Variations of the Cycle and Reproductive Health

Teaching the Billings Ovulation Method Part 2
Evelyn L. Billings and John J. Billings

5. Normal Fertile Cycle: Long Delayed Ovulation

Oestrogen fluctuations stimulate cervical mucus from time to time without ovulation. When this occurs, there is no progesterone rise and no Peak. Raised oestrogen levels stimulate the endometrium which bleeds. When the level is high, this bleeding is called breakthrough bleeding and when the oestrogen level falls, it is called withdrawal bleeding.

Common Occurrences

• Stress

• Breast-feeding

• Pre-menopause

• Post-Pill

Occasional Occurrences

• In some women normal cycles may be very long due to infrequent ovulation.

Management

• Establish BIP (dry in this example).

• Apply Early Day Rules for avoidance of pregnancy.

• Alternate evenings of dry days are available for intercourse.

• Apply the rule 'Wait and see 1, 2, 3' to all changes--see asterisks, Chart 7: (a) mucus; (b) mucus and bleeding; (c) bleeding not preceded by the Peak.

• When the Peak occurs, apply the Peak Rule. Note: any unexplained bleeding should be investigated.

Basic Infertile Pattern

The Basic Infertile Pattern is a pattern that reflects a basic low level of oestrogen in the early part of the cycle (before the Peak). As soon as the oestrogen level rises sufficiently the cervix responds and the mucus begins.

Under some circumstances, e.g. nearing the menopause, or damage caused by the contraceptive Pill, the cervix fails to respond to raised oestrogen and so produces no mucus capable of sperm survival. The BIP continues irrespective of ovulation. Conception is not possible.

Chart 7. Delayed ovulation in a normal fertile cycle. The record begins in the pre-ovulatory phase. Note application of the rule 'Wait and see, 1 2 3'. On five occasions (*) in the cycle, the pattern returned to the BIP and the rule 'Wait and see, 1 2 3' was applied. On day 42 the rule 'Wait and see' was applied and on day 46 the Peak was recognised and the Peak Rule was applied.

1	2	3	4	5	6	7	*8	9	10	11	12	*13	14	15	16	17	18	19	*20	21
dry	dry	dry	dry	dry	dry	dry	wet	dry	dry	dry	dry	wet	wet	dry	dry	dry	dry	dry	sticky	sticky
												High oestrogen Breakthrough bleed		Low oestrogen					Raised oestrogen.
Oestrogen (E1G: nmol/24hrs)   E1G baseline __ __ __
----	----		----	----		----	----				----	----	----						----	----
Progesterone (PdG: µmol/24hrs)   PdG confirms ovulation __ __ __
----	----	----	----	----	----	----	----	----	----	----	----	----	----	----	----	----	----	----	----	----
22	23	24	25	26	27	28	29	30	*31	32	33	34	35	36	37	38	*39	40	41	42
sticky	sticky	sticky	sticky	dry	dry	dry	dry	dry	wet	wet	wet	dry	dry	dry	dry	dry	wet	dry	dry	wet
No normal progression of mucus. No Peak.				Low oestrogen					Annovulatory withdrawal bleed (not menstruation) Low oestrogen
----	----	----						----	----	----	----	----	----	----			----		----	----
----	----	----	----	----	----	----	----	----	----	----	----	----	----	----	----	----	----	----	----	----
43	44	45	46	47	48	49	50	51	52	53	54	55	56	57	58	59	60	61	62	63
slippery	slippery strings spotting	slippery strings bleed	slippery	sticky opaque	sticky opaque	sticky opaque	dry	dry	dry	dry	dry	dry	dry	dry	wet
	High oestrogen. Pre-ovulatory breakthrough bleed.		Oestrogen fall	Progesterone rise			High oestrogen. High progesterone.				Oestrogen and progesterone fall.				Menstruation (withdrawal bleed), low oestrogen and progesterone
----	----	----	----	----	----	----	----	----	----	----	----	----	----	----
----	----	----	----	----	----		----	----	----	----	----	----		----	----

Reference: Evelyn L. Billings and John J. Billings, Teaching the Billings Ovulation Method Part 2. Variations of the Cycle and Reproductive Health, Ovulation Method Research and Reference Centre of Australia, pp. 14-15,  Melbourne, 1997

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