Maggie said her pediatrician immediately assumed that she was pregnant: an impossibility, because she was not sexually active. When the pregnancy tests came back negative, the doctor responded, “‘I don’t know what your problem is’ and brushed me off,” she recalled.
Meanwhile, the local parish’s natural family planning (NFP) instructor saw the teen’s distress and put her in touch with a Catholic fertility physician who could teach Maggie how to observe and chart the signs of her fertility.
“A sign of health in a woman is a normal, regular cycle,” Dr. Lorna Cvetkovich, a gynecologist and obstetrician at Tepeyac Family Center in Fairfax, Va., explains. “We know what a normal cycle looks like,” she continued, “so at any time the parameters fall outside of those, then that’s a clue that maybe they’re not ovulating, they may have a luteal phase defect, they may have fibroids. It can show you all sorts of things.”
For women whose cycles fall within a normal range, normal bodily processes present themselves in a predictable pattern.
In the first part of a woman’s cycle, called the follicular phase, hormonal signals from the pituitary gland trigger the follicles (egg-containing structures within the ovaries) to prepare an egg for ovulation and to secrete estrogen into the woman’s body. This rise in estrogen levels triggers changes in the kind of fluid the cervix secretes, as well as thickening the uterine lining, making them more able to support the conception process.
After ovulation a woman's body secretes progesterone, which causes a sharp increase in a woman’s basal, or resting, body temperature, as well as a preparation of the uterine lining for possible implantation. If a pregnancy occurs, the basal body temperature and hormone levels may continue to rise, whereas if pregnancy does not happen, the resulting dip in hormones triggers a drop in temperature, menstruation, and the beginning of a new cycle.
In a healthy woman who is not pregnant, this cycle will repeat every 21-35 days.
These changes can be observed by any woman, and can be used by married couples as a valid method to achieve or delay pregnancy, according to the teaching of the Catholic Church, which teaches that it is immoral to disrupt this natural cycle with the use of contraceptive pills, implants, barrier methods, or by having incomplete intercourse. Using these observations to help in the discernment of family size is known as natural family planning.
However, the same observations and data – commonly collected into charts for easier analysis – can be used to help diagnose gynecological issues such as ovarian cysts and growths in the uterus, called fibroids, as well as hormone deficiencies and other abnormalities affecting bodily functions. The information can also be essential in pinpointing issues surrounding pregnancy, such as the exact date of conception, infertility, and miscarriages.
This information is such a valuable insight into a patients health and symptoms – and an invaluable tool for doctors practicing reproductive medicine. “I just think it’s invaluable, and I don’t really know how people practice [gynecology] without having the charting,” said Cvetkovich. “There’s just so many uses, and it adds so much to your evaluation of the patient.”
Cycles and Diagnosis
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Disorders in other bodily systems – such as the endocrine system – can manifest in a woman’s menstrual cycle and her chart. “Thyroid plays a role in almost every function of the body, so it may show up as a sign in the cycle,” explained Cvetkovich.
For Christine, charting her bodily signs helped her to catch an issue with her thyroid that might otherwise have been missed. After charting for four years, she started noticing that some months there was no ovulation that could be detected by temperature or with chemical tests for the hormones that trigger ovulation.
“I had what looked like a really long cycle, and then eventually, what to the uninformed observer would look to be a light period. But because I knew I hadn’t peaked, I was able to identify it as estrogen breakthrough bleeding and not a real cycle,” she explained.
“It seemed like my body was trying to ovulate, and not really getting there.”
She approached her doctor, explaining she was not ovulating and that she would like to find the cause for something that was out of the ordinary. The doctor then ordered comprehensive blood tests, and found that some of her thyroid-stimulating hormone levels were elevated beyond normal – in fact, her levels were twice as high s they had been a year ago.
After receiving treatment, her cycles returned to their normal pattern.