where mucus cannot be observed are not allowed. However, since you can have sex any time of day post-ovulation with Billings, sometimes cycle day 1 is available if you have sex before bleeding occurs.
  • DOT allows sex any time of day within their rules. It automatically opens my window on day 7.

Cycle 53

Consecutive Fertile Window for Expected Abstinence:

Billings: 8 days

Sympto-thermal: 12 days

Marquette: 12 days

DOT: 12 days

General remarks: This is an extremely standard cycle in length and mucus patch (the average person will have a 5 to 6 day mucus patch when charting). I believe this is a great example of what methods would look like for someone of the average cycle length.

Cycle 54

Consecutive Fertile Window for Expected Abstinence:

Billings: 9 days

Sympto-thermal: 21 days

Marquette: 15 days

DOT: 12 days

General comments: My average coverline is 96.8 to 97.0, so regardless of earlier high temperatures and some illness I felt confident marking this coverline and temperature shift. Due to continous long, clear-ish mucus, my sympto-thermal peak was extremely delayed. Billings is a sensation focused method so I was able to mark my peak at an earlier time and have less expected abstinence.

DOT gave me a very risky day on this one. It is possible I could have been ovulating near the safe day. However, that would have only left 9 to 10 days for implantation and I had spotting, so whether this truly could have ended in pregnancy is up in the air. Even with well-timed sex, pregnancy will not always occur.

Cycle 55

Consecutive Fertile Window for Expected Abstinence:

Billings: 6 days

Sympto-thermal: 12 days

Marquette: 12 days

DOT: 12 days

General comments: This small fertile window in Billings might look scary to some, but it is not possible to get pregnant when the cervical mucus plug is truly closed. I have about one cycle like this every 13 cycles. I was also using the Kegg device during this cycle which is placed internally and reads electrolyte levels to determine the fertile window. It gave me the same 3 day dip for a fertile window, so I feel even more confident that those days were truly dry. I am missing temperatures on this one because my thermometer glitched and would not give me readings on these days. Sex day 1 was allowed because menstruation didn’t start until 5pm.

Cycle 56

Consecutive Fertile Window for Expected Abstinence:

Billings: 8 days

Marquette: 11 days

DOT: 12 days

General Comment: This was an extremely heavy period so I had no period days available in Billings. Even though the other methods gave me available days, I couldn’t have used them due to the pain, so ultimately the other methods didn’t really help out on more safe days.

Cycle 57

Consecutive Fertile Window for Expected Abstinence:

Billings: 10 days

Marquette: 14 days

DOT: 12 days

Cycle 58

Consecutive Fertile Window for Expected Abstinence:

Billings: 9 days

Marquette: 11 days

DOT: 12 days

General Comments: Marquette monitor missed my peak on this cycle. It misses peak on up to 10% of cycles. I relied on meeting LH rules instead of the monitor. Sex day 1 was allowed because menstruation didnt start until 1pm.

Reflecting on What’s Best for Me

I’m currently on cycle 59 charting, and I have tried a ton of methods. Right now, my ideal method is Billings and LH tests as a bonus marker.

While it may appear that Billings gives less safe days in some instances, what is most important to me is having the smallest consecutive fertile window. Having less expected abstinence actually makes me more likely to follow the rules. I was completely unsatisfied with only being allowed period sex in the sympto-thermal method because I have period pain issues. That means that I basically had no safe days at all in reality before ovulation with sympto-thermal.

I originally felt very enthusiastic about Marquette method. However, after 6 cycles of using the Clearblue Fertility Monitor, I realized that it always caught my LH surge after the cheap LH tests. In addition, it missing my peak even once is frustrating for the cost of the product. For that reason, I have decided to stop using the monitor when I run out of tests. I can use a 15 cent LH test and get the period prediction aspect (LH is my most steady indicator).

The DOT app tends to give me a risky cycle whenever I ovulate late and have a shorter luteal phase. I do not rely on this for pregnancy prevention. Overall though, DOT has not given me many risky ways. I use it for long-term period prediction, and it is the most accurate period predictor I’ve ever used for planning months in advance.

What to Consider Before Switching Methods

1. Why are you unsatisfied with your current method? Is it the amount of safe days, or is it the routine that you don’t like?

2. Do you have medical needs that could be addressed by another method?

Sometimes the grass isn’t greener on the other side, but if you are like me and can’t have period sex or don’t want to have period sex, methods like Billings without calculation rules will almost always include more safe days if you are dedicated enough to learn the method and chart it accurately.

Folks in irregular cycles like in postpartum time or with PCOS may benefit from more flexible methods without calculation rules

*DISCLAIMER: DO NOT TRY TO LEARN FROM MY CHARTS. MY CHARTS ARE NOT YOUR CHARTS.

My Experience Becoming a Certified Billings Ovulation Method Teacher

I recently completed my teaching certification for the Billings Ovulation Method through the Billings Ovulation Method Association in the USA (BOMA). This is a cervical mucus / sensation only method that has been taught for over fifty years in over 120 countries.

I began this certification having been quite dissatisfied with my previous certification in the sympto-thermal method. I found the sympto-thermal method inadequate for irregular cycles or postpartum cycles, as well as for any cycles with continous mucus.

This certification 100% cleared up all doubts I had about being able to teach people in these situations! I love that Billing’s motto is “Keep it simple.” Ultimately, this certification gave me the confidence to give up temperature taking as a part of my fertility awareness routine.

First Step:

Before beginning the certification, I took an introductory class with my spouse in the method. This gave me about 6 months to try to apply the principles to my charts before beginning training. I had previously certified in a “Billings-based method” but learned quickly that authentic Billings is a different creature altogether.

I recommend that anyone who is going to train in this method learn to practice it first for at least 6 to 12 cycles under the guidance of an accredited teacher. Joining this program without learning the method first is going to leave you lost on your charts – when you should be confident in your charts before helping others.

Second Step:

The class began in December 2019 and ran through September 2020. We met once a month for approximately an hour (sometimes a little more or less). Inbetween meetings, we were expected to read one to two chapters of material and complete 5 or more worksheets that included chart evaluation and quizzes.

I really appreciated the live classes because my previous certification had no live component. I’m a strong believer that synchronous connection is really important for learning something new.

During class, we were shown PowerPoints and given time to ask questions about the homework. Hearing from long-term accredited teachers about different charting circumstances did wonders for my existing knowledge base. It was incredibly valuable.

Full disclosure: It is important to know that Billings was founded by and is primarily run by Catholics. These meetings often began with prayer or referenced God. Teachers are not required to teach the religious component of the PowerPoint. That means that Billings can be presented in a secular manner. The WOOMB International head organization notably does not include religious elements in their presentation of the method. The science of the method is solid regardless of any ideology attached to it.

Third Step:

The next step after passing an exam on the material was to begin practicum. Practicum is the supervised portion of the certification where you teach 6 to 10 clients minimum in the method while submitting charts and questios to a supervisor selected for you by the organization.

This graphic is how long it took me to finish the practicum portion of the course. Most people take 1.5 to 2 years to finish the program. I went a little faster because I taught larger group classes and had clients lined up before it began.

Practicum was the most enriching part of the experience, and I recommend that anyone who does the training utilize this time to your best advantage. I learned how to help people identify complex basic infertile patterns where they never have dry days. This was not possible in my previous method. I was able to support multiple postpartum women as well as folks with PCOS or who were trying to conceive. I learned so much by meeting with my clients and sending charts to my supervisor.

The follow-ups and classes in Billings are mandatory live meetings (video calling, phone call, or in-person). The follow-ups generally last 15 to 30 minutes depending on the client and how early they are in the process. Follow-ups and classes are required to be live, and this is based on what was done to reach efficacy in the Billings studies. We generally meet with clients seven or more times in the first 6 months, and then every 1 to 3 months. Some people may have more or less follow-ups depending on when they reach autonomy and things like cycle characteristics (postpartum people tend to meet up until the third ovulatory cycle after return of fertility.)

Fourth step:

After having enough clients in different situations (postpartum, trying to conceive, trying to avoid, regular and irregular cycles), I had a final meeting with my supervisor. Before this, I had to compile a document of every client chart. This was a bit laborious as the Billings charts cannot be exported to PDF without losing part of the chart. I had to screenshot segments of the charts and then re-assemble them. This meeting with my supervisor lasted about two hours, and we discussed all of my client charts and any corrections that needed to be made.

Following that, I was recommended for the final step. I recieved a mailed in exam that involved correcting a full paper chart and writing why I made those changes and what mistakes were originally made.

I turned in this exam to two graders. They then met with me and discussed the chart and any necessary corrections. They approved my certification at the end of the meeting.

The Future

Billings Ovulation Method teachers are required to do continuing education to maintain their certification. This is an investment of approximately $300 to $600 every three years. While this is costly, it is really important to attend further training where the teacher can see more advanced charting techniques and learn about health conditions, efficacy, and more!

My Final Thoughts

I would recommend this certification program to anyone who is interested in having an in-depth understanding of cervical mucus charting. The Billings Method teaches about things like the “pockets of shaw” and the cervical mucus crypts. My previous certification did not include close study of the patterns of cervical mucus. This program fundamentally changed my thinking about temperatures always being a necessary part of charting. I ended up dropping temperatures completely after 3 years of using basal body temperature.

Billings allows teachers to order all supplies, including digital materials, for clients. This means I do not have to produce my own materials, and it is super useful for quickly mailing clients what they need.

To make the most of out of this program, I recommend also reading the scientific studies on the side. Unfortunately, the program did not go into a lot of depth on the previous research studies. As someone in academia, I really like understanding all the different correct use and typical use statistics. I’m often questioned about efficacy, and I want to be able to answer people’s questions. If this also describes you, I recommend the following articles:

The Discovery of the Different Types of Cervical Mucus

Use-effectiveness and client satisfaction in six centers teaching the Billings Ovulation Method.

Field trial of billings ovulation method of natural family planning.

A prospective multicentre trial of the ovulation method of natural family planning

A Trial of the Ovulation Method of Family Planning In Tonga

A Response: In Defense of Truth in the Science of the Billings Ovulation Method

Misrepresentation of contraceptive effectiveness rates for fertility awareness methods of family planning

A Dive Into Resting Heart Rate and the Menstrual Cycle

I purchased a Fitbit device close to two years ago, and within months I noticed that my heart rate appeared to be correlating with the phases of my cycle. I’ve been charting resting heart rate since 2018, and I can say with confidence that it has lined up every cycle. This shouldn’t be too surprising because we already know that progesterone causes basal body temperature to rise, but heart rate does not exactly follow that pattern. Heart Rate also rises in response to high estrogen levels in the fertile window.

We have known about the possible connection between heart rate and the menstrual cycle for over a century, but in the last 50 years a few studies have taken a closer look.

Palmero (1991) studied 64 women for 3 consecutive months and created a PMS group versus a non-PMS group. They found that “in the premenstrual phase, PMS group showed significantly higher resting HR levels than NPMS group.”

Moran (2000) followed 26 women and found that “resting-heart rate was significantly higher in both ovulatory (P < 0.01) and luteal (P < 0.01) phases than in the menstrual and follicular phases.”

Shilaih (2017) followed 91 women and found that they “observed a significant increase in pulse rate (PR) during the fertile window compared to the menstrual phase (2.1 beat-per-minute, p < 0.01). Moreover, PR during the mid-luteal phase was also significantly elevated compared to the fertile window (1.8 beat-per-minute, p < 0.01), and the menstrual phase (3.8 beat-per-minute, p < 0.01).”

I want to highlight these last two studies in particular, because many of the other studies have an issue. Marco Altino explains why:

“The great majority of studies looking at HRV and the menstrual cycle collected one single data point during the follicular phase and one single data point during the luteal phase. I don’t have to tell you how little sense that makes, considering the high day to day variability in these parameters.”

This is an excerpt from his blog on heart rate variability in the menstrual cycle. Read the full blog here.

The 2017 study published in Nature by Shilaih, et al found that heart rate may rise up to 5 days before ovulation occurs. This means that heart rate could potentially be a used as a way to time intercourse for conception.

My results are so steady with resting heart rate that I dream of someone using it in a long-term study with other fertility signs. Wouldn’t it be cool if we could avoid pregnancy using heart rate too?

Below is an example of my results with resting heart rate. To convert my heart rate to fit in a fertility awareness app, I use a conversion. Essentially, one heart rate beat = .1 Farenheit change on my temperature scale. A heartbeat of 69 becomes 96.9, 70 becomes 97.0, 71 becomes 97.1 This preserves the original ratio, and it allows me to show the data with other fertility signs. For your own conversion, you may model this. If you have a lower heart beat rate, you can still convert, but you may need to do an additional equation.

My resting heart rate rose during the most fertile days of the cycle. Ovulation most likely occured on Cycle Day 15 or Cycle Day 16 on this chart. In addition, while I have not found evidence of this in the literature, I have observed that I tend to get a one day rise 3 to 4 days before the fertile window opens with cervical mucus. On this chart, that was Cycle Day 6.
A second example. Ovulation most likely occured on Cycle Day 14, 15 or 16. Heart rate rose on Cycle Day 14.

In conclusion, I believe that resting heart rate is a very unique sign to track, especially if you already use a wearable fitness tracker. I will note that a false heart rate rise can be caused by illness, alcohol or food close to bedtime, nightmares, and more! This is not dissimilar to what can obscure a temperature. I hope that in the future more studies are done so that we can see if heart rate can also be used for avoiding pregnancy purposes.

Selected Heart Rate Study Citations

Moran, V. H., Leathard, H. L., & Coley, J. (2000). Cardiovascular functioning during the menstrual cycle. Clinical physiology (Oxford, England), 20(6), 496–504. https://doi.org/10.1046/j.1365-2281.2000.00285.x

Palmero, F., Choliz, M. Resting heart rate (HR) in women with and without premenstrual symptoms (PMS). J Behav Med 14, 125–139 (1991). https://doi.org/10.1007/BF00846175

Shilaih, M., Clerck, V., Falco, L. et al. Pulse Rate Measurement During Sleep Using Wearable Sensors, and its Correlation with the Menstrual Cycle Phases, A Prospective Observational Study. Sci Rep 7, 1294 (2017). https://doi.org/10.1038/s41598-017-01433-9

A Day in the Life of a Billings Ovulation Method User

Have you ever wanted to know what it is like to chart with the Billings Ovulation Method? This blog attempts to give an overview of what it is like for one individual to chart with the Billings Ovulation Method (BOM) over a single cycle. I go through each day of the cycle and explain my overall charting habits. All times are just approximate. I get personal and discuss some challenges I experience with natural family planning. BOM involves tracking sensation felt at the vulva along with the visible appearance of cervical mucus as a person goes about their day to day activities.

Day 1: Record heavy bleeding. Heavy bleeding feels wet. Done! Users are not allowed to use heavier days in the Billings method when avoiding pregnancy. This is a true day one of a cycle because it was preceded by a Billings peak day.

Day 2: Record heavy bleeding. Heavy bleeding feels wet. Done!

Day 3. Record medium bleeding. Medium bleeding feels wet. Done!

Day 4: Very light bleeding. It is now possible to observe my basic infertile pattern of dry.

8am: I feel dry and see a small amount of blood.

10am: I still feel dry.

8pm: I still feel dry. I see no mucus. Sex is allowed in the evening of this day. We use this day.

Day 5: Extremely light bleeding. Technically this day is not allowed for intercourse since I used the day before and Billings method rotates alternative evenings. We use this day anyway #rulebreaker

Day 6: I feel dry. I do not see anything. I record this day as “possibly fertile” since I broke a rule and used the day before. Every day after intercourse gets this white stamp in the pre-ovulatory time of the cycle.

Day 7: My basic infertile pattern of dry is still there! I notice nothing the entire day in the bathroom and my vulva sensation is dry. Sex is allowed in the evening. I consider my evening 8pm because I go to bed around 9pm on average. We use this day.

Day 8: I feel dry all day and see nothing. However, this day is not allowed since Billings alternates days. We skip this day.

Day 9: I feel dry all day and see nothing. However, we do not use this available day because we are both tired. It happens!

Day 10:

9am: I feel a bit moist. I don’t see anything when wiping in the bathroom.

11am: Still feel moist. I do not see anything in the bathroom.

2pm: Still feel moist. I do not see anything.

4pm: Still moist. Nothing seen.

4:45pm: Walking to my car from work. Still moist!

8pm: Overall observation for the day is moist. I record it. The fertile window has opened. This is known as the point of change.

Day 11:

7am: I feel moist as soon as I walk to the bathroom. I see very scant clear mucus on the tissue.

I do not see or feel anything for the rest of the day.

8pm: Overall observation for the day is “moist, clear”

Day 12:

7am: I feel moist, but see nothing.

10am: I feel moist, but see something white.

8pm: The feeling remains the rest of the day. I record “moist, white” for the day.

Day 13:

7am: I feel dry.

11am: I still feel dry.

1pm: I feel wet sensation when walking to my office. This is a change, so I keep that in mind.

I feel damp the rest of the day. I never see anything in the bathroom. I record “wet” as the most fertile sensation that day.

Day 14:

6:30am: I immediately feel moist.

9am: I see long clear strings when wiping in the bathroom.

11am: I have a wet sensation when walking around.

3pm: I walk around my work place. I still feel moist.

5pm: I see clear strings again.

8pm: I record “wet, clear strings” on my chart.

Day 15:

7am: I feel a gush as soon as I wake up. I do not see anything in the bathroom.

9am: I see scant, clear mucus on the tissue when wiping.

11am: I feel very wet walking around my work place.

1pm: I do not see anything on the tissue.

3pm: I do not see anything on the tissue.

5pm: I feel wet sensation while making dinner.

8pm: I record “wet, clear” as my observation for the day.

Day 16:

7am: I do not feel or see anything when waking up.

9am: I still do not feel or see anything.

12pm: I go for a 20 minute walk. When I get back, I feel slippery sensation. I go to the bathroom and see copious amounts of long, clear mucus.

8pm: I felt slippery the rest of the day. I record “slippery, long clear” on the chart.

Day 17:

6am: I feel dry when waking up.

8am: I don’t see anything or feel anything.

11am: I don’t see anything or feel anything.

8pm: The day was nothing felt, nothing seen all day. I record dry. This means yesterday was my peak day because it was a changing and developing pattern ending in slippery followed by an abrupt dry up to no longer wet or slippery.

Day 18 and Day 19:

I have the same experience as day 17. I pay attention all day and observe no mucus or sensation.

Day 20:

Ovulation is expected to be over and the cervical mucus plug has re-closed for the cycle. Sex is available any time for the rest of the cycle until day one of menstruation occurs. I can chart, but it is not necessary to wait until the evening and observations are less important as sex may interfere at any time.

Day 28: I record heavy bleeding and the rules restart.

Real Talk: Diffulties / Obstacles With Billings Not Seen on the Chart

These are things that I find can be difficul in my own personal experience. I know that people in really long cycles or with other irregularities may have different issues than me.

Challenge One: Alternative evenings only can be a struggle, and it seems even harder for me right before the fertile window opens due to my mood at this time of the cycle. This follicular phase is much longer for me than my luteal phase on average, and this means alternative evenings is the rule for most of my cycle. If someone has a partner with a conflicting schedule, this can especially be offputting. I think anyone who is going to practice this method should consider whether this is practical for their lifestyle.

Challenge Two: Expected abstinence in Billings can be hard, and I have fairly short fertile windows on average. I originally practiced sympto-thermal, and I switched to Billings when I realized that overall consecutive abstinence was much less overall (for my own cycle, Billings: 9 days, Sympto-Thermal: 14+ days). I tend to break some rules still, but this is much more suitable for my fertility intentions level than sympto-thermal.

Look out for my next blog on “A Day in the Life of a Marquette User.”

Disclaimer: Do not try to learn how to chart from this post. Everyone has their own unique cycle and this is just an example of charting with Billings in a regular cycle. Please reach out to me if you would like to learn this method with me as your guide. Alternatively, you can find a teacher here.

One Cycle Seven Ways: Experimenting with Marquette (Clearblue Monitor), Billings Method, Sympto-Thermal, Daysy, Kegg, DOT, and more!

Over the last several months, I have been testing multiple femtech products (such as Daysy Fertility Tracker, Kegg, DOT) and comparing them to charting methods like Marquette, Billings Ovulation Method, and Sympto-Thermal (NFPTA). These products and methods rely on different fertility signs such as basal body temperature, cervical mucus, urinary hormones, electrolyte levels, and calendar dates.

Disclaimer: Do not attempt to learn to chart using this post. My own experience may not reflect your unique cycles. My fertility intentions may not be your intentions.

Keep in mind that different methods may change safe days over time. The following data is only a snap shot of what fertility windows for avoiding pregnancy could look like. In particular, the Daysy thermometer only has 4 cycles of data on me.

Expected Consecutive Abstinence Over 3 Cycles

Cycle 52

  • Billings Ovulation Method: 15 (9 consecutive)
  • Marquette: 13
  • Sympto-thermal: 16
  • DOT: 12
  • Daysy: 15

Cycle 53

  • Billings Ovulation Method: 14 (8 consecutive)
  • Marquette: 13
  • Sympto-thermal: 13
  • DOT: 12
  • Daysy: 14

Cycle 54

  • Billings Ovulation Method: 16 (9 consecutive)
  • Marquette: 15
  • Sympto-thermal: 19
  • DOT: 12 (EXTREMELY RISKY)
  • Daysy: 15

From this data, you can see that sometimes the amount of expected abstinence does not differ from method to method, and sometimes it differs a whole lot! On my last cycle with DOT, it ended my avoidance window on the day after peak fertility occured. Fertility is still potentially high on the 3 days following this date.

Billings method almost always had the least consecutive abstinence because it relies on real-time fertility signs to open the window. However, because it rejects calculation rules and relies on one primary sign, only alternative evenings are ever allowed for pre-ovulatory sex. In addition, heavy days of menstruation are not allowed due to the possibility of early ovulation, and the bleeding obscuring the opening of the fertile window.

Other methods like Daysy, Sympto-thermal, DOT, and Marquette do allow pre-ovulatory consecutive sex, but most of that falls during menstruation for my cycle ranges (25 to 30 days).

Whatever method works best for someone is very dependent on their lifestyle and what someone is willing to diligently track.

The Same Chart Seven Ways

The highlighted days represent days to not use in order to avoid pregnancy with these methods.

My hearts are left on to show the fertile window and for authenticity. Do not use these charts to try to learn the rules of any method or to determine when sex is safe. You will see some broken rules based on my own personal intention level and on the fact that not all fertility signs will show the same window.

The Billings Ovulation Method draws the fertile window based on vulva sensation and cervical mucus. Any heavy bleeding is considered potentially fertile because it obscures readings and ovulation can always happen early. It requires alternating evenings for sex during the established basic infertile pattern.
This is the Marquette Method while using only urinary hormones and calculation rules. Fertile window opening determined by calculation rule based on last 6 cycles or first “H” reading on the Clearblue monitor. Clearblue measures estrogen and luteinizing hormone. My first window is also closed by a progesterone test in addition to meeting PPHLL rules.
This is the double-check sympto-thermal method per Natural Family Planning Teachers Association (NFPTA) rules. It opens the fertile window based on the shortest cycle in the last year minus 20. It closes the fertile window based on cervical mucus and basal body temperature.
This is a chart with the Daysy Fertility Tracker. This basal body thermometer learns your patterns over time and opens the fertile window based on past cycle data. The fertile window changes with time, and this is technically my 3rd Daysy cycle. Caution days and Red X days are for avoiding intercourse. Daysy does not allow the user to mark temperatures questionable, but I have marked two days questionable because I drank alcohol or had the heater on.
This example chart includes my cervical mucus notes for more context. DOT is a calendar based method that looks at the last 12 cycles of data. Only people in regular cycles can use DOT. Black moons are days available for intercourse based on the calendar method. In the next line, I also have included Kegg. Kegg predicts ovulation for trying to conceive purposes only, so I am including it as a bonus comparison. By reading the electrolyte levels in my cervical mucus, it determined that these 3 days were the most fertile days of the cycle. A full Kegg review is forthcoming in December 2020.
This is a resting heart rate chart. Resting heart rate has been shown to correlate with the menstrual cycle. I convert my heart rate like this: 69 = 96.9, 70 =97.0, 71 = 97.1, etc to be able to fit it onto the graph. You can see that it very closely followed my ovulatory pattern.
Here is my chart with all the data in one. It is so cool how different fertility signs draw the fertile window!

Unfortunately, my Mira Fertility sticks were flawed, so I had to remove that data from this experiment. In the future, I will do a comparison post also using this device. I am currently still testing the Kegg device, and a review with full Kegg charts is forthcoming in December. Kegg cannot be converted to display on the Read Your Body app, so I could only include the fertile days in this post.

Do you have any questions about all of these methods?

Consider coming to my free Instagram Live on femtech on November 28th. You can find me @chartyourfertility.

On December 12th, I’m offering a “pay what you can” introduction session that is minimum $5 to $30 USD on regular FABM methods and what the main differences are. Reach out to me if you would like to come.

Finally, a special shout to the Body Literacy Collective and the Read Your Body app for making this post possible by creating the most versatile charting app on the market!

In Defense of Mucus-Only Methods (Specifically Billings Ovulation Method)

In the fertility awareness world, there are many misconceptions about mucus-only methods. While I cannot speak to mucus-only methods that I have not trained in, I can speak for what I have learned in training in the Billings Ovulation Method. There is so much history of the development of the method that I cannot touch on everything here. For those wanting to learn more, this document goes over some of the history of the method. Outside of that, WOOMB has many useful links.

First and foremost, the usual criticism leveled at mucus-only methods is that they have a low efficacy rating when compared to the sympto-thermal method. However, this is much more nuanced than it may appear at first glance. Let’s look at the most often quoted study for Billings.

This section of statistics is copied directly from a WOOMB International breakdown found here:

“1976-78 an independent trial was conducted by the WHO, in five countries (India, the Philippines, New Zealand, Ireland and El Salvador).

This study had two phases:  
869 couples entered the three-month ‘teaching phase’,
725 couples continued in the 13-cycle ‘effectiveness phase’,
with a total of 10,215 cycles in the entire study.

The teaching phase showed that in the first cycle of charting, 93.1% of women were able to record an identifiable ovulatory mucus pattern denoting fertility, and that by the third cycle of charting, 97.1% of women had an excellent or good interpretation of the method.

The results for the entire study were:
2.2 pregnancies/ hwy    (per 100 woman years)  –  method-related pregnancy rate
22.3 pregnancies/hwy  (per 100 woman years)   –  total pregnancy rate

The total Pearl Index  – 22.3/hwy  comprised:
• Conscious departure from the rules of the method: 15.4/hwy.
• Inaccurate application of instructions: 3.9/hwy.
• Method failure: 2.2/hwy.
• Inadequate teaching: 0.3/hwy.
• Uncertain: 0.5/hwy.”

The first thing you should notice is that perfect use was 97.8%. This is pretty high. The second thing you should notice is that typical use includes people who knowingly broke the rules! All typical use always includes this. This statistic of 22.3% typical use failure is used to scare folks away from mucus only, especially when compared to one specific sympto-thermal trial by Sensiplan. However, the Thyma double check sympto-thermal had a 35% typical use rate in one trial. No method is impervious to bad typical use rates because this is dependent on how open someone is to pregnancy, as well as cultural factors. This is a flaw (depending on your perspective) of all FABM methods; someone can choose to achieve pregnancy because fertility is not suppressed.

The next thing to consider is that the older statistics of the Billings Method were based on a different peak rule, a very similar peak rule to which all sympto-thermal methods have adapted. As Billings continued to develop, the method was strengthened by over 850,000 hormonal assays completed by Dr. Brown which tested estrogen, follicule-stimulating hormone, progesterone, and luteinizing hormone. These tests were matched to Billings Ovulation Method charts. The method has been scientifically validated in over 10 total trials.

As the method was studied, the peak rule was changed to help women recognize patterns of fertility and infertility. They discovered when the specific peak rules were met, a changing and developing pattern of discharge and sensation <more specific rules apply to this>, ending at a slippery sensation felt at the vulva 《with walking sensation》and followed by an abrupt change to no longer slippery or wet, that a woman could detect a false mucus patch build up without the need for temperatures. Because of the science that Dr. Brown, Dr Evelyn and John Billings, and Dr. Odeblad verified through numerous studies, they were able to strengthen the mucus only method enough to no longer rely on temperatures without fear of double peaks. The most recent Billings study in China found a 100% perfect use rate and a 99.5% typical use rate when users were very strictly avoiding and highly motivated with the rules.

In short, the Billings Ovulation Method is very effective and for careful charters does not suffer the problem of false peaks. Again, I have barely scratched the surface of all the trials and science involved. I recommend researching Erik Odeblad and the pockets of shaw for more information.

So why do mucus-only methods get such a bad wrap? In the secular communities, I think there are a few main reasons.

1. The methods must be learned through a teacher. Learning these methods takes dedication and regular live (or online) meetings with a real person. Most folks don’t feel like making this effort or think they can’t afford it. Billings has a policy to never turn anyone away in need. Many do free services or payment plans when asked. There is also a charity associated with Billings that can sponsor Catholic couples to help them afford classes.

2. The next reason is that many sympto-thermal users have fundamental misunderstandings of what Billings is. As a certified sympto-thermal teacher and someone who has read about fifteen books on sympto-thermal, it is dissapointing how much of the original science of fertility and the cervix is left out of our materials. My mind was blown when I discovered how things really work when learning a mucus only. From the pockets of shaw to the functions of the cervical crypts, there is so much to learn that is not included in Taking Charge of Your Fertility. This does a great disservice to sympto-thermal charters.

3. Due to these misunderstandings, they think the method cannot be used by those with irregular cycles. They also may think that a non dry basic infertile pattern is not possible due to a misunderstanding of the science of the cervical plug and the effect of estrogen in the vagina.

Potential Cons of Mucus Only:

I do not say any of this to say that the Billings Method is right for everyone. It takes dedication and a willingness to follow the rules if strictly avoiding pregnancy. In addition, there are a few cons to mucus only.

1. A yeast infection or bacterial vaginosis would obscure observations and cause abstinence. However, arguably even a sympto-thermal user would need to abstain when they have an infection.

2. Women who are careless with mucus observations may end up with an unintended pregnancy. If you don’t want to track mucus carefully, this is not the right method for you. If you can’t follow the rules to safely have intercourse, such as evenings only during basic infertile pattern on alternate evenings in the pre-ovulatory time of the cycle, this method may be too restrictive for you.

3. A weak mucus patch that does not fulfill the stringent peak rules may cause more abstinence without a temperature shift to confirm. However, this often signals a potential health issue and should be investigated.

4. Mucus only methods do encourage abstinence when avoiding pregnancy. However, most sympto-thermals do the same. Anyone who is okay with an elevated risk due to barriers or alternative protected sex can always do what they want to do but should be prepared to face the consequences if a barrier method fails.

Conclusion:

Mucus only methods can be highly effective choices for avoiding pregnancy. Recent trials of Billings consistently show 99% or better with perfect use. In some cases, they may reduce abstinence because they allow women to identify false mucus build ups that do not lead to ovulation and non-dry basic infertile patterns. For women who want to eliminate barrier method usage, they offer a way to identify fertility in real time when in irregular cycles due to PCOS, postpartum, or perimenopause. This eliminates much of the extended abstinence or barrier method usage that sympto-thermal users may experience.