A better ovulation education
I know you weren’t taught this in school (because I literally went to school for it and wasn’t taught it).
Reproductive health is complex, yes. But that doesn't detract from your right (and NEED) to know this information In order to make the best decisions for yourself now & in the future. If the best time to learn this was your early 20's, the next best time is always now.
A period does not always equal ovulation
Ovulation is when a mature egg moves from the ovary, travels through the fallopian tube and into the uterus, where it awaits potential fertilization for the next 12-24 hours.
Ovulation is so important because it’s how we make the hormones of the lovely menstrual cycle graph happen. Our ovaries are responsible for the estrogen surge from the growing follicle, followed by a progesterone surge by the structure (corpus luteum) that just released the newly developed egg. It’s important to note that a period is not confirmation that ovulation occurs, as it’s possible to have a period without ovulating. Luckily, it’s also very possible to restore ovulation if it’s not occurring.
The menstrual cycle is a beautiful and complex process, once again proving how incredibly smart nature is. And even though I had seen the classic hormone graph hundreds of times before, if you asked me a few years ago to explain it back to you, I could NOT.
To help with the big-picture understanding of what the cycle is all about, I have annotated the graph below to help explain what the major events do (and do not) mean:
If you’re on hormonal birth control, ovulation may be suppressed. The pill, ring, patch, implant, and injectable will all suppress ovulation, so this hormone pattern above will not be occurring each month.
For the pill in particular, the graph looks more like the one to right: where the “period” that happens is a withdrawal bleed in the absence of the daily hormones, but not a biological period.
The daily spikes represent the dosage of the synthetic hormones each day, as well as how the placebo pill in the fourth week allows for a bleed in the absence of the hormones. This placebo week is actually optional, as the hormonal pattern of the menstrual cycle is absent on the pill.
However, not all hormonal birth control is created equal!
The low-dose hormonal IUDs suppress ovulation in some cycles (25-55% of cycles on Mirena/Liletta, and 3-12% of cycles on lower doses with Kyleena/Skyla). So it’s hard to know exactly if/when you are ovulating with these birth control methods, but there are ways to confirm if ovulation is happening (see #3).
By the way, that’s ok! Being on birth control can provide an opportunity to work on improving health while free of any symptoms that you had experienced previously. If birth control is something you’re wanting to change types or transition off of, that’s also great as it will allow you to start monitoring your ovulation patterns.
There are plenty of ways to support your reproductive health and nourish everything involved in the ovulatory process so that if or when you come off hormonal birth control, you will likely make the transition symptom-free.
2: “Day 14” is an population average that can cause a lot of unnecessary stress
When couples start trying to conceive, one common issue that arises is not knowing when ovulation actually happens in their unique situation. This can result in months of trial-and-error that could have been easily avoided by not assuming that “ovulation happens on day 14.”
Even the textbook diagram I linked above perpetuates this.. (“fake news” was a little much, but I didn’t have space for “a one-size-fits-all estimation that does NOT apply to everyone!”) Day 14 is based on a population average, and should NOT be applied broadly.
A regular menstrual cycle will be between 24-35 days (with flow between 3-7 days), and not vary more than 8 days from cycle to cycle (when outside of this range, a cycle can be considered irregular.) And the fertile window is 3-5 days before ovulation, until 1-2 days after ovulation. Ovulation can occur in a regular cycle anywhere from cycle day 10 and 23. That’s a wide range - and also not day 14!
A big data study in 2020 looked at the menstrual cycle lengths and ovulation days of 32,595 women. They found that 25% of the women selected a 28-day cycle as how long they thought their period was, however, “only 12.4% of users actually had a 28-day cycle. Most women (87%) had actual cycle lengths between 23-35 days, with a normal distribution centered on day 28, and over half of the users (52%) had cycles that varied by 5 days or more.”
Here's a helpful figure from that study and how to read it:
Take your average cycle length and find it on the y (vertical) axis
Go across that row until you find the darkest blue color
See what day of your cycle that corresponds to on the x (horizontal) axis
The darker the blue color, the higher the probability of ovulation occurring on that day.
What I hope you notice is there is a LOT of individualization happening here, and that day 14 lines up for some folks...but it definitely doesn’t for others.
If you use a tracking app that happens to adjust for this, that's fabulous! But educating ourselves first and getting to know our unique patterns and rhythms will provide us with endless benefits throughout our lives.
3. How to support and confirm ovulation
If you are on hormonal birth control, there are still things you can do to support your reproductive and ovulatory organs! Some of the highest-impact places to start are getting plenty of sleep (at least 7 hours per night), a colorful and balanced diet, and also making sure you’re eating enough throughout the day. Regular exercise and nervous system balance (taking time for mindfulness, mental peace, and breath-work through your day) have also been shown to really support reproductive health.
Hormonal contraception can deplete key nutrients such as folate, vitamins B2, B6, B12, vitamins C and E, as well as magnesium, selenium, and zinc. Getting your levels checked is the best way to know if you’re actually deficient, and prioritizing foods rich in these vitamins and minerals is a great place to start. This would also be a great time to ask your provider about a thyroid hormone panel, since thyroid issues are treatable and a supported thyroid is a huge part of hormonal health and balance.
If you are not on hormonal birth control, it’s easier to start paying a bit more attention to your body to start identifying signs of ovulation. Two main fertile signs to pay attention to are cervical mucus and basal body temperature (BBT).
Cervical mucus is the QUEEN indicator of your fertile window. It is a mostly-water hydrogel and allows sperm to survive and travel to promote conception. There are many descriptors for the “type” of cervical mucus (egg white, sticky, creamy, etc) - but an even simpler way to think about cervical mucus is “peak” or “not peak.” Peak mucus is clear, stretchy, and slippery. If the mucus resembles these characteristics, that’s a fertile sign! And there’s no such thing as less or more fertile - regardless of how much mucus you see. The signs of your fertile window indicate just that: you’re in your fertile window!
Basal body temperature is a measure of our resting metabolic rate, and should be measured first thing in the morning (every morning, and ideally before you stretch, get up, drink water, or talk!). The rise of progesterone that happens after ovulation causes an increase in basal body temperature which can be seen when your morning BBT is charted. This temperature rise confirms ovulation, but does not predict ovulation. Tracking your BBT for a few months will give you a really good idea of when ovulation occurs for you. To do this, you should use a BBT thermometer (not the one you use when you’re sick), but they are equally affordable and available at most drugstores. You can chart your morning temperature in a free app like FertilityFriend or others to get an idea of your trends.
If you aren’t on hormonal birth control but have realized you are not ovulating, first know that having this information is already invaluable, because then you can start taking steps to repair and induce ovulation again. Identifying the root cause is crucial (be it due to PCOS, a thyroid issue, under-eating, overexercising, insulin resistance, etc) and your provider will be able to help you treat this further.
In general, just becoming more aware of your cycle: how you feel, how your energy changes, if you even see cervical mucus, and how long your cycle lasts are all great starting points to getting in touch with your body and fertile signs.
And since we’ve only scratched the surface…
If you’re ready to be soothed by the science of fertility to feel better about and more in control of your reproductive health…
Fertility, Empowered re-opens its doors mid-March!
It’s my mission to replace any fertility anxiety you might have with wisdom, support & a healthy quiet confidence for the rest of your life.
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Written by Michelle Cawley, MS. 2/14/23
Updated 2/27/24
The information on this website is provided for educational purposes only and should not be treated as medical advice. WTT Nutrition makes no guarantees regarding the information provided or how products may work for any individual. If you suffer from a health condition, you should consult your health care practitioner for medical advice before introducing any new products into your health care regimen. For more information, please read our terms and conditions.
REFERENCES
Chidi-Ogbolu, Nkechinyere & Baar, Keith. (2019). Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Frontiers in Physiology. 9. 10.3389/fphys.2018.01834.
Soumpasis I, Grace B, Johnson S. Real-life insights on menstrual cycles and ovulation using big data. Hum Reprod Open. 2020 Apr 16;2020(2):hoaa011. doi: 10.1093/hropen/hoaa011. PMID: 32328534; PMCID: PMC7164578.
Vigil P, Lyon C, Flores B, Rioseco H, Serrano F. Ovulation, a sign of health. Linacre Q. 2017 Nov;84(4):343-355. doi: 10.1080/00243639.2017.1394053. Epub 2017 Nov 27. PMID: 29255329; PMCID: PMC5730019.
Holesh JE, Bass AN, Lord M. Physiology, Ovulation. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28723025.