Mid-cycle bleeding that follows a pattern

Jan 21, 2008 12:07

I've been charting for a year now, and noticed that my cycles form rather an odd pattern. I get lots of eggwhite, often all the way through my cycle, which I've been told here is normal with a copper IUD. I also get mid-cycle spotting (though today, CD15 which is far too early for a period, it was more like light bleeding - it it had occurred a ( Read more... )

iud (intra-uterine devices)

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th3_unicorn January 21 2008, 14:25:53 UTC
I'm using LadyComp and I know about over 30 other women who do and not one of them is the least unhappy about it.

I'm guessing you got the info from the raxmedical.com site, unfortunately, as much as I've browsed that one too, my knowledge on the product is mostly based on the italian site, as I'm in Italy.

I have studied the sympto-thermal method for two months prior to purchasing the device, because I preferred to rely on something that was proven to function, as opposed to my unexperienced self.
It does rely on temperatures alone , but it shouldn't be mistaken for the rythm method. LadyComp in fact is able to learn your cycle and foresee what your bbt curve will be like. That's how it can detect anticipated ovulation, giving you red light before usual. It's highly reliable in this regard, and it also takes away human error in interpreting your chart.
It doesn't use the FAM rule, it's more precise than that. Unfortunately, only its programmers know exactly how its algorythm works. We just get to know it's 99.3% reliable for contraception purposes.

I keep my chart at fertilityfriend.com just because I like to cross-check.
I've been only using it for 2 months, so I can't really say whether it matches LC's predictions or not.

I asked the italian distributor why IUDs should be taken out before taking temps, and what I stated in my previous post is the answer they gave me.
I wasn't referring to the fever you get from infection caused by an IUD, but to the systemic inflammation it causes, although maybe it won't reflect on everyone's temperatures.

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elettaria January 21 2008, 15:06:18 UTC
Nope, I was using ladycomp.com, though thanks for the link, I'll have a look at that too.

IUDs do not cause systemic inflammation. The ladycomp.com site is full of misinformation about various contraceptive methods, and that alone is enough to make me highly suspicious. It's possible that the person you spoke to was thinking of the hormonal IUD, Mirena, which does indeed raise body temperatures as it works hormonally. Copper IUDs are not systemic in their action, do not affect hormones, and do not affect temperatures. They do affect cervical fluid, but that's because they're actually present in the cervix (the device sits in the uterus, with a string passing down through the cervix so that it can be removed when its time is up).

I've only ever heard that temperature is related to ovulation in one way: that it rises following ovulation. I've never heard that its fluctuations before ovulation can predict when ovulation will occur. As far as I know, temperature changes before ovulation are generally random. I'm curious to know why they think they can predict ovulation from temperatures. I'm particularly interested since it's meant to be impossible to use temperature alone for timing conception, as temperature can only tell you when you've already ovulated, at which point it's too late.

I can't find any links to clinical trials on either website, and I'm not impressed by any product which pushes testimonials instead. I'd also like to know why on earth it is so horrendously expensive. I'm also worried by this:

If your sleep habits are irregular, you can use the monitor effectively, as long as you take your temperature after you have slept for five hours, at least three of which, should be consecutive. It is beneficial, especially in the first three months of use, to take your temperature at a fairly regular time of day (within 3 hours of the usual time).

Temperature goes up over time, and it's very important to take it at the same time every day. According to TCOYF, temps go up by 0.1 degree every half hour, and from my experience that seems to be correct. Do they automatically adjust for temperatures taken early or late?

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th3_unicorn January 21 2008, 15:16:43 UTC
I think they do, it's not specified, but I've found controversial information about sleeping longer. Some say temperature goes up, some that it goes down.
I don't have much data about from my experience, but I don't think I've seen stable responses to it, and my waking times do vary a lot, in terms of slept hours and time of the day when I take my temp.

I have to say I've read excerpts from TCOYF from the official website, but many of the rules explained don't quite convince me.
I guess it works fine for FAM, but there are other details that make LC work differently. I do wish I knew every detail about it, but that's only for their mathematician team to know (and they're obviously not interested in divulging their recipe).

The trial you've read about might refer to the failure index for typical use, meaning cases where couples have unprotected intercourse on a red day. I've read the article from which the 0.7% index comes from, and that only includes "device's errors", although it doesn't rule out possible mistakes in usage (like temping with a fever or while taking meds or wrong placing of the sensor)

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elettaria January 21 2008, 16:13:09 UTC
As far as I know, the website for ovusoft doesn't explain the full method, let alone how it works. Which bits were you not sure about?

I wasn't aware that there was any controversy about the effects of time on temperatures, do you have links on that, or can you remember anything else? (Not trying to put your back against the wall and demand academic references in triplicate before I believe anything! Though they're pretty damn useful.) As far as I know, it's agreed that temperature is rising at that part of the day. I don't know how firm they are about the 0.1 deg per 30 minutes thing, I'd suspect that there might be a bit more variation with that, but that's why it's recommended to take your temperature at the same time on the dot. There are various other factors with this: what time you went to bed, how well you slept, what your sleep was like for the three hours before temping. I actually did a survey on this in this community a while back, not sure where it's been filed. I, for instance, find that I'm OK if I get up to go to the loo or answer the door before I temp, as long as it's more than 30 min beforehand, and it doesn't seem to matter if my sleep was broken (as it usually is due to sleep disorders), but other women find that this will affect their temperatures enormously. I've heard women say that they can vary their waking time without throwing off the temp, but again I'd want to see their chart before deciding, based on all those uneven charts I've seen on FF.

As far as I know, there is only one constant with temperatures, and that is the thermal shift at ovulation. Temperatures rise following ovulation, and the FAM rule is that they have to rise at least 0.2 degrees (although there is a type of rise called a slow-rise, where the first temp after ovulation may be less than that; women who get such rises have to allow an extra day before they are safe for sex again). That's it. The temperature rise is caused by increased levels of progesterone in the body. Progesterone raises temperatures, as incidentally do progestogens, which is why progestogen-only methods of contraception such as the hormonal IUD Mirena will raise your temperature (I charted through three months on the progestogen-only pill, and this is exactly what happened). When the temperatures go down again is more variable: some women's temps remain high during menstruation due to residual progesterone (mine do), others start falling just before menstruation begins. I have never heard that the temps during the follicular phase do anything special while gearing up for ovulation. I'm guessing that they must, since LC does have a pretty good efficacy rate (and yes, I know how to treat typical and perfect use stats: both are important, and I don't like any site that ignores one), but I'd like to see an explanation of exactly what they're reflecting. Micro-changes in hormonal levels? Since there's this business with the 14-day window of fertility, I suspect that the reason why the efficacy rate is so high is because they're leaving the widest possible margin for error. Confirming that ovulation has occurred is one half of the equation. The other half is knowing when fertility begins, which is done by observing CF in classical FAM. If you don't know when fertility begins, you can play safe by guessing the earliest possible date, say ten days before the earliest recorded ovulation. In other words, if my earliest ever ovulation date was CD12, they'd assume that fertility could begin at CD2. Ovulation, while usually falling within a shortish timescale, can occur at any time, and may be delayed by stress for example.

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th3_unicorn January 21 2008, 16:38:10 UTC
It's five days, in LC's case. I assume it does take the earlies ovulation, at the beginning and chooses that as the possibile start date of your fertile window. But I know, because the company says so, that it's able to predict your bbt chart in a way that enables it to detect variations in ovulation date (should it come earlier or later).

About the controversy on temperature and slept hours, I read that you need a certain amount of hours to bring your temperature down to basal level. I wouldn't know why it should raise sleeping longer, although I know that's what women find.

Like I said, I wish I too knew what LC is basing its predictions on, but that's not going to be open to public anytime soon.
It is partially true about it giving a wider fertile window, but only in the beginning. How many fertile days are there on average in a 28-day cycle, using FAM? Is it less than 8-10 ?

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elettaria January 21 2008, 17:54:01 UTC
I'm not sure what the average fertile window is with FAM, are we including the three days after ovulation for safety? I think it's generally around five days of fertility before ovulation, but that's one thing I can't tell from my own charts, as copper IUDs change the CF.

The sleep thing: two issues here. One is when you take your temperature, and that needs to be constant. The other is how much sleep you have beforehand. There's a bare minimum, usually set at five hours and preferably with the last three uninterrupted. Some women find that relatively minor changes in their bedtime outside those five hours count, others don't. It doesn't seem to make a difference for me, and my sleep's all over the shop, but I do have to be absolutely consistent with waking time. I started off with temping whenever I woke up, but the temps were too erratic, so I changed to setting my temperature for the earliest I'm likely to be getting up, the time my partner sets his alarm for, and they've been fine since then. Of course, I now have a tendency to wake up a bit before I'm due to temp dying for the loo, but if it's over half an hour beforehand I'm OK to get up briefly, and if it's less I just have to cross my legs. I suspect that for most people, by the time you've had five hours, your body has gone back to its usual rhythm for that time of night. Circadian rhythms are pretty stubborn things. I keep meaning to take my temperature once an hour all the day through to see what my daily pattern is, but never get around to it, and I haven't yet worked out how I'd stop it from being swayed by meals, activity and such. But I do know that it rises during the day, which is why a late temp will be higher than it should have been. It's also why the definition of fever is different depending on whether it's morning, afternoon or evening, as a temperature that's considered low-grade fever in the morning would be normal for the evening.

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th3_unicorn January 21 2008, 18:20:40 UTC
Following the LadyComp user manual, you only have to have 4-5 hours of sleep, that can be added up, as long as you have one whole hour of sleep before taking your temp. The device was designed to work for women that work night shifts and such, so I'm guessing it does adjust the temperature, but it doesn't show it.
The measuring time is 6 hours and calculated each day based either on the set alarm clock or on the time you measured the day before.

But it's famous for not being disrupted in its calculations by erratic sleep patterns or different amounts of sleep.

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elettaria January 21 2008, 19:28:41 UTC
Again, this is where it would be valuable to be experienced in FAM before trying this thing. That way you'd be able to spot whether your sleep pattern was buggering the thing up. No idea where that survey I posted about factors affecting temping was, but what it really impressed on me was that different women are sensitive to different factors. I'm also wondering about those women who do everything right and just can't get a workable chart.

I wonder if those erratic charts you see in the FF galleries are due to people not tempting strictly according to the rules? It always makes me shudder at the idea of how many women are risking pregnancy due to an inaccurate ovulation date. No idea how many women are using FF for contraception, of course, they're not meant to, but it's going to be a fair number.

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elettaria January 21 2008, 16:13:27 UTC
I am utterly puzzled by the way LC writes that cervical fluid is irrelevant. I'll explain further, as I didn't realise in my earlier post that you haven't read up fully on FAM. Here's what the LC site says:

The mucus method is not very reliable or very adaptable as there are 4 different types of mucus and in the case of many women the mucus only appears when it is too late for contraception, i.e. , after ovulation, and continues for an unnecessarily long time.

The four types of mucus are sticky, creamy, eggwhite and watery, in the order in which they appear. Some methods conflate eggwhite and watery as they are very similar, both are fertile, and not everyone gets watery. Sticky is definitely infertile. Creamy is usually infertile but shows that fertile is on the way; for women who don't get fertile CF [cervical fluid], for instance if they're breastfeeding, creamy may sometimes be considered potentially fertile (there are straightforward rules about this). CF appears in the run up to ovulation. After ovulation, fertile CF dries up and the woman returns to either dry or infertile CF. So it's incorrect that "the mucus only appears when it is too late for contraception, i.e. , after ovulation, and continues for an unnecessarily long time". The whole point is that it appears exactly when contraception is required! Fertile CF nourishes sperm, keeps it alive longer (ever heard varying stats on the lifespan of sperm? that's why) and enables it to swim up to the egg in time for conception. Infertile CF is hostile to sperm, shortens the sperm's lifespan, and blocks the cervix. Various methods of hormonal contraception work by keeping the cervical fluid permanently at the infertile state. Cervical fluid is extremely important, and not the unreliable mystery LC is making it sound. In addition, if women only use one method of charting (for example during a long period of probable infertility, such as when breastfeeding), it is recommended that they make that one sign their CF.

The thing that really annoys me about contraception is the amount of rivalry between methods. TCOYF slags off IUDs in a highly inaccurate way; LC slags off IUDs *and* FAM, and doesn't discuss the important factor of user error at all. Doctors advocating hormonal contraception rarely want to hear about non-hormonal methods - or the side-effects from hormonal methods; fans of barrier methods fail to mention the big problems with user error and low efficacy. This LC, if it's really using a valid method rather than just playing safe in a mathematical way, would be an excellent idea if it could include CF as well. Everything would be stored together, and there wouldn't be the risk of misremembering the temperature or forgetting to write it down, plus I gather it includes an alarm clock that presumably doesn't need to be manually reset every day. I'm guessing that it can automatically adjust temperatures taken at the wrong time, although it's best for the woman to train herself to take them at the same time if at all possible. Being able to keep the device by the bed would be very useful for checking whether it's a fertile day or not (I did a survey about the problems using FAM for contraception a while back, and that one turned out to be a biggie, to my surprise). The snag would be that you'd presumably still have to rely on examining the CF yourself, I haven't heard of any device you can stick into it to determine whether it's fertile or not.

There's the political issue as well. One of the things many women appreciate about FAM is that it puts contraception into your own hands by teaching you what is going on with your body. If you're fertile, it should be fairly obvious from your chart. If your chart is unclear, at least you know that it's unclear and to play safe until it's clear again. The idea of relying on some computer is like the idea of relying on FF's ovulation detector without being able to see my chart and interpret it myself.

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th3_unicorn January 21 2008, 16:48:32 UTC
I completed fertilityfriend's course in 20 lessons, so I'm very familiar with the information you posted.

Although I know the method, I still would find it troublesome for me to decide whether that day is fertile or not, simply judging by mucus observation.
I haven't figured out the answer to "what if I have intercourse and only a couple of hours later I find I have creamy mucus?" ok, it's not *quite* fertile as eggwhite, but as no one states that it's not fertile at all, it doesn't rule out well enough for me whether that is a red or green day. I do cross-check that information and chart it as well, but only for a better understanding of how my body functions.

I do strongly advocate learning the sympto-thermal method before taking on LC use. It's a very active and complete way to learn about fertility, because you can chart LC's information as well. The company also prints out your data on request, for you gyno to evaluate, in case of suspected hormonal issues.

Someone should come up with a biological error-proof method for judging the fertility of mucus everyday lol
Maybe measuring PH would help. Some women have difficulty conceiving because their fertile mucus is too acidic.

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elettaria January 22 2008, 20:32:06 UTC
Ooh, just found this on a UK site selling LadyComp:

Lady-Comp and Pearly also help prevent "estrogen dominance", a leading contributor to many illnesses, including a documented 66% increased risk of breast cancer.

Now that is dreadful. Taking your temperature every day does not prevent oestrogen dominance. Returning to your natural hormones is not the same as actively preventing a problem which may be caused by artificial hormones, and it's highly misleading to phrase it like that.

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elettaria January 22 2008, 21:16:28 UTC
By the way, I looked up LadyComp and reviews and found some interesting ones.

"The Lady Comp is little more than a thermometer"

Forum with many LC users - they're very pro LC, I suspect one woman of working for them. She incorrectly says that painkillers can't raise your temp (and discounting other factors that can indeed change your temp), so has evidently not been on codeine!

Article on LadyComp - fairly good so far, though another one that's poor when discussing rival methods of contraception (fishhook my arse).

I'm a bit alarmed by all these "when it's red, use a condom" people. Don't they know that the only time a condom failure counts is when you're fertile, so that you're taking a huge risk?

From a site on Bioself:

Your philosophy: Your fertility, which is active for only a few days of your monthly cycle, is yours to control! Don't give away this control to a doctor, an instrument or a drug! A better knowledge of your menstrual cycle fosters your health, sex life and wellbeing. Bioself is a powerful and reliable tool that can enable you to reach this goal.

No, give away the control to a computer instead.

I am getting a strong suspicion that people are cashing in on the growing popularity of FAM, which is fairly easy and dirt cheap, and trying to make money out of it by preying on women's fears of making mistakes and also fear of actually having to make an effort.

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recuntulous January 27 2008, 14:03:09 UTC
1. codeine raises your body temperature?! This might explain a lot about my soaring temps after the tonsillectomy and maybe I didn't have an infection as badly as I thought I did. (yes, that's quite off topic. i said it anyway.)

2. It seems like some women are using FAM or the LC as a way of knowing when they're safe to have sex without condoms without getting pregnant, as opposed to birth control in general, which would require the abstinance days. It worries me that people don't realize that using a condom on fertile days is only as effective as using just condoms, which is something that I see you pointing out on here a lot, and that's great. Is it in the FAQ or bio or anything? why doesn't TCOYF shout this out to everyone? Maybe it does? Maybe women are alright with the condom stats and want FAM so they can have condom-free sex sometimes and that's all? (Although TTC is a whole different story.)

3. "Don't give away this control to...an instrument..." Isn't the computer just another instrument?

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elettaria January 21 2008, 15:06:29 UTC
Aha, I've found the links to the trials. Hmm. The first one gives a failure rate of 3.8%, which is certainly not the figure they're throwing around the website. Firstly, I don't believe in excluding user error stats: if user error is part of the method, then it should be included. (There's pretty much no space for user error with IUDs, implants or injections, for instance.) In addition, women participating in clinical trials are likely to be more diligent about using the device, plus they've probably been screened so that women with various health conditions will have been excluded.

I'm not keen about the way it's slagging off FAM either:

These results cannot be compared with the results of prospective studies of original methods of natural family planning (NFP). Prospective studies (pES) of the symptothermal method of NFP showed a user effectiveness of 2.8 PI in Germany, and a method effectiveness of 0.3 with 758 women and 14 870 cycles [13]. We are sure that the motivation of a NFP user is different from that of a user of a new technology (NT) like the temperature computer. NT users may not pay as much attention to abstinence or may not adjust it so carefully to the stage of the cycle. Therefore, we think that the use effectiveness of 3.1 PI is overestimated because of the retrospective character of the study [...] We do not think that clients using original NFP methods are the same as those using new technologies [2,3,19].

Not to mention all the whining about how terribly difficult FAM is to learn, and how it takes years. Utter nonsense. FAM is relatively simple, TCOYF takes a few hours to read, and yes, it takes a few months to get to know your cycles, get used to your own signs, and so forth, but I gather that the computer device also takes a few months to get used to your data, and that to begin with it errs hugely on the side of caution as well.

I'm also noticing that it calculates the average fertile phase as being 14 days, which is far longer than the fertile phase you're likely to get through FAM. The thing that strikes me the most, however, is that *nowhere* can I see a discussion of how it actually works, how they can predict ovulation before a thermal shift has occurred. The BBT pattern is not a simple curve, any idea why they're calling it a curve?

As for trusting an algorhythm over human interpretation: look at the chart gallery in Fertility Friend and you'll see why I prefer human interpretation. I'm assuming, by the way, that you have read up properly on FAM, know what the rules are, and how to apply them.

Don't get me wrong: I think it's great that this sort of thing is being developed. I'm just finding that far too many things on that site are setting off alarm bells. Including this bit I've just found:

In the present study about two-thirds of the women had no problems obeying the rules, one-third declared that they had some problems. Interestingly, these figures were related to the age of the participants: 6.6% (14 out of 213) of the 21-25 year age group admitted to having problems; the figure concerning problems with abstinence rose to 14.5% (18 out of 124) in the 31-35 year age group; over 35 years, the figure was only 2.3% (1 out of 42).

So their definition of one-third is...?

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th3_unicorn January 21 2008, 15:24:43 UTC
I am a bit confused because the information I have relies on a different source.
From what I know, LC will aim to cut down to 8-10 red days average in a 28-day regular cycle. It starts with giving you more for the first 3-4 months, as it learns what your typical pattern and ovulation time is.

I've always about the curve being called a bbt curve lol because it ideally draws two curves on your chart (one going up, the other one going down).

I know, it's frustrating that it won't explain in detail how it works, but so far I've figured it's for two main reasons: a) only few women would have the math background to understand it, b) they don't mean to divulge how it works, because otherwise people wouldn't need the device

There is a less naive theory, which would be LadyComp being sort of a rip-off, but then it goes unexplained why it seems to be so effective (no unwanted pregnancy reported by users on the whole wide web!)

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elettaria January 21 2008, 16:28:35 UTC
I wouldn't go on how many reported pregnancies there are on the web, that sort of anecdotal info is dreadfully misleading (problems are often reported far more than problem-free methods of contraception, for instance), and it's a little-known device which makes it harder. We're relying on the two clinical trials being well-performed. Unfortunately I don't know enough about how clinical trials work, apart from knowing that they usually pre-select for good users, and being stuck by the business where they say that a third of users had trouble and then give that same figure as way lower than a third.

It shouldn't be about maths alone, it should be about hormones. There's no reason for them not to divulge the theory, that's not the same as giving a how-to manual. Ovulation is a relatively complex process, so I'd imagine it's possible to trace the earlier stages of that process through temperature readings. The thing is that as far as I can tell, the pattern with pre-ovulatory readings is pretty random once menstruation has finished. (During menstruation is a different matter. My temps fall during menstruation rather than before it, and I've found a correlation between the day of the greatest temperature drop with heavier blood flow, cramps and menstrual migraine.) Sometimes the body can gear up for ovulation and then delay it due to a factor such as stress. This can be reflected in a few days of fertile CF, followed by infertile CF, then back to fertile CF, but I've not heard of a corresponding pattern in temperatures.

To be honest, I suspect that this may just be a more personalised version of Cycle Beads, which uses averages and a huge fertile window , as well as excluding women whose cycles are not between 26 and 32 days long. Such methods are particularly prone to fall flat when an irregular cycle occurs, for instance with a very late ovulation. I had one of those just the other month, I ovulated at the time I'd normally be expecting a period, and it's the longest cycle I've ever had off hormonal contraception. I suppose the LC would keep you in the potentially fertile window until ovulation was confirmed, but I don't know how good it is at that. Anyway, using temps to confirm that ovulation is past and nothing but cycle averages to work out when fertility begins isn't more effective than FAM alone, it's less so, and it certainly allows you less time for sex. Either the LC is doing this, in which case it's a rip-off, or it really has found some reliable pre-ovulatory pattern reflected in temperatures without anywhere mentioning that it's done this. The whole thing is odd and intriguing.

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