Dear Doctor,

I’m confused about ovulation and safe days. My period is regular but I’ve failed to understand the cycle and when the biggest chances of getting pregnant are. Is it before or after my period? And how do I know that I am ovulating? Sometimes I feel mild pain in my abdomen a few days after my period. Is that it?  ​

Barbara

Dear Barbara,

Ovulation is when a mature egg is released from the ovary, pushed down the fallopian tube, and is made available to be fertilised. Approximately every month, an egg will mature within one of your ovaries. As it reaches maturity, the egg is released by the ovary where it enters the fallopian tube to make its way towards waiting for sperm and implantation in the uterus. This is regulated by the balance of hormones, estrogen and progesterone. These in turn are regulated by hormones from the pituitary gland. The thyroid gland also influences fertility. Ovulation starts from puberty and can continue for a few months even after cessation of menstrual cycle. Hormonal disorders like disease conditions of the thyroid or pituitary, putting on weight or losing weight, ovarian disorders, taking hormonal contraceptive pills, are some of the conditions that can influence ovulation, hence, fertility of a woman.

If one desires a baby, having sex at this time increases the chances of conception and vice versa, that is, these days it can be avoided regarding intercourse if pregnancy is not wanted. The days apart from day of ovulation are "safe days”.  Usually ovulation occurs any time from 14 to 21 day of the menstrual cycle (counting the day when bleeding starts as the first day). This happens after menstrual bleeding. But this is not hard and fast. Exceptionally it can occur early as the menstrual cycle varies from one woman to another, so do the days of ovulation. There are other signs which a woman should know and can be used to identify the day of ovulation.

Usually, there is an increase of basal body temperature (BBT). If one takes the oral temperature first thing in the morning before leaving the bed, there would be an increase of one to two degrees. Another sign is thickening of the cervical (lower part of uterus) mucous. There is thick sticky vaginal discharge, which can be felt by fingers. Pain in the lower abdomen, painful breasts on touching, spike in libido, are some of the other signs, which help to identify ovulation. Some women experience pain in the legs along with lower abdomen pain.  A woman can chart her BBT for three months consecutively and thus estimate the possible day of ovulation. Serial ultrasound examination done from about the 14 day of menstrual cycle can reveal the growth of the Graafian follicle and its rupture, releasing the egg. Thus, the precise day of ovulation can be pin pointed. Ultrasound examination is useful to identify the time of ovulation while planning procedures and interventions for fertility.

Dr. Rachna Pande is a specialist in internal medicine.

rachna212002@yahoo.co.uk