"Reading the Signs of your Body" full transcript
TAMMY RUBIN: Nobody talks to girls about their cervical fluid. It's like denying semen exists. It’s like, it's denying that you sneeze and blow your nose.
TAMMY: So, your cervix? Do you know what your cervix is?
ALLISON BEHRINGER: ehh kinda.
TAMMY: I’m skipping the anatomy lesson, I’m going right to charting..
ALLISON: This is me about 4 years ago, taking a lesson with a woman named Tammy Rubin. She’s a certified Fertility Awareness and Reproductive Health Educator.
TAMMY: I can't guarantee anything for you, I can just tell you the science and you know, what I have what I've learned and what I want to pass on
ALLISON: The events leading up to finding Tammy are chronicled in the first episode of Bodies, “Sex Hurts.” You can listen back if you want all the details. But to summarize: When I was 24, sex became painful. When I told my doctor, I was dismissed.
And it was having a really negative impact on my relationship with my then-boyfriend.
And then, through a friend, I learned that it could be the birth control pill that was causing the pain. I’d been on the pill since I was 18, and I’d never given it a second thought. But then I started looking into it more...and yes--painful sex, as well as low sex drive and trouble lubricating were ALL potential side effects of the pill.
So I went to an OBGYN specialist who confirmed that it was indeed the pill that was causing my issues. He told me to stop taking the pill, use a topical hormonal gel to help get my hormone levels back to normal and go to pelvic floor physical therapy.
I did all three things, and after about 6 months, the pain went away. And honestly, my sex drive was better than it had ever been.
And so after I got off the pill, I didn’t want to take hormonal birth control again. But I didn’t want to get pregnant, either. Condoms were fine contraceptives for the time being, but they didn't seem like a sustainable solution for the rest of my reproductive life.
I started researching and came across this thing called the fertility awareness method. At first, I was like, Soooo the rhythm method? That very unscientific way of guessing where you‘re at in your cycle? But as I learned during my sessions with Tammy, it’s NOT the same thing as the rhythm method.
TAMMY: Once you see that fluid, the fertile window is opening. And the change in cervical fluid marks the beginning of your fertile time.
ALLISON: Turns out, my body – and the body of anyone with a menstrual cycle – sends two major signals over the course of a cycle.
And if you can learn to read those signs, you can figure out on your own, when you’re fertile...and when you’re not fertile.
This truly blew my mind.
And so, for the final episode of season three... I want to devote this episode to the Fertility Awareness Method:how it works, how it can be used for contraception, why it’s vital information for people trying to get pregnant, and why it especially matters for people with polycystic ovarian syndrome or PCOS.
I’m Allison Behringer, and from KCRW, this is Bodies. And a heads up, this episode includes a discussion of infertility.
Before we dive in further, here’s a little primer on what practicing the Fertility Awareness Method looks like: in other words, what it means when you start “charting” your cycle.
OK -- so the two major signs:
Sign #1: Cervical fluid. I actually remember being a teenager and noticing a clear kinda slippery liquid in my underwear. Back then, I learned that it was just “discharge” and nothing to worry about. But it’s so much more than that!
It’s what helps the sperm travel up the vagina and through the cervix and into the fallopian tubes. And so if you’re noticing cervical fluid, it means that you’re approaching ovulation and that you’re entering the phase of your cycle when you can potentially get pregnant.
So to track this, you could do a couple things: you might notice it in your underwear. Before you go to the bathroom, you could insert a finger just a half inch into your vagina. Or you could take a folded piece of toilet paper and wipe yourself to see what’s there.
TAMMY: And notice what that feels like. Is it dry? And frictiony? Like, can you hear it? Or is it incredibly slippery? Like you're slipping on a banana peel? What is it like?
ALLISON: Cervical fluid or mucus, as some people call it, ranges from looking like creamy hand lotion to stretchy raw egg whites.
TAMMY: If it stretches, that is absolutely peak fertile fluid.
ALLISON: Ovulation lasts 24 hours – or 48 in the rare case two eggs are released. After ovulation ends, the cervical fluid goes away.
Sign #2: Your resting temperature, also known as basal body temperature.
TAMMY: You want to put the thermometer deep under your tongue, okay.
ALLISON: To measure this, you’ll want to use a digital thermometer and take your temperature first thing in the morning.
After you’re done ovulating, the egg disintegrates, and then your basal body temperature increases by about a half or a full degree and stays high until menstruation begins.
Each day, you record these two signs: your temperature and your cervical fluid on a chart (by the way, there’s also an optional third sign: checking the position of your cervix).
So it does take practice, but once you learn to read and interrupt these signs – this can arm you with the knowledge of which days you can actually get pregnant.
And so if you’re using the Fertility Awareness Method to avoid pregnancy, there’s a couple rules to follow to calculate your fertile window.
The rules err on the safe side, so this fertile window typically ends up being about 8 to 10 days, depending on your cycle.
And during that window, you either abstain from penetrative sex or use a barrier like a condom. And when used correctly, this method can up to be 98% effective.
To dive a little deeper into all this, I recently spoke with Lisa Hendrickson-Jack. She’s a holistic reproductive health practitioner and like Tammy, she’s also a certified fertility awareness educator.
LISA HENDRICKSON-JACK: Essentially, what I do is I help women and people who menstruate really understand their cycles and their body. So the method that I primarily teach is the sympto-thermal method. And so essentially, that just means that we're combining the mucus observations with the temperature.
ALLISON: This is the method I learned from Tammy. There are other methods, like just charting your cervical fluid or just charting temperature.
But the important thing is that Lisa and other fertility awareness educators draw a clear distinction between these methods and the calendar or rhythm method.
LISA: So basically, the rhythm method is, when you're not really relying primarily on your signs at all, you're not looking at your mucus or your temperature, but you're writing down essentially your previous cycle lengths, and then you're gauging when you're fertile based on those dates. So for most women and people who menstruate, it's not the most effective method, because most of us don't just are not robots, we don't just have the same cycle over and over again. So most of the modern fertility awareness based methods kind of incorporate more of those signs.
ALLISON: Gotcha. Gotcha. So it sounds like the sympto-thermal that's about like collecting real time data, and then using that to inform decisions versus the rhythm methods, the calendar methods, take previous data and use that to try to predict the future.
LISA: That's right.
ALLISON: I'm curious, in your practice, what are some myths that you see about the cycle?
LISA: I think the biggest one, is that you can get pregnant every day of the cycle, that you're fertile all the time. So I mean, I was taught that when I was in junior high, and most of the people that I know also had that conversation. So from a scientific standpoint, this is something that has been studied, it's biology, there's about a six day window of fertility in the menstrual cycle.
Because outside of that window, the vagina is actually quite acidic, and the sperm don't survive very long. So cervical fluid is the right pH. So when you're in the fertile window, your vagina becomes a very hospitable environment to sperm. The cervical fluid also rapidly draws the sperm into the cervix, where it actually can hold them there for up to five days.
ALLISON: Gotcha, so they can kind of hang out until the egg is ready. They're just like, hanging on the side.
LISA: Yes, it's like a cervix hotel, home away from home. So with that in mind, then if you have sex up to five days before ovulation day, that means the cervical fluid can keep the sperm alive. So you can have sex on Monday, ovulate on Friday, and have the conception happen on Friday because of the sex you had on Monday. And in the studies, there's not conception noted outside of this window.
ALLISON: So can you just go through the main use cases for doing this for charting for understanding your fertility.
LISA: I think there's a couple of categories of people who use the method. You know, first and foremost, I think a lot of people find fertility awareness when they're trying to conceive. Because we're taught that you can get pregnant every day of the cycle, you know, many of us when we're ready to get pregnant, we just come off the pill and, you know, have a go and literally expect that we're going to be pregnant instantly, because that's what we're told. And at some point, many, you know, who are trying to conceive, discover that it's not just so simple.
LISA: But then there are also some who you know, anybody who's taken contraceptives like combined hormonal contraceptives, like the pill, the patch, the ring, etc. who can't use it, whose body does not respond well to it. So there are people who go on these hormones, and they have a bad reaction.
And usually what happens is, they, you know, they're given another one and try this brand, try this other type, and whatever. So I get a lot of people in my programs who are just at their wit's end, you know, they're just like, I really just didn't think there were any other options. So there's kind of like the interesting, practical, but then there's like the desperation of like, I need an alternative.
I often get the question of, you know, do you think fertility awareness is appropriate for teenagers? And I say, Well, yeah, because it like, it doesn't mean that they're having sex, necessarily, like you can chart your cycles and learn about your body. And it's not that I'm saying that it should be their birth control method. But I think that, you know, every woman and person who menstruates should have the opportunity to learn how their cycle works.
And one of the reasons I think it's really helpful for teenagers is because when you can identify ovulation, the second half of the cycle is the most stable. So if you can pay attention to when you have cervical fluid, and when it stops, you can actually predict your period. And I don't know, any 15 year old, who wouldn't want to be able to, to know. So it's never a surprise when the period is coming.
And then there's the health piece. It's really really helpful to know what's normal, what comes out of the vagina on a regular basis, so that you can be able to distinguish between an infection and regular healthy cervical fluid. So a lot of my work is, is really around the menstrual cycle is a vital sign.
There's nothing like your menstrual cycle to show you if something's out of alignment.
ALLISON: For years, something was out of alignment for a woman named Nika Wedge. Ever since she was a teenager, she’s dealt with all kinds of health issues. When she was 16, she was hospitalized for a burst cyst on her ovaries. She had unpredictable periods and long cycles. And she always felt tired.
NIKA WEDGE: At that point, I was just being considered lazy, even though I did field hockey, cheerleading, and I was told I was lazy.
As she got older, the problems persisted. when she was 24, she gained 60 pounds in a year and couldn't figure out why
NIKA: It's kind of crazy thinking back now all the instances that I was like someone please help me. I'm in chronic pain. I'm constantly tired. It’s like, what is wrong with me?
ALLISON: When she was in her late twenties, she got married and was really excited to have a kid.
But after trying for over a year, Nika still wasn’t pregnant.
NIKA: In my head, I'm like, Okay, it's not him. He has two children. So it's me and it sucks. It's not a good feeling.
ALLISON: She went to her OBGYN. The doctor did some bloodwork, which showed that she had high levels of androgen hormones, as well as an ultrasound, which showed many cysts on her ovaries. These two things, combined with her history of infertility led the doctor to diagnosing her with PCOS, -- polycystic ovarian syndrome. It’s a hormonal disorder and it’s estimated that about 10% of people with ovaries have PCOS.
The diagnosis explained so many of Nika’s symptoms over the course of her life.
Nika says though, that her doctor didn’t seem too concerned about the PCOS.
But she gave Nika some advice for getting pregnant: lose weight.
NIKA: I was like, Oh, crap, I need to lose weight. Which, hello? You know, I'm 30 years old, struggled with weight my whole life.
ALLISON: Nika tried the keto diet, she tried working out with a fitness instructor 4 times a week. Even though she was losing some weight, she still wasn’t getting pregnant. Something still seemed off to Nika. And so she started doing some research, trying to learn everything she could about PCOS.
And that’s how she found Caitlin Johnson, a registered dietician who specializes in PCOS and helping people get pregnant. Here’s Caitlin
CAITLIN JOHNSON: With PCOS, particularly, food first is really the way to go. Because your diet and lifestyle incredibly impacts, kind of the hormonal cascade that happens. So we think based on the research that over 80, maybe closer to 90% of people with PCOS have insulin resistance.
And the unfortunate kind of cascade of hormones that happens in a PCOS person is that extra insulin makes the ovary produce extra testosterone and that testosterone kind of tips the scale in different symptoms, acne showing up, hair falling out, stopping ovulation and impacting cycles. So if we can approach your food and impact your insulin resistance, we can lower some of these symptoms.
ALLISON: They started working together. Caitlin helped Nika make small changes to how she was eating. She also taught her about charting– how to keep track of her cervical fluid and temperatures, in order to figure out when she was fertile and to get pregnant. Here’s Nika again:
NIKA: And just learning that with PCOS, you don't necessarily ovulate two weeks after you have your period. You don't necessarily ovulate every month,
ALLISON: After about a year of working with Caitlin, Nika got a positive pregnancy test.
NIKA: I honestly almost fainted because there was two lines. I kind of was in denial at that point, because for so long, you're just defeated.
The doctor did some bloodwork and it showed that her levels of the hormone known as HCG were rising—another positive sign that she was pregnant.
And then she went in for an ultrasound. When she got home, she got a call from her doctor.
NIKA: And she calls me and says Nika, I'm so sorry. I know you've been trying for so long. But there's the gestational sac, but there's no yolk sac. And there's no heartbeat. And she said, You know, I said okay, I said, So are we sure? She said yes, we see this all the time. I said, and at that point, I still didn't really understand it. I'm like, so basically I miscarried. And she's like, well, we can call in a prescription for you, which will help pass everything.
I was devastated. Even still now talking about it. I'm like, I can't even believe that happens. And so I had gotten off the phone with her because I was crying. I couldn't even, I couldn't even talk anymore.
ALLISON: Right away, Nika reached out to her dietician, Caitlin.
CAITLIN: And she called me and I said do not take that medicine. Send me your charts right now. Let's figure out when you ovulated, there's no concern. And taking a breath here and not having to make a quick decision.
ALLISON: Caitlin told Nika that she might not actually be as far along in her pregnancy as the doctors were assuming. That it might just be too early to detect a heartbeat.
CAITLIN: So when you go into the doctor with the positive pregnancy test, and they're confirming that and then they started for treatment, what's the question they asked you? What was the first day of your last menstrual period? They calculate everything based on that. But a woman with PCOS often has really long and irregular cycles.
ALLISON: Nika told her doctor that she wanted to wait. She wanted to make sure that the pregnancy wasn’t viable before she took the pills that would essentially expel whatever was in her uterus. Two weeks later, she went in for another ultrasound. Her friend came with her. Nika wasn’t optimistic
NIKA: I'm planning Okay, let's have like the biggest glass of wine after because I'm not pregnant, my doctor said I'm not pregnant. And so I had all these plans to just go down there, do what I had to do, and come home and kind of grieve.
ALLISON: Her friend sat by her side while the ultrasound technician got the equipment ready.
NIKA: And you know, she stuck the wand in there. And within like, one second, she's like, there's your baby. And there's, there's the heartbeat. I was in complete shock. And was like, Are you kidding me? And she's like, No, there's your baby. And there's a healthy heartbeat.
I expected to not have a baby I expected just nothing. Because that's what I was told. So, you know, when she congratulated me and I, I have the picture, you know, the ultrasound picture of he looks like a little, a little tadpole.
About 8 months later--just a few weeks ago-- Nika gave birth to a healthy baby boy
NIKA: And I just, until I had him in my arms and, he was healthy. Like, I just even – still in the back of my mind, I didn't believe that he would be healthy. I didn't believe that he would make it out.
Nika’s story is just one extreme example of the potential risks of the one size fits all approach to the cycle. And of the power that can come from being familiar with your fertile signs.
After the break, the good and the bad of the fertility apps. And we talk to an OBGYN about why this knowledge isn’t more mainstream.
ALLISON: We’re back. I’m speaking again with Lisa Hendrickson Jack, the certified fertility awareness instructor. I told her about my experience trying to chart my fertile signs.
So personally, when I came across fertility awareness and started charting, but I have to say in the beginning, it was really tricky. I'm just wondering if you have any advice for people who are just starting out fertility awareness, and might be getting frustrated, or discouraged or confused, just kind of trying to get the hang of it and learn it?
LISA: So I think my best advice, in general, is that if you choose to learn on your own, so if you choose to self teach, you have to approach it with patience. So you want to give yourself a minimum of three to six full cycles. And I said cycles not months. Especially if you’ve just come off of contraceptives, it can take a while before everything normalizes and often that looks like longer cycles, irregular cycles, things like that.
And I honestly, you know, I really do believe that if you are wanting to use fertility awareness, for birth control, and you're serious about it, that you should seriously consider at least having a few sessions with a certified instructor.
I like the analogy of learning to drive. So I drive a standard car, you know, the one the stick shift. So I could read about it all day. But I'm not really going to learn until I get in the car. Yeah. And then as soon as you get in the car, I have all these questions because stuff comes up that isn't in the book. So if that's you, then you want to consider at least getting a couple of sessions with somebody just to help you get on the right foot.
Especially if you start to feel confused, because then what happens is like, if you're confused, then you can, you know, inadvertently get pregnant. And then that really kind of taints your idea of the method itself, when really what you needed was some support to really understand how to do it.
ALLISON: So what I've – what I found is that discussions of fertility, awareness, charting, sympto-thermal methods. There's not a lot of talk in the mainstream medical community that OBGYNs know, if you go in and ask for alternatives. So what's your perspective? Like, why is it that you think that this very scientifically backed fertility awareness methods aren't more adopted by mainstream medicine?
LISA: Because they're not taught in medical school.
ALLISON: Mm hmm. How is that? What?
LISA: I feel like, I don't know. I feel like the answer’s so straightforward. But yep, legitimately, they're not taught in medical school.
- RASHMI KUDESIA: But I would agree that I don't think that that's necessarily part and parcel of OBGYN residency training, personally, I would say I became much more familiar with all of that in my training as a infertility specialist.
ALLISON: This is Dr. Rashmi Kudesia. She’s a board-certified OBGYN and reproductive endocrinologist in Houston, Texas.
- KUDESIA: I think the fact that that training really only comes after four years of medical school, four years of residency and into a three year fellowship is really silly. Because it's the most basic foundational knowledge out there, right?
And so treating the menstrual cycle is what the American College of OBGYN says is the fifth vital sign. So you know, right after your blood pressure, your heart rate, your temperature and your respiratory rate, the menstrual cycle is trying to tell you something about your body.
Dr. Kudesia points out that hormonal birth control shuts this sign down. So even though not everyone on hormonal birth control experiences side effects like depression, low libido, difficulty orgasming, it does have a hormonal impact. Your cervical fluid and other elements of your cycle are being effectively 'turned off'".
- KUDESIA: So really being able to listen to that signal and understanding what it's telling us. And when something is off, I think it’s really important and really needs to be instilled in young folks. Because otherwise, you know, people go through their teens and 20s, before they realize something is wrong. And you know, that really does folks a disservice.
ALLISON: I'm curious why, in your opinion, you think that fertility awareness hasn't really yet been adopted by more OBGYNs and mainstream medicine?
- KUDESIA: I think OBGYNs in this country are really unfairly maligned in the sense that there's so much risk of lawsuits. And so I think what happens is that people are concerned that if it's not used properly, that if it doesn't work that they would be blamed for, you know, undesired pregnancies.
And I think that's the biggest thing, honestly, holding folks back is that it takes a lot of time and practice to be able to, and it usually takes months to learn your cycle, before it can reliably be used for contraception. And so I think if folks aren't adequately trained and comfortable to provide that training to their patients, they're not going to bring it up unless asked.
ALLISON: And it’s true... taking a pill every day is a much smaller time investment than properly learning the fertility awareness method.
If used perfectly every cycle, the Fertility Awareness Method has a failure rate of approximately 2% per year. That’s the same rate as a condom. But of course the efficacy rests on the shoulders of the person interpreting their signs. So in actual use, failure rates may be higher, depending on how strictly you follow the rules.
There are a lot of fertility apps that can help a person track their cycle ... but from what I’ve noticed, a lot of these apps are just fancy versions of the rhythm method: it looks at when you had your last period to try to predict future fertile windows, rather than actually keeping track of the real time data of cervical fluid and temperature. I asked Lisa for her take on the apps.
LISA: I think one of the great things about apps is that it has brought so many people into the knowledge of their cycles in one way or another. I think the the challenge or the caution that I would, that I would put out there is that, for someone who has no history or background or knowledge about fertility, awareness, cycle charting, I wouldn't use an app to predict your ovulation and to tell you when you should have sex and you shouldn't.
And the reason is kind of tongue in cheek. So what I always say is like, the app doesn't know what's in your underwear. So you should check.
In my opinion, the best application of the predictor kind of apps, is when you yourself, have taken the time to understand your cycles, And then the app is kind of like a fun addition to that. So that would be my only caution, because people get pregnant unintentionally, when they, you know, follow the app without the knowledge, first of what's happening in their body.
If charting is something that you're wanting to do and that you're more serious about it, I would start just shut off that predictor setting even just for that first three to six months. So for people who menstruate who are serious about charting and who are kind of really wanting to learn, the predictor setting causes them to question their own observations. So you literally went to the bathroom five minutes ago, you saw mucus in there, but the app is telling you that it's not a fertile day. And you're sitting there saying, uh uh, so shut it off. Trust your observations, trust your own body.
ALLISON: In many ways, talking about Fertility Awareness brings up so much of what is wrong with our healthcare system and so much of what we talk about on this show: medical paternalism, using pharmaceuticals as a fix-all, inadequate sexual health education, and being conditioned to think our bodies are something to be ashamed of.
But it’s also an example of what happens when people come together to share information about their bodies.
This isn’t to say, of course, that the Fertility Awareness Method is the right contraceptive choice for everyone. It takes time to learn, especially if you have an irregular cycle or PCOS. So you should always talk to your healthcare provider.
But even if you have no interest in using it to avoid pregnancy or in getting pregnant, it can still be a window into your health. At the end of the day, it’s simply awareness, it’s knowledge.
Our culture encourages us not to look too closely at our bodies. But by tuning in, by paying attention, by literally feeling the signs that our bodies are sending us, we resist the expectation that we be strangers to ourselves and we gain the power to be advocates, for ourselves and one another.
Much of the research for the episode was based on a book called Taking Charge of Your Fertility by Toni Weschler -- it’s a great resource if you want to learn more. If you want to read more from Lisa, you can check out her book, The Fifth Vital Sign.
And if you’re looking for an app that won’t make predictions for you, many of the people I spoke to recommended one called Read Your Body as well as Kindara, which allows you to turn off the predictor.
I wanna invite you to join the Bodies Facebook Group. Nothing is off the table, and everyone is welcome. It’s a place where you can share your reactions to episodes, post articles, ask for doctor recommendations, or just find support for a health challenge you’re going through.
For a link to the Bodies podcast facebook group, as well as episode transcripts, and additional resources on fertility awareness and PCOS, go to KCRW.com/Bodies.
You can follow Bodies on Twitter and instagram at @bodiespodcast. Or you can email me: allison@bodiespodcast.com. And you like Bodies, please consider writing us a review on Apple Podcasts — it helps other people find the show.
This is the last episode of season three, so I just wanted to take the chance to say thank you to the incredible team that makes Bodies. And personally, to the people in my life who have nourished my body and spirit over the course of production.
And on behalf of the whole team, thank you to everyone that participated in this season — for putting yourself out there and sharing your story.
And thank you, listener, for bearing witness to these stories.
I don’t know exactly what’s next for Bodies, but we would love to hear your thoughts, so please keep in touch.
This episode was reported and produced by me, Allison Behringer, with reporting by Kalaisha Totty. Story editing by Mira Burt-Wintonick with editorial advising by Cassius Adair.
Nisha Venkat is with us as KCRW’s USC Luminary fellow. Our team also includes producer Hannah Harris Green and managing producer Rebecca Mooney.
Original score by Dara Hirsch. Mixing by Teeny Lieberson.
Special thanks to KalaLea, Sharon Mashihi, Camila Kerwin and Kristen Lepore.
Episode art by Neka King. Cover art by Sarah Bachman.
Bodies is supported and distributed by KCRW. Thank you to the whole KCRW staff, especially Chris Ho, Adria Kloke, Mia Fernandez, Kerin Smith, Krissy Barker, Liv Surnow, Melanie Makaiwi, Katie Gilcrest, John Meek, Andrea Bautista, Connie Alvarez, Anyel Fields and Jennifer Ferro.
Thanks for listening.