The Female Cycle: The Fifth Vital Sign Marguerite Duane, MD, MHA, FAAFP Saturday, January 30, 2016

Disclosures No Disclosures

Objectives Define the normal menstrual cycle. Describe important hormonal events in the cycle and the resulting physiological changes. Highlight the key external observations or biomarkers that women can learn to chart to better understand their fertility cycle. Review a variety of fertility charts and discuss specific observations that may indicate a potential underlying health issue. State additional opportunities to learn how to address women’s health issues using fertility charts.

Ovulation Methods Charting Cervical Fluid Sign Billings Ovulation Method™ CREIGHTON MODEL FertilityCare™

Sympto-Thermal chart Two-level temperature pattern Phase I Phase IIPhase III Mucus observations Mucus interpretation Cervix observations Luteal phase Menses : X X X / / P1 2 3 (c) FACTS 2013

Sympto-Hormonal charts

The Normal Menstrual Cycle Overall Length – days – days in young teens Normal length of: –Bleeding range: days –Mucus cycle range: days –Luteal phase range: days Phases | Follicular (Pre-ovulatory) | Luteal (Post-ovulatory) |

Intricate Interplay of Hormones GNRH

Key Events in the Cycle normal cycle length variable: days (c) FACTS 2013

Observable effects of the hormones | Follicular phase || Luteal phase | |  Fertile window  | Hormone Level FSH LH Estrogen Progesterone

Schematic of cervical fluid  Type E mucus (L, S, P)  Allow sperm penetration  Type G mucus (or fluid)  Sperm penetration blocked (c) FACTS 2013

Methods of Charting –Ovulation Methods (Cervical Fluid) –Billings Ovulation Method™ –CREIGHTON MODEL FertilityCare™ –Sympto-Thermal (Fluid + Temperature) –SymptoPro –Couple to Couple League –Sympto-Hormonal (Fluid + Urinary hormones) –Marquette –FEMM

Using Charts to Aid in Diagnosis

Resources Cervical Fluid Methods Billings USA: Family of the Americas: Creighton Model: or Two Day Method: Sympto-Thermal Methods Couple to Couple League, Serena (Canada), SymptoPro, Sympto-Hormonal Method Marquette Model Standard Days Method: Lactational Amenorrhea Method:

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