Blog

What are Fertility Awareness Methods

fertility awareness methods, toronto naturopath

Fertility awareness methods allow the opportunity for people to track their cycle, with the goal of knowing when ovulation occurs. There are a variety of methods (as listed below) and are about 76-88% effective, with a possible increase in effectiveness if you use multiple methods together. 

With most of these methods, it’s wise to track your period and these particular signs for at least 3 months (6 months for calendar methods) to get an idea of your body’s rhythms before you use any of the methods for contraception. 

The Temperature Method

If you’ve been following my blog for a while, you might remember a blog post discussing basal body temperature and fertility.

A quick recap: body temperature changes throughout the menstrual cycle. It’s lower in the follicular phase and slightly higher in the luteal phase. This slight rise in temperature occurs after ovulation, and happens after the formation of the corpus luteum which releases progesterone (the hormone responsible for the temperature change). 

By following this method, you would measure your basal body temperature everyday and chart it (on an app or on paper).  

Days are considered safe once 3 days has passed since the initial rise of temperature, as well as a drop in temperature before the onset of the next menstrual cycle. This is an opportune time to have unprotected vaginal sex (with or without ejaculation). 

During your fertile days, you can avoid sex or use another birth control method. 

The Cervical Fluid Method (The Billings Method)

This method is based on cervical fluid changes, another topic I covered a while back. 

A quick recap: During the follicular phase, increasing estrogen levels will lead to the production of cervical fluid. Cervical fluid will change in colour, texture, and amount during the period, and is considered especially fertile around ovulation. 

Similar to the Temperature Method, cervical fluid needs to be charted everyday, starting from the end of the menstrual cycle. The changes that you may see will give you an idea of when ovulation may occur – which is great if you are hoping for pregnancy (unlike temperature, where it tells you that ovulation has passed).  Record everything daily: your period days, dry days, wet days, sticky days, cloudy days, and slippery days.

There are 3 ways to check your cervical fluid: (1) Before urination, wipe the opening of your vagina with white toilet paper or tissue. Observe the colour and feel of the fluid. (2) Look at your underwear for any discharge – note the colour and texture. (3) Insert your clean fingers into your vagina, and note the colour and texture of cervical fluid on your fingers. The best way to feel the consistency of your fluid is to rub it and stretch it between your thumb and index finger.

This fertility awareness method may not be best for people who don’t generally produce any cervical fluid. 

Source https://pregprep.com/wp-content/uploads/2013/08/131107_pregprep_chart1.jpg

The Symptothermal Method

This method combines cervical fluid, cervix changes, basal body temperature, and calculation to determine the beginning and the end of the fertile period. At the very least, you should be tracking cervical fluid and basal body temperature to determine when to avoid or engage in sex (depending on your goals, obviously). 

The Calendar Method (The Rhythm Method)

This is one of the methods that need at least 6 months of charting your period. 

Mark the first day of your cycle on an app or on a calendar. Remember, the first day is when you notice significant bleeding – not spotting. Mark the first day of your next cycle. Count the number of days in between your period. You’ll find the fertile part of your cycle, once you subtract 18-21 days from the shortest cycle (of the 6 cycles that you have tracked). You would find the end of the fertile part of your cycle by subtracting 9-11 days from your longest menstrual cycle. 

A real life example:

Dec – Jan = 30 days
Jan – Feb = 33 days
Feb – Mar = 28 days
Mar – April = 26 days
April – May = 32 days
May – June = 27 days

My shortest cycle was 26 days 
My longest cycle was 33 days

Start of my fertile phase is (26 days – 21 days) and (26 days – 18 days) = Days 5 to 8
End of my fertile phase is (33 days – 11 days) and (33 days – 9 days) = Days 22 to 24

Therefore, I would be considered fertile between days 5 to 24 of my period. Many couples may find this way a bit constricting, and may need to have another means of contraception if they still want to engage in vaginal sex. 

This method may be unreliable if you experience irregular menstrual cycles. 

The Standard Days Method

This fertility awareness method identifies a standard window in which someone may be fertile. You can only use this method if your cycle is really regular and is never shorter than 26 days and never longer than 32 days. You must also be cool with not having vaginal sex or using another contraceptive method between days 8 and 19 of your cycle – as they are considered the most fertile. 

Final Thoughts

There are at least 5 ways of practicing fertility awareness. Your best bet is paying attention to your basal body temperature and cervical mucus, and doing so for at least 3 cycles if you’re choosing this as your primary method of birth control. Speak to your Naturopathic or Medical Doctor to determine if these methods are right for you.

What is Cycle Syncing?

June 18, 2018
cycle syncing

Have you ever heard of the idea of planning you life around your period? I can imagine that women with endometriosis plan their activities around their painful periods, but are women with relatively healthy periods doing this? 

What is cycle syncing?

Cycle syncing is the practice of planning your life around all the phases of your menstrual cycle. While the scientific community generally believes that there are two predominant phases of the menstrual cycle, a few others believe that there are four phases of the cycle. 

The Four Phases

  1. Follicular Phase: 7-10 days long

  2. Ovulatory Phase: 3-4 days long

  3. Luteal Phase: 10-14 days long 

  4. Menstruation: 3-7 days long

Hormones and Cycle Syncing

hormone levels and cycle syncing

As you can see from the above diagram, hormone levels change throughout the menstrual cycle. The cycle syncing method follows the same changes, but will attribute certain features (namely the ones below) to the monthly hormonal fluctuations. 

Food and Cycle Syncing

Food choices seem to play a huge role when it comes to cycle syncing. Fresh and light foods are recommended during the follicular phase, estrogen-metabolizing foods during the ovulatory phase, B vitamin/calcium/magnesium/fibre-rich foods during the luteal phase, and lastly low glycemic foods during the menstrual phase. 

Exercise and Cycle Syncing

Exercise and forming healthy habits are important foundations of cycle syncing. In the follicular phase it might be the perfect opportunity to try something new because it’s that time of the month to do so. Energy levels are the highest during ovulation, so it’s encouraged to take part in activities that are high impact. During the luteal phase there is a transition between high to low impact exercises as menstruation approaches. Lastly, during menstruation rest and relaxation predominate – and if you want to engage in some activity, try walking, stretching and yoga.  

Self-Care and Cycle Syncing

The follicular phase appears the best time to be social and RSVP to many gatherings. It’s also the best time to start projects you’ve been working on. The ovulatory phase has you focus on community, and since this is the ‘sexiest’ time of the month, go on first dates as well. During the luteal phase, energy begins to wane, and you may want to turn your energy inward and stay at home. Lastly, menstruation is the best time to check in with yourself and see how things are going. 

My Thoughts on Cycle Syncing

The Four Phases

A couple of things that I don’t necessarily subscribe to are: idea of the four phases of the cycle. Menstruation and ovulation in particular are considered part of the follicular phase of the cycle. They are events of that particular cycle. Also, menstruation is not considered the last ‘phase’ of the cycle. It’s the phase that kicks everything off! 

Food Choices

I believe that switching up smoothie preferences can be more of a sustainable option compared to switching things up on a weekly basis. Maybe that’s just me know, when I’m preparing lunch or dinner, I’m eating things that both my partner and I like and are quick and easy (for the most part!). Moreover, all the general recommendations given during each of the four phases can realistically be applied during the entire month. It’s always important to be eating foods rich in iron and B vitamins. Fibre is necessary everyday, not only for 10 days of the month. 

Exercise

This is one of the features that I like the most, because exercise, energy and hormone levels really go hand in hand. First off, during the first couple days of your period, you’re likely not going to want to be running a marathon. Because estrogen and progesterone are so low, it is a good time to rest – especially if you tend to experience unwanted symptoms during your flow. As energy increases (as do hormones), getting back to your regular routine can be incredibly helpful to help maintain mood, and overall health. I don’t subscribe to the idea of saving high impact activities during ovulation – workouts like HIIT confer so many great benefits, that it would be a shame to do them only a couple days in a month. This is the same with yoga. 

Self-care

As I reflect on self-care and energy levels during the cycle, I do notice in myself that I am often more social around ovulation, and tend to relax at home during menstruation and towards the end of the luteal phase. That said, not everyone experiences this or has the luxury to start projects/go out when they please. 

Mindful Periods vs. Cycle Syncing

To be honest, I’m not too sure if I’m a big supporter of cycle syncing. That said, I do believe that it’s important to pay attention to your body during the month and acknowledge what you’re feeling and experiencing. I think cycle syncing provides a good framework of how it’s possible to experience a healthier period, and integrate healthy practices. Instead of following every single practice to a T (ie. only doing house work during the luteal phase), you can pick and choose which practices to integrate into your daily routine.  

Period Tracking

You can start paying more attention to your period by tracking your flow, and any other symptoms that may pop-up during the month. This will give you an idea if any symptoms keep recurring, or if anything arises that is out of the blue!

Feeding your Flow

When it comes to maintaining a good diet for healthy menstruation, obviously fruits and vegetables are going to be the mainstay of the diet, limited amounts of dairy, and your choice of healthy protein (ensuring you’re getting all the essential amino acids). The B vitamins, magnesium, iron, and fibre don’t need to be only consumed during parts of the cycle – they need to be eaten all the time! This is important for menstrual flow, estrogen detoxification, and supporting all the chemical reactions going on within the body. 

However, I will say that eating greens is particularly important for women because of estrogen detoxification, as well as for the TCM liver (which basically governs menstruation). Moreover, I’m also a big proponent of eating red foods (not red 40) to help build blood. Which is something most women need, as they are often iron deficient

Exercise

Do what you can. Seriously. If the first day of your cycle has you wiped out, rest. It’s as simple as that. You don’t need to pick up a new form of exercise each cycle (ie. zumba in July, spin in August) but you can if you’d like. Look at your other health goals and see which form of exercise is best for that. If you’re always stressed out, then something like yoga or walking will be just as nourishing as bootcamp. 

Self-care

Whether you’re out with friends for a ladies night or sitting on your couch rewatching New Girl, self-care is mandatory. With work stress, family stress, and the like – refilling our cup is necessary. This could tie into food, exercise, but is can also be practicing the word ‘no,’ only doing things that bring you fulfillment and even avoiding those toxic friends. A certain time of the month does not need to dictate what you do. 

What do you think?

I want to hear what you think about cycle syncing? Is this something you practice? Do you find it to be effective? Let me know in the comments below. 

If you are interested in joining a free community supporting women with periods, feel free to join Know Your Flow Toronto. I hope to see you there!

Do you Have PMDD?

June 11, 2018
pmdd, toronto naturopath, naturopathic doctor toronto

Sometimes PMS can feel absolutely overwhelming, and in these cases we want to consider premenstrual dysphoric disorder as the true cause of the symptoms that you may be experiencing. 

What is PMDD & how does it differ from PMS?

Otherwise known as premenstrual dysphoric disorder, PMDD is a collection of mainly emotional and behavioural symptoms which happen before your period, and may negatively impact your quality of life. 

PMDD is similar to PMS, but primarily focuses on the number, severity and characteristics of psychological symptoms. 

Why does PMDD happen?

We don’t know why PMS occurs, and like most women’s health conditions (ie. endometriosis), we don’t know why PMDD happens. Nevertheless, it’s thought to be due because of hormone sensitivity, especially with progesterone. This is not due to an imbalance of hormones per se, but due to abnormal responses to normal ovarian steroid changes. 

Symptoms of PMDD

Diagnostic symptoms for PMDD is found in the 5th edition of the  Diagnostic and Statistical Manual of Mental Disorders, and includes:

One (or more) of the following symptoms must be present:

  • Mood swings, feeling suddenly sad or tearful, increased sensitivity to rejection

  • Irritability, anger, or increased conflicts

  • Depressed mood, feelings of hopelessness, self-deprecating thoughts

  • Anxiety, tension, feelings of being keyed up/on edge

One (or more) of the following symptoms must be present (in addition to the above symptoms):

  • Decreased interest in usual activities

  • Difficulty in concentration

  • Lethargy, fatigue, lack of energy

  • Changes in appetite, over eating, specific food cravings

  • Hypersomnia or insomnia

  • Feeling overwhelmed or out of control

  • Physical symptoms such as: breast tenderness, swelling, joint or muscle pain, bloating sensation or weight gain

Diagnosing PMS

Diagnosing PMDD is similar to diagnosing PMS. You must be experiencing some of the above symptoms during a specific time in your cycle. Moreover, it actually takes at least 2 months to diagnose PMDD.  

Here are the specific criteria:

  • Symptoms occur after ovulation (aka. if you’re not ovulating, it’s not considered PMS)

  • At least 5 (of the above) symptoms are present 

  • Symptoms occur in the final week before the start of your period

  • Symptoms begin to improve within a few days after your period

  • No symptoms should be experienced by the end of your period and before ovulation

  • Symptoms must be rated (the best tracker to use is called the Daily Record of Severity of Problems)

  • Symptoms do not occur because of an underlying issue (see conditions below)

  • Symptoms must cause significant distress or interfere with work, school, social activities, or relationships with others

Conditions that may worsen PMDD

There are other health conditions that may mimic the symptoms of PMDD. They include:

  • Anxiety

  • Depression

  • Panic disorder

  • Persistent depressive disorder

  • Personality disorder

  • Drug/medication use 

First of all, these symptoms need to be tracked on the DRSP. Secondly, if PMDD is truly the reason for these symptoms, they should be disappearing at or after your period. If they are occurring all month long, then there’s probably an underlying issue that’s not PMDD, and instead these symptoms are being magnified during your period! 

That said, these conditions may concurrently occur with PMDD.

Non-Pharmacologic PMS Treatments

Reducing inflammatory foods

Admittedly, this is probably not the treatment you’re most excited about (I get it), but it is a helpful one! Inflammation disrupts communication between hormones, and can affect neurotransmitters. 

Start slow, and say “see ya” to dairy first. Once you’ve got that covered, add alcohol to the list too. One of the treatments for PMDD is increasing your calcium intake. Obviously this is tough if you’ve cut out dairy – but you can skill get calcium from leafy greens, sesame seeds, and quality supplements! 

Reducing stress

Stress often results from an imbalance between demands and resources. For instance, you may have a deadline at work, but no time to complete your tasks. Stress may occur due to a variety of reasons and may be daily hassles, traumatic events, or even be perceived.  

Stress has many effects on the body, and it may predict cyclical mood changes, and can arise from past traumatic events, current life stressors, or perceived stressors. With respect to the cycle, stress can specifically worsen PMS symptoms, and increased stress can actually predict more severe symptoms as well. It’s the gift that keeps on giving.  

Tackling the topic of stress is a huge issue on it’s own, and certainly requires a spectrum of different treatments, some listed below. However, simple techniques like practicing self care and emotional regulation can be a good start-off point.  

Prioritizing Sleep

This might seem like a no-brainer, but sleep is critical when it comes to ensuring that our body has recharged. What’s my sleep routine? I aim for 8 hours of sleep, in a cool, dark and quiet room. If I’m using a device before bed, I’ll have it on night mode. And on some nights, I start to wind down with a glass of chamomile and lavender tea. 

Magnesium

This often deficient nutrient, is needed in almost 300 of our body’s chemical reactions! It helps to reduce inflammation, stress, and acts as a muscle relaxant. Leafy greens and pumpkin seeds contain magnesium, but often choosing the right form and dose of a supplement will help replenish your stores faster. 

Vitamin B6

This vitamin has mixed reviews when it comes to helping PMS. It also helps reduce inflammation, promotes better detoxification of estrogen, and is needed for the formation of progesterone and neurotransmitters. Too much Vitamin B6 might cause numbness in the fingertips and toes, so be sure to work with a healthcare practitioner when using it. 

Chasteberry (Vitex Agnus Castus)

This one of my most beloved herbs. It improves communication between the brain and ovaries, and helps to calm the nervous system. I frequently recommend it to my clients.  

CBT & DBT

Cognitive Behavioural Therapy is a form of psychotherapy that treats problems and boosts mood by changing dysfunctional emotions, behaviours, and thoughts. Whereas Dialectical Behavioural Therapy provides you with new skills to manage painful emotions and decrease conflict in relationships. 

CBT often addresses the idea of ‘hot thoughts’ (ie. I’m not good enough) in an attempt to observe your response to them as opposed to reacting to these thoughts. 

DBT uses techniques like mindfulness and emotional regulation to address some of the symptoms you may be experiencing. For instance if you are feeling anger, emotional regulation will help you identify the feeling you want to change, check the facts (why you are angry – perhaps your partner is not picking up their phone), identify your action urges (send an angry text), and ask your gut if acting on this emotion is effective in this situation (will you get the response that you desire)? 

You can even practice opposite reactions to help emotional regulation. For instance, if you are feeling sad the opposite reaction would be to get active (ie. do 20 jumping jacks, go for a walk, etc.). 

If you’re a planner, you may want to consider listing your triggers and creating an action plan when they occur. Click here to download the action template.

Next Steps

Now that you’re pretty much an expert when it comes to PMDD, the first thing you should be doing is tracking your symptoms for at least 2 months using the DRSP. There’s also an app called Me v. PMDD, which may also be helpful tracking symptoms. In order to be consistent with tracking your symptoms, consider pairing it with another activity such as brushing your teeth.

If it is PMDD, you can certainly adopt some of the treatment measures listed above. However, be mindful that if you choose to use supplements – it’s best to do so under the supervision of a Naturopathic Doctor. I strive to recommend the highest quality products, ingredient forms, and dosages. 

A note on treatment for PMDD, usually trying something for 3-6 is a good way to ascertain if the treatment is good for you. If you’re not noticing any benefit, then don’t be afraid to move onto the next treatment option. 

PS. If you found this information helpful, please sign up for my monthly newsletter called The Flow for great and informative content like this!

do i have PMDD

References

Walsh S, Ismaili E, Naheed B, O’Brien S. Diagnosis, pathophysiology and management of premenstrual syndrome. The Obstetrician & Gynaecologist. 2015;17(2):99-104. doi:10.1111/tog.12180.

Endicott J, Nee J, Harrison W. Daily Record of Severity of Problems (DRSP): reliability and validity. Arch Womens Ment Health. 2005;9(1):41-49. doi:10.1007/s00737-005-0103-y.

Nevatte T, O’Brien P, Bäckström T et al. ISPMD consensus on the management of premenstrual disorders. Arch Womens Ment Health. 2013;16(4):279-291. doi:10.1007/s00737-013-0346-y.

O’Brien P, Bäckström T, Brown C et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health. 2011;14(1):13-21. doi:10.1007/s00737-010-0201-3.

Dickerson L, Mazyck P, Hunter M. Premenstrual Syndrome. Am Fam Physician. 2003;67(8):1743-1752.

Ismaili E, Walsh S, O’Brien P et al. Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder. Arch Womens Ment Health. 2016;19(6):953-958. doi:10.1007/s00737-016-0631-7.

Kadian S, O’Brien S. Classification of premenstrual disorders as proposed by the International Society for Premenstrual Disorders. Menopause Int. 2012;18(2):43-47. doi:10.1258/mi.2012.012017.