Barb's Daily Dose

Your Menstrual Cycle

The menstrual cycle is my life. I know, it's crazy, but without knowing how it works, it's impossible to do my job.  If you understand this, then you will understand these important issues that most women face at some time in their lives:

• Why the pill works
• What happens when you can't get pregnant
• How you can get pregnant
• What happens in menopause
• What happens with PCOS
• What makes the world go around - sorry, couldn't resist  

The Typical Menstrual Cycle
This is a fast, quick explanation: 

The Typical Menstrual Cycle
This is a fast, quick explanation: 

Ovulation chart

Trying to get pregnant?  Not interested in expensive tests and treatments?  

Want to keep it simple?  Or maybe you're doing all the other things and it's been recommended that you chart your temperatures. In any case, I've got another free download for you!

Nurse Barb's Ovulation Chart now available free!  

Buy my award winning Fertility Guide used by Fertility Experts. Tell your friends. 

Here's how to do chart your temperature

• You can start on the first 1 -3 days of your period. That's the beginning of a new cycle.
• Begin by using a digital thermometer and taking your temperature before you ever get out of bed in the morning.
• Next put a mark on the chart corresponding to your temperature.

In a normal cycle, a woman's temperature has 2 distinct phases. 

• There is a low phase prior to ovulation and then a higher phase after ovulation. 
• Ovulation usually occurs between the 2 phases.  
• It's a good idea to try to time intercourse for the time in the cycle when the temperature shifts from low to high.

Trying for a Boy or Girl?

Two questions that I hear a lot is how can couples increase the chances that they'll have a baby that's a girl or how can they try for a boy?  Amazingly enough, there are some things that you can do to increase the likelihood that you’ll have a baby with your desired sex.  This is not guaranteed, but there are some experts who provide advice for increasing your chances more than flipping a coin.

To have a Baby Boy 

 First, you must eat lots and lots of broccoli. Just kidding. That’s an old wives tale. To increase the chance of having a boy try to time intercourse to be as close to ovulation as possible. Try not to have intercourse any sooner than 24 hours prior to ovulation and no later than 12 hours after.

To Have a Baby Girl

To increase your chances of having a girl try to time intercourse for 3 or more days before ovulation. Remember sperm can live for 5 days.

A Good Resource

These recommendations will increase your chances, but only by about 20%. There is a book you might consider How to Choose the Sex of Your Baby by Dr. Shettles that goes into great detail about how to have a boy or a girl.   

Good luck.

Breastfeeding as Contraception?

Recently I was asked whether women who breastfeed need to worry about contraception. 

The answer is:

You sure can.  If you're lucky enough to have the energy and the hots for your partner right now, even though you're probably sleep deprived and craving a little time to yourself. If you're thinking about some cuddling and some intimacy with your partner, then please be sure to use some form of birth control. Although women who are breastfeeding might not have a period, they can still ovulate and get pregnant.

So, play it safe and lubricate, lubricate, lubricate.  Most women who are breastfeeding find that their vaginas are very dry and don't stretch like they used to.  Likewise, their sexual response might be slower. This is a completely natural side effect of breastfeeding.  You see, the hormone prolactin that makes milk, inhibits the hormone estrogen which helps keep our private girl parts moist and able to stretch.  So, no matter what you use for birth control, get yourself some lubricant, and have fun. For more on breastfeeding, see my Personal Guide to Breastfeeding.

What is Basal Body Temperature?

Trying to get pregnant and taking your temperature

Why and when should I check it? 

Great question, if you're trying to get pregnant. This is your body's temperature at rest before you get up in the morning. Because temperature can fluctuate throughout the day, taking your temperature the first thing in the morning, before you get up, before you eat or drink anything, will give you an accurate reading. 

Here's what to do:

• Download a Basal Body Temperature Chart.
• You can use a digital thermometer or an old fashioned glass one, with 1 degree separations (it's just easier to see). 
• Keep the thermometer by your bed. 
• When you wake up, take your temperature before you get up, and before you put anything in your mouth. Record the values on a sheet that you can download. 
• Start taking your temperature around the first few days of your period and continue to put little dots on the graph. 
• Then connect the dots. 

What it all means

Simply, before a woman ovulates (produces an egg), her temperature will be low. After ovulation, her temperature will be higher. Ovulation will occur sometime during the days when the temperature moves from low to high. 

It's best to plan to have sex when the temperature begins to increase. Sometimes, health care providers like to see your recordings because it can help us determine easily that you're ovulating, without you spending a lot of time & money on lab tests and ultrasounds  It also helps us advise you when to have intercourse. For more on Fertility issues, see my Personal Guide to Fertility. 

PCOS Part 3

A few weeks ago I posted Part 1 of PCOS.

Last week I posted the 2nd part of our series on PCOS.

Today, we'll talk about how PCOS manifests in women's lives and what they should watch out for.

Quick Review

Women with PCOS often do not ovulate and they have an imbalance in their hormones. Many will have long intervals between periods and some may only have 1 period a year. When this happens, these women are at risk too much estrogen stimulation on the lining of the uterus, without the balance of progesterone.

Heavy Bleeding
With PCOS, because of the imbalance of estrogen and progesterone, the lining of the uterus, known as the (endometrium) may grow too much and a woman may experience heavy and prolonged bleeding. There are many terms for this, and what's important to know is when to be concerned. Check in with your health care provider if:
• You have been bleeding for more than 10 days in a row
• You are soaking through a pad and/or a tampon in less than 1 hour for more than 3-4 hours
• Your periods come more often than every 21 days.

Abnormal bleeding
With PCOS, women are more at risk to have abnormally heavy bleeding that may be a sign of abnormal, pre-cancerous or cancerous cells within the endometrium.

PCOS part 2

This is part 2 in our series on PCOS. Here's a link for Part 1.

Most women with PCOS see a health care provider for a few common reasons. Either they aren't having periods, their periods come infrequently, or they have heavy bleeding.

This is what PCOS looks like with an ultrasound

Poly = Many

Notice that there are many small black areas within the ovary.
Each of these black appearing areas are cysts that are filled with fluid.
It's not unusual to see 10 - 12 cysts on each side.
Each month more cysts begin as others regress.
Most women do not feel these cysts.
These cysts are usually small and rarely burst causing pain.

Is there a cause for PCOS?

Can it be prevented?

Can PCOS ever go away on it's own?

Review
In order to understand what happens with PCOS, let's briefly review what happens in a typical menstrual cycle.

• When a woman starts her period, the ovary is also active. Several follicles, which are where the eggs develop begin to grow under the influence of FSH (follicle stimulating hormone).
• These follicles produce the hormone Estrogen.
• One of the follicles really grows fast, producing the most Estrogen and it becomes known as the dominant follicle, which will ultimately be the one that releases the egg.
• This high level of Estrogen triggers the release of LH (luteinizing hormone).
• About midway through the cycle, there is a surge in LH which causes the egg to be released about 24-36 hours later.

PCOS

Poly Cystic Ovarian Syndrome

This is the first part in a multi-part series on PCOS. I care for many women with PCOS and they've told me that there isn't a lot of information that's easily understood available.

What women with PCOS may notice:

• Too much hair in places you don't want it, like the upper lip, chin, around the breasts and tummy

• Difficulty losing weight

• No periods, irregular periods or 1 -2 each year

• Acne

• Darkened skin around the neck and/or armpits

• Inability to become pregnant

What your provider may notice

• Elevated levels of LH (Luteinizing hormone)

• Lowered FSH (Follicle Stimulating hormone)

• On an ultrasound, 10 or more cysts on one or both ovaries. This is how PCOS got it's name. Poly means many. When there are many cysts, there are Poly Cysts.

Trying To Get Pregnant Again?

Why is it taking so long?

Like many new moms, Lauren, was enjoying being a mom to her 3 year old daughter, Alexa. She and her husband, Rob loved their little family and were both more than ready for number 2. She watched as more and more friends became pregnant again and wondered when it would happen again for her. It wasn’t as if she and Rob had any problem getting pregnant the first time, they had tried for 4 months when their home pregnancy test turned positive. Yet now, they’d been trying for almost a year, and every month brought disappointment. Lauren was concerned and starting to worry that maybe her dream of another baby might not come true.

Unfortunately, Lauren’s experience is not unusual. Many couples find that though they became pregnant easily with their first, getting pregnant again is elusive. In medical terms, we call this secondary infertility. After the first baby, as time goes on, pregnancy rates decline, which can leave some couples grappling with what to do.

First Steps

The most important first step for any couple trying to conceive is to first see a health care provider who specializes in women’s health and make a plan for how to proceed. When people want to get pregnant, they don’t want to wait, they want to be pregnant yesterday, and anxiety and worries can build. Having a clear idea of a step-by-step plan is reassuring and helps couples know what to expect on this uncharted journey.

There are many low stress, low cost ways to increase the likelihood of getting pregnant. First, consider increasing the frequency of sex. If you can find the time and energy with all the other demands on your time, having sex 2 to 3 times each week increases your chances. Next, think about keeping track of when your periods begin and end. Combining this with basal body temperature charting will give you and your health care provider an idea of whether you’re ovulating regularly.

Fertility Awareness

Fertility awareness kits, that are available at the drug store, help predict when you’ll be ovulating, so that you can make plans to be together. However, these kits do require some additional work. Despite all the joking about how men can have sex at any time and don’t need much to get their motors revved up, many men actually find it difficult to “perform on demand” and may need to be coaxed and cajoled into having sex on a schedule.

Consider seeing a specialist if you are:

• Under 35 and have been trying for 1 or more years.
• Over 35 and have been trying for 6 or more months.
• Over 40 and have been trying for 3 or more months.
• At higher risk for infertiltiy for any reason and you are ready to try to conceive.
• At higher risk for infertility from a history of endometriosis, fibroids, irregular periods, and prior serious pelvic infections and you’ve been trying for 3 or more months.
• Concerned about any factors that may affect your male partner.
• Concerned about recurrent miscarriage

Know what to expect

If a couple hasn’t become pregnant after 6 months of trying, many health care providers offer oral medication, such as Clomid for 1 to 3 months. If this is something you’re considering, be sure to ask about lab tests and ultrasounds and know what to expect in the short term and what the plan is if those interventions don’t work. As we get older, it’s important not to waste more than 6-12 months trying, but seek the advice of a fertility specialist. The American Society of Reproductive Medicine www.asrm.org is a great place to find a certified fertility specialist.

For more information see www.blueorchidpress.com/fertility.html .