It's estimated that approximately 64% of reproductive-age women in the United States use some form of contraception, and among those, hormonal birth control methods are highly popular. Methods like the birth control pill, hormonal intrauterine devices (IUDs), and injectable contraceptives like Depo-Provera are commonly used. According to the Centers for Disease Control and Prevention (CDC), about 28% of women using contraceptives opt for the birth control pill, making it one of the most widely used methods.
But more women are coming to realize that hormonal birth control ushers in a wide variety of side effects that often make it unusable: extreme weight gain, mental health issues, gut disruption, decreased sex drive, PCOS, and even infertility. Birth control affects all women differently, but it's becoming much more common to see women ditch the pill for greener pastures. However, many of these women are still trying to prevent pregnancy. So how do they do that without relying on synthetic hormones?
It all starts with tracking your cycle properly and learning your body's biomarkers. Your body will never lie to you, which is the good news, but you do have to learn what signs to look for so you can better understand your cycle, balance your hormones, prevent pregnancy, or get pregnant sooner. And the best place to start is your cervical mucus.
What Is Cervical Mucus?
Cervical mucus is a fluid secreted by the cervix, the passage that connects the uterus and vagina. This mucus undergoes various changes throughout the menstrual cycle, serving different functions such as lubrication, protection against infection, and aiding in conception. During different phases of the menstrual cycle, the consistency of cervical mucus changes. Monitoring these changes can be a part of natural family planning methods and can also indicate underlying health conditions.
"Cervical mucus is the only biomarker that will alert you to your fertile window opening."
"Cervical mucus is the only biomarker that will alert you to your fertile window opening!" Mairead Suthoff, an experienced fertility awareness educator, tells Evie. "It is also consistent in how it changes right after ovulation to signal a time of 'infertility' once again."
Suthoff says there are other biomarkers that help you "build a bigger picture of cycle health," but cervical mucus is the "one biomarker that does it all." You may have heard about another biomarker called Luteinizing hormone (LH), which plays a critical role in a woman's menstrual cycle. Produced by the anterior pituitary gland, LH levels surge approximately midway through the menstrual cycle, triggering ovulation, or the release of a mature egg from the ovary. This "LH surge" is a key indicator of fertility, marking the most fertile days in a woman's cycle. LH strips are over-the-counter test kits used to detect this surge in LH levels in urine. By using these strips, women can identify the optimal time for conception, usually 24 to 48 hours following the LH surge.
However, these strips aren't very useful for preventing pregnancy. "LH does not alert you to your fertile window soon enough to avoid a pregnancy and a positive LH surge does not guarantee ovulation," Suthoff explains. Then there's basal body temperature.
Basal body temperature (BBT) is the body's lowest resting temperature, usually measured right after waking up and before any physical activity. In a woman's menstrual cycle, BBT experiences distinct changes, primarily influenced by hormone fluctuations. During the first half of the cycle, the follicular phase, BBT remains relatively low. After ovulation, triggered by a surge in luteinizing hormone (LH), progesterone levels rise, causing a noticeable increase in BBT, usually by about 0.5 to 1°F. This temperature elevation remains throughout the luteal phase until menstruation begins. Tracking BBT can help identify the fertile window, as the temperature rise confirms that ovulation has occurred. However, it's important to note that BBT tracking is "only useful as retrospective data for pinpointing ovulation" and Suthoff says it can be "thrown off by things like illness, alcohol, and poor sleep.
Cervical mucus is the gold standard for identifying your fertile window.
That's why cervical mucus is the gold standard for identifying your fertile window, regardless of whether you want to prevent pregnancy, get pregnant, or better track your cycle to understand your hormones.
"The cells at the base of your uterus, in your cervix, respond to changes in hormones, specifically estrogen and progesterone," Suthoff explains. "So over the course of an entire cycle, you could (and many women do) rely exclusively on cervical mucus patterns to tell you when you're fertile or not. Cervical mucus patterns will alert you to your fertile time of the month."
You can determine whether your patterns are normal and you can even use cervical mucus patterns to detect certain illnesses and diseases like STIs, cancers, infections, endometriosis, and more.
How Does Cervical Mucus Change Throughout Your Cycle?
First it's important to know the basic phases of your cycle: menstruation, and a fertile window with ovulation. The period is when you're bleeding and "sloughing off the uterine lining that had been built up in the previous cycle." On the other hand, your fertile window is when your eggs are maturing in the ovaries and preparing for ovulation. It's the only time of the month you can get pregnant.
Your cervical mucus patterns will change throughout your cycle.
"Ovulation is at the tail end of the fertile window and it is the release of a mature egg," Suthoff adds. "The luteal phase is the part of the cycle that happens after ovulation and is the most stable phase. It is dominated by the activity of progesterone."
Your cervical mucus patterns will change throughout your cycle. Because there isn't much hormonal activity happening during your period, you're not going to observe much mucus while you're bleeding. "Shortly after your period ends your fertile window will open in response to signals from the brain going to the ovaries and telling them to mature some eggs," Suthoff says. "Estrogen is produced from those maturing eggs. When estrogen rises in response to follicle stimulating hormone (FSH) then cells in the cervix begin to produce a moist type of mucus due to low levels of estrogen." As FSH rises, mucus becomes more lubricative, clear, and stretchy.
This is known as "peak type mucus" and is commonly referred to as "egg-white" texture because it actually does resemble raw egg whites. This is when you're in your fertile window. So if you want to prevent pregnancy, either refrain from intercourse or use some kind of barrier method. And if you want to get pregnant, now's the time to get busy.
Post-ovulation, the leftover cells in the ovaries will produce progesterone, which will "stimulate the cervix to produce a dense type of mucus that may appear scant and creamy." Many times this mucus isn't even really observable. That's when you know your fertile window has definitively ended.
"So to sum up: period bleed, dry, moist, egg-white, dry—that's the usual pattern of a normal cycle," Suthoff says.
Write down what you observe every day.
How to Track Your Cervical Mucus
It's really simple. You just start by "paying attention to sensation," Suthoff says. When you walk around, when you're sitting, when you're using the restroom—just ask yourself what you're feeling down there. Is it moist? Wet? Dry? Suthoff says you can wipe yourself before you use the bathroom is you're afraid you're going to miss something.
"Don't overthink it and overanalyze what you see," she advises. "[In] the first two to three cycles, most women are more confused than they are confident. After you get a few cycles under your belt, you'll start to see some patterns emerge and you'll get more confident in what you're observing."
Write down what you observe every day. You can use an app or an old-fashioned notebook. If you still feel lost after a few cycles, it's best to work with a certified instructor who can guide you and help you decipher the signals your body is sending you. This might be especially useful if you're coming off of hormonal birth control, because there isn't really much to observe in terms of mucus when you're on the pill. "That is by design," Suthoff suggests. Hormonal contraceptives "shut down the brain-ovary connection" so there's no hormonal fluctuation, which means there are no changes in mucus.
"If they do see mucus, it may be more crumbly and scant which is often just cellular sloughing," she says. "The body is constantly renewing cells. There also might be breakthroughs of mucus, especially if they are inconsistent with their pills. Every woman responds differently and each birth control option is a little different."
But if you're on the pill currently and you plan on getting off in the near future, Suthoff recommends you start tracking while you're on the pill anyway. Just so you can get in the habit of it, and so you can also start identifying what signs your body is sending you.
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