How do I know if I’m Ovulating?
As a naturopathic doctor who works primarily with women’s health and hormones, the menstrual cycle is an aspect of health that comes up in most of my patient visits. With the menstrual cycle, it is imperative to develop consistent and reliable tracking methods to obtain objective data to truly be able to understand each patient’s individual experience, as well as monitor treatment progression and outcomes.
In terms of ovulation specifically, many patients think that this only applies to fertility tracking or if you are planning to conceive. Becoming aware of ovulation can provide so much more information about a person’s menstrual cycle and hormonal health beyond trying to conceive.
Knowing if ovulation is occurring consistently can help us with the diagnosis of PMS and PMDD, help us to determine treatment goals in patients with perimenopause and menopause, PCOS, irregular menstrual cycles, and much more.
In terms of overall cycle tracking, I encourage my patients to choose a phone application to record their data. Using an app can be a very effective way to track your cycle, basal body temperature and cervical mucus. The following few apps have been shown to have the best reliability and focus on the science of your cycle.
– Clue
– Flo
– Glow Ovulation
– Fertility Friend
– Fertility App
In terms of specific cycle parameters, I encourage patients to record/track the following:
– Day 1 of your period: this is the first day of a full bleed. Do not record spotting as your day 1. If Day 1 is recorded consistently, this will provide information regarding cycle length and variability.
– Bleeding time/length and quantity: this will help determine if heavy bleeding is something we need to investigate.
– PMS symptoms: premenstrual symptoms are a result of our body’s response to fluctuations in our hormones throughout the cycle (not the actual level of the hormone, as many might think). A lot of people experience symptoms such as bloating, breast tenderness, mood fluctuations, cravings, cramping, skin changes and many more during the luteal phase of their cycle (the 1-2 weeks leading up to their period). It is important to record these symptoms as they occur, and knowing if ovulation has happened is a key indicator if these symptoms are in fact due to fluctuations in hormones.
In addition to the above, for ovulation specifically we track the following:
Cervical Mucous
● Record cervical mucous throughout the month.
● Egg white cervical mucous that is sticky in consistency usually indicates ovulation, and can happen between day 10-15 in the cycle
There are other ways that we can track and predict ovulation, with a few examples listed below.
Ovulation Predictor Kits (OPKs)
Ovulation predictor kits can be found in many stores and online. They are used to measure the level of a hormone called LH (luteinizing hormone) that peaks right before ovulation occurs. Depending on the length of the person’s cycle, you start around Day 11 and use the testing strips with urine every morning until you get a positive test (2 solid lines). When your test is positive, this indicates that you will be ovulating in the next 24-72 hours (this is a good time to make note of that cervical discharge as well). There are circumstances, however, where these kits can falsely predict ovulation (i.e in PCOS, patient’s have a consistently elevated LH hormone as they are trying to mature many follicles to ovulate throughout the cycle, leading to a false positive). Putting this all together can help us understand your cycle better.
Basal Body Temperature Tracking (BBT)
Basal body temperature is a precise temperature measurement using a specialized thermometer that is to be used every morning upon waking. Signs of ovulation include a 0.5 degree temperature increase due to the thermogenic property of progesterone, which occurs right after ovulation. Again, this is best paired with tracking cervical mucus as this is the gold standard for predicting ovulation between 10-14 days with egg-white consistency.
It should be noted that there is a difference between predicting ovulation and confirming ovulation.
Serum Progesterone Testing 7 Days After Suspected Ovulation
In certain circumstances, we can use serum blood testing of progesterone 7 days after suspected ovulation to confirm if ovulation occurred that cycle. A level above 5-6 nmol/L can confirm ovulation, however an optimal value around 30 nmol/L can make us confident that strong ovulation is occurring. This might be a test that’s recommended depending on the patient goals and practitioner assessment.
Perimenopause Considerations – Tracking Your Cycle in Perimenopause
It is important to follow the same principles of cycle tracking as we approach perimenopause. Over the age of 40, a woman’s menstrual cycle becomes less consistent. An egg may not be released every single month, and this interferes with the production of hormones such as estrogen and progesterone. The initial changes in perimenopausal cycles may be subtle. Knowing if ovulation is occurring can help us monitor cycle length changes, bleeding changes and PMS symptoms. This can help your health care practitioner review the best treatment options for your experience individually, as the hormonal fluctuations can influence your symptoms and how you feel. As you approach perimenopause, your total cycle length will begin to change. A 7-day change in either direction (shorter or longer) when you have had regular cycles before indicates the beginning stages of perimenopause. Cycles often get shorter before getting longer, but every person has a unique experience. You may also notice changes to the volume of blood lost with each period. Perimenopausal cycles can be heavier than normal or lighter than normal. You may also notice an increase in other symptoms when you approach perimenopause. You may find you have more difficulty sleeping, hot flashes, vaginal dryness or changes to your mood. You can track these symptoms against your cycle, as sometimes they occur all month long, or they may occur only during phases of your cycle. Drastic hormonal fluctuations can influence your symptoms and may be why a patient experiences poor sleep and the most hot flashes at a certain time of the month. You may also notice that your PMS symptoms are absent during longer stretches without a period, or if your period arrives early. This may indicate that you did not ovulate, which means changes in mood, breast tenderness, bloating etc cannot be explained by premenstrual fluctuations any longer.
As always, ask your practitioner what the best method of tracking and testing your cycle is right for you!
Education about your menstrual cycle leads to empowerment, and brings you a step closer to accomplishing your health goals.
References
Morishita H, Hashimoto T, Mitani H, Tanaka T, Higuchi K, Ozasa T. Cervical mucus and
prediction of the time of ovulation. Gynecol Obstet Invest. 1979;10(4):157-162.
doi:10.1159/000299936
Leiva R, Burhan U, Kyrillos E, et al. Use of ovulation predictor kits as adjuncts when using
fertility awareness methods (FAMs): a pilot study. J Am Board Fam Med. 2014;27(3):427-429.
doi:10.3122/jabfm.2014.03.130255
Steward K, Raja A. Physiology, Ovulation And Basal Body Temperature. In: StatPearls.
Treasure Island (FL): StatPearls Publishing; July 18, 2022.
Leiva R, Bouchard T, Boehringer H, Abulla S, Ecochard R. Random serum progesterone
threshold to confirm ovulation. Steroids. 2015;101:125-129. doi:10.1016/j.steroids.2015.06.013
This article is intended for informational purposes and does not replace medical advice. To see if these treatments would be right for you speak with you health care provider or book in for a free discovery call.
