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Cycles & Ovulation Pt.2

This is part 2 of an in depth explanation of menstrual cycles, conception and how it relates to gestational age.

Written by Options Nurse Manager- Louise Hall, RN

In the previous blog post, we looked at the menstrual cycle and the fertile window.  Keeping these things in mind, let’s take a look at the difference between gestational age and the date of conception.

When a woman is pregnant, doctors, nurses, and midwives routinely ask about the first day of her last period (FDLP).  Why is this?  Well, in the past, the FDLP was the most reliable way to determine how far along in a pregnancy a woman was.  The number of weeks and days since her FDLP is how the pregnancy was dated, and this was relayed to the patient as the estimated gestational age (EGA).  Using this type of dating, a pregnancy carried to full term will last 40 weeks.

Looking at the menstrual cycle though, it is highly unlikely that a woman would get pregnant on the first day of her last period.  Even though this is true, in the past, the FDLP was a concrete date that could be used not only to estimate how far along she was, but also when she would deliver.  Since the introduction of routine ultrasound use in pregnancy, however, it has been discovered that the FDLP can over- or under-estimate how far along a woman is by about a week.  Additionally, some women don’t track their periods closely, or their cycles could be irregular due to recent childbirth or breastfeeding, PCOS, or the use of hormonal birth control, and the FDLP reported may be a general estimate.  Currently, early ultrasound is considered the gold-standard for dating a pregnancy.

Let’s give a brief example. Say three women came to a pregnancy clinic on July 21.  All three women report that their FDLP was June 1st.  The first woman has the “text-book” cycle length of 28 days.  Assuming that this cycle was normal for her, she will most likely be 7 weeks 1 day pregnant by gestational age, and her baby would have been conceived about 5 weeks ago.  The second woman has a cycle length of 21 days.  Again, assuming this last cycle was normal for her, her gestational age could be 8 weeks 1 day, with her baby conceived about 6 weeks prior.  Finally, the third woman reports a 35-day cycle.  Her gestational age might only be 6 weeks 1 day, with conception occurring about 4 weeks prior.  All three women report the same FDLP, but they all could be at slightly different stages in pregnancy.

If there is such variation in pregnancy dating based off the FDLP, and if ultrasounds are the most accurate way to date a pregnancy, then why is the EGA still used when it’s based off of the FDLP?  In part, it probably is related to the fact that it is how pregnancy has been measured for generations.  But additionally, some women don’t receive an ultrasound in the early weeks of pregnancy, and once a woman is beyond 10-12 weeks EGA, the measurements are less precise and the FDLP becomes a more reliable way to date her pregnancy.  Unless the difference in EGA is substantial, if there is a difference in the date given by an U/S and a woman’s reported FDLP, the FDLP is considered more accurate.

Even though the guesswork in determining conception can’t be removed entirely, with a basic understanding of the menstrual cycle, the fertile window, and how gestational age works, it can be a lot less confusing.  While I learned the basics about the menstrual cycle in school, it wasn’t until after I had graduated that I learned more about the fertile window and the specifics of when conception could occur.  As women, it is good for us to understand the design of our bodies.  It can help us understand how to plan or prevent pregnancies without the use of hormones, if that is important to us, and it can help us recognize early if something unusual is going on that could warrant a visit to the doctor.

Monthly Cycles & Ovulation

This is part 1 of an in depth explanation of menstrual cycles, conception and how it relates to gestational age.

Written by Options Nurse Manager- Louise Hall, RN

As a nurse, I have been asked by multiple women what the “conception date” of their baby is.  This can be a confusing topic, especially if a pregnancy is dated at, say, six weeks, but she only reports having sex once about four and a half weeks ago.  So how can one determine when a baby was conceived?

First, we need to review a few things about a woman’s menstrual cycle.  Over a period of about 21-35 days, the hormones in a woman’s body fluctuate.  The menstrual cycle begins on the first day of her period.  Estrogen and progesterone levels decline, and the lining of the uterus sloughs off.  Bleeding can last anywhere from 2-8 days, with some women reporting shorter or lighter periods, and others longer or heavier ones.  As the uterine lining is shed, hormones start changing again, with estrogen levels rising, causing the lining of the uterus to thicken and an egg in the ovary to mature.  How quickly this happens after a period starts depends on each individual person.

Once the egg is ready to be released, there is a surge of hormones that cause the egg to leave the ovary and enter the fallopian tube.  This is called ovulation, and it is accompanied by a rise in the hormone progesterone.  At this point, the egg is ready to be fertilized.  If it is fertilized, it travels down the tube and implants in the uterus about a week after conception. The high levels of progesterone make sure the uterine lining is ready for this implantation.  But if fertilization does not occur, the egg disintegrates and is reabsorbed into the body.  About two weeks after the egg is released, the cycle ends, and a new cycle begins with the starting of another menstrual period.

The phases of the menstrual cycle are standard to all women of childbearing age, though exceptions do occur, such as with PCOS (polycystic ovarian syndrome), and changes that occur naturally as a woman is nearing menopause.  Additionally, there are typically about 14 days between when ovulation occurs and the start of her next period, with usually only a few days variation between women.  What varies most often is the length of time during the first half of the menstrual cycle.

For example, if a woman’s cycle is only 21 days long, she most likely ovulated around day 7 of her cycle.  On the other hand, if a woman’s cycle was 35 days, she probably ovulated closer to day 20.

The difference in when a woman ovulates makes a difference in when she is considered fertile.  The “fertile window” is the days during a menstrual cycle that a woman could potentially get pregnant if she is sexually active.  The fertile window is often considered to be 5 days before through 48 hours after ovulation.  There are two factors that are considered when identifying the “fertile window”.  First, sperm can stay alive in a woman’s body for up to 5 days, so even if a woman doesn’t have sex on her ovulation day, if she did within the previous 5 days, she could still conceive.  Additionally, the egg can stay alive for 24-48 hours after ovulation, so she is still able to conceive during the day or two after she ovulates.

Job Search Tips

“Where do I start?”

Looking for a job can be overwhelming. Here are some tips that can help get you started. Just remember, you don’t have to do everything all at once!


  • Don’t limit yourself to online applications. Contact companies directly and don’t be afraid to follow up.
  • Keep your resume to one page and stick to work experience that is most relevant to the job you’re applying for.
  • Always dress to impress. A good rule of thumb is to wear something that is one step above what the job’s dress code is. For example- if the job’s dress code is business casual, then you should wear something more on the business/formal side for the interview.
  • Set goals. For example; dedicate a certain number of hours each week to job searching and/or decide how many jobs you want to apply for each day.
  • Use https://www.loopcv.pro/ to automate the job application process for you and provide you with a list of jobs that fit your profile.
  • Create a LinkedIn account, update your job history and start connecting with people who are already in the career that you’re interested in.
  • While you’re searching for a job, volunteer or find an internship in the field you are interested in (https://www.internships.com/). You can add this to your resume and it will help with networking.
  • Use https://novoresume.com/ for easy resume building and templates.
  • Have someone you know and trust proofread your resume and/or cover letter. Especially if you know someone who is (or has been) in a hiring manager role before.

Marijuana And Pregnancy

Marijuana is the most commonly used drug in the United States. Marijuana use is a concern for individuals who are pregnant. Is it safe?

While many states have legalized its use for medicinal purposes, and several states, including Oregon, also permit it for recreational use, marijuana is still federally illegal.  Because of this, the regulations on its study are highly restricted and there are few experiments on its effects, both positive and negative.  Additionally, most of the studies that have been done used marijuana with THC levels equivalent to what they were in the 1980s or earlier.  THC levels have nearly tripled since that time, so it has been argued that the findings of these studies may not accurately report the risks associated with marijuana use by the average American today.

Many pregnant women report using marijuana to either manage anxiety or to deal with morning sickness. As we’ve mentioned before, there is little data to support it’s use to minimize morning sickness. We do know that studies have shown that higher doses of THC are linked to increased heart rate and anxiety and panic attacks, the opposite of the intended outcome.

When it comes to marijuana, many of its compounds can cross the placenta, so what the mother takes in, whether through topical application, ingestion, or inhalation, will affect her baby.  THC, the compound in marijuana that alters mental perception, is stored in fat, so it may accumulate in the baby’s tissues over time.  Additionally, smoking marijuana poses risks similar to those of smoking cigarettes.  Tar is present in smoked marijuana like it is in cigarettes, and some of the carcinogens found in cigarette smoke were found in higher concentrations in marijuana smoke.  Smoking marijuana has been linked to premature birth, increased rates of stillbirth, low birth weight, intrauterine growth restriction, and smaller head circumference. 

Marijuana use not only affects a baby in the womb, but it can affect the baby if the mother chooses to breastfeed as well.  The same marijuana components that cross the placenta also cross into the breastmilk of women who use marijuana.  The most significant of these is THC.  Because of the fat content in breastmilk, THC levels in breast milk can be higher than those measured in the blood plasma of the mother.  Additionally, THC can be detected in breastmilk up to 6 days after the mother’s last use.  Thus, even though the exposure to THC is lower in the infant than in its mother, the baby is still exposed to a significant amount of THC over time, especially if the mother uses marijuana on a regular basis.

Even with only a few studies being done to show the effects of marijuana on a pregnant woman as well as her unborn child, the information we do have shows that the possibility of marijuana having a negative effect are high. If you think you might be pregnant, schedule an appointment with us today for a free pregnancy test and if you have any further questions or concerns related to marijuana and pregnancy, and please do not hesitate to reach out to your doctor.


References:

ACOG. (2017). Marijuana use during pregnancy and lactation, Committee Opinion #72.

Ashton. (2018). Pharmacology and effects of cannabis: A brief review, British Journal of Psychiatry.

Avery, J. (2019). Marijuana: An honest look at the world’s most misunderstood weed, Christian Medical & Dental Associations.

Bertrand, Hanan, Honerkamp-Smith, Best, and Chambers. (2018). Marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk.

Bridgeman and Abazia. (2017). Medicinal cannabis: History, pharmacology, and implications for the acute care setting, Pharmacy and Therapeutics.

Centers for Disease Control and Prevention. (Accessed 12/2021). Marijuana and public health: What you need to know about marijuana use and pregnancy.

Di Forti, et al. (2019). The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study, The Lancet Psychiatry.

DOH, Government of the District of Columbia. (Accessed 1/2022). Medical cannabis: Adverse effects & drug interactions.

MedlinePlus. (2021). Marijuana, National Institutes of Health.

Nall, R. (2018). The effects of smoking weed while pregnant, Healthline.

National Academies of Science, Engineering, and Medicine. (2017). “Prenatal, Perinatal, and Neonatal Exposure to Cannabis”, ch. 10, pp. 245-266, The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.

National Academies Press. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research, National Academies Press.

National Institutes of Health. (2020). Marijuana research report: Can marijuana use during and after pregnancy harm the baby?.

Sohn, E. (2019). Weighing the dangers of cannabis, Nature, 572.

Substance Abuse and Mental Health Services Administration. (2021). Marijuana and pregnancy.


I Never Wanted To Be A Mom

Have you found yourself facing an unplanned pregnancy and asking yourself, “How did this happen? I have never wanted to be a parent.” It can be difficult wrapping your head around a pregnancy when this is something you told yourself would never happen.

As a teen I decided I didn’t want kids.

I had a front row seat to the deep pain and grief my parents experienced at the hands of my siblings. I vividly remember the tensions and the “I hate yous” that were thrown around along with the yelling and screaming that filled their conversations.
As I sat on my bedroom floor, trying to drown it out, I decided that I wouldn’t have kids. Why would I willingly open myself up to be hurt??

After graduating from college and getting married I became a nanny. My first position was with a family who had 3 young boys. It was a sharp learning curve to say the least, but it didn’t take long before those sweet kids worked their way into my heart.
I vividly remember driving to work one morning and this beautiful sense of pride came over me. I was incredibly proud of the littlest boy who was learning and growing by leaps and bounds every day. In that moment I knew that if I could feel this much emotion for a child that wasn’t mine, surely, I would feel it a thousand times more for one who was.

That was the day my heart began to open to the idea of having my own children.

Nearly 10 years later I now have 3 kids. I never would have guessed how much I’d love being their mom. Of course, there are days when I lose every ounce of sanity but never once have I regretted having them. They fill my days with wonder, early mornings, joy, frustration (which forces me to grow) and an abundance of love. One day they will likely make choices that break my heart, just like my siblings broke my parents’ hearts, but I know that because of the deep love I have for them, we will make it through every bump along the way.

We can’t predict our future and often what ends up happening is far greater then we ever imagined.


Navigating Relationship Differences

You know how they say “opposites attract”? That may be true, but attraction doesn’t equate to having the right tools to navigate a healthy relationship. Even if two people are extremely alike, they may not know how to handle conflict when it arises.

The reality is, that all couples will have conflict at some point. It is totally normal to disagree with your partner. It’s all about how you handle these disagreements that will make or break a relationship.


Seek first to understand. NOT to prove your point.

In conflict, it’s often our first response to think about what you’re going to say next or to think of ways prove your point. Make sure you are consciously making an effort to not only hear what your partner is saying, but trying to understand where they are coming from. Don’t talk over each other and keep your tone and volume at an even level as best as possible. Work as a team to solve the issue instead of going against each other. Try not to take things personally.

Understand that you each have a past and triggers.

We were all raised in different households with different families which means we all have a different idea of what’s “normal”. Whether you grew up in a healthy environment or a not-so-healthy one, we all have different triggers that we inherited at some point growing up. It’s important to know what those triggers are so that when they arise, you can recognize them and respond appropriately instead of letting your emotions get the best of you.

It is okay to call “Time-Out”.

Sometimes, naturally, arguments can escalate. When you notice that the discussion has gotten to a point that it is no longer productive, say “time-out”. If both you and your partner agree to both stop the conversation at that moment and take some time separately to cool off and then regroup, it will help keep things productive and respectful. It is important that you always come back together after a few minutes. Don’t use this as a way to give your partner the silent treatment but as a pause to take a moment to calm down.

Having good communication in a relationship takes work. No one is perfect, but healthy relationships acknowledge our imperfections and have grace.

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