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Periods

Periods MUST be Regular

Keep a calendar of every day you have bleeding AND every day you have intercourse. If you are NOT getting regular monthly periods, come see me SOON. If you get regular monthly periods and you do not get pregnant in 6-12 months, come see me.

Ovulation

Women who get regular monthly periods are most likely ovulating. Often there is a physical warning that the period is coming, like breast tenderness or cramping. We can measure a serum progesterone (a test to measure the amount of progesterone in the blood) to prove a women is ovulating. For women who do not get regular, crampy periods with breast tenderness we can do other tests. The most common tests look for abnormalities of the thyroid (TSH) and pituitary (prolactin or luteotropic hormone). There are different medicines to treat each of the non-ovulation problems detected by blood testing.

How do you know if you are ovulating?

Basal body temperature (BBT) charting is less accurate than a good menstrual calendar. Ovulation predictor kits are accurate, but expensive. Additionally, if a couple tries to time intercourse too much, they can miss a month, so we do not recommend timing intercourse based on LH (luteinizing hormone) kits.

To determine if you are ovulating, you should ‘ask yourself’ the following questions.  If you are “mostly yes” then it is very likely that you ARE ovulating, and you should have frequent intercourse and expect to become pregnant.  If your answers are “mostly no” or “not every month,” then we would like to evaluate you for any ovulation problems.  Keep track, on paper, of the following information.  It will help determine what tests we may, or may not need to perform.

  • Are your periods regular, meaning are there the same number of days in every cycle?
  • Are there 25 to 31 days per cycle, counting from the start of one period to the start of the next?
  • Is the amount of bleeding predictable every month?
  • Do you have 3-6 days of bleeding?
  • Do you get some physical warning, like breast tenderness, that your period is about to start?
  • Do you get some menstrual cramps with the bleeding?
  • Does your vaginal discharge change midway through the cycle, from wet to mucousy?

Basal body temperature charting

We do not ask patients to measure their temperature in the morning. We can determine whether a woman is ovulating without this information. BBT is not accurate enough for us to make solid decisions about ovulation, especially when there are other more reliable tests available.

Timing intercourse:

  • Day ONE is the first day of the period.
  • Have intercourse every day, or every other day on days 10-16 of days 7-21.
  • Do not have intercourse more than once per day.
  • Keep a calendar of every day you have bleeding AND every day you have intercourse.