there but for the grace of Gd
More than once, as I'm about to be seduced, I've looked down and seen the first few drops of blood.
Only a few times, but definitely more than once.
Even more often, I've looked at my calendar, counted the days, set my heart on one last time for the month, and then something has come up. One of us is too tired, one of us doesn't feel well, a delay or distraction or deadline comes up that night... somehow we're prevented. Each time something different; I never see the pattern while it's happening. Inevitably I storm and cry about it. Partly because I'm especially shaky about separation just before it happens, partly because I'm hormonally off balance from the approaching period.
But a couple of hours later, wouldn't you know it: I'm bleeding early.
I've wondered why this happens to me every so often, and whether it happens to others. I think it's partly because I'm irregular by up to a week, so that sometimes my halachic separation days are spread a day or three or five apart. And maybe I push my luck, planning to be intimate with my husband on those intervening days, when really I might get my period at any time.
When I was first married I called the rabbi in a panic one night because my separation time had been during the day, and my last bedikah before nightfall was questionable. He said, I can't look at it now. We have to wait until tomorrow morning when it's light out. I wailed, but I thought we had one more night, I told my husband we would! He said, gently, this is what I advise all couples to do: sit down with the calendar together. Not right after you come home from mikvah, make it a few days later. Figure out what is your last completely safe day, before any of your separation days start. Make sure to be together on that day. After that, give up on the rest of the month, until you know whether you've gotten your period or you're pregnant. It will save you a lot of emotional turmoil in the end.
I was horrified, and did my best to forget I'd ever heard that. But I've been married a lot longer, and while I could see the wisdom even then, I am better able to tolerate the idea now. I try to do this a lot of the time. And still, even when I do, I sometimes get caught short. So incredibly short.
Each time it happens, I think to myself: what if all the frustrating delays, the obstacles, the inexplicable urge to glance down at the pajamas or sheets at the last instant, is really Gd trying to protect you from something far worse?
Comments
Hee. Funny.
Heh. Chana, it's true that there are some months when I'm too lazy, but most of the time I am already tracking my ovulation with something more precise than that (ovulation predictor kits). I do this partly for my fertility treatments and partly because, without it, I would have NO idea when I was getting my period.
I do know, roughly, how many days there will be between my ovulation day and my period, but there is still some variability. The kind of thing I'm talking about is being early by a day or two, sometimes even less. This is inevitable, given that the closest you can pinpoint ovulation by any method, whether temperature or test kit, is within a 12-36 hour period. I also would not be surprised if the "set number of days" you refer to can normally be one day more or less.
But I also suspect in general that the guidelines set forth in Taking Charge of Your Fertility are more useful for someone who is fertile, than for someone who is not. The premise of charting your temperature is that everything is working the way it's supposed to: you have a surge of luteinizing hormone and then you ovulate. You produce progesterone for a fixed number of days and then you get your period. Etc.
When you're infertile I think this assumption is a lot less likely to be true. Something is wrong, and it may very well be the relationship between your hormones and your cycle. For instance, many people have what is called a luteal phase defect, where the number of days between ovulation and their period is NOT as long as it's supposed to be. Other people don't ovulate despite high levels of LH. Others would never get their period without exogenous hormones.
I do know some infertile women who continue to chart, and apparently it does give them some useful information. For people starting out, certainly, it's a very good way to get to know your own cycle.
Personally, I'm far past the point where it would do me any good.
Eden,
Ovulation predictor kits can give you false positives if you have PCOS (the most common form of female infertility) because they test for a LH surge which is high through a lot of the month in women with hormonal problems. If you added temperature tracking, it would at least tell you (within ~24 hours) when/if you actually ovulated which is useful information for your reproductive endocrinologist as well as yourself.
If you aren't ovulating (even if the predictor kit thinks you are) then it won't tell you when you will get your period, but will give you useful information.
My experience with an insufficient luteal phase was that I would have spotting that wouldn't make me a niddah (at least on colored underwear) and that I could still predict when I would get my period.
All that charting helped my doctor to see what was wrong and keeping it helped to see the effects of medication.
Thank you for clarifying that point about elevated LH, Chana, the way I initially wrote it was confusing. You are correct, ovulation kits are probably not a good choice if you have PCOS.
However, if you have PCOS, I doubt you would rely very much on charting your temperature, either. The rise in temperature that you'd be looking for is an indirect sign that you are producing progesterone, as you normally should after you ovulate. But most REs measure progesterone directly with a blood test on cycle day 21, if there's any question as to whether you're ovulating. They would also be monitoring you by ultrasound to see whether you're developing a mature follicle, and later to see whether it deflated.
Moreover, even normal progesterone levels or promising ultrasounds are not a guarantee that you ovulated. And vice versa. The only thing that guarantees there was even an egg in your follicle, that it wasn't just an empty one that fooled you, is actually extracting an egg from the follicle.
However, I don't have PCOS, and ovulation kits do work for me. I don't believe I could pinpoint my ovulation day any more precisely with temperature charting; in my experience, it was much less so. And given that there is still a 12-36 hour window for that, there's still going to be a 12-36 hour variation in when I get my period.
Just to be clear, I did chart the first year I was trying to conceive. It was a good first approach for me: annoying, but low tech and cheap. I stopped when my first RE showed no interest in seeing my charts; the 2nd and 3rd haven't asked for them, either. All of them recommended ovulaton test kits or else monitored my LH level directly by blood test.
As I said, if charting provides useful information to other infertile women, that's great. For me it's a lot of effort totally not worth the information it yeilds.
I would just add that what you're describing doesn't technically sound like a luteal phase defect to me.
I also have spotting before my period (in fact, unlike you, my rabbi says the spotting does make me a niddah as soon as it reaches the size of a penny, because it's so consistently the first stage of my period) but this is not considered a shortened luteal phase at all. The first day of my cycle, for medical purposes, is not until the first day I have a full flow.
In any case, as far as I know a luteal phase defect can be suggested by not enough days between ovulation and your period, but not definitively diagnosed that way. That's because it's only indirectly about the number of days. What it really means is that you're not building up a good enough uterine lining and producing enough progesterone to support a pregnancy; this has the effect of bringing on your period too soon. In order to be sure that's why your period is early, as far as I know, the doctor would have to do a progesterone level and an endometrial biopsy.
Of course you are most familiar with your own diagnosis, Chana, so if your doctor has said something other than this, let us know.
Eden,
My husband and I aren't actively trying to conceive at the moment, but plan to start trying in the near future. As I posted elsewhere (I don't know how to link these things), we've been practicing t"h for 4 months now. It's something that interested me for a while, but I was bleeding for 15-20 days each month, which my doctor said was "normal for someone in her early 30's" the first time I asked about it. I was not willing to try observing t"h with cycles that long. The first 5-10 days were spotting less than the size of a penny so were less of an issue.
When I insisted she look into what might be wrong, she did some testing and found testosterone levels four times the "normal" limit as well as possible cysts on my ovaries by ultrasound. After some insistence that I didn't want to write myself off as infertile (which people with PCOS shouldn't), she referred me to a OB/gyn.
After more tests, we decided to try metformin alone (although I take a fair number of nutritional supplements also). After a couple months on metformin my testoserone levels dropped into the middle of the normal range (it's possible it happened sooner, but that was the first time we did bloodwork after starting medication). I was also by that point having 28-30 cycles consistently and having an obvious basal temperature shift. My gyn likes that I'm keeping temps because ovulation predictor kits don't say much with PCOS, but unless there are other undiagnosed issues, with PCOS a temperature shift is a good indication of ovulation.
I found that both before the meds and now that from the first day of the temp shift I have 11 days until my period begins. I can't predict night or day, but it's still helpful. I also no longer see blood or anything like it more than 12 hours before a full flow begins which has made life much easier.
Hopefully the metformin will make it easy to concieve when we start trying, but only time will tell.
"My husband and I aren't actively trying to conceive at the moment"
Ah! Well, that (and the fact that you're working with an OB/GYN, not an RE) goes a long way toward explaining the difference between our approaches. :-) It certainly sounds like the metformin is making a difference for you. Best of luck when the time comes. And I must say, this -
"I was bleeding for 15-20 days each month, which my doctor said was "normal for someone in her early 30's" the first time I asked about it"
is horrifying to me, and good for you for standing up to her about it!!
I have a fairly irregular cycle, but have been tracking temperatures and cervical fluid for fertility awareness - a benefit is that every woman has a set number of days after she ovulates when she will get her period (unless she's pregnant). Most people do the tracking either to know when they are most fertile or to avoid conception, but you could track just to know when you will become a niddah. Sometimes if there are irregular cycles you will see it's because you aren't ovulating and that's worth seeing a doctor about. Taking Charge of your Fertility has a good desciption of how to chart it.
Good luck.