Cycle tracking is the #1 easiest, most empowering thing I ask my patients to do.
All you have to do is sign up for a free app, take your temperature when you wake up each morning, and input that number into the app. Press snooze and lay in bed for a few more minutes with your thermometer. Who wouldn’t be into that? (I’m into that!)
But many women struggle to put this habit into place. I’ve been tracking my Basal Body Temperature (BBT—your temperature before you get moving) for twenty years, even when I travel. It’s that easy. And generally, I feel like if I can do something, then anyone can. So, what is the resistance many women have to BBT tracking?
Self-care. Let’s call it out. Many women struggle with paying attention to and taking care of themselves rather than others. I understand that the demands of work and family can pull us in many directions, but if you know you are one of the millions of women who shy away from self-care, I say, “re-examine the airplane oxygen mask instructions: Put your mask on first! You are no good to anyone when you run out of oxygen.”
Another obstacle I need to acknowledge is maybe you don’t fully understand why I’m asking you to track your temperature.
The reasons I’d want you to connect to your cycle are vast, but here are 5 super important questions we can answer with the charts you create when you track your BBT in a reliable app:
Do your symptoms have a hormonal component?
When I ask my patients about the frequency of their symptoms, some report that it’s about once a month. Hmmmm? That makes me wonder if their symptom is influenced by their hormone cycles. Sometimes patients will come to me saying that they feel their symptoms may have something to do with their hormones, but they’re not sure.
In fact, the Fertility Friend app (I have no affiliation - click the study link at the end of this article to see why I recommend this particular app) has a drop-down menu labeled “Specifics” that allows you to check physical symptoms (including headaches, gassiness, skin breakouts, and sleep difficulties), mood, energy, and weight. You can even customize your data entry to include any symptoms not listed.
*If we determine by looking at your charts over time that your symptom does happen at the same point in your cycle every month, then our treatment for that health issue needs to be about balancing those hormones rather than just targeting that complaint.
2. Is insulin resistance the reason you have hormone symptoms?
Is your difficulty balancing blood sugar and insulin the root of why you’re not ovulating and therefore experiencing irregular cycles?
Patients who tell me they sometimes skip or have irregular periods may have polycystic ovary syndrome (PCOS)). If they do have PCOS, ovulation may not be happening normally because of insulin resistance promoting androgen (male hormone) production. Other symptoms indicating higher androgen levels include acne, head hair loss, hair showing up in male pattern places (lip, chin, abdomen), anger, irritability, or mood swings.
The recent study linked below showed the Fertility Friend app can accurately predict if and when ovulation happens, particularly when cervical fluid is tracked along with temperature (check out the green area of the chart below).
Here's an example of what the app looks like when the user inputs temperatures that reflect regular ovulation:
The user’s temperatures appear as blue dots, and the software connects them with a blue line. In the figure above, even though the user skipped several days of temperature tracking, the software has determined the two red lines that indicate when ovulation occurred.
*If the app reveals that you’re not ovulating normally and you experience symptoms of excess androgens, then we should do bloodwork to calculate your level of insulin resistance (HOMA-IR). If your HOMA-IR score is >1.9, then we need to increase your insulin sensitivity in order to get your hormones balanced.
3. Are your symptoms improving over time?
Along with restoring ovulation and calming PMS symptoms, patients sometimes come to me to work on reducing heavy menstrual bleeding. Sometimes our goal is to shorten the length of bleeding if patients report losing blood for several days.
Day 1 of your cycle (at the bottom left of the chart) = the first day of menstrual blood flow.
To be sure that the work we are doing is paying off, the charts should start to reflect less blood loss (see Day 1-6 in the Figure above). Notice that this person had 3 medium blood loss days (“M”), followed by 2 light (“L”), and one day of spotting (*). They had medium blood loss on the 14th-16th of the month (Days 1-3 of their menstrual cycle), light Days 4-5, and spotting on Days 6, 30 and 31 of their cycle. Then medium blood loss signals their their next Day 1 at the end of this chart.
4. When are your actual fertile days?
Some women are working to optimize their fertility and want to know when to plan intercourse for conception. Others want to avoid pregnancy without using a hormonal contraceptive method like the birth control pill or an IUD.
Patients looking to avoid pregnancy are often relieved to find out that we actually have a short fertile window each month (see green area of graph above). Inputting your observations about your cervical mucus changes into the app will make it that much more sensitive at predicting your ovulation day. Our egg only survives about 24 hours after ovulation, but sperm can potentially live for 5 days. So intercourse 5 days before ovulation could potentially result in pregnancy.
5. What day exactly do you need to start using your period products?
Even if you have regular, 28-day cycles, knowing exactly when your period is coming is empowering. All of us menstruating people have had the experience of not being prepped. But my patients who track temperatures know that the day their temperature drops (see Figure above) is the day their period will show up. This can save us from embarrassing or inconvenient moments.
Another reason I think women may resist using the app I suggest is that they think it's going to be difficult to input their information and share the charts they create with me for us to interpret together. I can assure you this is not the case.
The picture below on the left shows how the Fertility Friend app looks to you when you input your data on your phone. The image on the right is what the software comes up with in response. This user simply clicked on the date, and input their temperature, their menstrual blood loss, and their symptoms.
I recommend inputting your temperature for that morning, and your blood loss, plus symptoms (if you’ve decided to track any), from the previous day. This keeps inputting to once a day, and it takes one minute.
To print your chart, click the share icon above your chart (see graphic below), then click Fertility Report Email under Printable Report, and then click Download.
Like everything, it gets easier with practice!
As I mentioned, I’ve been using Fertility Friend for 20 years, so when a study published in 2020 critically appraised menstrual tracking apps, I started to sweat about potentially having to switch my recommendations and my own habits! Then after reading the results, I was so relieved that Fertility Friend performed the best out of the free to use apps examined. Phew!