LITMIR.BIZ

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methods of contraception).

       Will it take time to get pregnant following taking the Pill?

      Some women get pregnant straight away, while for others it takes time to get their cycles back on a regular basis. It can be harder for some women to conceive after stopping the Pill – particularly if they are over 30 years old and have never had a child. So planning ahead is useful. You could also check your rubella status (by having a simple blood test) while still on the Pill, because if you need to have a vaccination it is essential that you are not pregnant.

      One of the disadvantages of the very effective contraceptive Pill, on which many of us rely to control our fertility, is that it wipes out a woman’s individual menstrual cycle, which is of course its aim. The doses of hormones given to achieve this have to be large enough to over-ride a woman’s own hormones, and this tends to blanket any normal fluctuation and effects a woman might recognize.

      Coming off the Pill to get pregnant means also getting back in touch with those signs and symptoms of fertility, some of which might not be welcome if the Pill was prescribed for menstrual cramps, acne, mid – cycle spots or other hormone-related aggravations. But it’s important to become familiar with your own cycle, if you don’t become pregnant straight away, and to see these hormonal fluctuations as positive signs of your fertility.

      It used to be thought sensible for women coming off the Pill, or stopping any other form of hormonal contraception, to wait a few months for their cycle to regularize and also to allow time for these artificial hormones to be excreted from the body. However, it is now advised not to wait, especially as there is some evidence to show that coming off the Pill kick – starts a woman’s hormonal activity and may actually encourage conception.

      The other advantage with being familiar with your own cycle, and what its ups and downs might be, as well as its regularity or otherwise, means that if there are problems with conception you have a baseline for considering what those problems might be.

      For some women, once they know what to look for, their personal indicators of fertility are very clear – cut – it’s that, ‘Oh, yes…’ moment. Fertility UK statistics illustrate that over 60 per cent of couples who contact a fertility awareness practitioner via www.fertilityuk.org do so in order to increase their understanding of the menstrual cycle to help plan a pregnancy.

       How long can I expect before my periods return following the Pill?

      Delays are not uncommon, especially in women over 30. It really helps to understand your cycle. Initially you may experience some irregularities in your cycle, including cycles that are longer than 35 days. Also, you may not ovulate in all cycles. If you are doing a temperature chart you may not get a rise in temperature – this happens, on average, in 10 per cent of cycles. Some women will have no periods (amenorrhea) or a cycle lasting over 90 days.

       Am I more likely to have Polycystic Ovary Syndrome (PCOS) after taking the Pill?

      It seems that some women who do come off the Pill and then have irregular cycles are diagnosed with Polycystic Ovary Syndrome. The Pill prevents PCOS, as it prevents ovulation and reduces the hormonal activity that causes PCOS, but there is little evidence to suggest that you are more likely to get PCOS after stopping the Pill, if you have not had it before. However, existing PCOS symptoms may have been masked by the Pill – and so become apparent after stopping.

       If I am trying to chart my fertility following the Pill, what can I expect?

      The first thing to remember is that there are many different types of Pill – some are combined pills containing oestrogen and progestogen (synthetic progesterone), other hormonal preparations (including pills, patches, injections and contraceptive implants) contain progestogen only. The main effect of oestrogen in pill preparations is to prevent ovulation, while the main effect of progestogen is to cause a thick mucus plug at the cervix, stopping sperm from getting through.

      After stopping the Pill (or other hormonal contraceptive products) there will be much variability in how long it takes for full ovulation to return and for cervical secretions to return to their most fertile characteristics. Normally these things happen very quickly after stopping contraceptive pills (or sometimes, of course, even if you miss out on taking your pill regularly!), but sometimes it takes several months to a year or more for the return of full fertility.

      After stopping the Pill it is possible that you may immediately have regular cycles with clear – cut fertility signs, but many women experience irregular cycles – often longer cycles – and there may be disruptions to the normal pattern of secretions because the progestogen in your pill has kept your cervix tightly closed and plugged with a sticky white mucus to stop sperm from entering. It can take a while for the cervix to start producing the more sperm – friendly wetter, clearer secretions again in good quantities.

      If you are recording your temperature, there may be some cycles with no temperature rise (possibly indicating the absence of ovulation), while other cycles may show a rise in temperature but it may occur fewer than 10 days before the next period starts (indicating a short luteal phase). If this is the case, your cycle would not be fertile as there would be insufficient time for implantation to succeed.

      Many women report heavier and brighter red bleeding after stopping the Pill – this can be quite alarming. Hormone – withdrawal bleeding which you get during the pill – free interval is much lighter and pinker than the fresh red bleeding of a normal period. If you are concerned, do talk to your doctor.

       How will I know if I am ovulating or not?

      It is not possible to tell from cervical secretions, temperature or LH kits whether ovulation is happening or not. The build – up to the wetter, clearer secretions indicates that ovulation is approaching, LH kits generally show that ovulation is imminent, and the rise in temperature may be a sign that ovulation has occurred – however none of these signs is conclusive.

      Aim to have as much sex as possible at any time you see any cervical secretions – this gives sperm the best possible chance to start their journey!

      It will be hard at first to recognize your individual pattern. If you are concerned about a delay in conceiving, of course you should speak to your doctor in the first instance.

      For many women there is a wealth of minor signs and symptoms that can help identify their fertile times. Let’s take a look at some of these.

       Increased Libido

      An increase in libido – of course this is also related to other emotional, social and physical factors, but for many women trying to get pregnant, increased sexual interest is an indicator of hormonal changes around the time of ovulation.

       Mid – cycle Abdominal Pain

      Because the ovarian follicle enlarges, prior to ovulation, by up to 23mm, and ruptures at ovulation, it’s not surprising that some women become aware of a sharp twinge or dull ache on either the right- or left-hand side of their lower abdomen, about halfway between the navel and hip bone and halfway between the navel and pubic bone. This can last for anything up to a couple of hours, and may be combined with a crampy feeling, not dissimilar to menstrual cramps, which may be because of the swollen ovary or the extending of the womb and Fallopian tubes, caused by the increase in oestrogen. The actual cause of the pain is still not known – the most likely culprit, as identified by research carried out in Germany, is related to a very slight bleed into the peritoneum as the follicle ruptures.

       With other fertility awareness already in place, many women can easily identify this time of peak fertility, which can be an extremely useful indicator. Mid – cycle, or ovulation pain is also referred to as mittelschmertz – though it has to be mentioned that research has shown that of all the subjective indicators of fertility, this one is the most varied in relation to ovulation (when studied on ultrasound scans).

       Breast Tenderness

      This

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