Fertility Awareness (Indicators) and menopausal transition

The Fertility Indicators and Pre-Menopause – (Mucus, Temperature, Palpation of Cervix)

Cervical Mucus and pre-menopause:

Cervical mucus as a fertility indicator is less clear in the pre-menopause as:

  • The normal oestrogenic build-up to peak mucus may not occur due to anovulatory cycles.
  • Even in the ovulatory cycle, mucus is not always discernible as fertile-type mucus is scant and occasionally absent making the mucus an unreliable symptom.
  • With natural aging of the cervix the S crypts decline in number so that the quantity and the duration of the more-fertile mucus symptom is diminished. The S mucus may occur for one day or part of a day during the fertile phase and the woman may miss this symptom altogether.
  • The area in the vulva sensitive to the presence of mucus is also diminished making it more difficult to appreciate the mucus symptom.

Palpation of the Cervix and pre-menopause:

The changes in the cervix itself are more objective and a more reliable fertility indicator in the pre-menopausal years.4

 

Temperature (BBT) and pre-menopause:

In the peri-menopause the thermal shift is the only positive sign of ovulation and of the definitively infertile phase of the cycle. Therefore it is important to record temperature every day during the pre-menopause so that delayed ovulation and also the very early ovulation can be detected.

Special RULES apply in the pre-menopause situation in the symptothermal double-check method of natural family planning, and the woman must be taught these rules by a qualified NFP teacher.

References:

  1. Liu JH, Gass ML; ‘Management of the perimenopause'; 2006; Pub. McGraw-Hill, ISBN 0-0-142281-1
  2. Odeblad Erik; ‘The discovery of different types of cervical mucus and the Billings Ovulation Method'; Bulletin of the Ovulation Method Research and Reference Centre of Australia, Vol 21, No3; 3-35; Sept 1994. (on the internet if you google ‘Erik Odeblad, cervical mucus’).
  3. Odeblad E, ‘Investigations on the physiological basis for fertility awareness’ page 7; Bulletin for the Ovulation Method Research and ReferenceCentre of Australia, vol 29, no 1, p2-11, march 2002, (internet, Billings Ovulation Method)
  4. Flynn A, Brooks M; ‘The Manual of Natural Family Planning'; pages 74-80; 1996; ISBN 0 7225 3115 X
  5. Soules MR, Sherman S, Parrot E et al; Executive summary: Stages of Reproductive Aging Workshop (STRAW). Fertil Steril. 2001; 76: 874
  6. Flynn A, Worthington W; ‘Teachers Training Manual'; ‘symptothermal multiple index method’ of natural family planning.
  7. Harlow S D, Mitchell ES, Crawford S; ‘The ReStage Collaboration: defining optimal bleeding criteriafor onset of early menopausal transition'; Fertil Steril; vol 89, No1, Jan 2008.
  8. Alvero Ruben, Schlaff William D; ‘Reproductive endocrinology and infertility, The Requisites in Obstetrics and Gynecology'; 2007, page 229; ISBN-13:978-0-323-04054-9
  9. McKinlay SM; ‘The normal menopause tradition: and overview ‘; Maturitas; 1996; 23:137
  10. Wallace RB, Sherman BM et al; ‘Probability of menopause with increasing duration of amenorrhea in middle-aged women'; Am. J. Obstet. Gynecol. 135: 1021, 1979.
  11. Richardson SJ, Senikas V, Nelson JF; ‘Follicular depletion during the menopausal transition: evidence for accelerated loss and ultimate exhaustion'; J Clin Endocrinol Metab. 1987; 65:1231
  12. Brown JB; ‘Types of ovarian activity in women and their significance: the continuum (a reinterpretation of early findings)'; Human Reproduction Update; Vol 17; No 2; p141-158. (this is a classic article which gives a greater understanding of the menstrual cycle throughout the reproductive life).
  13. Cynthia A. Stuenkel, MD, Margery Gass MD et al; ‘A decade after the Women’s Health Initiative – the experts agree'; Fertility and Sterility; vol 98, no 2; August 2012; p313-314.
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