As fertility progressively declines, ovulation tends to become irregular and infrequent with subsequent irregularity of menstruation.

There may be variations in cycle length both pre and post-ovulatory, the presence or absence of ovulation, or shortening of the luteal phase. The temperature shift will vary accordingly.

Menstrual loss will vary from scant to very heavy bleeding which could result in anaemia and fatigue. The cervical mucus diminishes in quantity and loses its fertile characteristics in many cycles.

A typical pattern of infertility will be recognised - persistent dry days are most common, but other women will have persistent moistness, an unchanging pattern of secretions.

Variations in cycle length

• Average length cycles

• Shorter cycles than usual (23 days or less)

• Very long cycles

• Ovulation may occur early resulting in an early temperature shift

• Ovulation may be delayed resulting in a delayed temperature shift

• Shortened post-ovulatory or luteal phases (8-10 days or less)

• Menstrual loss will be varied

• Monophasic cycles shown by the absence of a temperature shift

• Varied length - often persistent dryness throughout

• Bleeding is normally very light

• Persistent dryness is most common

• A basic infertile pattern (BIP) of moistness - (constant, unchanging pattern for at least 2 weeks)

• Increasing numbers of dry days as mucus production decreases

• Occasional sticky mucus patches during otherwise dry days

• Decreasing amounts of slippery stretchy mucus

• Mucus pattern starting very early

• Very short mucus build up prior to temperature shift

• Variations in shift day dependant on cycle length and length of pre and post-ovulatory phases

• Monophasic chart in anovulatory cycles

There may be variations in the amount and regularity of menstrual loss:-

• Heavy prolonged bleeding with clots

• Sudden brief or more prolonged episodes of bleeding or flooding

• Bleeding may be very light

• Spotting may occur either between periods or in place of a true period

• A true period follows ovulation. It is preceded by a temperature shift 10-14 days earlier.

• Any other bleeding may be associated with oestrogen activity, and increased fertility

Important note -
If periods are getting further apart, shorter and lighter then there is generally no cause for concern.

But if periods are getting closer together, longer and heavier, or if there is any bleeding between periods, medical advice must be sought.

Menstrual disturbance may be due to hormone imbalance, but it should always be investigated as there are many other causes.

Any woman who experiences vaginal bleeding more than one year after her last menstruation should seek medical advice.

Fertility awareness during the pre-menopausal years enables a woman to understand cyclic changes.

By recording her mucus symptom and daily temperatures she can see why her period may be delayed, identify the type of bleeding and monitor her declining fertility

Pre-menopausal cyclic irregularity Two consecutive 16 week pre-menopausal charts recorded by a 46 year old woman.

Note the irregularity of the cycles Using an extended coverline, some cycles are biphasic and others are monophasic.

Post-menopausal infertility 5 years later there is only one biphasic cycle in June.

Following this there are six cycles without further signs of ovulation.

There are periods of blood loss, but very little mucus. As this woman is over 50 with 6 anovular cycles, she will no longer be fertile so can stop charting.

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