What is Ovulation?
Ovulation is the release of an egg from your ovary. This process should occur monthly in women from puberty to just before menopause. Egg follicles or wanna-be eggs have been in your ovaries since you were born. During every menstrual cycle, some of these follicles are stimulated to mature into an egg. As the egg follicle develops, it releases the hormone estrogen. When the egg develops sufficiently and enough estrogen is produced, it signals the pituitary gland in your brain to release a hormone called LH (luteinizing hormone). LH surges to provoke egg release or ovulation.
When is Ovulation?
Ovulation should occur each month, roughly in the middle of your cycle. If your menstrual cycle is 28-30 days, ovulation should be around cycle day 14-15. You should never assume that is the case, nor use that assumption as a means of birth control! Ovulation can be erratic and unpredictable. It can’t just be assumed based on your cycle length. Some women will ovulate early, some late. Some don’t ovulate at all despite regular menstrual cycles.
Period tracker apps are also not a reliable means of knowing when you are ovulating. The app just assumes ovulation to be in the middle of your cycle, which may not be the case.
What are the Signs of Ovulation?
One of the key signs of ovulation is the presence of something called “cervical mucous”. This is a glob of stretchy, slippery discharge that you may notice around the middle of your cycle. When you wipe with toilet tissue, it may feel slick. If you examined the tissue, you might see a glob of clear mucous. If you touch the mucous, it tends to be stretchy. This mucous is also called “egg white” mucous because it can be similar in consistency to a raw egg white.
The LH surge I mentioned earlier is what triggers the production of this mucous. The mucous itself helps with fertility. Cervical mucous will be present anywhere from one to three days prior to ovulation. If you are trying to conceive, the day that you spot the mucous is a good day to have intercourse.
Your Basal Body Temperature may dip the day you ovulate. That dip is followed by a rise the day after ovulation.
What are Ovulation Symptoms?
Symptoms are something that you may have observed or felt that is associated with ovulation. The following are symptoms that are commonly associated with ovulation:
- Breast pain or tenderness
- Spotting
- Cervical mucous
- Cramping
- Mood changes – sadness, weepiness
- Change in libido
- Headaches/migraines
- Changes in the feel of your cervix – it becomes softer, like your lips around ovulation
- Nausea
- Swollen breasts
The fact that these symptoms are common does not necessarily mean that they are normal. In fact, they can often be a sign of hormonal imbalance.
How Do I Know When I’m Ovulating?
Knowing when you are ovulating can be tricky. You can look for the above signs and symptoms of ovulation. But these may be signs that your body is trying to ovulate. They are not necessarily proof that you were successful in ovulating. You can use an ovulation predictor kit or a urine dipstick-type test. Again, this only tells you that your body is trying to ovulate. It doesn’t prove that ovulation was successful. Another method to confirm ovulation is Basal Body Temperature Charting. To me, this is the best means of determining when and if ovulation is occurring.
What is Basal Body Temperature Charting?
BBT, or Basal Body Temperature, is your resting body temperature. To chart this, as soon as you wake up in the morning, without getting out of bed or moving around much, grab a thermometer and take your temperature. Upload your temperature numbers to an app that will plot a graph of them. Most apps will also indicate where they think ovulation occurred.
What should happen is that for the first 2 weeks of your cycle, your temperatures will be lower, between about 36 to 36.5 degrees Celsius. There will be a slight dip, about -0.2 degrees Celsius, followed by a rise in temperature of about 0.5 degrees. For the next 2 weeks of your cycle, your temperature should be around 36.5-37 degrees Celsius. Just before your next period is coming you should see it drop back down to 36-36.5 degrees Celsius. One of the apps that I often recommend for this is called Kindara.
How Long Does Ovulation Last?
Ovulation typically happens in a day. However, you can be fertile for 7 to 10 days around this time.
When Should I Take an Ovulation Test?
If you are uncertain when you ovulate, you may want to start testing around day 8 or 9 of your cycle. Another recommendation would be to take your usual cycle length. Subtract 17 from that number and start checking on that day of your cycle. For example, if your normal cycle is 28 days, subtract 17 equals 11, so start checking on day 11.
Some women ovulate very early, although it’s not ideal. If you are just starting out, test first thing every morning until you get a positive test. Once you have established your usual ovulation time, you can start checking 2-3 days before that.
How do I Use an Ovulation Test?
Most ovulation tests involve urinating on a plastic stick or dipping the test into a urine sample that you have collected in a clean, dry container. It’s best to check when you wake up first thing in the morning, as the urine is the most concentrated. Follow the directions for your specific test kit.
Most tests involve urinating on the test strip or stick and waiting to see if one or two bands become visible. One band is the control band to ensure that the test is working. That one should always appear. If it doesn’t, the test may be invalid. If there are two bands, that means that LH is surging and your body is trying to stimulate ovulation. This means that you will ovulate within one to three days. You should read the test in less than 10 minutes. Waiting longer means that the test may not be reliable.
How do I know if I’m ovulating?
To review, you can determine if your body is trying to ovulate by looking for the above signs and symptoms. You can do an ovulation predictor test (OPK) to see if your body is trying to ovulate. The presence of these signs and symptoms or a positive OPK doesn’t guarantee that you are ovulating. You can confirm ovulation with Basal Body Temperature charting. Period tracking apps will often guess when you are ovulating. This is not a reliable method. Without BBT data, the app is only predicting based on your cycle length. Fertility clinics will monitor ovulation by checking blood work regularly from cycle day 3 to ovulation, along with regular ultrasounds to monitor the size of the egg follicle.
What if I am not ovulating?
There are many reasons why you may not ovulate. Determining the cause typically requires extensive blood work for your hormones.
Possible causes of a lack of ovulation include:
- Underactive thyroid or hypothyroid
- High prolactin
- High testosterone
- Too much DHEA
- High DHT
- HPA axis dysfunction
- Autoimmune disease
- Stress
- Being underweight
- Starvation diets
- Extreme exercise
Underactive thyroid or hypothyroid
Your thyroid is like the gas pedal for your body. It dictates the speed at which everything else runs. If your thyroid is running slowly, so will everything else, including your ovaries. Improving thyroid function can be done by supplying vitamins and minerals like zinc, copper, selenium, iodine, and tyrosine for your thyroid. In many cases, hypothyroidism is caused by an autoimmune disease known as Hashimoto’s. This can be corrected by fixing a leaky gut and moderating immune function.
High Prolactin
Prolactin is a hormone that enables breastfeeding. It can also rise due to stress. High prolactin can interfere with the normal functioning of the ovaries. I use an herb called Chastetree, along with vitamin B6 and magnesium, to reduce excess prolactin production.
High Testosterone
Testosterone is a male-type hormone or androgen. Women have a certain amount, too. It can help women with energy, drive, motivation, and libido. However, too much testosterone can interfere with the normal functioning of the HPG axis. The HPG axis is the communication line that occurs between your brain and your ovaries. The HPG axis orchestrates the stimulation of egg follicles to mature into eggs, the subsequent production of estrogen, the release of the egg, and the production of progesterone. High testosterone is a common finding in PCOS. A healthy diet and exercise regimen moderate excessive testosterone production, along with herbs like Saw Palmetto and nettle root, Berberine, Cinnamon, Myo-inositol, and d-chiro inositol.
Too Much DHEAs
DHEAs is a weak androgen produced by your adrenal glands. Similar to testosterone, it can be increased in PCOS and disrupt ovulation. A healthy diet and exercise regimen moderate excessive DHEAs production, along with herbs like Saw Palmetto and nettle root, Berberine, Cinnamon, Myo-inositol, and d-chiro inositol.
High DHT
DHT is a particularly potent form of testosterone. It is produced from normal testosterone by an enzyme called 5-alpha-reductase. This enzyme works faster when insulin levels increase, which is triggered by carbohydrate and sugar intake. A healthy diet and exercise regimen moderate excessive dihydrotestosterone production, along with herbs like Saw Palmetto and nettle root, Berberine, Cinnamon, Myo-inositol, and d-chiro inositol.
HPA axis dysfunction
All of your endocrine glands work together. The hypothalamus and pituitary in your brain direct the rest of the hormone-producing glands. There can be faulty signalling from your hypothalamus and pituitary to your adrenal glands or an inadequate adrenal gland response. The adrenals supply building blocks to your ovaries to produce estrogen. The release of estrogen as an egg is developing is what triggers ovulation. If the building blocks are inadequate, estrogen doesn’t rise sufficiently to prompt ovulation.
Autoimmune disease
An autoimmune disease can affect many organ systems, including your endocrine system. Organs that are under an auto-immune attack may lose their function. This has been determined to lead to premature ovarian failure.
Stress
Under stress, your body perceives that you are in danger and prioritizes vital bodily functions. For your survival, it is much more important for your heart and lungs to work than for your reproductive organs to work. So, the high cortisol produced when you are stressed can shut your ovaries down.
Being underweight
Fat cells secrete estrogen. If you are very underweight and your body fat is low, estrogen levels can be too low. When your body thinks that you are starving, it will preserve vital organs and neglect non-vital ones like your ovaries.
Starvation diets
Similar to being under stress, if you aren’t eating enough, your body will prioritize and conserve energy. Vital organs will receive nutrients at the expense of non-vital ones like your ovaries.
Extreme exercise
Very intense exercise can create a similar environment in your body as stress does. Your reproductive organs will become a low priority and high cortisol from the stress of the exercise can interfere with ovarian function.
Why does it matter if I’m ovulating?
Even if you never intend to have children, it matters if you ovulate. If you don’t ovulate, you miss out on a vital female hormone, progesterone. Progesterone is important for maintaining a healthy mood. It helps your brain to use the anti-depressant hormone serotonin. If you are suffering from anxiety or depression and you are not ovulating, it may be due to the lack of progesterone that goes with a lack of ovulation. Progesterone also helps with metabolism to maintain a healthy weight and bone density.
Ovulation matters if you are trying to get pregnant. Having a regular period does not necessarily mean that you are ovulating.
Whatever the reason, as a naturopath I can help to fix a lack of ovulation. Book an appointment here or call the clinic at 416-481-0222. I can give you tailored advice in person or virtually if you are anywhere in Ontario. If you are elsewhere, I can’t provide personalized treatment, but you can get general information about natural approaches for PCOS-related anovulation in my ebook here.
Authored by Dr. Pamela Frank, BSc, ND
Ovulation Research
Contraception. 2002 Oct;66(4):231-5. The accuracy of the peak day of cervical mucus as a biological marker of fertility. Fehring RJ.
Dr. Pamela has practiced as a naturopathic doctor in Toronto since 1999. She has received numerous “Best Naturopath in Toronto” awards. She is registered with the College of Naturopaths of Ontario.
Dr. Pamela Frank uses a natural treatment approach that may include acupuncture, herbal medicine, nutrition, diet, vitamins, supplements, and other natural remedies to restore balance and provide long-term resolution to almost any health problem.