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A small amount of blood in your cervical mucus may be harmless, caused by hormone fluctuations, or even the implantation of an embryo if you have conceived. But sometimes it may indicate cervical or uterine polyps, or fibroids. There are also a number of cancers of the reproductive system that can affect your patterns of cervical mucus and menstrual cycle. It's important to discuss with your doctor any spotting or blood in the mucus that is a change from your usual pattern, or changes in your normal menstrual flow.

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Inflammatory processes of the reproductive system are the second most frequent cause of infertility. They are usually secondary to genital tract infections (often caused by STIs). If you have learned to chart your cervical mucus patterns you will quickly be able to recognise an abnormality and seek treatment promptly, which may prevent fertility disorders. For example, you may see a small amount of blood in your cervical mucus, or experience a continuous discharge alongside an ovulatory pattern of mucus.

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The Billings Ovulation Method® chart of a 28-year-old woman showed several months of abnormal cycles, with excessive thick and sticky mucus and no obvious changing pattern suggestive of ovulation. In one cycle, she experienced fertile symptoms followed immediately by bleeding, then fertile symptoms again. Her Billings Ovulation Method® tutor referred her to her GP for investigation.

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You may be wondering which irregularities in your mucus pattern and your menstrual cycles should be considered abnormal. There are different kinds of ovarian activity that are completely normal responses to different times and events in your life. Your Billings Ovulation Method® chart will help you make the connection between what is going on with your mucus pattern and menstrual cycle and what is going on in your life and your body. So let's take a look at these normal "irregularities" before we look at what might be abnormal.

The Onset of Menstruation

When adolescent girls first begin to menstruate, their cycles are often irregular until their hormone patterns mature. In the first couple of years there may be times when no egg is released from the ovary. The bleeding following this hormone activity can be irregular, prolonged and heavy. Knowing that ovulation can be delayed for weeks or months is helpful information when working out what is and what isn't normal. Studies have proven that teenagers can recognise when ovulation does occur by monitoring their patterns of cervical mucus. If a girl's cycles haven't settled into a regular pattern of 25-33 days within two years she should visit her doctor for investigation.

The Approach of Menopause

At the other end of reproductive life, women approaching menopause also experience changes in their menstrual cycle. Mucus patterns may become irregular in response to fluctuating oestrogen levels. Delays in ovulation, with patches of mucus and episodes of bleeding, may become common.

Stopping Hormonal Contraception

If you've stopped hormonal contraception you may not show signs of fertility for some weeks or months until your own ovulatory hormones return to normal function. You may notice that there is no well-defined mucus pattern, indicating that you haven't yet started ovulating again, or that the cervix hasn't recovered from the effect of the contraceptive and isn’t yet producing fertile mucus. If you're planning a pregnancy, research shows lower conception rates in the first three months after discontinuing the pill, sometimes persisting until the tenth month. But every woman is unique. Your fertility may return quickly and you could become pregnant within a few weeks after stopping contraception. By keeping a chart of your mucus patterns you will be able to track your returning fertility.

If you’re planning a pregnancy it’s a good idea to start taking a folic acid supplement, ideally for a few months before you become pregnant.

Breastfeeding

After giving birth and weaning from breastfeeding your return to full fertility may take several weeks or months. You may notice a long delay until you return to regular menstrual cycles. Or you may return to fertility within the first few months of giving birth even if you’re fully breast-feeding.

Other Events

Long-distance travel, hormone therapy, hormonal contraceptives, strenuous physical activity, significant weight loss or gain, stress, and illness can all disrupt your hormone levels and cause changes in your patterns of cervical mucus and menstrual cycle.

If your chart reveals abnormal patterns that you cannot explain, you may have a hormonal disorder or some other problem that requires further investigation. The next section looks at normal types of bleeding, and then we get on to abnormalities to look out for in your pattern of cervical mucus or menstrual cycle.

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Ovulatory Dysfunction is the absence of ovulation or abnormal ovulation activity. This condition is a major cause of infertility. It is often associated with irregular menstrual cycles and is usually caused by hormonal disorders. For example:

Polycystic Ovarian Syndrome

Adrenal and ovarian hormone abnormalities are the most frequent cause of ovarian dysfunction, and the most common example of this is Polycystic Ovarian Syndrome (PCOS). It is estimated that 5 to 10 per cent of Australian women have PCOS, but many don't know they have it. Often women with PCOS have insulin resistance, which causes high insulin levels. Their ovaries and adrenal glands may also be producing too much of the hormone testosterone. These hormonal imbalances mean that the follicle containing the developing ovum can't mature properly. Often the ovum doesn't get released from the ovary, so there is no ovulation. The struggling follicle keeps making more testosterone, and this interferes with the ovulatory process. It isn't long before lots of these tiny cysts cover the ovaries.

If you have PCOS you've probably had irregular cycles since you first began menstruating. Other symptoms can include acne, hirsutism, and weight gain, but some women have none of these symptoms. When keeping your chart you may notice a continuous fertile type of mucus pattern, or days of sticky or slippery mucus forming no progressive pattern to a peak of fertility.

Women who are diagnosed with PCOS may be prescribed the Pill as a way of inducing regular monthly bleeds. But the Pill only treats some of the symptoms without treating the underlying cause. For example, taking the Pill doesn’t address the problem of insulin resistance, which increases the risk of developing diabetes. Insulin and glucose levels should be measured, and medication, diet and exercise may be prescribed to treat the insulin resistance. Regulating insulin levels and restoring glucose balance can help control testosterone production as well. This will help restore normal ovulation and regular cycles.

Keeping a chart of your cycles and your cervical mucus patterns will help your doctor diagnose this condition and plan your treatment. And if you're trying to conceive, your chart will help you work out which cycles might be fertile ones. Diet, exercise and medical treatment will help restore normal ovarian activity.

A Billings Ovulation Method® teacher will help you make sense of your chart and recommend you seek medical advice when necessary.

Other Hormonal disorders

Hyperprolactinaemia: Prolactin is a hormone associated with breastfeeding, but sometimes high levels of this hormone develop after taking certain medications or due to conditions like a pituitary tumour or a hormone imbalance like hypothyroidism. The excess prolactin interferes with the hormones that control the growth of the follicles. Women with this hormonal disorder may not menstruate at all, have irregular bleeding or they may have short cycles with pre-menstrual spotting. Hyperprolactinaemia can be treated with medication.

Hyperthyroidism/hypothyroidism: Women with thyroid hormone levels that are too high may have irregular menstrual cycles with long gaps between menstruation and unusually light bleeding. Women with thyroid hormone levels that are too low can experience irregular bleeding which may be abnormally heavy and prolonged. In the section called Case Studies you can read about a woman whose abnormal patterns of cervical mucus helped her identify a thyroid abnormality.

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The Billings Ovulation Method® is not just for women who are trying to conceive or for those who are wanting to avoid pregnancy. It is knowledge that every woman ought to have. Why? Because it can help you to safeguard your reproductive health.

The Billings Ovulation Method® Chart is Diagnostic

Changes in your cervical mucus are an accurate reflection of what is going on with your reproductive hormones. The chart you keep will be an accurate record of these hormonal events. Over 50 years of research and hormonal assays confirm this.

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Menstruation

The lining of the uterus, called the endometrium, thickens during each menstrual cycle in response to the hormone oestrogen. Progesterone levels begin to rise around the time of ovulation, changing the endometrium to make it ready for the implantation of a fertilised egg. If conception doesn't take place, the levels of progesterone and oestrogen fall, causing the endometrial lining to be shed.

Oestrogen breakthrough bleeding

Whenever oestrogen rises the endometrium responds. Oestrogen breakthrough bleeding is the result of high levels of oestrogen and sometimes occurs before the follicle goes on to ovulate. Alternatively the follicles may not develop as they should and remain in a state of chronic stimulation so that the endometrium continues to build; when the endometrium outgrows its blood supply, breakthrough bleeding occurs.

Breakthrough bleeding indicates potential fertility and may be associated with other symptoms such as visible mucus or a slippery sensation. Bleeding may be prolonged and heavy, or may be experienced as a day or two of light bleeding or spotting.

Oestrogen withdrawal bleeding

When a follicle containing the ovum (egg) begins to develop it produces oestrogen, which causes the endometrium to start thickening. But sometimes the follicle doesn't fully mature, and there is no ovulation. The follicle breaks down so the level of oestrogen drops, the endometrium is no longer supported and bleeding can occur. This bleeding can be profuse, perhaps with clots, and it may go on for some time, or it may be light or just spotting.

Oestrogen withdrawal bleeding and breakthrough bleeding can happen at times of fluctuating oestrogen levels, such as during puberty, when breastfeeding, after you stop taking hormonal contraception, and as you approach menopause. If in doubt, consult your Billings Ovulation Method teacher™ who will advise you if you need to seek medical investigation of unexplained bleeding.

Embryo implantation

This may happen about a week after conception when the fertilised ovum implants into the endometrium.

Any unexplained bleeding should be investigated. The next section looks at abnormalities in your pattern of cervical mucus and your menstrual cycle that should be investigated.