• Nathan Riley, MD

Obgyno Wino Podcast Episode 21 - Fertility Awareness Methods - Interview w/ Lisa Hendrickson-Jack

"It's a special state that interns get into. Not depressed from the usual causes - reversals, self-insights, ill health - and not tired so much as depleted, a well run dry. The well was life force, ebullience, Whitman's 'Sun-rise would kill me / If I could not now and always send sun-rise out of me.' It was the state of being no longer able to send sunrise out of you. And the intern is facing a dark night - a fearful nothingness that he or she has never seen before, that society hides away in tall fluorescent-lit boxes. And that he or she has to get through, because there is no other way to be a doctor except to get a medical license, and there is no other way to get a license except to get through...I liked medicine more than I thought I would - what I got to do, be, and see when I was with my patients. There was deciding what was most urgent and then strategizing the most efficient way to get the diagnosis. There was the camaraderie, the sense of being in this together, not as the health-care team beloved of marketing, but as a group of people with a common goal. There were the patients, and the level to which I had to risk, professionally, morally, and ethicaly, in order to do a good job." - excerpt from 'Slow Medicine', a book by Victoria Sweet, MD


I had the privilege of interviewing Lisa Hendrickson-Jack for episode 21. She's an expert in fertility awareness methods and authored The Fifth Vital Sign. She also hosts a podcast called Fertility Friday. Check her out!

Five Pearls

1. Women are often undereducated in the physiology of menstruation and fertility - this is bullsh$t, though easily fixed

2. Cervical mucus is not only a consequence of hormonal fluctuations that take place throughout the menstrual cycle but an critical component to harboring sperm in their safe passage from the vagina to the uterus.

3. Timing intercourse based on expected menstruation in an effort to conceive is problematic for a variety of reasons, namely that even the most "regular" woman's will fluctuate cycle-by-cycle

4. Abnormal menses (duration, frequency, volume) is often reflective of some other underlying endocrine or otherwise health disorder

5. Physicians' practices can benefit immensely from opening their minds and hearts to the work of other health care professionals who may know a thing or two about women's health that wasn't taught in medical school or OB/GYN residency

The menstrual cycle

- As you will recall, the menstrual cycle is comprised of two phases: pre-ovulatory and post-ovulatory

- Pre-ovulatory phase: in the ovaries, follicles are growing; in the uterus, the lining is thickening, estrogen rising, progesterone low

- Ovulation: rising estrogen triggers a surge of luteinizing hormone (LH), which triggers ovulation

- Post-ovulatory phase: in the ovaries, the corpus luteum continues to produce progesterone until conception happens; in the uterus, the endometrium is prepared for implantation of an embryo if conception occurs

- Menses: if conception doesn't occur, the corpus luteum says adios resulting in a drop in progesterone, which triggers the sloughing of the endometrial lining

- a normal menstrual cycle ranges from 21-35 days (depending on which data set you use), though most education and defaults in women health (even due date calculators) assume a 28-day "regular" cycle

From Pg 49 of 'The Fifth Vital Sign'

- due to the varying proportions of hormone levels through the cycle, changes take place to the ovaries and uterine lining (as mentioned above); these hormones also cause changes in cervical mucus consistency, cervical positioning (cervix drops and the external os will peek open ever so slightly), and basal body temperature

Diving deeper on cervical mucus

- cervical mucus is the gatekeeper to the uterus, as far as sperm are concerned

- throughout the cycle, the consistency and volume of mucus changes depending on the relative amounts of estrogen and progesterone

From Pg 37 of 'The Fifth Vital Sign'

- for roughly 5 days prior to ovulation, estrogenic mucus predominates

- this "E-type" mucus has a smooth, lubricative sensation on the fingertips

- when this mucus is present, the sperm can live within it for up to 5 days, meaning intercourse

- in addition to sustaining sperm, E-type mucus also provides swimmable channels from the sperm to pass from the generally inhospitable vagina to the intrauterine cavity where they can continue on seek out an ovum for conception

- when E-type mucus isn't present, fertility isn't possible! Put another way, timing intercourse or artificial insemination on days in which E-type mucus is present is necessary for conception (regardless of the day of your cycle based on your advanced mathematics)

From Pg 63 of 'The Fifth Vital Sign'

Basal body temperature (BBT)

- 24-36 hr prior to ovulation, there will be a discernible increase in basal body temperature; the amount that increases is highly variable and individual

- most women that try to track their BBT complain of wild fluctuations

- alcohol consumption, poor sleep hygiene, stress, allergies, and medication can alter your basal body temperature

- Lisa recommends keeping the thermometer in your mouth for at least 10 minutes prior to recording temperature as this will allow the thermometer (yeah don't believe this will make a difference. Try it. You'll see...)

We cover a lot more in the episode, and Lisa's book covers it all. Seek her out: Lisa's website, book, podcast, Instagram, and Twitter.

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