Mastering Your Pregnancy Timeline
The term planning for pregnancy can include many topics and cover a variety of interests. The process may be faster for some and not always direct. Whether you find yourself ready for pregnancy now, interested in pregnancy later, or just wanting to understand your body there are many points to consider.
Knowing Your Menstrual Cycle
The best place to begin is by learning about the body’s natural process of conception. The menstrual cycle (commonly known as a period) is the hormonal process a woman’s body goes through each month to prepare for a possible pregnancy.1 Menstrual cycles begin in puberty, which happens toward the end of adolescence and lasts until menopause is reached. The average cycle lasts 28 days but can vary from 21 to 35 days.1 Menstrual cycles are a sign that the body is working as it should.
The duration of a period is determined by the amount of time the body takes to move through the four stages of menstruation. To learn more about the menstrual cycle and its stages, please view our infographic here!
Charting Your Fertility Patterns
Knowing how the menstrual cycle works and the changes that happen can help you know when your chances of getting pregnant are highest.1If you are trying to conceive, tracking your fertility can help ensure you are optimizing your ovulation window. If you’d rather wait to start a family, it is good to know the times of the month when pregnancy is more likely. There are 3 ways to track your fertility. It is best to use a combination of methods for the most accuracy:
Basal Body Temperature Method – Your Basal Body Temperature (BBT) is your temperature at rest as soon as you wake up in the morning. While BBT is different for everyone, this temperature rises slightly during ovulation. Keeping track of this temperature daily will help to predict your most fertile days.
Basal temperatures should be taken orally, at the same time every day, and with a basal body temperature thermometer. These special thermometers can be found at most pharmacies for about $10. A normal BBT falls between 96- and 98-degrees Fahrenheit. In ovulation, this temperature only rises 0.4 to 0.8 degrees.3 Most women have ovulated within 3 days of the BBT spike. Your body’s temperature may remain higher until the menses phase starts.
Peak fertility is 2 to 3 days before the temperature peaks (ovulation) and 12 to 24 hours after ovulation.
Several factors can change your body’s temperature:
Drinking alcohol the night before
Smoking cigarettes the night before
Getting a poor night’s rest
Having a fever
Doing anything in the morning before you take your temperature (even going to the bathroom or talking on the phone)
Calendar Method – Record your monthly cycle on a calendar for 8 to 12 months. The first day of your period should be marked as Day 1. Write down the total number of days in each month’s cycle, as this number can change monthly.
Using this record, you can identify the days you’re most fertile in the months ahead:
To find out the first day when you are most fertile, subtract 18 from the total number of days in your shortest cycle. Take this new number and count ahead that many days from the first day of your next period. Draw an X through this date on your calendar. The X marks the first day you’re likely to be fertile.3
To find out the last day when you are most fertile, subtract 11 from the total number of days in your longest cycle. Take this new number and count ahead that many days from the first day of your next period. Draw an X through this date on your calendar. The time between the two Xs is your most fertile window.3
Cervical Mucus Method – This method (also known as the ovulation method) involves following the changes in your body’s cervical mucus throughout the month. The hormones involved in the menstrual cycle change the type and amount of mucus produced before and during ovulation. There are usually a few days after the period where no mucus is present. As the egg matures, mucus production increases and appears white or yellow, cloudy, and sticky at the vaginal opening. The mucus is heaviest just before ovulation and appears clear and slippery. These are termed “wet days”. About four days after it appears, the mucus decreases and becomes sticky and cloudy. There may be a few additional dry days before the menses phase begins again.
Contraceptives
Maybe getting pregnant isn’t in your plan for the next few years. One of the best ways to prevent pregnancy is to use contraceptives. Contraception (also known as birth control) is any medicine, device, or method people use to prevent pregnancy.4 There are many different contraception options. Most of these are reversible, while a few options are permanent.5 Contraception options are available for both men and women. Many elements should be considered when selecting a birth control method, such as safety, effectiveness, availability, and how well the method will work for the individual.5 Consider protection from the risk of sexually transmitted infections as not all types of contraceptives offer this. Although hormonal contraceptives and IUDs are highly effective at preventing pregnancy, they do not protect against sexually transmitted infections.5 Below is a list of the types of contraceptives.
Reversible contraception methods:
Intrauterine Contraception
Levonorgestrel intrauterine system (LNG IUD): The LNG IUD is a small T-shaped device like the Copper T IUD. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant. The LNG IUD stays in your uterus for up to 3 to 8 years, depending on the device. This method is over 99% effective.5
Copper T intrauterine device (IUD): This IUD is a small device that is shaped in the form of a “T.” Your doctor places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. This method is 99% effective.5
Hormonal Methods
Implant: The implant is a single, thin rod inserted under the skin of a woman’s upper arm. The rod contains a progestin hormone that is released into the body over 3 years. This method is 99% effective.5
Injection or “shot”: Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. This method is 96% effective.5
Combined oral contraceptives: Also called “the pill,” combined oral contraceptives contain the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than 35 years and smoke or have a history of blood clots or breast cancer, your doctor may advise you not to take the pill. This method is 93% effective.5
Progestin-only pill: Unlike the combined pill, the progestin-only pill (sometimes called the mini-pill) only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. It may be a good option for women who can’t take estrogen. This method is 93% effective.5
Patch: This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. This method is 93% effective.5
Hormonal vaginal contraceptive ring: The ring releases the hormones progestin and estrogen. You place the ring inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. This method is 93% effective.5
Barrier Methods: Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm.
Diaphragm or cervical cap: The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup. Before sexual intercourse, you insert them with spermicide to block or kill sperm. Visit your doctor for a proper fitting because diaphragms and cervical caps come in different sizes. This method is 83% effective.5
Sponge: The contraceptive sponge contains spermicide and is placed in the vagina where it fits over the cervix. The sponge works for up to 24 hours and must be left in the vagina for at least 6 hours after the last act of intercourse, at which time it is removed and discarded. This method is 86% effective for women who have never had a baby and 73% for women who have had a baby.5
Male condom: Worn by the man, a male condom keeps sperm from getting into a woman’s body. Latex condoms, the most common type, help prevent pregnancy, HIV, and other STDs, as do the newer synthetic condoms. “Natural” or “lambskin” condoms also help prevent pregnancy, but may not protect against STDs, including HIV. Condoms can only be used once. Do not use oil-based lubricants such as massage oils, baby oil, lotions, or petroleum jelly with latex condoms. They will weaken the condom, causing it to tear or break. This method is 87% effective.5
Female condom: Worn by the woman, the female condom helps keep sperm from getting into her body. It is packaged with a lubricant and is available at drug stores. This method may help prevent STDs. It can be inserted up to eight hours before sexual intercourse. This method is 79% effective.5
Spermicides: These products work by killing sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm, or cervical cap. They can be purchased at drug stores. This method is 79% effective.5
Fertility Awareness-Based Methods
Lactational Amenorrhea Methods: For women who have recently had a baby and are breastfeeding, the Lactational Amenorrhea Method (LAM) can be used as birth control when three conditions are met: 1) amenorrhea (not having any menstrual periods after delivering a baby), 2) fully or nearly fully breastfeeding, and 3) less than 6 months after delivering a baby. LAM is a temporary method of birth control, and another birth control method must be used when any of the three conditions are not met.5
Emergency Contraception: Emergency contraception is NOT a regular method of birth control. It is also NOT an abortion pill. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke.5 Emergency contraception (also known as the plan b pill) delivers an extra dose of hormones as an attempt to prevent egg fertilization. However, the outcome is not guaranteed.5
Copper IUD—Women can have the copper T IUD inserted within five days of unprotected sex.5
Emergency contraceptive pills—Women can take emergency contraceptive pills up to 5 days after unprotected sex, but the sooner the pills are taken, the better they will work. There are three different types of emergency contraceptive pills available in the United States. Some emergency contraceptive pills are available over the counter.5
Surgical methods of birth control:
Female Sterilization—Tubal ligation or “tying tubes”: A woman can have her fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization. The procedure can be done in a hospital or an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately. This method is over 99% effective.5
Male Sterilization–Vasectomy: This operation is done to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. The procedure is typically done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero; this takes about 12 weeks. Another form of birth control should be used until the man’s sperm count has dropped to zero. Vasectomies can be reversed, but there I no guarantee that fertility will be resumed. This method is 98% effective.5
Things You Should Know About Birth Control
As we learned, there are many options for birth control. There is not one option that is the best for all, rather you should consider many factors to determine the option that is best for you. Each method has its pros and cons. Birth control pills often cause lighter, more regular periods and can lower the risk of ectopic pregnancy, where condoms are the only method that can also protect from STIs.
Generally, long-term contraceptive use does not negatively impact one’s ability to conceive. Many believe taking a break from birth control preserves their fertility. However, there appears to be no medical benefit to doing this.
Ultimately, knowing your options is the best way to plan for pregnancy, whether you’d like that to be now or later. It is best to consult with a medical provider when making this decision. The information provided in this blog is meant to help you determine what is best for your family. Now that you understand what’s happening internally, you can move forward with an empowered decision. If you would like additional information, P&I is here to help.
Written by: Candace Page, MPH
Blog Reviewer: Dr. Krista Mincey, MPH, Dr.PH, MCHES
References
Office on Women’s Health. US Department of Health and Human Services. (2021). Menstrual Cycle. Menstrual Cycle | Office on Women’s Health (womenshealth.gov)
Cleveland Clinic. (2022). Menstrual Cycle. Menstrual Cycle (Normal Menstruation): Overview & Phases (clevelandclinic.org)
Office on Women’s Health. US Department of Health and Human Services. (2021). Trying to Conceive. Trying to conceive | Office on Women’s Health (womenshealth.gov)
Cleveland Clinic. (2022). Birth Control Options. Birth Control: Forms, Options, Risks & Effectiveness (clevelandclinic.org)
National Center for Chronic Disease Prevention and Health Promotion. (2023). Contraception. Contraception | CDC