1. The Female Cycle: The Fifth Vital Sign Marguerite Duane, MD, MHA, FAAFP Saturday, January 30, 2016

2. Disclosures No Disclosures

3. Objectives Define the normal menstrual cycle. Describe important hormonal events in the cycle and the resulting physiological changes. Highlight the key external observations or biomarkers that women can learn to chart to better understand their fertility cycle. Review a variety of fertility charts and discuss specific observations that may indicate a potential underlying health issue. State additional opportunities to learn how to address women’s health issues using fertility charts.

4. Ovulation Methods Charting Cervical Fluid Sign Billings Ovulation Method™ CREIGHTON MODEL FertilityCare™

5. Sympto-Thermal chart Two-level temperature pattern Phase I Phase IIPhase III Mucus observations Mucus interpretation Cervix observations Luteal phase Menses : X X X / / P1 2 3 (c) FACTS 2013

6. Sympto-Hormonal charts

7. The Normal Menstrual Cycle Overall Length –21- 35 days –21- 45 days in young teens Normal length of: –Bleeding range: 4 - 7 days –Mucus cycle range: 4 - 8 days –Luteal phase range: 10 - 16 days Phases | Follicular (Pre-ovulatory) | Luteal (Post-ovulatory) |

8. Intricate Interplay of Hormones GNRH

9. Key Events in the Cycle normal cycle length variable: 21-35 days (c) FACTS 2013

10. Observable effects of the hormones | Follicular phase || Luteal phase | |  Fertile window  | Hormone Level FSH LH Estrogen Progesterone

11. Schematic of cervical fluid  Type E mucus (L, S, P)  Allow sperm penetration  Type G mucus (or fluid)  Sperm penetration blocked (c) FACTS 2013

12. Methods of Charting –Ovulation Methods (Cervical Fluid) –Billings Ovulation Method™ –CREIGHTON MODEL FertilityCare™ –Sympto-Thermal (Fluid + Temperature) –SymptoPro –Couple to Couple League –Sympto-Hormonal (Fluid + Urinary hormones) –Marquette –FEMM

13. Using Charts to Aid in Diagnosis

14. Resources Cervical Fluid Methods Billings USA: http://www.boma-usa.org/http://www.boma-usa.org/ Family of the Americas: http://www.familyplanning.net/http://www.familyplanning.net/ Creighton Model: http://www.creightonmodel.com or http://www.fertilitycare.orghttp://www.creightonmodel.comhttp://www.fertilitycare.org Two Day Method: http://irh.org/twoday-method/http://irh.org/twoday-method/ Sympto-Thermal Methods Couple to Couple League, http://www.ccli.org/http://www.ccli.org/ Serena (Canada), http://www.en.serena.ca/Homehttp://www.en.serena.ca/Home SymptoPro, http://www.symptopro.orghttp://www.symptopro.org Sympto-Hormonal Method Marquette Model http://nfp.marquette.edu/index.phphttp://nfp.marquette.edu/index.php Standard Days Method: http://irh.org/standard-days-method/http://irh.org/standard-days-method/ Lactational Amenorrhea Method: http://irh.org/lam/ http://irh.org/lam/

15. Please evaluate this presentation using the conference mobile app! Simply click on the "clipboard" icon on the presentation page.