Ovulation 101: The Basics

I was having a discussion with a male friend who mentioned that nowadays it seemed like the vast majority of women have a hormone imbalance. Based on recent statistics, it is estimated that worldwide, 1 in every 15 women has PCOS and Endometriosis affects an estimated 1 in 10 women during their reproductive years which is approximately 176 million women in the world.

You would think with these types of figures that women would take their hormone health more serious but like me a few years, I had no idea that anything was wrong until everything started going wrong.

When I think back to how disengaged I was from my body prior to discovering I had a hormone imbalance and to what I know now about PCOS and Endometriosis it honestly shocks me.

I guess you can call this my silver lining amidst all the emotional and physical turmoil that having either of the above (in my case, more than likely both) has brought into my life. There isn’t one miniscule shift in my hormones that I’m not aware of now and how to possibly manage it and for that, I suppose, I am grateful to be so attuned with my body.

I was on birth control for a few years when I decided to come off as I realized that my PMS symptoms were getting worse over time. About two weeks before my period I would experience strong shifts in my mood which resulted in me being either easily agitated or in a depressive state. My PMS symptoms also included bad bloating, breast swelling and tenderness and one or two cystic pimple mostly around my chin or jawline.

I should state for the record that I am not anti-birth control. Being on birth control was not the reason I had all the above issues; what it did was mask them for a very long time so I was unaware I had a hormone imbalance. It was only when I came off and started having severe cystic acne (which lasted for over 3 years and didn’t get better till I changed my diet, I should add) and an intense mid-cycle pain did I realize that something was very wrong.

I later discovered that the intense pain I felt was my body naturally ovulating for the first in years. Remember, when you’re on birth control it stops you from ovulating in order to prevent pregnancy; that’s how birth control works. Also remember that the period that you get on birth control isn’t a real period either. It’s technically a withdrawal bleeding from withdrawal of the hormones in the pill; this is why you get your period two or three days after you’re finished with your 21 days dosage packet.

The painful ovulation that I now experience (it never went away even though my acne did) is a condition called Mittelschmerz and is often due to endometriosis. As I’ve mentioned in previous posts I have yet to be medically diagnosed with endometriosis but all my symptoms (severe period pain and heavy bleeding since my first period at age 11, chronic pelvic pain, left sided pelvic pain during my period and lower back pain) all lead me to believe that I am in an advanced stage of this disease. I distinctly remember having no period pain the first time I had my first ‘fake’ period on birth control, so this is why I said that birth control hid my conditions for years. This lasted only for a little while though and I went back to having severe cramps on the first two days of my cycle. For all women that experience very painful and heavy periods, please know that this is not normal (even though we’re told from young that it is) and you should make an appointment with a gynecologist as soon as possible to confirm if you have a hormone imbalance.

The pain I sometimes get from mittelschmerz can be very unbearable at times, I won’t lie, but it also thankfully comes with another silver lining; after I get this pain, like clockwork, my period comes either 14 or 15 days after.  Having this knowledge can be very helpful when planning outdoor and out of the country trips and for this I grit my teeth during the pain.

This leads me to point of this post; do you know when you ovulate? From several discussions with women with and without hormone imbalances, most don’t have a clue. Knowing when you ovulate can make a difference, especially, for those who are trying to conceive. Women cannot conceive without ovulating, so even if you are fertile conception will be impossible.

So, what is ovulation? Ovulation is a part of your menstrual cycle. It happens when an egg is released from your ovary. When the egg is released, it may or may not be fertilized by sperm. If the egg is fertilized it may travel to the uterus and implant to develop into a pregnancy. If left unfertilized, it disintegrates and the uterine lining is shed during your period. Understanding how and when ovulation happens can help you achieve or prevent pregnancy and can also help you in diagnosing certain medical conditions.

Women with PCOS tend to produce excess androgens or male hormones and because of this, ovulation can be affected. Their cycles may be irregular, longer than normal or may not occur at all and they may or may not ovulate in a given cycle.

With Endometriosis, the tissues overgrowth around the ovaries may prevent an egg from entering the fallopian tubes and the endometrial overgrowth in the ovary may prevent ovulation from occurring. Endometriosis may form inside the fallopian tubes, preventing the egg and sperm from meeting.

I would like to add that eating healthier and exercising regularly has made a world of difference in increasing the efficiency of my hormone regulation and managing my pain levels with regard to both of the aforementioned conditions. I wouldn’t say that diet and exercise works all the time (sometimes if I’m very stressed, which results in elevated cortisol levels, and my sleep quality is poor it can throw my hormones off) but for the most part it helps about 80% of the times, for me.

A healthy diet that consists of lots of vegetables, fruits, protein and omega 3 as well as regular exercise can increase ovulation and in doing so increase fertility. A poor diet that includes lots of trans-fats, poor carb choices as well dropping carbs too low, extreme sugar consumption and extreme dieting as well as lack of exercise and excessive exercising can halt or disrupt ovulation and threaten fertility. If you’re trying to conceive or just trying to have a regularly scheduled period you can see how consistent monthly ovulation is critical.

So, how do you know if you’re ovulating regularly? This one is pretty easy to answer. If you have a regular monthly period then you’re ovulating regularly. Since a lot of women with PCOS have irregular periods, which signals irregular ovulation, an unplanned pregnancy is something that can occur. These women would have gotten used to their sporadic menstrual cycle and would not have known when they would have begun ovulating. I actually know at least three women diagnosed with PCOS that have had unplanned pregnancies because of this. If an unplanned pregnancy is something that you would absolutely not want then knowing when your body is ovulating is obviously critical. I cannot stop repeating how helpful a healthier diet, weight management and regular exercise can help in regulating ovulation.

How do you track ovulation? Tracking ovulation is something that takes a little time as it will entail paying a lot of attention to your body. Here are the basics when it comes to understanding ovulation and the menstrual cycle.

The ovarian cycle occurs in three phases: The follicular phase, ovulation and lastly the luteal phase. I will dissect these more in another post but this is the short version explanation for each phase.

The Follicular phase is the part of your cycle where the follicles in the ovary mature. It begins on the first day of your period and ends with ovulation. Estrogen is the main hormone at play in this phase.

Ovulation signals that follicular phase is over. This is where the egg is released from the ovaries and is ready to be fertilized by sperm.  The fertility window re: the period where pregnancy can occur is on the day you ovulate and at least 5 days prior to ovulation. If you’re trying to conceive then this is the best time to try. An increase in estrogen levels trigger a sharp rise in the LH hormone from the pituary gland and the ruptured follicle will now secrete progesterone and estrogen to prepare the uterus for pregnancy.

The Luteal phase occurs is the last part of the menstrual cycle or also called the post ovulatory portion of a woman’s cycle. When a pregnancy does not occur during ovulation, the uterine lining prepares to shed and the completion of the shedding signals the beginning of a new menstrual cycle. The main hormone in this phase is progesterone.

Noting the above information, here are some things you can do or pay attention to:

  • Track how long your menstrual cycle is: I regularly have a 28 day menstrual cycle. Some months it goes to 27-29 days but it mostly stick to 28 days. From when menstruation/bleeding occurs to when you have your next period/start bleeding again is your menstrual cycle. So how do I know this? Here is an example of a breakdown:

Day 1 – 4: I get my period and this is the total length of my period. This is also the beginning of my follicular phase.

Day 5 – 14: Day 5 is the day after my period and my body’s estrogen levels will begin to rise to prepare for ovulation. My fertility window begins day 9-13 post menstruation and if I were trying to conceive then this would be the prime time to try. On day 14, when my estrogen has peaked, I usually feel my mittelschmerz pain which signals that I am ovulating and it is my most fertile day (ironically).

Day 15 – 28: After ovulation, my estrogen levels will begin to decrease as my progesterone levels continue to rise until is the main hormone at play and my uterus lining begins the process of shedding. On day 28, 14 days after I ovulate, my lining would have completed shedding and my period will begin, starting over the entire cycle.

As you can see, in order to begin tracking ovulation, you need to know how many days there are in between your last and next period. If you have a regular period, I would advise that you log the first day of your period and when your next period begins in order to know how long your cycle is.

  • Another way to track ovulation (albeit, maybe not the most accurate in my opinion) is counting backwards from the luteal phase. The normal luteal phase can last anywhere from 11-17 days. In most women, the luteal phase lasts 12-14 days. In my case, as you can see, my luteal phase is 14 days long. If you’re already close to your period then wait till it’s the first day of your period and then count back 14 days. This could give you an idea of when you might have ovulated. Again, this method might not be the most accurate as it mostly all comes back to how long your cycle is. If your menstrual cycle is exactly 28 days, then day 14 will most likely be the day you are ovulating. If you have a 25 day cycle, you will mostly likely ovulate on day 11, whereas if you have a 35 day cycle, ovulation most likely occurs on day If you feel like you’re close to your period and would like to start the process of tracking when you ovulate, then this can be the first step.

 

  • Life can get very busy as we all know and because of this a lot of women are not even aware of the physical changes that occur during ovulation. To be honest, if I didn’t have mittelschmerz I might have been ended up in the same boat. There are several physical signs though that can be a giveaway:

–  Changes to your cervical mucus: Ever noticed a white discharge in your underwear at certain times of the month? I know a lot of women may or may not have and have probably mistaken it for an infection but it’s far from. After your period finishes, your cervical mucus aka vaginal discharge is clear and watery. However, around your fertile window it becomes thicker (the consistency can be described as being like raw white egg for some women). This is due to the increase in estrogen and is designed to help the sperm swim towards the egg. If you notice this discharge then this is a good indicator that you are in your most fertile period.

–  Changes to your cervix: If you’re very comfortable with your body or have some knowledge about the inner workings of your body then you would know where your cervix lies and, if your hand is long enough, it is possible to feel your own cervix and detect the changes depending where you are in your cycle. For most of your cycle your cervix might feel a bit dryer or harder (like the tip of your nose) but around the time an egg is released it will feel softer (more like an earlobe) and wetter and it will also be higher and more open. Learning to track your cervical position will take some practice and will probably take a few months, so if you’re planning to conceive then I’d advise that you start practicing and take notes of your cervical position at different points in your cycle (for example a week after your period ends and up until the week before your period).

–  Slight Abdominal pain: Having mittelschmerz means that my abdominal pain can be very painful at times but I’ve also spoken to a lot of women that mention that they sometimes feel a mild sensation or nagging feeling at the middle of their cycle but usually just associate it to a minor ab strain or a little gas pain. This can be another way of your body indicating that ovulation is taking place but sometimes it can also point to that ovulation occurred the day before as the discomfort might be due to the aftereffects of the follicle popping. This is not the best way to gauge ovulation in my opinion as it’s not as useful as visibly seeing cervical discharge but it might be something to note.

–  You ‘feel’ different: Call it evolution’s way of encouraging procreation but several research have shown that around ovulation there is an increase in a woman’s libido that may be attested to the peaking of the LH and estrogen hormones. In addition to an increased sex drive during ovulation, some women may experience an improved sense of taste, smell and sight. Some might feel a little bloated due to water retention and some could experience slightly more sensitive breasts as well mid cycle. These are all things to keep a mental note off as they could indicate that you’re about to ovulate.

– Changes in body temperature: One minute you can survive the air condition in your cold office by just wearing a shirt and the next day you need to also wear a sweater because you’re freezing. This is because your body goes through several temperature changes during your menstrual cycle. During the follicular phase your body temperature is a little lower and you might feel colder, whereas closer to ovulation and in the luteal phase your body temperature raises. This is likely due to the increase of progesterone in the body. If you’re like me, you’ve probably even experienced night sweats during your period and have probably been attributing it to a warmer night when in reality it’s because of the increase in progesterone levels. Even though I’ve never used any, you can ask your gynecologist about using a Body Basal Temperature Thermometer to chart your BBT for ovulation as well as an Ovulation Predictor Kit (a.k.a an OPK Kit).

I’d encourage any woman when trying to track ovulation for conception to keep a log of everything from body basal temperature to cervical mucus discharge to get the most accurate ovulation prediction.

“If you listen to your body when it whispers, you won’t have to hear it scream.”

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