Am I Ovulating? The Ins and Outs of Cycle Tracking

 Period Cycle Tracking
As a naturopathic doctor who works primarily with women’s health and hormones, the menstrual cycle is an aspect of health that comes up in most of my patient visits. With the menstrual cycle, it’s imperative to develop consistent and reliable tracking methods to obtain objective data to truly understand each patient’s individual experience, and monitor treatment progression and outcomes.

In terms of ovulation, many patients think this only matters for fertility tracking or if you’re planning to conceive. But becoming aware of ovulation can provide so much more information about a person’s menstrual cycle and hormonal health. Knowing if ovulation is occurring consistently can help doctors diagnose Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD), and determine treatment goals for patients with perimenopause and menopause, Polycystic Ovary Syndrome (PCOS), irregular menstrual cycles, and much more. 

There's An App For That 

For cycle tracking, I encourage my patients to choose a phone app to record their data. This can be a very effective way to track your cycle, basal body temperature, and cervical mucus. The following apps have been shown to have the best reliability and focus on the science of cycles:

» Clue 

» Flo 

» Glow Ovulation 

» Fertility Friend 

» Fertility App

The specific cycle parameters I suggest patients record/ track are:

Day 1 of your period: This is the first day of a full bleed. Do not record spotting as your day 1. If day 1 is recorded consistently, this will provide information regarding cycle length and variability.

Bleeding time/length and quantity: This will help determine if heavy bleeding is something we need to investigate. 

PMS symptoms: Premenstrual symptoms are a result of our body’s response to fluctuations in hormones throughout the cycle (not the actual level of the hormone, as many might think). A lot of people experience symptoms such as bloating, breast tenderness, mood fluctuations, cravings, cramping, skin changes, and more during the luteal phase of their cycle (1-2 weeks leading up to their period). It’s important to record these symptoms as they occur; knowing if ovulation has happened is a key indicator that tells us if these symptoms are, in fact, due to fluctuations in hormones. 

For ovulation specifically, we can also track cervical mucus: 

» Record observations about your cervical mucus throughout the month. 

» Egg-white cervical mucus that is sticky in consistency usually indicates ovulation and can happen between days 10–15 in the cycle.

Other Tracking Methods 

There are other ways that we can track and predict ovulation, such as kits, temperature tracking, and blood tests. It should be noted that there is a difference between predicting and confirming ovulation. 

Ovulation Predictor Kits (OPKs): Ovulation predictor kits can be found in many stores and online. They are used to measure the level of luteinizing hormone (LH) that peaks right before ovulation occurs. Depending on the length of a person’s cycle, you start around day 11 and use the testing strips with urine every morning until you get a positive test (two solid lines). When your test is positive, this indicates that you will be ovulating in the next 24-72 hours this is a good time to make a note of that cervical discharge as well.

There are circumstances, however, where these kits can falsely predict ovulation (e.g., PCOS patients have a consistently elevated LH hormone as the body tries to mature many follicles to ovulate throughout the cycle, leading to a false positive). Putting this all together can help us understand your cycle better.

Basal Body Temperature (BBT) Tracking: Basal body temperature is a precise temperature measurement taken with a specialized thermometer every morning upon waking. Signs of ovulation include a 0.5-degree temperature increase due to the thermogenic property of progesterone, which occurs right after ovulation. Again, this method is best paired with tracking cervical mucus (looking for that egg-white consistency), as this is the gold standard for predicting ovulation between 10-14 days.

Serum Progesterone Testing 7 Days After Ovulation: In certain circumstances, we can use serum blood testing of progesterone seven days after suspected ovulation to confirm if ovulation occurred that cycle. A level above 5–6 nmol/L can confirm ovulation; however, an optimal value around 30 nmol/L can make us confident that strong ovulation is occurring.4 This might be a test that’s recommended depending on a patient's goals and practitioner assessment. 

Perimenopause Considerations 

Tracking Your Cycle in Perimenopause: It is important to follow the same principles of cycle tracking as we approach perimenopause. Over the age of 40, a woman’s menstrual cycle becomes less consistent. An egg may not be released every single month, and this interferes with the production of hormones like estrogen and progesterone. The initial changes in perimenopausal cycles may be subtle. Knowing if ovulation is occurring can help us monitor cycle length changes, bleeding changes, and PMS symptoms. It can also help your healthcare practitioner review your best treatment options, as hormonal fluctuations can influence symptoms and how you feel.

As you approach perimenopause, your total cycle length will begin to change. A seven-day change in either direction (shorter or longer) when you have had regular cycles before indicates the beginning stages of perimenopause. Cycles often get shorter before getting longer, but every person has a unique experience. You may also notice changes in the volume of blood lost with each period; perimenopausal cycles can be both heavier or lighter than normal. 

It's common to observe an increase in other symptoms when you approach perimenopause. These may include:

» difficulty sleeping 

» hot flashes 

» vaginal dryness 

» mood changes

You can track these symptoms against your cycle, as sometimes they occur all month long, or they may occur only during cycle phases. Drastic hormonal fluctuations can influence your symptoms and may be why a patient experiences poor sleep and the hottest flashes at a certain time of the month. You may also notice that your PMS symptoms are absent during longer stretches without a period, or if your period arrives early. 

This may indicate that you did not ovulate, meaning changes in mood, breast tenderness, bloating, etc. cannot be explained by premenstrual fluctuations any longer. As always, ask your practitioner which method of tracking and testing your cycle is right for you. Education about your menstrual cycle leads to empowerment and will bring you one step closer to accomplishing your health goals.