Today we talk about when you see lightning, you always get to hear thunder. But when you see a menstrual cycle, you always know you ovulated. I'm, Doctor Mark Amos and this is taco. About fertility Tuesday. Butter and jelly, lightning and thunder, pizza and pineapple. These are things that should always come together. Well, I guess not pizza and pineapple, but the other for sure. But what about amenses and ovulation? It's basically assumed when you have a menstrual cycle
that you ovulated. And it's a pretty fair assumption. But the thing is, it's not always true. There are some people out there who will bleed, which feels like amenses, but in reality is a withdrawal bleed and they didn't ovulate. And as you can imagine, if you don't ovulate, you can't get pregnant. So in today's episode of, talk about fertility Tuesday, we're going to talk about how do you know if you're ovulating? Can you know? And if you suspect you're not,
how can you find this out? So to understand this, you have to understand what a menstrual cycle is. The purpose of a menstrual cycle are two phases. The first phase is to develop an egg. The second phase is to support the potential pregnancy. We break these phases into follicular phase and the luteal phase. The first half is the follicular phase. This begins when you get your period
until the point of ovulation. The luteal phase is the point after ovulation until you either get your period or if you end up getting pregnant during the follicular phase. The first phase, your body releases FSH from the brain to make the ovaries cause a follicle to grow until the point it ovulates. Now during this time, the estrogen from the follicle is causing the lining of uterus to get thicker and thicker and thicker. So eventually it will be good enough to implant
into. But before the embryo can implant into the uterus, the lining needs undergo luteinization. And that occurs in the luteal phase. And after you ovulate, the sac that released the egg now becomes a production factory for the hormone progesterone. And we call this a corpus luteum. This then secretes progesterone, which prepares the uterine lining for a potential pregnancy. Now this corpus luteum has a kind of time clock to it. It lasts for about twelve to 14 days and then it collapses.
And at that point the progesterone level then drops completely. So if you don't get pregnant, the corpus lilium will collapse, the progesterone level will drop and then you will get a period. What causes the period to come is the shedding of the lining from the loss of progesterone. So you have to first have progesterone, then remove progesterone to be able to get the lining to shed itself. And the purpose of shedding is to prepare them for the next month for potential
pregnancy. If you are fortunate enough to become pregnant, then what will happen is when the embryo implants into the uterine lining, the syncidiotrophoblastic cells will then start releasing hcg, human chorionic gonadotropin. This signals to the corpus luteum to keep making progesterone. That's because progesterone is usually created through lh luteinizing hormone, but hcg will mimic that hormone and so it rescues the corpus luteum. So instead of it, collapsing in those twelve to 14
days, it continues. And that's why we associate when someone, let's say, is pregnant and gets bleeding, we associate with something wrong with the pregnancy, because if something happens to the baby, the ecg level will drop. And if the ecg level drops, then that can cause the progesterone levels to drop. Now, an interesting
caveat. If you are doing a frozen embryo transfer and you are giving injectable progesterone, even if there is bleeding, it's probably not from the pregnancy, meaning the baby, because you're giving the progesterone, they can't drop. Only in a natural pregnancy or with a pregnancy through ovulation can the pregnancy mean the baby acg levels drop to cause bleeding, because then the acg levels drop, the progesterone level drop, and that
causes bleeding. So the important thing to understand here is that the follicular phase is to develop the follicle, which also develops the thickness of the lining. The luteal phase is to get the lining prepared for implantation. And only when the uterine lining is given progesterone for a period of time and then remove does someone withdraw the blood from the uterus, causing them, period. And that causes immenses. now, it doesn't have to be natural. You can give
someone progesterone. So if I give you proverae or prometrium or injectable progesterone for about seven to ten days, and then I remove that hormone, you will also get amenses. This is very similar to even how birth controls work. So, birth controls give you both estrogen and progesterone, and you take it for, let's say, 21 days. Then you stop it. Taking sugar pills, the progesterone levels drop, you have another menses. But, this menses is not the same menses as
ovulation. We call this a hormonal withdrawal bleed. Basically, this is just distinguishing it from a hormonal withdrawal bleed, from ovulation. By ovulating, you make progesterone, and then it disappears. In a situation with medication, you are taking the progesterone because you're not making it. And then the withdrawal of that progesterone when you stop it is what causes the uterine lining to shed, causing the
menses. So, now that we defined how a menstrual cycle works and what causes a woman to get a menses, the question is then, how can you bleed and not be ovulating? And so this could be other causes of bleeding. What could happen is when the lining of the uterus builds up and gets thicker and thicker and thicker, it can eventually bleed. Think of it as it can't support its own weight, so the lining is building up on top of itself, and eventually it's too much, and it comes out.
But there can also be times when, even monthly, you're getting a period. And that's because there's hormonal fluctuations that are occurring. And even though you're not, ovulating, those hormonal fluctuations can be causing a the bleeding to be occurring even though it's not due to progesterone. Now, the name category we call this is anovulation, meaning you're not ovulating. This is the most common cause for someone to think they're getting
their period every month, but they're not. So this is where either you have significant things like polycystic ovarian syndromes or hormonal imbalances or something that causes your body to not release an egg anymore, but because that lining is thickening up over the month, because you're still making estrogen in the follicular phase. But you never go in the luteal phase. Eventually, you just get shedding of the lining, and
you get a period. Now, most of the time, this comes in very odd times, meaning it's not every single month. You might go a couple months without a period. Then you might get a period. Might be 45 days and 35 days. And usually that's how you can figure those ones out. But the thing is, no one really is checking their menstrual cycle that well, most women go, okay, well, I got a period in July. I, got a period in August. They don't think twice about it, but they really
looked at, they would notice it's changing all the time. The second situation is where it feels like it's perfectly on time, but then when you check it, it's still fluctuating. Now, the thing that's really interesting is the period is very accurate. Most women can tell you the day they're going to get their menses. The first time I heard this, I couldn't believe it. They could literally tell me the day they're going to get it. That is what we would consider usually normal. Now, it doesn't mean
there's not some flexibility here. And someone can be two days late or one day late, but if you are five days or, more fluctuating between your cycle day, there could be an issue there. Now, where a lot of women get a little confused is they think when they're on the birth control pillow, that that's a menses that is not. So, a lot of times I'll talk to people, say, well, it says here your menses were every month. They're like, yeah, it's been
perfect. But I say to them, but haven't you been on birth control? And they're like, oh, yeah, I've been on birth control. That is not a menses. That's just a withdrawal bleed from a hormonal removal of progesterone. The same thing. If you're taking progesterone, such as provera or prometrium every month, that does not mean you're ovulating. You're just giving yourself the hormone that caused the withdrawal bleed. So then how do you determine
if you need to get this worked up? Well, in general, this really matters for people when they're trying to get pregnant. So if you're trying to get pregnant and your cycles are not regular, you want to see a fertility doctor or OBGYN within the first six months. But if your periods are every month and you start charting them and start noticing they're not as accurate as you thought, potentially you may be one of those people
who may not be ovulating. Now, the way you can test for this are a couple ways you can do what are called ovulation predictor kits. And these do check the hormone LH. Now, LH can be elevated in people with polycystic ovarian syndrome. And so when you do these kits, it's very important that you look that it's negative, negative, negative, and then becomes positive and stays positive for a day or two and goes down. That seems to be more accurate than if you just see
it composite. The first time you do it, you don't know was it always elevated or did it go up? But the other thing is, whenever it says you did ovulate, you should be getting a period in approximately two weeks. If you check the test and says you ovulated, but you don't get a period for three weeks, then you know that wasn't really ovulation. Because ovulation always occurs in that twelve to 14 days, meaning you get your period twelve to 14 days after the ovulation.
And so if that doesn't happen, you're either pregnant or that was an ovulation. One of the most accurate ways is to check a progesterone level on the 21st day of your cycle. Now, this assumes you have a 28 day cycle. If you have a 35 day cycle, then you want to check on day 28, basically midway between that two week timeframe, from when you ovulate to when you get your menses. As long as that progesterone is above four, you are ovulating.
Now, you'll hear people out there talk about progesterone levels should be above ten. That is not true. That is something completely different. You just want to make sure that it's above four to at least verify you're ovulating. There are also some great apps out there that use your hormones, such as urine hormones, check body temperature and try to determine this as well. And they're pretty accurate as well.
But in the end, the only thing that is absolutely going to be accurate is checking a progesterone level to verify if you ovulate it. So, in summary, if you get perfect 28 day cycles and your ovulation is exactly twelve to 14 days from when you get your menses, then you probably don't have an issue. But if your periods are irregular or I. If, like I said, your period is coming longer than those twelve to 14 days, or if you've ever been diagnosed with
polycystic ovarian syndrome, this could be an issue. And even though you think you may be getting your menses, you may not be and should be seen for this. So unlike peanut butter and jelly sandwiches and thunder and lightning, sometimes your menses acts like pizza and pineapple and doesn't always come together. What surprises me more is that sometimes patients realize this and yet they are told to just lose weight or to keep trying. And I think the most important thing to know here is don't do
that. If you suspect this is going on, find out. Don't waste any more time and get to a doctor so that way you can get this treated. Sometimes as simple as taking a medication can get you to ovulate again. Hopefully this episode was helpful to someone, or maybe someone you know that you can tell them about. As always, if you liked the episode, please tell your friends about it and tell the communities that you're in about it. And if you also love us, give us a five star review
on your favorite medium. As always, I greatly appreciate everyone who listens to this, and I love doing this weekly. I look forward to getting talking to you again next week on talk about fertility Tuesday.