When I was pregnant with my daughter, I was forewarned that the postpartum period is a challenging time for a woman to chart her cycle and to understand the changes her body is going through. Inevitably, experience confirmed this for me.
Because my husband and I practice the Sympto-Thermal fertility awareness method (FAM), we tracked both my mucus patterns and my temperature every day starting shortly after our daughter was born. However, my charts were anything but regular, and I had some serious questions and reservations. Like many other postpartum mothers, I found myself struggling to understand my charts and what they meant for my future fertility. Luckily, I was able to get the help I needed from my trained Sympto-Thermal instructor (along with the understanding that we would need to be patient through a few longer periods of abstinence than usual).
Why practicing a FAM isn’t easy during the postpartum period
At the recent Fertility Appreciation Collaborative to Teach the Science (FACTS) Conference in Cleveland, Ohio, I listened to a talk given by Dr. Richard Fehring, the creator of the Marquette Model of Natural Family Planning (NFP) at Marquette University. The Marquette Model is a sympto-hormonal FAM, as it determines the probable time of ovulation using both cervical mucus observations and hormone readings from the ClearBlue Easy Fertility Monitor.
In his talk, Dr. Fehring explained why fertility awareness methods can be difficult to use during the postpartum transition—that period starting immediately after giving birth and lasting until menses, or when normal cycles resume.
First of all, there are no menstrual markers during this time—no monthly reminders of where you should be in your cycle. In addition, ovulation always precedes true menstruation, though some women will experience a bleeding episode before their first postpartum ovulation. Consequently, a woman hoping to avoid or postpone pregnancy should not wait until her cycle resumes to start charting again.
Second, traditional markers of fertility, such as cervical mucus and temperature increases, can be very unpredictable during the postpartum period as well. As one study of twenty-six postpartum women who collected urine samples and recorded mucus observations reveals, “Before the return of menses, mucus reflected hormonal changes in only 35 percent women and after first menses in 33 percent of cycles.” The study concluded that “hormone profiles do not correlate well with mucus observations during the postpartum return of fertility.” In other words, it is very difficult to predict the return of fertility during the postpartum period with solely mucus observations.
The good news: monitoring hormones themselves may prove more useful
While Dr. Fehring explained that women can successfully use any fertility awareness method postpartum with special protocols and one-on-one counseling with their NFP instructors (as my husband and I did), he also explained how the Marquette Method can be particularly helpful during this time because of its unique reliance on testing hormone levels. A woman goes through extreme hormone changes during pregnancy, labor, delivery, and after birth, and those hormones don’t bounce back to their pre-pregnancy levels for quite some time. Therefore, analyzing estrogen and progesterone levels in urine is often more helpful in predicting postpartum fertility than observing mucus and temperature.
After delivery of a baby, estrogen and progesterone hormone levels significantly drop, as integrative physician Dr. Aviva Romm explains, “The postpartum hormone drop is considered the single largest sudden hormone change in the shortest amount of time for any human being, at any point of their life cycle.” When those hormones level out again varies from woman to woman. It is therefore extremely beneficial for a woman to measure her hormones during this postpartum transition to help determine the return of fertility, as well as to help identify any potential issues (such as Postpartum Depression).
New hormonal technologies
The good news is that there are new hormonal monitoring technologies that help simplify the postpartum transition by measuring postpartum hormones. These new devices are generally more effective than fertility awareness apps because they are not just offering predictions based on one’s menstrual cycle history—they are personalized to one’s specific hormone levels. Note, however, that they are not meant to replace learning an evidence-based FAM, but rather to complement using a FAM.
While there are many options on the market (or coming soon to the market), Dr. Fehring noted that the following new technological advances are especially worthy of consideration during this postpartum period.
1. Mira Monitor
Created by a team of biological scientists and engineers, the Mira Monitor is one of the latest advances in at-home fertility testing technology. It was created in order to help women experiencing unexplained infertility to increase their chances to conceive.
The Mira Monitor gives quantitative hormone analysis by measuring Luteinizing Hormone (LH) concentrations in a woman’s urine, including the surges that happen 24-48 hours before ovulation. These fertility hormone concentration results then automatically sync with the Mira app. The app, in turn, gives personalized insights into a woman’s window of fertility, making it a reliable (though not fail-proof) predictor of ovulation, especially during the postpartum period.
The Mira Monitor also has big future plans to offer at-home testing for vitamin, Influenza, and allergen testing. The Mira Fertility Starter Kit costs $199.00 and includes 10 disposable test wands, with a replacement pack of 20 wands costing $50.00.
Proov is a rapid response progesterone test developed by a scientist who suffered from infertility issues for years. It works, very simply, by collecting a urine sample, dipping a test strip into the sample, and waiting five minutes to read your results.
The main reason to test one’s progesterone levels is to confirm ovulation. Other reasons to measure progesterone include trying to conceive, predicting one’s period, determining progesterone levels during pregnancy, and determining one’s overall wellbeing.
Proov is especially useful during the postpartum period, when a woman’s progesterone levels take a nosedive, as it can help determine when one’s hormones level back out, and thus help predict the return of fertility.
A Proov kit containing an individual pack of 7 test strips (which the site explains should be enough to last 1-2 months), costs $39.99, while a 3-pack (containing 21 test strips) costs $89.99.
The OOVA at-home fertility test is the result of a partnership between Mount Sinai Health System and Thorne Research. It works by measuring two key fertility hormones, Luteinizing Hormone (LH) and progesterone, in a woman’s urine with paper-based test strips. These test strips are then scanned with a smartphone camera into the OOVA app. The app then interprets the data and predicts peak periods of fertility, making the monitor ideal for women seeking to achieve pregnancy. Whereas many Femtech options work best for women with regular cycles, OOVA prides itself on having such an individualized approach that women with irregular cycles can use it successfully.
Aparna Divaraniya, the CEO and co-founder of OOVA, understands the need to determine each woman’s unique cycle and pattern of fertility, as she told Endocrine Today: “No two women are alike, and it’s about time we start treating them as individuals.” Divaraniya further explains, “OOVA provides women with personalized information by learning her fertility profile. By capturing hormone trends through daily urine samples, we remove the subjectivity and need for invasive procedures required to diagnose fertility issues. Our hope is that physicians will be able to use the information provided by OOVA to guide diagnoses. OOVA’s first product is just a glimpse at the future of personalized health care.”
In addition to predicting fertility, OOVA’s technology aid women with cycle management, post-pregnancy menstrual cycle assessment and pre-menopause concerns. An OOVA startup kit costs $159.99 and includes app access and the first month’s worth of supplies. Monthly refill cost for subscribers is $99.99, and $135.99/refill for non-subscribers (more on why OOVA is so pricey here).
Greater Clarity Ahead
The future is certainly looking bright for fertility awareness in the wake of new technological advances. New fertility technology has the potential to truly help women maneuver some of the harder aspects of tracking and predicting one’s fertility, such as during the postpartum period.
As exciting as these advances are, women who choose to rely on them to assist in predicting their fertility should use them in conjunction with a fertility awareness method. These monitors and test strips are best used as a complementary tool in your fertility awareness charting, as any woman who charts using a FAM can tell you: nothing compares to the empowerment that comes from knowing and understanding your own body.
When this article refers to fertility awareness methods (FAM), or natural family planning (NFP), we are referring to Fertility Awareness-Based Methods, evidence-based methods of cycle charting which can be used as effective forms of natural birth control when learned by a certified instructor.
This article was last updated June 28, 2022.