Innate Wisdom Podcast
Season 1 | Episode 1
Natural Family Planning for Birth Control & Getting Pregnant, & Busting Cycle Myths with Jamie Murphy
What It's About:
For our first episode of the Innate Wisdom Podcast, I invited Jamie Murphy, a Fertility Awareness mistress and educator. When it comes to all things female cycle, she seriously knows her stuff! Listen to hear more about:
- Myths & truths of Fertility Awareness
- The different types of Fertility Awareness Methods
- Practical tips on how to use Fertility Awareness for trying to conceive (TTC), conception & contraception, and natural birth control
- How you can use Fertility Awareness to track irregular cycles and the return of menstrual cycles postpartum
- How you can use Fertility Awareness to support you during fertility treatments
- The effect of hormonal birth control on fertility
- And so much more!
[00:00:00] Loren: All right, everyone. Thanks so much for listening and tuning in today's guest, I'm so excited to have, it's Jamie Murphy. She is a fertility awareness guru. And, welcome, Jamie.
[00:00:14] Jamie: Thank you for having me.
[00:00:17] Loren: I’m so excited to have you. And I just have to say I'm such a fan of your account and your content that you put out. It's so creative, but also so educational at the same time. So… super big fan.
[00:00:28] Jamie: Thank you. I like to make it fun, but the informative it's sort of the science communicator part of me.
[00:00:35] Loren: Yes. I think that's the best way to learn too.
[00:00:36] Jamie: Absolutely.
[00:00:40] Loren: All right. Well, before we dive into, you know, everything, fertility awareness, I would love to know what brought you to where you're at today, you know, how did you become an expert in helping women with their fertility?
[00:00:53] Jamie: Yeah, so, in college, I studied biology. I've always had a love for journalism and biology. And so, science writing was a sort of a big part of my life. I worked at a lab and then I had my daughter. And as we'll sort of get into today, charting postpartum sort of throws you into the middle of fertility awareness in a way that maybe you weren't in over your head at the beginning. So, I've been using fertility awareness for about four and a half years, but it was really after I had my daughter and I was sort of watching for that return of fertility, trying to figure out what was going on that I really took fertility awareness into my own hands and really decided I needed autonomy at the time I was using a method that I wasn't super happy with. And so, I decided I'm going to do this so that I know what's going on with my body and I can figure this out. So, I found a method that fit well for me, and I know that's another thing we'll dive into today. And then – I think it was the end of 2020 – I decided, okay, I'm going to make sure that no woman ever feels like I did sort of at the beginning of this, where I was clueless, I felt like I had to rely on somebody else for interpretation. And when I had questions, they just asked me if I was sure I wasn't pregnant, which is not helpful for a sleep-deprived hormonal postpartum mother to hear. So yeah, my whole goal with my practice is to make sure people understand their bodies and have the tools to use fertility awareness autonomously while also knowing they have a resource to fall back on when they have questions. Because as you know, from your practice and working with clients, we're working in a time where women have been using birth control for like unprecedented; to unprecedented amounts of time. And that has affected charting I feel in a way that maybe some of the self-help texts just really aren't built to accommodate.
[00:03:01] Loren: Mm-hmm I definitely agree with that. And thank you for sharing your story. I can definitely resonate a lot with it. I, myself, not postpartum, but post birth control, which is kinda similar yeah. You know, I had this huge desire to get off birth control, so I got off of it and I was just like, how am I going to manage this? How am I going to understand when I'm fertile and when I'm not? So I can use it smartly and just becoming more in tune with my body. I did utilize some tools as well, but there is no replacement for understanding your body, you know, what's happening every day of every week of every month, because it fluctuates so much and things shift too. I remember I had periods for two weeks when I first got off for birth control and I didn't ovulate for a year and a half. So I wouldn't have known that if I wasn't taking my temperature because I was bleeding every four weeks, it eventually changed, but it's just, there's just so much value and learning how to interpret the signals that your body's trying to send you. And it can be such a great tool.
[00:04:15] Jamie: And when we're talking about tools, which is sort of a good segue into talking about the types of fertility awareness, but I think it bears mentioning that, you know, when you're coming off of birth control and you Google, you know, ways to avoid fertility, naturally, you're going to come up with a lot of femtech and that advertising is so sexy and they have influencers and they're telling you, you can do this thing so easily and it will learn your body. Did you have any idea what your body was doing for that year before you ovulated? My client's cycles for three or four genuine ovulatory cycles are so different. How is an algorithm which is based on a consistent chart, because it's basically relying on a calculation rule. How is that supposed to have any idea what's going on or if you're having an ovulatory bleed or anovulatory bleed, if you don’t?
[00:05:12] Loren: Yeah, the tech, you know, we can talk about this a little bit later too, but the tech is only as good as the information that you give it, too. So if you don't know when you're ovulating and you can't confirm that on the calendar, then it's going to guess for you. But if you don't tell it it's wrong, then it's going to be off forever and so I'm totally with you on that too.
Definitely. There's so much to be learned and you know, I'm constantly learning too still, even though I've been doing this for like five, six years now, charting without any birth control, there's just always something to learn and your body just tells you something new and you kind of go with it. Yeah. I would love to, like you mentioned, I would love to talk about the different natural family planning and charting cycles options, because there are so many different ways to track your cycles in addition to the femtech tools. But, you know, also. There's just so many different options and signs from your body that you can utilize. So would you mind talking about the different kinds and can you also talk about the specific kind that you teach or use in your practice?
[00:06:19] Jamie: Yes, absolutely. And I genuinely appreciate this question because I feel that a lot of times when we introduce fertility awareness method, it's this monolith that really is only referring to one type when this is an umbrella term for multiple types of methods. And so of course, the most common one you hear, and when someone refers to this is often what they mean would be a method of fertility awareness that tracks temperatures. So your basal body temperature in the morning and cervical mucus, you know, whether that's tissue checks or walking sensation, this is called the sympto thermal method. This is where femtech can come into play, right? So I do have clients who chart mucus, but also still use their little Natural Cycles thermometer, even though they're not relying on predictions, but temp drop is another great option for people who maybe don't sleep consistently or have erratic sleep patterns. That's just a wearable thermometer that again, is tracking that basal body temperature throughout the night. So, this is the method that I teach the organization I'm certified through is called Sympto-Pro. I may be a little biased, but I do think it's just a fabulous method with a lot of flexibility. That's made it a great fit for most of my post-birth control clients, but you have other options, right? Because some people say temping is just not for me. It wouldn't fit with my schedule. Or maybe if we're dealing with significant thyroid issues, they just don't feel comfortable doing temperature. And they're not seeing that shift that maybe they like. So, there's another form of fertility awareness called the sympto-hormonal methods. So, this is where you're looking at cervical mucus, that's the sympto- part, but then hormonal, maybe you're testing with the clear blue monitor. So, here's another piece of fem tech. This is a monitor that reads out test strips from first morning. You're in every morning, it's very objective. It's a machine. You cut that little test strip in there and it tells you if your fertility is low, high or peak. And so one really popular method that I think I'll mention later on today is the Marquette method. A lot of postpartum women love this because that temping can be really tough, you know, in the middle of the night. And maybe they don't want to invest in a Temp Drop. Now there is another category that I also personally love.
This is when I learned for fun. This is the cervical mucus-only methods of fertility awareness. The big one here is the Billings Ovulation method. And essentially, it's just about developing subjective categories of your own walking sensation and cervical mucus tissue checks. And then you worked very closely with an instructor to determine, you know, what's infertile for you, what's fertile for you. And so when I have someone who comes to me, say with PCOS and they say: I see mucus every day, I don't know how fertility awareness would work for me. Maybe that's where I direct them to an educator who works on these more personalized patterns with clients so they can determine what's fertile or infertile. And so basically, you know, I just wanted to share, because maybe symptom with thermal methods, aren't a good fit for you, but there's something else out there that you love, or you use in a different stage of life. So, all modern methods of fertility awareness are 99 plus percent effective, 98%. If we're talking postpartum and we'll circle back to that, but you can find something that works. And also, there are multiple methods that have a medical component, so you can work with restorative reproductive medicine practitioner.
[00:10:09] Loren: Fascinating. So there's so many options. and yeah, definitely. I think there's a misconception that fertility awareness is just, you know, cervical mucus, basal body temperature, and cervix height, whereas there are actually so many more options. And if that doesn't work for you, don't worry because there's something else that probably does.
[00:10:28] Jamie: Yeah.
[00:10:29] Loren: So, so fascinating. Thank you so much for sharing. Now my next question is, which ones can you use to understand or track for conception? So, if your goal is pregnancy, but they also be used for birth control. Because I think there probably is some application for that too, right?
[00:10:50] Jamie: Yeah, absolutely. So when we're looking at any of these signs generally, or any of these methods, they're going to have a sign for estrogen and they're going to have a sign for progesterone. So. Any of these could be used to conceive or to avoid a pregnancy because what we're doing is we're identifying a fertile window, whether that's for someone trying to achieve a pregnancy, that's highly important, especially with erratic cycles. If you're targeting cycle day 14 and you have a 30-something day cycle, you're going to stop trying maybe on cycle day 14 to 19, and then you say, okay, that's good. You're going to miss your actual fertile window. So, when we're trying to achieve a pregnancy, we're always targeting those days of highest apparent fertility. However, our method defines them. I think it'll be most helpful if I just sort of talk about this in terms of the sympto thermal method, just so we want to sort of apply, but when I'm working with people trying to conceive. Focusing on those days of, you know, egg white mucus, highly clear stretchy stuff, or that classic meme that you always see, you know, when you feel that gush like that egg drop and you think you've started your period, but you haven't, that's a day of high fertility, right? So, these are the ones my clients are looking at. And I actually thought it was worthwhile to sort of bring up this nice stat. There was a 2003 German study of couples trying to conceive who were instructed in a sympto thermal method, 38% of those couples conceived in the first cycle, which is an incredible number because we always think of that, you know, there's a 25% chance of pregnancy each cycle, and that comes from sort of the ubiquitous Wilcox study. So, there's a group of scientists who really pinpointed that conception window, that possibility of conception. And that's the one always quoted. And they found that assuming, you know, daily intercourse, when you hit that day of ovulation, your chance of conception for the cycle would be 25%. That's sort of where we get that number. So, it's really interesting to see when couples are actually targeting their fertile window, we get a significant percentage of clients achieving pregnancy.
[00:13:10] Loren: Have you heard that other stat too? It's not too old. It's definitely newer than 2003. I think it's from 2010, but 50% of couples trying to conceive are trying to conceive at the wrong time.
[00:13:23] Jamie: Yes.
[00:13:25] Loren: So I think that plays into what you're saying really nicely, because if you know what your fertile window is, then your chances automatically go up.
[00:13:34] Jamie: Oh, a hundred percent. Yeah. In 2018 actually, I have a quote saying that up to 75% of couples had little knowledge of the actual biological window of fertility. So, this like up to three quarters of people just genuinely don't know when to have sex. And they're told by their doctor, “See you in a year”! If they're not even targeting the window of fertility, what are we doing? And that's one note I wanted to actually make about the application of FAM for trying to conceive. I refer my clients out to fertility specialists or to their doctors after six months of working with them. If we know that this isn't a timing issue, you can save time too, because then you're not waiting a full year. You know that you've applied fertility awareness to find your fertile window and it’s not a timing issue, what else can we investigate? Yeah. So, you know, it's great for trying to conceive, and those are some of my favorite types of clients to get, because it really shows that, you know, they're making an investment that maybe the world tells them is sort of unnecessary, just relax and have fun, but it can give us a lot of answers.
[00:14:51] Loren: Mm-hmm and that relaxation and fun is important too. But also I think that if we're trying to conceive and kind of shooting in the dark, it can also lead to unnecessary disappointment when the actual fix might be as easy as just maybe shifting when we get jiggy or have intimate just a little bit.
[00:15:12] Jamie: Absolutely. I have people tell me on my Instagram all the time, like “before I followed you, I didn't even know to look for cervical mucus. Now I'm pregnant. Thanks so much”. So, for some of us, it really is about timing, but speaking of timing, if we flip the coin, we also then know when to avoid unprotected intercourse in order to avoid pregnancy. And so, as I mentioned, fertility awareness has a 99 plus percent efficacy when we're avoiding unprotected genital contact during that fertile window. And there are studies that have looked at sort of condom use at the tail ends of the fertile window. So it's not even necessarily just abstinence based, but that condom use also wasn't sort of on the days of peak fertility. So that's something to keep in mind. But one thing I did want to mention was this efficacy rate is very specific, right? This is what we call method effectiveness. Meaning somebody has taken a course of instruction with an instructor. Why is that? Not because we're gatekeepers, but because when we're looking at the literature, the population studied was given instruction before the study, right? So, if we are factually reporting efficacy rates, we have to match the conditions under which FAM was practiced in order to get that efficacy rate. So, it just involves a course of instruction and then consistent turning every day, which can seem overwhelming to people when they take that first session. But as I'm sure you're used to having done it for years, I've done it for years. It takes seconds. You get very used to it in the routine. So, it's really just a part of your day, but I have clients who have been working with me for over a year and they tell me “My family stopped making jokes about the new grandchildren months ago”. Right? Like this is a very fabulous, reliable way to avoid pregnancy.
[00:17:16] Loren: That's amazing. That's a funny, funny joke. I think there's also a lot of pressure put on women too, that maybe want to take a natural route from their doctors, especially women that want to come off the birth control. Their doctor will tell them, okay, see you when you're pregnant in like a month or so. And so I think that's just so unnecessary. And if they obviously don't understand fertility, I grew up thinking that I was fertile every single day of every month of every year of my reproductive life. So it's like that Mean Girls movie “Don't have sex. You will get pregnant and so…”
[00:17:55] Jamie: “And die.”
[00:17:56] Loren: Yeah. And when I started learning about my body, I was just shocked, but also really disappointed because I was like, “are you kidding me? I've been taking this birth control pill”. When the only thing I'm trying to address is happening only one to two days out of every month, but I'm taking this pill a hundred percent of the time and who knows what it's doing. And definitely I should do a whole episode on that because, I can share tons on that, but it's just really incredible. So, for anyone listening out there, I think fertility awareness is a great option for birth control. I wish I had known about it and I've been using it successfully, and you've been using it successfully and effectively for years. And it can be just as effective to help pregnancy as it is to prevent pregnancy too. If you're doing it right.
[00:18:45] Jamie: Both my pregnancies are from one very casually timed day at the beginning of the fertile window, because we use it to achieve, we use it to avoid, we know when we're fertile and so things can happen when, you know, you start trying to conceive and it can give you a lot of peace of mind too, that you don't even have to do all the things right. Just apply what you've been using for years or months, depending on how long it is before you switch intentions. But that's all there is to it. so, yeah. It's very versatile.
[00:19:21] Loren: It's incredible. Well, I would love to dive into some myths or misconceptions next, because I think we just kind of covered one or it's a good segue at least. And I would love to hear from you what the most common myths or I guess the myths that are the most erroneous in your sort of world. And if you could break them down a little bit for us?
[00:19:43] Jamie: Yes. So like you said, there is a laundry list of sort of myths. And so when we're looking at sort of misconceptions about turning in general, I controlled myself. I chose sort of three big ones, mainly because these are ones that I often see in sort of that messaging you hear. Not only for sort of fem tech, but also when we're talking about how fertility awareness can't be used at all to avoid pregnancies. So more in the line of like birth control marketing. And so, the first one is that it's too difficult to interpret cervical mucus without, like, clinical training. Like you need to have a doctorate to be able to interpret this sign that your body produces monthly. And so, I just wanted to say, you know, there are methods that have done studies around the world, right? So, we're looking at different levels of literacy, you know, different educational backgrounds and these people can use fertility awareness effectively.
In some cases, there are literally no recorded pregnancies, method related pregnancies during the course of a study. And in terms of the method I teach, we have two categories of mucus. So, some people come to me after reading what's touted as like the fertility awareness Bible – and I do say it's the Bible because of the size of the thing – but it’s Taking Charge of Your Fertility. Like you could use it as a door stop, so you know, it has four categories of mucus and people just get overwhelmed. They're like, how do I break it down? This is so subjective. And so, learning a method from an instructor, especially when that method doesn't have that many categories to work with, we're literally just looking for signs of changing estrogen, right? So, it doesn't have to be that complicated. My clients are always amazed after the first session, how simple things suddenly are, you know, you can chart it very easily. It's not overwhelming. It takes just a couple seconds. Every time you visit the restroom, it's so empowering. And so, it's really unfortunate that, you know, we instill in people this idea that you can't understand your body it's too mysterious because it's you, it's an amazing physical sign of hormonal changes. So, you don't even need to technically do hormone testing to just get a general idea every day of those hormones rising and falling. So, that's a big one. The second, and I'm sure you had experience with this as you came off the birth control pill, it's impossible to chart with the regular cycles, right? I get that so much on Instagram. “Oh my cycle isn't 28 days. This wouldn't work for me.” Or people saying, “Don't tell that to women. It only works if your cycle's 28 days.” This isn't your grandmother's NFP. It's not the calendar method that was 75% effective, because people's cycles do vary for so many reasons that first half of your cycle before ovulation is very responsive to stressors to illness, you can have a delay and ovulation and you know how empowering it is to catch that on a chart or to know when you're bleeding, but it's not in ovulatory bleed. And to be able to understand that and seek help if this happens consistently. So that's another big one. And like you said, you were having anovulatory bleeds for a significant time. And that's something people don't understand, right? An anovulatory bleed isn't the same as a period because it's not telling us that progesterone is dropping. It's telling us that you have such an extended stimulus of estrogen, that your endometrium, the tissue, that lines, the uterus is getting so thick because of this estrogen exposure that it's collapsing under its own weight. And it's just being pummeled by estrogen and you're bleeding and then your body's trying to ovulate but doesn't so that endometrium collapses again. So, you are not getting the protective and sort of positive health benefits of progesterone at any point, during those bleeds, until you finally ovulated a year and a half later, it can be really helpful to just know that your periods are true periods because I've had people tell me, “You know, before I started looking for that sign of progesterone” - in our case, that's the temperature shift – “I didn't know that I was just having anovulatory bleed every 28 to 30 days. Maybe that's why I'm not getting pregnant. Maybe that's one of the reasons that I have significant PMS or signs of high estrogen.” Absolutely.
[00:24:38] Loren: I agree. And regardless of whether your cycles are regular or irregular, this can be just as valuable to get in tune with your body. That's what I like about fertility awareness so much. It's not “follow this thing to the tee” or “follow this thing to the tee”. It's “get to know your own body”. And that's what you use. That's the sort of north star, not anything else. So, you can incorporate other things with it, but that understanding and awareness of your body is just, what's going to guide you. And no one's going to know that better than you and no one's going to care about that more than you.
[00:25:13] Jamie: Absolutely. And you begin to understand what's normal for you. And so if something isn't normal for you that maybe doesn't set alarm bells off for anybody else, you know, something is wrong, so important. A hundred percent. And then the final myth that I love hearing because yeah, it's often repeated is that because we can't know the exact timing of ovulation, this method's useless. It doesn't help us to avoid pregnancy, which again, we know isn't true. Because we're not looking for the actual day of ovulation. We know, based on the literature. That ovulation occurs in a fixed range of time, around the signs that we're charting. And so, fertility awareness rules, if you're following some methods, protocol bakes into its rules, that window of time where it would be possible for conception. And we assume we're infertile only when we know there would be no chance of an egg being present at that point. And then at the beginning of the cycle, we only assume infertility until we see a sign of fertility. And then we begin assuming fertility, because we don't know when ovulation is going to occur. So, we're assuming we're fertile because we know cervical mucus can keep sperm alive for three to five days. Right? That's so important. And it's not just that real stretchy egg white stuff. I guess this wasn't on my sort of list of misconceptions, but all cervical mucus is fertile until proven otherwise. So that's one thing that infographics, cutesey little infographics on Instagram, will tend to get wrong. Is that only that egg white stuff is fertile. If you're trying to conceive and you don't see a lot of it, but you're skipping the days of like sticky or creamy mucus, you're missing out on potential days of fertility. You know, that may be closer to ovulation than you think.
[00:27:19] Loren: Two for one there. I know, that's so fascinating and yeah, I think that's definitely something that a lot of us get wrong for sure. And again, it all goes back to, if you can understand the signs that your body's giving you, that ovulation is going to occur within a certain amount of time. And whether you're having ovulation on day 30 or ovulation on day 14, the signs around that day are going to tell you exactly when it's going to happen. Maybe not exactly when it's going to happen, but they're giving you signs that it's coming soon. And that's going to inform how you proceed around those dates. And I do love the treat. It's almost like guilty until proven innocent, kind of.
[00:28:08] Jamie: So for, for people who have continuous mucus patterns, we're going to assume it's that mucus is guilty for a couple of cycles until we see your pattern. And then there are methods that allow educators to help you to determine what's infertile sort of going forward and what your point of change truly is. So it's such a personal practice and it really sort of just revolves around your body and we can work with that. So that's why I'm such a big fan of fertility awareness.
[00:28:49] Loren: Absolutely, same here. Those myths were so interesting. Are there any others that you want to cover?
[00:28:51] Jamie: Yes, absolutely. The first you sort of just touched on it. When you mentioned ovulation on day 30, I just wanted to sort of address head on that idea of the 28 day cycle. Right? Because I actually have had clients tell me, they thought they must have PCOS because their cycles were 35 to 40 days. And my method, at least their methods will sort of vary in what they consider typical and what the range could be. But my method is looking for anywhere from 23 to 40 days to be within our typical, beyond that, we do consider that long, most of my clients with PCOS are often looking at cycles 50, 60 days long, you know, maybe we're only ovulating six times a year instead of 12, things like that. But you know, when you're looking at recent literature on just menstrual cycle characteristics, when they're collecting this data sort of from period apps or from Natural Cycles, things like that. We actually find that the average menstrual cycle is actually inching closer to 30 days now, which I thought was really interesting for me. So, I track with this app called Read Your Body, and I love it because it compiles all these stats for you for each cycle. And my average sits at around 35 days. So, I'm looking at my peak day so that day of highest apparent fertility, it often sits at day 18 for me and not day 14, which has been very important for both of my pregnancies. Very interesting sort of tidbit there in terms of how fertility awareness can help with dating a pregnancy.
[00:30:41] Loren: For sure. Just to jump in there too, isn't it? Something like only 14% of women ovulate on day 14?
[00:30:47] Jamie: Like just over 10%.
[00:30:51] Loren: And so when you're going to the doctor and they're like, okay, so you should have a 28-day cycle. So you're, you know, trying on day 14 or that's when you're ovulating, that's like not right for the majority of women.
[00:31:07] Jamie: Mm-hmm Nope. Another reason for fertility awareness. And then that means that when you're dating a pregnancy, if they assume that you ovulated on day 14, for a lot of people, that means that they're going to be measuring behind or they're going to be told, oh, this isn't a viable pregnancy. Mm-hmm, absolutely terrifying consequences of this like myth. So yes, that's something I say, knowing when your peak day is, can be critical to your prenatal care. Yeah, that's a great myth to bust. Another one. You know, both four people trying to avoid or trying to conceive the myth that we can get pregnant any day of our cycle is so damaging. A), because I've had clients who have been on birth control and like doubled up on barrier methods because they're so afraid of pregnancy and they think I'm insane when I tell them there are infertile days where you can go unprotected and not have a pregnancy, they think I'm crazy. And for people who are trying to conceive, that can cause a lot of heartbreak because they don't understand if they can get pregnant any day of their cycle, they're going to feel betrayed when that period comes, you know, cycle after cycle, because they don't know how to time intercourse. So, it's important to know. There are six days where if intercourse occurs, a pregnancy could occur, we would only know sort of these six days. In retrospect, if we knew the day of ovulation, we know the day of ovulation itself and the five days before are the days where conception is possible. There are no recorded cases of conception happening after 24 hours past ovulation. So that's really important because we actually find that on average, most women have about six days of egg white mucus. And so that's very interesting that that kind of lines up nicely with those six days of possible fertility. Obviously, some women have less and maybe it's not egg white, so it's not a perfect sort of matchup for everybody's cycle, but it's an intriguing idea for sure. And yeah, so that's why pinpointing those days of mucus when trying to conceive, the sperm are going to be able to survive in that cervical mucus. So, they're going to be there waiting for ovulation because we know, once that egg is released, it's like a ticking time bomb. The amount of time that it takes for that thing to become non-viable is very quick. And so using cervical mucus as a predictor of impending fertility and impending ovulation is so helpful for people trying to conceive. And for people trying to avoid, they know those are the days of highest of apparent fertility. They know that one population occurs, they hit that window. They follow their rules. They are infertile for the rest of their cycle. You cannot get pregnant every day.
[00:34:02] Loren: Mm-hmm, that's a really important one. And yes, one that I wish I had known, 20 years ago. That would've been great.
[00:34:12] Jamie: Last one I did want to touch on because sometimes people who self-teach fertility awareness or, you know, have been naturally avoiding pregnancy for a long time will say this: We can't actually feel the event of ovulation. We don't actually feel the follicular rupture. So all of our eggs are contained in fluid, filled sacs called follicles, and some people around the time of ovulation feel some twinging called mittelschmerz in their abdomen. It is not the actual event of ovulation. And I found this really interesting paper that asked women to start tracking LH. So that would be like an ovulation predictor kit. It's looking for a luteinizing hormone, sort of the brief pituitary hormone that surges before ovulation. They wanted women to start testing themselves whenever they thought they were ovulating. And so, the common one people say is “I'm so in-tune with my body, I can feel when I ovulate”. Well, when women tried to do it that way, we found that 29% of the women who thought they were ovulating actually caught a surge in LH based on cramps alone. So that means that when they felt that cramping, they were starting to get their surge of luteinizing hormone, which precedes ovulation. It's not the event of ovulation. This hormone has to be released first for that follicle to rupture, but it just always makes me laugh. It's probably related to prostaglandins, which increase with high levels of estrogen or water retention. So, again, we can thank estrogen for that. So, if anything, that mittelschmerz is a sign of high estrogen. It's not a sign of ovulation. And I have clients who feel it during mucus episodes that aren't ovulatory. So do not rely on that cramping alone to tell you that you ovulated.
[00:36:16] Loren: That is fascinating. And I guess, you know, based on that too, that makes so much sense because there are women that feel super sick sometimes around ovulation and they can have, like, these fainting episodes or these terrible vomiting episodes, migraines, that kind of thing. And it's from that super high level of estrogen, prostaglandins, that kind of stuff. So, another way our body communicates with us, and maybe we need some support during our follicular phase to maybe support that estrogen detoxification.
[00:36:49] Jamie: Yeah, absolutely. Some people get period poops around ovulation again, because of those high levels of prostaglandins. And so that's just telling us, our hormones are getting very high right now. Fingers crossed that that leads to ovulation because it's the high levels of estrogen that sort of trigger the release of luteinizing hormone, but it doesn't always work. And that's where we get sort of this false peak, right. While we're waiting for our body to ovulate. But we're dealing with the fun effects of high estrogen during that time.
[00:37:23] Loren: Yes, oh my goodness. You mentioned period poops for those who don't know period poops are poops that come almost like diarrhea or really just uncomfortable bowel movements before or around menstruation. And it's usually due to high levels of prostaglandins and that also contributes to the cramping happening and PMS. And so that can also happen during or around the time of ovulation, whether the ovulation occurs or not. Which is just totally fascinating.
[00:37:56] Jamie: And you know what, I think one of the things you learn as you're charting your own cycle and becoming aware of it is that these pretty little boxes were meant to fit in, in our phases and how we're supposed to feel doesn't always reflect our lived experience because…I love ovulation. You know, I feel vibrant, social, sexy, energetic, but that's not the case for everyone. Depending on what they're dealing with hormonally, they may experience it as a second PMS almost because of estrogen at that time. You know, I have people tell me, I feel terrible. I can't wait until I ovulate. So that that feeling goes away and I can sort of experience relief. And so, it can be a great way to tune into your body and sort of what you need, because you can let go of that shame of not fitting in a box and figure out what your body needs.
[00:38:48] Loren: Absolutely. That's really well put. So let's move on from myths, because those were mind blowing. Thank you. I'd love for anyone considering charting, what are some do’s and don'ts as a way to start?
[00:39:03] Jamie: So, I gave just a little short list for both. Basically, when we're talking about what should we be doing? We should be consistent with charting. I often see this with people who self-teach and then come work with an instructor. There's a lot of inconsistencies in their charts because they're overwhelmed. So first of all, try not to overwhelm yourself and just focus on making sure there's data for every day. Whether you're dry or whether you see something, even if you don't know what it is, you know, take notes, watch these changes through your cycle. If you're using a sympto thermal method, make sure you're temping every day. Again, some methods are going to be less strict than a very popular thermometer out there on the market that says you have to take your temperature the same time every day or a pregnancy that's caused would be your fault because you didn't take your temp at the same time. That's not how most methods deal with temping. Ideally, if you can learn with a practitioner, you know, sometimes that cost can be a real barrier to people. Luckily, this is a growing field and there are a lot of educators in practicum who will offer reduced rates to work with people. So that's a fabulous resource, you know, that's how I sort of built my client base initially. People were like, oh, I can learn this very cheaply. So, you know, one thing that's just something to chew on: If the cost of an instructor is too much, let's just take a step back and think about what the cost of a pregnancy would sort of mean for your finances right now, right? Like if this is something you truly need to do, either for financial reasons or medical reasons, like you need to avoid a pregnancy, then make sure you're using this method with confidence and sort of setting yourself up for the most success that you can. And then finally, always try the most fertile thing that you see every day. That's sort of my big piece of advice because you may see different things throughout the day as you're checking every time you're in the restroom chart that most fertile thing. For don'ts, I have a much shorter list. Again, don't assume you've ovulated just based on vibes. That's my big one. Increased energy libido, cramping - great secondary signs of ovulation, not a true sign of high hormone levels that could result in ovulation. Haven't studied those. So, stick with what we know. And then the only other piece of like advice in terms of, maybe kind of steer clear don't mismatch methods. The biggest thing: Don't compile a bunch of fam related Instagram content into a saved folder and make that your method, different methods, categorize things differently, have different rules for confirming ovulation. So just stick with one, to sort of set yourself up for success there. And so, you don't confuse yourself because there's a lot of chatter.
[00:42:25] Loren: That is some great advice for sure. Yes. You want to make sure what you're doing is trying to improve and not just, I mean, there's definitely empowerment in sort of familiarizing yourself and self-teaching, a lot of things and just becoming more in-tune. But I think there's also a lot of value in that education piece and solidifying your knowledge and making sure that you're reaching your goals in the way that, you know, you want to.
[00:42:46] Jamie: Exactly. That's the thing for some people, maybe it's not as big a deal for them, or they're not anxious learning on their own until they maybe come up against a roadblock they don't quite understand. They may be able to just teach themselves and that works for years and years. And there are plenty of people for whom that's the case. If you're very anxious or if you have major concerns about a pregnancy, but you want to use this method, then maybe it's a good idea to make sure that you have all the information you have someone other than the internet at large to ask questions too. I think that's the main value I provide as an instructor is I have clients a year down the road still come to me when a chart is very strange. I mean, we're in the middle of a pandemic. If someone's cycles, aren't strange, I would be surprised. I have seen a lot of weirdness over the last couple years. So, it can be helpful just to have that double check.
[00:43:45] Loren: I believe it. Absolutely. Absolutely. All right. So those are great ways to kind of level set if you're thinking about beginning charting. I guess, for women that are interested in using charting for contraception, what should women keep an eye out for if they’re tracking?
[00:44:06] Jamie: Yeah. So, I just sort of wanted to keep this simple too, but essentially when does your first fertile sign appear? So, we know we've had a true period. We know there's a certain amount of time that has to occur for those follicles to mature and start producing estrogen. So, when does that first sign of estrogen appear? That's when you start to assume yourself fertile, and then when do we get that sign that ovulation has come and gone, right? So, have we closed our fertile window? Have we opened it? Have we closed it? These are the big things we're looking for when we're trying to avoid a pregnancy.
[00:44:45] Loren: Absolutely. The open and close for sure. And again, all mucus is fertile, mucus unless proven otherwise.
[00:44:54] Jamie: Exactly.
[00:44:57] Loren: Such good advice there. Okay. So the flip side, what should women look out for? If they're tracking with the intention of conception?
[00:45:04] Jamie: Yes, couple big ones. Right? First of all, are you ovulating? Because like we've talked about at length, you can be bleeding, but not ovulating. I have been told on the internet before you can get pregnant without ovulating, I'm here to tell you one half of a baby, is it an egg? You only release an egg at ovulation. So, are you ovulating? Your chart will show you. I often do sort of quick little chart consults with people trying to conceive because nobody has told them how to confirm ovulation. And so we'll look at a chart and say, okay, you're ovulating. This was an ovulatory cycle. The other one, we actually haven't surprisingly touched on this yet, but the chart can be a good sort of first line when we're looking at, you know, symptoms of hormonal issues. And I guess we did sort of touch on that with ovulatory bleeding or like intense sort of ovulatory symptoms. But the big one I look for with clients trying to conceive, how long is your luteal phase when we're talking about sympto thermal methods? That means how long is your high temperature phase? Most methods define a truly fertile cycle as one that has at least an 11-day luteal phase, because that means that implantation could have occurred. HCG could have been produced before the endometrium shed. You know, when I'm looking at deficient luteal phases, that may be a case where these women's pregnancies don't have a chance to even get off the ground before their period comes or with an indication that progesterone levels are low and maybe supplementation upon getting that positive pregnancy test or even, you know, once you've confirmed ovulation, starting to supplement progesterone may sort of help them. If they've been experiencing recurrent losses, there is a really exciting paper that came out a couple years ago, I think maybe last year, that shows for women with recurrent loss, progesterone supplementation can lead to healthy pregnancy outcomes. For my first pregnancy, this was a case where my chart did not show any sort of progesterone deficiency except for I had terrible PMS for a long time. But fortunately, I was working with a practitioner who had my levels tested and they were abysmally low. So, progesterone supplementation was recommended for that pregnancy. Excitingly, you can work on your cycle health. You know, I don't have PMS anymore. Just out of curiosity, I had my levels tested this pregnancy and they are sitting at healthy levels without any sort of supplementation. But some people want to be pregnant yesterday, so knowing their progesterone is low, can help us to make sure that one potential reason for loss is avoided.
[00:48:03] Loren: Those are great tips when it comes to charting for conception. I think that you broke down a lot for us. There are definitely different aspects too. There's understanding when you're ovulating understanding your fertile window, but also understanding that really important piece to conception: Are we making enough progesterone? I don't know exactly the rate of loss associated with that, but you need that progesterone to sustain that pregnancy, but also in the first trimester, in the work of Katharina Dalton, and she talks about this morning sickness can be associated with potentially progesterone deficiency. I think there's a lot of other options. when it comes to that or drivers of morning sickness, but that's one hypothesized reason. And it's that corpus luteum is what is producing progesterone until the placenta is created. And that happens kind of in the second trimester. So, the placenta's being developed in the first trimester and it doesn't start producing progesterone until the second trimester. So, it's going to really carry you through not just the conception part, but the first trimester, which is super important.
[00:49:17] Jamie: It was so interesting to see the stark differences in pregnancies. I'm almost like my own sort of study here. Because my first trimester last pregnancy, it wasn't morning sickness. It was like lunch sickness where I just couldn't keep my lunch down for an entire 10 weeks. And this pregnancy, like, yeah, there was a little fatigue because my body was sort of switching gears, hormonally to do something it hasn't done in two and a half years. So, there was a little fatigue, mild nausea, but it lasted two weeks. And then I was like, “oh wow, this is cool. You know, this is how pregnancy could be”. And so for sure, I think there was a progesterone component to it for me, at least based on my history.
[00:50:00] Loren: That's so interesting. Connecting the dots with your personal experience. Mm-hmm that's fascinating again, so fascinating. So I have a different kind of question, similar but different. So, I think a lot of women have the privilege to be able to conceive without any assistance, but there are a lot of women that do opt for, or choose to have assistance for their conception, like IVF or IUI. So I'm really interested to hear your perspective on charting while using these fertility or assisted reproductive technologies.
[00:50:39] Jamie: Yeah. I was actually really intrigued by this idea because it's definitely something I occasionally get questions about, but I feel like we don't talk about it a whole lot because fertility awareness is seen as one way to help you get pregnant naturally, and then there's anything else. But at least in terms of IUI, especially if people are going an unmedicated route, right. So, they're not having any sort of ovulation-inducing medication, it can be really helpful to chart so you know when to time that IUI, and so I've seen charts like that that are really sort of interesting to me because it makes sense. You know, they're still looking at sort of their fertile window and when the best time to schedule an ultrasound would be, you know, to schedule the IUI for medicated cycles. I would say maybe there's not so much value in identifying ovulation at that point, because it's sort of a cycle on wheels, right? Like it's on its own little track, but people do like to continue charting because they can sort of see that temperature rise. And we know that if we get 18 to 20 high temperatures, there's a 99% chance of pregnancy. So, you don't even need a positive pregnancy test to confirm ovulation if you're charting with fertility awareness, but also importantly, especially for medicated cycles, it can be really helpful to be charting your cycle so if that round fails, you can chart a return of fertility. That is a question I get sometimes because a lot of the literature, or even just sort of like, I don't know, different institutions will publish articles on failed cycles of IVF or IUI. There is no information on when to truly expect that next ovulation. If someone just wants to then try on their own or even schedule another round, it can be really helpful to chart sort of what your body does as it returns to a baseline and just have that information for yourself. That way you know when you've ovulated again, when you've had a period after a failed round.
[00:53:02] Loren: Yeah, so the unmedicated aspect of, you know, ART there's value because you'll still be able to time that properly. And then the value in even the medicated side of things, you'll be able to understand, okay, if things didn’t sort of fall into place as originally planned and you have this break, how to track your fertility and look out for those signs of fertility as your cycle comes back as well.
[00:53:33] Jamie: Yeah, because I've seen it could take like four to six weeks after a field medicated cycle to sort of like get back to normal. And I've had people like that appear in my DMs, like not knowing what on earth is going on and it would be so much more helpful to have a chart to look at and say, okay, right. Honestly, I see this in the case of like a chemical pregnancy. So just one that truly ended very, very early and maybe you're still producing HCG for a while or it's ectopic. What is my body doing? I'm still bleeding…Well, your temperatures are still very high. Seems like HCG is still there and you can go and get that checked out.
[00:54:18] Loren: Those are great tips. Thank you so much.
[00:54:21] Jamie: Yeah, no, I was so intrigued by that question.
[00:54:24] Loren: Yeah it’s definitely, I think with the world of fertility awareness, I think there are still so many applications. So when we have to shed light on these applications for women, there's a significant amount of women going through this as well, so, got to support them too. So, we kind of touched on this in the beginning too, because it ties into a lot of your personal experience and sort of the reason you became who you are, but I would love to chat about postpartum cycles and these can take a while to normalize, especially after delivery, it really ranges like really ranges. And so with that aside, is there any piece of advice that you would give a mama who's in the process of regaining her cycle, but is not quite regular yet?
[00:55:11] Jamie: Yes, absolutely. And so one thing I do want to say, right, because first of all, hang in there. It can take a while for cycles to return often because of that interaction of prolactin and estrogen, right? So, we're producing prolactin because we're breastfeeding, but it can drive down estrogen levels. That's often why people feel drier after birth. They may require lubrication with intercourse, and it's just a hormonal consequence of this period of time. But it also means we make patches of mucus that aren't related to fertility at this point. And it may go, which was my case. I think I started seeing patches of mucus around month five postpartum, and I didn't ovulate until 13 months postpartum. So that's a long time to be seeing bits and patches of mucus and not know what's going on. So, there are two methods of fertility awareness with research showing efficacy of their protocols for postpartum. Again, efficacy is at 98% instead of 99+% in typical cycles, but that's the Billings Ovulation Method or the Marquette method, sort of that clear blue monitor based method we were talking about earlier. So, if you're looking to sort of go that route, those are always the ones I'm going to direct people to. Although I do have a protocol for, um, postpartum charters with my method, we don't have like an efficacy rate with research to back it, although we do borrow from the methods that do. It can be difficult charting that just because of those hormonal interactions and also, I think this played a big piece in my own journey, it's not just that prolactin, estrogen relationship that may delay that return of fertility. In my case, I bought into that lie that your body has to bounce back immediately postpartum. So, what happens if you are up consistently throughout the nights, you're not resting, you're breastfeeding and burning calories. You are maybe exercising a lot to get that body back and you're skipping meals. Suddenly we have this HPO Axis connection to ovulation that we can see in typical cycles, not even postpartum, right? Like we're disrupting this connection between our brain and our ovaries as our bodies are trying to survive. So that's a piece I do like to mention because I've seen it. In my own life. Right. You know, how much of my return of fertility was related to weaning, which I'm sure a large portion of it was, but also starting to eat again, increasing calories to the point where my body did finally ovulate. And one other note, after that return of fertility, if you are still breastfeeding, some women get their cycles back couple months into postpartum or a year, but they're still breastfeeding. Just know that that can cause longer cycles, you know, patches of mucus, even though those cycles are ovulatory, they could just be a little erratic for however long that breastfeeding journey lasts.
[00:58:46] Loren: It sounds like there are a couple of options to support women looking to chart. I get a lot of questions too like, “I'm thinking about getting on the birth control pill while I'm breastfeeding. Do you know anything about this?” And that could probably be its own episode, but I think that there are still natural ways that you can chart your cycles and use fertility awareness as contraception and building bodily awareness as your body sort of comes out of this pregnancy state, regulating during breastfeeding and sort of bringing back that fertility as it comes.
[00:59:23] Jamie: Pregnancy is huge “risk,” I guess, essentially. And so you don't even have to have delivered your baby yet before they're already asking you how you're going to prevent the next one. Or you could be two days postpartum and they're like, okay, how are you going to prevent the next one? Right? Like your fertility needs to be shut off until you're ready to have children. And then you can come off and magically have a child. And then as soon as you have that child shut it all down again, because you know, pregnancy, um, delivery is such a huge burden. And there's definitely so much to say there about the reproductive burden that women carry, but also how we've come to see fertility and pregnancy as huge, risky things that have to be avoided at all costs. When we know that so many hormonal methods are such terrible fits for so many people, it blows my mind that it's just expected that a new mom goes on some hormonal contraceptive method when her hormones are on their own sort of rollercoaster as you know, labor ends and pregnancy ends. And she's sort of trying to figure that out.
[01:00:41] Loren: Yeah, I feel like it's a one-size-fits-all solution for, not a one-size-fits-all population. You know, everyone's goals are different too, but there are other more natural options for sure. And thanks so much for breaking that down and for being so candid. I really appreciate that.
[01:00:59] Jamie: Yeah, absolutely.
[01:01:02] Loren: So, Jamie, is there anything else you want to talk about? ‘Cause that was my last question.
[01:01:05] Jamie: Yes, that is just birth control and return of fertility because the primary client base I have is people who are coming off birth control either to continue avoiding pregnancy, but they just have been through it all.
They've been put through the ringer and nothing quite worked or they're trying to conceive and they're just coming off birth control. So, I just wanted to take a moment to sort of discuss what's normal because we've been told that we can be on birth control until we're ready to have children. And when people want to come off birth control and not have children, they're often told, “why there's no reason to stop taking birth control?” But I think there's this idea that your cycle will return right away. And so, for people who are trying to avoid pregnancy, they think, oh, great, this will be easy. And for people who are trying to conceive, they think, oh, great, this will be easy. So, I'm not here to say birth control is going to permanently affect your fertility because I don't necessarily buy into that. I am here to say there is research to show that it can take a while for things to normalize. And I love this to be part of the conversation, because again, we put ourselves into these boxes and people think that there's something wrong with them if they've come off birth control and things are erratic, right? And for women trying to conceive, it can just be really relieving to know there's a period of subfertility that we're going to go through. So, women who use injectable contraceptives are going to have the longest delay in return of fertility five to eight cycles. So that's, even once we get that first true period, we may see shorter luteal phases, longer times to ovulation, things like that. And that makes sense. When we're talking about injectable contraceptives, those are long-acting contraceptives that are going to just take a while for our body to get rid of. Patch contraceptives takes about four cycles. Oral contraceptives or vaginal rings, we're looking at three cycles, which is typical for what I see for clients.
It's really clients who are using longer acting contraceptives who see more anovulatory cycles. Sometimes people on the pill, they come off and things go right back to normal. Sometimes it can take a couple months or in your case, it can take a lot longer. And then the IUDs, those generally take about two cycles or so to sort of see a return to more normal cycles. But what's interesting as a fertility awareness educator is if people were dealing with things that any form of contraceptive was just sort of masking, suddenly all of those things are going to come back. Or as I know you've talked about at length, post pill-induced PCOS. So, it's not the actual PCOS but it's something very similar. It's something I've seen. One thing I wish research did was look at women who have been using it for as long as, you know, our generation has been using contraceptives because, you know, you find maybe the longest, any, like test group has been using it as 10 years, but I work with people who've been using it for 15 or 20. And so that will definitely play a role too, but just know it can take time and your body will sort of figure it out.
[01:04:44] Loren: Absolutely. I think that's a nice heads up because a lot of women come off the pill with the intention of getting pregnant and maybe they got on the pill, a lot of them are thinking about getting on the pill when they're getting married. And then when they decide to get pregnant, they're coming off the pill thinking, okay, I want to get pregnant right away. There are so many other considerations too, besides that fact of like period of subfertility, but I I'm very familiar with the research you’ve cited and there's this other research too. I don't want to misquote it, but I think I read something like it can be normal for 18 months of subfertility to occur as well, depending on the contraceptive method. So that is a year and a half. And that's about how long it took me to get my cycle to ovulate again. So just some considerations too. You're going to have to learn your body anyway to get pregnant, so why not? This is me talking to my young self. Why not just learn it now so that you can use it for contraception and then for conception later on.
[01:05:56] Jamie: I will say when you've been trying to avoid pregnancy and then like switch to trying to conceive, there is nothing like, sort of making that switch and suddenly wanting to conceive and not having any like anxiety in the back of your head about if you're using the rules. It's so incredible because you know, you're using days of potential fertility because you know what your body is doing. There is no feeling like it.
[01:06:31] Loren: Yeah. It's very liberating for sure. That's awesome. Well, Jamie, thank you so much for taking the time to chat with me for sharing your incredible expertise. I think that a lot of women hopefully will walk away from this, even partners - hopefully if you're a partner listening - walk away empowered and just, you know, have more options and hope for managing their fertility regardless of their goals. So, thank you so much. Where can people find you and follow and support you?
[01:06:59] Jamie: So, it's very simple. My Instagram is sort of like my one stop shop right now. That's @followingmybody. There are links there to sort of my webpage and reaching out in terms of either short chart consults or sort of one-on-one work, which. I have to sort of figure out as I transition to my maternity leave, but you know, I am still taking clients for April, May, probably June, because that's who I am. But yeah, you can find and connect with me there. I will be sort of sharing my postpartum journey. Right now I'm sharing flashbacks to previous cycles that I've shared. So, you can come familiarize yourself with mucus and normalize it. And I have a big love for anthropology. And so, I talk a lot about menstrual taboos and sort of the cultural analysis of reproduction over there. So, we didn't even get to touch on all of that stuff that I've got floating around in my head. So, people can find me there and kind of follow along.
[01:08:04] Loren: Oh my goodness. Thank you so much. Yes. I love following you on Instagram. It's so fun and educational. Like I mentioned earlier.
[01:08:11] Jamie: It's just like Instagram is just sort of my stream of consciousness and people are just there for the ride. And I so appreciate it.
[01:08:21] Loren: I appreciate you. Well, I do have one more question. I was just kidding that that was my last question. But I love to leave everyone with one piece of advice that they can take action on. So if you could choose one thing that our listeners could take action on, implement today, what would that be?
[01:08:44] Jamie: Start to cultivate a body literacy practice for yourself, even if it has nothing to do with fertility awareness right now, because that seems intimidating or overwhelming. Start to get to know what your body needs or what your body is asking for. It becomes a little simpler when you are sort of cycling naturally, because you'll see these rises and falls. But I think all of us could just do with cultivating a relationship with our body that helps to break down some of the shame and stigma that we just sort of bear on our shoulders all the time. And for me, fertility awareness is a big part of that practice, menstrual cycle awareness, and sort of normalizing these functions for me, for my daughter, for future generations, but just start to get to know your body so you can fall in love with your body.
[01:09:36] Loren: That's so beautiful. I love it. All right. Thank you so much, Jamie. We'll talk soon.
[01:09:39] Jamie: Thank you.
[01:09:42] Loren: Take care.