Fertility Awareness Method for Hypothalamic Amenorrhea

I’m a HUGE advocator for tracking your cycles using Fertility Awareness even when you have HA. I know what you’re thinking: but I don’t have a cycle to track?! Well, trust me, it’s valuable to start even without a cycle. But a caveat here, if you are not ready to track something or feeling totally overwhelmed by tracking, don’t do it. You’ll know when the time is right.

I coach plenty of women, both 1:1 and inside of The HA Society, to track their cycles both before they get that first period and most definitely once they do get it and are ready for their second one and beyond!

Tracking cycles during HA and the early months of HA recovery is helpful because seeing signs of progress in hypothalamic amenorrhea recovery can be pretty slow. A lot of the time it’s all unknown until the day we get a bleed. But that’s not true! There are plenty of signs that you can learn to identify.

By using cycle charting we can see if the lifestyle changes you’re making are having an impact to your:

  • Basal body temperature (BBT)
    We see this by taking your temperature because many HA’ers have lower-than-normal preovulatory temps. As we’re increasing food intake, adjusting meal times, gaining weight, de stressing and all that good stuff, we’re able to see if this is making a difference in your BBT. If we can see your basal body temperature get up to a baseline that is healthy for you, we know we’re on track.

    Naturally, tracking your BBT allows us to spot issues and know where to look for creating a custom plan just for you!
  • Cervical mucus production (CM)
    Our cervix produces mucus thanks to an increase in estrogen, and that mucus is actually the magical substance that keeps sperm alive while they await ovulation. When we’re not ovulating, we don’t see this mucus. When our body is preparing to ovulate, we do. So tracking mucus production is valuable.

Tracking allows us to closely monitor and track other major symptoms like breast tenderness and mood too. In general, we are really bad at self reporting and remembering what we’ve seen. This makes cycle charting really valuable for you as an HA’er, no matter where you’re at in your cycle.

Knowing how to chart correctly is the tricky part. Anyone who helps women with cycle tracking will tell you there’s a learning curve and working with someone to learn how to chart is going to help you skip the learning curve. This is especially true when you have HA because your charts won’t look how they look in the courses and textbooks. Those example charts and teachers are often not talking about women with hypothalamic amenorrhea.

We’re looking for subtle shifts in the data that tell us what might be keeping you in HA and what’s going to help you get it out. The data from charts can help us determine if we need to:

  • Get your body weight up
  • Increase your food intake
  • Adjust your eating schedule
  • Look at your stressors: caffeine intake, life stressors, lack of sleep
  • Do a nutritional assessment and see what’s missing from your diet

If you’re ready to try this on your own first, or just need a quick refresher, here are some tips to get you up to speed and charting correctly from the start.

Tips to Chart Well with HA

Choose your tools

Charts

I actually don’t use the apps, but many of my clients do. I chart using paper charts. You can buy this book by Fertility Friday which I love because it also has great information in the front of the book to help you interpret as you go.

One app I don’t mind that is free is Fertility Friend. You’re looking for a chart that shows a temperature spike that’s easy to read on a graph (we’ll get to this) and this app generates charts that show your temperatures nice and clearly.

Credit: Fertility Friend

Image courtesy of Fertility Friend – super easy to read visually

Some of the other apps don’t show the ebbs and flows of your temperatures very clearly and it can be hard to interpret easily. Additionally, if you’re working with someone else who is interpreting your charts, some of the charts are only really readable inside of the app so a third party interpreter is working a little blind. Consider this if you might be sending screenshots to friends, coaches or fertility doctors…

One of my clients charts – not as obvious to read visually.

You need to hover over the dates to see the temperatures and so it makes it hard. Fertility Friend generates a graph with all the dates and temperatures so it’s easy for the third party to give advice. Especially hand if you’re inside of The HA Society where members send me their charts regularly with questions. 

Thermometer

I use a simple, cheap drug store basal body thermometer. Just like with my paper charts, I simply prefer to do it all manually and be the person responsible for interpreting my own charts.

There are all kinds of fancy thermometers and even ones that are connected to apps like the Daysy. I don’t mind the apps and have helped plenty of women find success with them. However, if you’re going to use them keep in mind that they interpret your chart for you, so you’re not gaining as much of the life skill that comes with manual interpretation.

I also find that because these apps are really optimized for women with cycles that are generally pretty stable, not HA’ers, the algorithm can get a bit confused and confirm ovulation when we can see that actually it didn’t really happen. There is only so much these apps can interpret with math. AI isn’t quite there yet.

Tips for taking your temperature accurately

These tips are really important. I don’t think I’ve had one client that I haven’t had to troubleshoot wonky charts by revisiting these principals. Remember that if your charts are looking super weird, a large part of it is likely some kind of user error or something that can be optimized in the charting method first. We always visit these basics before going down the rabbit hole of “there’s something wrong with you!”

Note that these tips will only make sense to people with a basic understanding of charting already. If you want some help from the VERY beginning let me know and I’ll make that resource for you.

  • Take your temperature at the same time every day
    Ideally within 1-2 hours of your normal wake up time. So if you normally wake up at 7am but today you wake up at 6am or at 8am, that won’t make a huge difference. If you wake up at 4am on weekdays and sleep to 9am on weekends, that will show crazy spikes in your chart every 5 days. Crazy spikes like that can be interpreted by the apps as ovulation when really, you’re just sleeping in so your temp is higher.

    If I have clients who have a sleep schedule like this, we either have them still set an alarm for 4am to take the temperature and go back to sleep or we use temperature adjustment calculators. You just pop in your usual wake up time VS today’s time and temperature and it will calculate the likely difference. But remember this is NOT fool proof and ideally only for people who wake up a little outside of their wake up usual time.

    If you usually wake up at 6am but today you wake up at 3am and can’t go back to sleep, you’re honestly better off just skipping that day in my personal opinion and getting back to it the next day VS using the temp adjuster.
  • 5 consecutive hours of sleep before taking your temp
    This is hard to control, but ideally you’ve had 5 consecutive hours of sleep. It’s ok when doesn’t happen, we all wake up in the night. Just note on your charts that you did wake up and it wasn’t 5 hours of sleep. No worries, your temps won’t be WILD from a quick wake up but they might sit a little higher that day. Knowing this can help you identify why you might be seeing a spike in your temperature so you don’t assume something is happening that really isn’t.
  • Hold your thermometer in your mouth for 10 minutes
    This sounds like forever I KNOW. But seriously. I have had many girls show me their charts and it looks like a sawtooth and they think they have a thyroid issue. But in the end, it’s because your temperature reading isn’t stabilized yet.

    Think of those old thermometers before the digital ones were around. You had to hold those in your mouth for a while before the temperature would read. You couldn’t pop it in and out in 30 seconds.

    The reality is that digital thermometers are still the same. It takes a while for your mouth warm up the thermometer to get an accurate reading. So if you have one of those thermometers that beeps after 30 seconds or so, try holding it in your mouth for 10 minutes before you press the button to actually take the temperature.

    Let it warm up. If 10 minutes is a no go for your lifestyle, do as long as you possible can. You’ll see your temps stabilize and be MUCH easier to read. Pro tip: I set my alarm for 10 minutes early, my “temp alarm”, and then put it back in my mouth. Do my meditation, morning thoughts, fall back asleep…then the real alarm goes off and I take the temperature.
  • Don’t move around
    I can’t give all these temp tips without mentioning the importance of staying in bed while you take the temperature. If you get out of bed even to pee and immediately take the temp, it can screw up your reading. Truth be told some women don’t react as wildly to having got out of bed for a bit, but some do. You’ll probably learn which bucket you fall into over time but in the beginning we don’t know how your body will react so better just stay in bed until you’ve taken that temperature.
  • Alcohol will make your temperature spike the next day
    Just something to note.
  • Check for mucus all the time
    I find a lot of women report “not much cervical mucus”. It’s really common to start checking for mucus only by looking in your underwear when you go to the toilet. Know this: cervical mucus does NOT exclusively land in underwear. It has no idea what underwear even is.

    Cervical mucus will secrete from your cervix and come out while you pee or poop and when you wipe. This makes it easy to miss if you only look into your underwear. If you check diligently, it will become impossible to miss!

    Fold your toilet paper flat so there are no creases and wipe before you go to the toilet. Check for mucus on the toilet paper. Then, when it’s time to regularly wipe, do that and check your toilet paper again. Now you’re checking before you wipe, after and in your underwear.
  • Consistent low temperatures
    This is common in HA’ers and important. Your preovulatory temperatures (so all the temperatures before you’ve ovulated) should be at a minimum, 36.4C/97.5F. Postovulatory (after you ovulate) they should spike to a minimum of 37C/98.2F. So if you’re not seeing a period and noticing your temps are dropping below that, then you know that’s a tangible place for you to start working to improve with lifestyle factors.

Those are my have-to-know tips for trackers with HA (but really, all trackers).

Want to learn more about fertility awareness, hypothalamic amenorrhea, body image and all that good stuff?

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Published by Dani Sheriff

Host of The HA Podcast and Founder of The HA Society

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