Читать книгу Zita West’s Guide to Getting Pregnant - Zita WEST, Zita West - Страница 55

What if I have a brown discharge for a few days before my period starts? Does this count as Day 1?

No, Day 1 is the first full flow of blood, the first day of red bleeding.

I have just come off the Pill and want to get my system cleaned up before starting to try for a baby.

Don’t, because research shows that you are more fertile in the first couple of months that you come off the Pill. Getting pregnant can become harder in following months.

Most women get pregnant very quickly after stopping the Pill – in fact, some fertility clinics put women on the Pill to get the ‘rebound’ fertility effect. With newer lower-dose pills, there is no reason to wait for the Pill hormones to get out of your body. There are no adverse effects shown if you get pregnant immediately after stopping the Pill (or other hormonal methods of contraception).

Will it take time to get pregnant following taking the Pill?

Some women get pregnant straight away, while for others it takes time to get their cycles back on a regular basis. It can be harder for some women to conceive after stopping the Pill – particularly if they are over 30 years old and have never had a child. So planning ahead is useful. You could also check your rubella status (by having a simple blood test) while still on the Pill, because if you need to have a vaccination it is essential that you are not pregnant.

One of the disadvantages of the very effective contraceptive Pill, on which many of us rely to control our fertility, is that it wipes out a woman’s individual menstrual cycle, which is of course its aim. The doses of hormones given to achieve this have to be large enough to over-ride a woman’s own hormones, and this tends to blanket any normal fluctuation and effects a woman might recognize.

Coming off the Pill to get pregnant means also getting back in touch with those signs and symptoms of fertility, some of which might not be welcome if the Pill was prescribed for menstrual cramps, acne, mid – cycle spots or other hormone-related aggravations. But it’s important to become familiar with your own cycle, if you don’t become pregnant straight away, and to see these hormonal fluctuations as positive signs of your fertility.

It used to be thought sensible for women coming off the Pill, or stopping any other form of hormonal contraception, to wait a few months for their cycle to regularize and also to allow time for these artificial hormones to be excreted from the body. However, it is now advised not to wait, especially as there is some evidence to show that coming off the Pill kick – starts a woman’s hormonal activity and may actually encourage conception.

The other advantage with being familiar with your own cycle, and what its ups and downs might be, as well as its regularity or otherwise, means that if there are problems with conception you have a baseline for considering what those problems might be.

For some women, once they know what to look for, their personal indicators of fertility are very clear – cut – it’s that, ‘Oh, yes…’ moment. Fertility UK statistics illustrate that over 60 per cent of couples who contact a fertility awareness practitioner via www.fertilityuk.org do so in order to increase their understanding of the menstrual cycle to help plan a pregnancy.

How long can I expect before my periods return following the Pill?

Delays are not uncommon, especially in women over 30. It really helps to understand your cycle. Initially you may experience some irregularities in your cycle, including cycles that are longer than 35 days. Also, you may not ovulate in all cycles. If you are doing a temperature chart you may not get a rise in temperature – this happens, on average, in 10 per cent of cycles. Some women will have no periods (amenorrhea) or a cycle lasting over 90 days.

Am I more likely to have Polycystic Ovary Syndrome (PCOS) after taking the Pill?

It seems that some women who do come off the Pill and then have irregular cycles are diagnosed with Polycystic Ovary Syndrome. The Pill prevents PCOS, as it prevents ovulation and reduces the hormonal activity that causes PCOS, but there is little evidence to suggest that you are more likely to get PCOS after stopping the Pill, if you have not had it before. However, existing PCOS symptoms may have been masked by the Pill – and so become apparent after stopping.

If I am trying to chart my fertility following the Pill, what can I expect?

The first thing to remember is that there are many different types of Pill – some are combined pills containing oestrogen and progestogen (synthetic progesterone), other hormonal preparations (including pills, patches, injections and contraceptive implants) contain progestogen only. The main effect of oestrogen in pill preparations is to prevent ovulation, while the main effect of progestogen is to cause a thick mucus plug at the cervix, stopping sperm from getting through.

After stopping the Pill (or other hormonal contraceptive products) there will be much variability in how long it takes for full ovulation to return and for cervical secretions to return to their most fertile characteristics. Normally these things happen very quickly after stopping contraceptive pills (or sometimes, of course, even if you miss out on taking your pill regularly!), but sometimes it takes several months to a year or more for the return of full fertility.

After stopping the Pill it is possible that you may immediately have regular cycles with clear – cut fertility signs, but many women experience irregular cycles – often longer cycles – and there may be disruptions to the normal pattern of secretions because the progestogen in your pill has kept your cervix tightly closed and plugged with a sticky white mucus to stop sperm from entering. It can take a while for the cervix to start producing the more sperm – friendly wetter, clearer secretions again in good quantities.

If you are recording your temperature, there may be some cycles with no temperature rise (possibly indicating the absence of ovulation), while other cycles may show a rise in temperature but it may occur fewer than 10 days before the next period starts (indicating a short luteal phase). If this is the case, your cycle would not be fertile as there would be insufficient time for implantation to succeed.

Many women report heavier and brighter red bleeding after stopping the Pill – this can be quite alarming. Hormone – withdrawal bleeding which you get during the pill – free interval is much lighter and pinker than the fresh red bleeding of a normal period. If you are concerned, do talk to your doctor.

How will I know if I am ovulating or not?

It is not possible to tell from cervical secretions, temperature or LH kits whether ovulation is happening or not. The build – up to the wetter, clearer secretions indicates that ovulation is approaching, LH kits generally show that ovulation is imminent, and the rise in temperature may be a sign that ovulation has occurred – however none of these signs is conclusive.

Aim to have as much sex as possible at any time you see any cervical secretions – this gives sperm the best possible chance to start their journey!

It will be hard at first to recognize your individual pattern. If you are concerned about a delay in conceiving, of course you should speak to your doctor in the first instance.

For many women there is a wealth of minor signs and symptoms that can help identify their fertile times. Let’s take a look at some of these.

Increased Libido

An increase in libido – of course this is also related to other emotional, social and physical factors, but for many women trying to get pregnant, increased sexual interest is an indicator of hormonal changes around the time of ovulation.

Mid – cycle Abdominal Pain

Because the ovarian follicle enlarges, prior to ovulation, by up to 23mm, and ruptures at ovulation, it’s not surprising that some women become aware of a sharp twinge or dull ache on either the right- or left-hand side of their lower abdomen, about halfway between the navel and hip bone and halfway between the navel and pubic bone. This can last for anything up to a couple of hours, and may be combined with a crampy feeling, not dissimilar to menstrual cramps, which may be because of the swollen ovary or the extending of the womb and Fallopian tubes, caused by the increase in oestrogen. The actual cause of the pain is still not known – the most likely culprit, as identified by research carried out in Germany, is related to a very slight bleed into the peritoneum as the follicle ruptures.

With other fertility awareness already in place, many women can easily identify this time of peak fertility, which can be an extremely useful indicator. Mid – cycle, or ovulation pain is also referred to as mittelschmertz – though it has to be mentioned that research has shown that of all the subjective indicators of fertility, this one is the most varied in relation to ovulation (when studied on ultrasound scans).

Breast Tenderness

This is also an indicator, often unwelcome for many women, that they are about to ovulate. Tenderness leading up to ovulation tends to be tingling in nature, because of the oestrogen effect. Tenderness that comes on towards the end of the cycle, influenced by the progesterone effect, is usually characterized by a heavy and full feeling, rather than tingling.

Spotting

In a very few women it is normal for them to experience a little mid-cycle spotting, or to have pink – coloured cervical mucus because of this spotting. For those women this is an indicator of peak fertility, but because it is so uncommon is not often listed as a fertility indicator. In addition, any mid – cycle spotting or bleeding must be reported to your doctor and checked out, as it can be an indicator of infection or disease. Make sure you are up to date on your smear tests.

What if my LH surge does not relate to my secretions?

An LH kit shows that ovulation is about to happen (within the next 24 hours). Cervical secretions give you about 5 days’ warning. To optimize your chances of pregnancy, have sex from the time your secretions start (this is the start of the fertile time). Normally the LH kit will become positive after you have had fertile secretions for a few days. Do not wait for a positive result from a urine sample – by the time you get this you are nearing the end of your fertile time. If you do have a positive LH test, continue to have regular sex for at least two days afterwards.

What if all of the LH tests are negative?

This can be very alarming for women, as you only get five test sticks, and if you have no idea about your fertility you won’t even be sure of when to start testing. If a woman has an irregular cycle, ovulation could vary anywhere between days 14 and 28, or even earlier or later than this, making it very hard to pinpoint exactly.

The LH sticks may not work for some women, for example some women over 40 may have higher LH readings. Similarly, some women with PCOS may have raised LH levels. If you use the sticks and find that you do not see any negative days – i.e. all your test results are positive – this may be a sign that you have an abnormally high LH level throughout your cycle. This should be checked by your doctor.

Ovulation does not occur in every cycle. It can be affected by factors such as age, the amount of time since you last gave birth, whether you are breastfeeding, how long it has been since you stopped taking the Pills, your body weight and stress levels. It is quite common not to ovulate in around 1 out of every 10 cycles. If you have two or more consecutive cycles where you do not think you have ovulated, see your doctor.

Why is my doctor going to check my progesterone levels?

Your doctor may do a progesterone test to check for ovulation. This is commonly called a Day 21 progesterone test. Doctors aim to test for the hormone progesterone about halfway through the second half (luteal) phase of your cycle – and for a woman with a cycle of 28 days, halfway between day 14 and 28 is Day 21. However, this only gives an accurate reading if your cycles are 28 days long. For shorter cycles the test may need to be done earlier, for longer ones, later. To time this test more accurately – and if you are aware of your fertile secretions – aim to get the test done about a week after your peak secretion day (i.e. one week after the secretions change back from being clear, wet and stretchy to being thick, white or dry again). If you are taking your temperature regularly, aim to have your progesterone test about six to seven days after your temperature rose to its higher level.

If you are told that a progesterone test shows you are not ovulating, this is not necessarily all doom and gloom. It simply means that you did not ovulate during that particular cycle. The test may need to be repeated to get an idea of whether this was an isolated incidence or a common occurrence for you.

What does it mean if my secretions do not get to the raw egg white stage?

Some women never notice egg – white type secretions yet conceive quite normally. It is the quality of the secretions high up in the cervix that count for the sperm. Avoid feeling inside your cervix to check for secretions, as this can be quite drying. As we get older the amount and quality of secretions reduces – so you may have noticed that these secretions were more abundant in your younger years. A reduction in secretions could be related purely to your observations – or may be related to slightly lower oestrogen levels. Many women never see the really stretchy type of secretion – but feel wetter only.

Can I use saliva, KY jelly or egg whites for lubrication during intercourse if I am dry?

No, unfortunately saliva has been found to be quite detrimental to sperm. In laboratory conditions, sperm cannot swim if they are in contact with saliva or any other lubricant – either water – or oil – based – all of these have some effect on sperm motility (movement). Although this has not been tested in women (and would be quite hard to study!), one has to assume that the effect would be the same in the body. Saliva of course contains an enzyme, ptyalin, which starts the digestive process – digesting carbohydrates – so this is not good news for the sugars contained in sperm or their swimming fluids!

Lubricating gels block the sperm. Egg whites are protein and can trigger an allergic reaction in some women.

I don’t seem to have many secretions, yet they seemed plentiful when I was younger. Is this common?

Yes, as we get older the quantity and quality of our cervical secretions are reduced. This is one of the reasons why fertility rates are lower in older women. The other factor is often that when young we are often unaware of the significance of these secretions and may even be quite alarmed by them. Sometimes women feel the secretions are a sign of infection – or that they may have damaged themselves somehow.

It is also common for women to report that as soon as they start to look out for the secretions, they no longer seem to see them. The amount of secretions will vary from woman to woman and sometimes from one cycle to the next in the same woman. If you are having sex around your fertile time (which is of course pretty vital) then often some of your natural secretions will get mixed in with the seminal fluid, which then comes away a few minutes after you have sex (even if you are lying flat) and can give you the impression that you’ve fewer secretions than you really have.

What if I spot between periods?

This depends on when the spotting is occurring. The first thing to remember is that ANY unusual bleeding or spotting must be checked out by your doctor. It is important to keep your cervical smears up to date, as these check not only for pre – cancerous changes but also for signs of infection.

If any spotting has been checked out medically and you are told that there is no concern medically, the following information may be helpful. Some women get spotting towards the end of a period – this may be quite normal as the period dries up. Some women have spotting leading into a period. This should be recorded at the end of the cycle – with the new cycle (Day 1) starting on the first day that you notice fresh red bleeding. If you consistently get some spotting for a day or so before your red bleed starts (pre – menstrual spotting), this may be an indication that your progesterone level is falling and may require medical help.

Very occasionally women who are observing cervical secretions report slight spotting tingeing the wet stretchy secretions – this is nothing to be concerned about (provided you are having regular smear tests) and may simply be due to the fact that you are more aware of your secretions than ever before!

Some women notice a tiny spot or so of blood (or even more) around the time implantation is occurring – so this could be a very positive sign.

I seem to have a long cycle and have secretions nearly all of my cycle.

Although most women report that they are dry immediately after a period and when approaching the next period, some will observe secretions for most, if not all, of the cycle. Again, if you suspect any infection, get this checked by your doctor.

Quite a common reason for secretions throughout the cycle is a cervical eversion (where the inner lip of the cervix protrudes onto the outside of the cervix, causing an increase in the wetter type of secretions). This is more common after you have been on the Pill, or after pregnancy or miscarriage, and may go away of its own accord. See your doctor or practice nurse, who will be able to see if there are any signs of an eversion. It is not necessary to treat this, unless the secretions are causing trouble with increased wetness. Your doctor will be able to advise you.

Women can learn to distinguish cervical secretions more easily if they get expert help from a health professional trained in fertility awareness methods – such help can be found at www.fertilityuk.org.

When I take my temperature it seems to be very low, and never gets above 35.5°C. Is this a problem?

If your temperature does not seem to fit on the scale of the usual fertility chart, the most likely reason is either a faulty thermometer or inexperience in taking your temperature. It may be worth consulting a trained fertility practitioner. If you have a very low waking temperature – and you are sure you are taking it correctly – then do check this with your doctor. If you also have other symptoms such as tiredness, or are feeling the cold, then there may be a thyroid problem. Your doctor will be able to check your thyroid function as part of other hormone testing.

I suffer from PCOS and have very irregular cycles. How can I know when I should have sex?

This is difficult. Many women with PCOS have erratic ovulation and confusing fertility symptoms, and can have patchy secretions throughout the month due to erratic hormone levels. Ovulation kits will be of no value if your level of LH is raised or high, as it sometimes is when you have this condition.

Plan to have frequent, regular sex throughout the month. I have seen many women conceive with PCOS; the good news is 70 per cent conceive naturally and 20 per cent conceive with the help of appropriate medication.

If you are older, have been diagnosed with PCOS and have made all the necessary lifestyle changes, don’t leave it too long before you consult with your doctor about problems getting pregnant – it’s possible you may not be ovulating.