JS#8 S€¦ · charting is a good, working thermometer. I definitely recommend the digital kind that rounds to the nearest tenths degree (ex. 98.5° instead of 98.52°) If you are

BBTCHARTING Unders tand ing your body

and menst rua l cyc le

th rough basa l body

temperatu re char t ing .

An Eas te rn and Weste rn

medic ine approach

ALL ISON LOCKE , R .TCMP , FABORM SEA OF QI HEALING

introductionBasal body temperature (BBT) charting is an easy, effective, andinexpensive way to pinpoint hormonal imbalances, determine menstrualcycle phases, monitor treatment progress, and read the body through itsthermogenic language. As someone who has dealt with irregularmenstrual cycles and hormonal imbalances since puberty, BBT chartinghas provided me with essential physiological information that served asclues that helped me unravel the hormonal mysteries of my body andlight the path to balance and healing. Whether you are struggling withyour fertility, trying to conceive now or planning to in the future, trying toavoid pregnancy, or just curious about the inner workings of your body,BBT charting can help you translate the seasons of your menstrual cycleand empower you to be proactive about your health.

disclaimerThe information provided in this e-book is not meant to diagnose, cure, or treat anydiseases. It is not a substitute for medical care, treatment, or advice and I highlyrecommend working with a family physician or trusted professional healthcare providerbased on your findings to determine proper treatment.

the menstrual cycleBefore we get into the details of BBT charting, it’s important to understandthe basics of the menstrual cycle. The menstrual cycle is divided into fourphases, the menses/bleeding phase (days 1-5), follicular phase (days 1-13),ovulation (roughly day 14), and the luteal phase (days 14-28). The follicular phase is the first half of the menstrual cycle, where thepituitary gland secretes the hormone FSH (follicle stimulating hormone)to send the message to your ovaries to start producing and maturingfollicles in preparation for ovulation. These maturing follicles graduallysecrete more and more estrogen, which, once it reaches a certain level,sends the message for your pituitary gland to release LH (luteinizinghormone), which is secreted for 24-36 hours and triggers ovulation tooccur. The phase of your cycle after ovulation is called the luteal phase, whichtypically lasts 14 days before your next period. After your ovary hasovulated, the ruptured follicle forms what is called a corpus luteum, whichsecretes the hormone progesterone. Progesterone is a thermogenichormone, meaning it has an impact on the temperature regulatingcenters of the hypothalamus. Progesterone is an incredibly importanthormone for maintaining the uterine lining for pregnancy. This rise inprogesterone after ovulation is what we are measuring with BBT charting.The drop in progesterone after the disintegration of the corpus luteumtriggers the degradation of the endometrium (uterine lining) and thus aperiod.

the menstrual cycle in chinese medicineIn Traditional Chinese medicine, the menstrual cycle is divided into twomain parts, the yin phase, and the yang phase. Yin correlates to dark,quiet, cool, and still. Yang is bright, loud, active, and warm. They representthe duality that exists in everyone and everything, including themenstrual cycle. The yin phase (follicular phase) is correlated with the risein estrogen and the formation of follicles in the ovary and growth of theuterine lining. There is also an increase in cervical mucous at this time asovulation approaches, as yin manifests as physical fluid in the body.Ovulation is the turning point of the yin phase transforming into the yangphase. The yang phase is the luteal phase of the menstrual cycle, wherethe thermogenic hormone progesterone warms the basal bodytemperature to sustain the uterine lining in case of implantation of anembryo. And lastly, the menstrual phase serves as the shift of the yangphase back into the yin phase and the cycle repeats.

bbt basicsBasal body temperature charting records the temperature of the body

upon waking. It is called basal because it is measured when the body is at

rest and the metabolism is at its baseline. The only requirement for BBT

charting is a good, working thermometer. I definitely recommend the

digital kind that rounds to the nearest tenths degree (ex. 98.5° instead of

98.52°) If you are recording in Celsius, a thermometer that reads numbers

in the hundredths may be helpful (36.45° instead of 36.4°).

Take your temperature as soon as you wake up after at least 3-4 hours of

consistent sleep. It’s best to take it at the same time each morning, or at

least within the same half hour for consistent readings (ex. every morning

from 7am to 7:30am). A general rule of thumb is to subtract 0.1° F/0.05° C

for every half hour later you wake up, and to add 0.1° F/0.05° C for every

half hour earlier you wake up.

Avoid getting out of bed, going to the bathroom, talking too much, or

cuddling a partner in bed before taking your temperature as it may cause

temperature shifts. Use the same thermometer for your entire cycle. Start

charting on the first day of your cycle (the first day of your period). Record

your numbers on a paper chart or a period app (I like Clue, Flo, Kindara,

and Natural Cycles). Of course you can also chart the old school way with

pen and paper, but using an App tends to be easier since they chart the

graph for you and may even draw the coverline and pinpoint when

ovulation occurred.

For more detailed information on charting your cycle (especially the pen

and paper kind), I recommend reading Taking Charge of Your Fertility By

Toni Weschler.

signs of ovulation- Increase in basal body temperature- Increased libido- Egg white, stretchy cervical fluid- Mild cramping or pain in the lower abdomen- Spotting- Breast or nipple tenderness- A positive LH strip 24-36 hours before- Heightened sense of smell- A high, soft, and open cervix

things that impact yourtemperature Some of the things listed below may cause a wonkytemperature. If you suspect something may haveinfluenced your reading, make a note next to it in orderto identify the pattern. - Alcohol- Sickness- Travel or jet lag- Thyroid disorders- Strenuous exercise- Sudden weight change- Medications and drugs- Physical or emotional stress- Sleep disturbances (restless sleep, insomnia etc.)- Using a heating pad or electric blanket

what bbt charting can tell you-When or if you are ovulating-Best times to avoid sex when not trying toconceive- Best times to try to conceive-When you are fertile and infertile during yourmenstrual cycle-Various potential health and gynecologicalconcerns (lack of ovulation, luteal phase defect,possible cysts, etc.)- Possible pregnancy- When to expect your period

fertility awareness method

Basal body temperature charting is a tool often used in conjunction with

cervical mucus observations for the Fertility Awareness Method (FAM). If

you are interested in learning more I highly recommend reading the book

Taking Charge of Your Fertility by Toni Weschler.

USING BBT TO GET PREGNANT: I encourage my patients to try to

conceive every other day during their fertile window (about 5 days before

the suspected ovulation, and the day of ovulation) and also the day of a

positive LH strip test/OPK. 

USING BBT TO AVOID PREGNANCY: You are potentially fertile the 5 days

leading up to ovulation (because sperm can survive in the body up to 5

days) and the day of ovulation itself. Once you record a positive ovulation

with at least 3 days in a row of higher temperatures, you are usually safe

for the remainder of your cycle. Other fertility signs such as cervical

positioning and cervical mucus are additionally important tools when

avoiding pregnancy before ovulation. During the fertile window and

ovulation, additional barriers such as condoms are required. I recommend

learning more about the Fertility Awareness Method for more accuracy

for avoiding pregnancy naturally.

interpreting your chartCharting your cycle can be tricky at first, and it can take a few cyclesuntil you get the hang of it and are able to see the fluctuating patterns.In general, we are looking for a biphasic pattern that separates thefollicular phase and the luteal phase with ovulation.

initially high follicular phase

If your temperature takes 2-3 days to fall back down to typical folliculartemperatures (below 98.6°F or 36°C it can indicate an obstruction of thetransformation of the luteal yang phase to the next follicular yin phase.This could possibly indicate endometriosis, where there is incompleteshedding of all the endometrial tissue thus obstructing the yang phase toyin phase of the menstrual cycle.

low follicular temperature

The follicular phase is typically below 98.6°F or 37°C. Below 36°C or 96.8°Findicates a low metabolic rate and possibly low thyroid activity, which canhave a negative effect on fertility and pregnancy. Ask your doctor to testyour TSH, free T3, and free T4. You may also have symptoms such asfatigue, weight gain, constipation, and sensitivity to cold. In Chinesemedicine, this pattern typically indicates a yang deficiency, andincorporating yang boosting factors such as moxibustion, warming herbalmedicine, and food therapy may help. Avoid cold and raw foods (ice water,raw fruits, salads) and incorporate more warming foods (sweet potato,cinnamon, chai or jasmine tea, chicken, lamb, ginger, walnuts etc.). Keepyour feet warm and incorporate regular physical exercise into your lifestyle.

high follicular temperature

High follicular temperatures, such as 36.6-36.9°C or over 97.6°F, can be dueto a variety of reasons such as stress, fever, lack of sleep, and alcohol. Ifthey are consistently high throughout the entire follicular phase this couldindicate higher metabolism (and possibly hyperthyroidism). In Chinesemedicine this indicates heat generating from many possible differentsources (liver qi stagnation creating friction and fire, yin deficiencygenerating deficiency heat, etc.). You may also notice scanty cervicalmucous. Acupuncture and Chinese herbal medicine are wonderful forclearing heat in the body. Avoid alcohol, caffeine, stress, lack of sleep,repressing emotions (like resentment and anger). Make sure you arestaying hydrated and eat cooling foods (fruit, green veggies).

unstable follicular phase

Temperatures through the follicular phase shouldn’t vary by more than0.3°C, or 0.5°F. Causes of fluctuations can be fever, sleep, or alcohol,changes in weight, exercise, or travel.  This pattern typically indicates liveror heart fire in traditional Chinese medicine. Focusing on stressmanagement techniques is crucial for this pattern, as is meditation anddeep breathing techniques to activate the parasympathetic nervoussystem. The treatment principles would be to clear heat, calm the mind(shen), and reinforce yin. If your chart is erratic throughout the whole cyclewithout a clear biphasic peak, it is likely that ovulation is not occurring atall. Usually it’s temporary, but if it occurs for more than three cycles in arow, consult with your primary healthcare provider. Medical causes offrequent annovulation could include hypothyroidism, PCOS, endometriosis,hyperprolactinemia, or primary ovarian insufficiency or failure.

short follicular phase

A follicular phase that is 10 days or shorter may be due to high FSH levels,which cause the follicles to ripen and ovulate too quickly (before they arefully mature). This may indicate poor ovarian reserve, and testing of FSH(follicle stimulating hormone), Estradiol, and AMH (anti-Müllerianhormone) may be helpful with diagnosis. In Chinese medicine, a shortfollicular phase is often due to yin deficiency with heat provoking earlyovulation. Avoiding alcohol, getting enough sleep, avoiding caffeine,regular acupuncture, cooling and nourishing Chinese herbs, and diettherapy can be helpful. Avoid hot spices and include yin tonifying foodssuch as organic soy products, asparagus, eggs, black beans, and blacksesame seeds.

long follicular phase

Follicular phases vary from person to person, ranging from 12 to 18 days canbe completely normal. However if ovulation does not occur until cycle day21 or longer, then it is worth looking into. Polycystic Ovarian Syndromeshould be ruled out with ultrasound and bloodwork, as well as anemia(with testing of ferritin, hemoglobin, and hematocrit). A long follicularphase could indicate decreased blood circulation to the uterus. In Chinesemedicine, this could indicate insufficient building blocks of the body’shormones causing slow follicular growth such as blood, kidney jing, orkidney yin. High stress levels can also delay ovulation so managing stressand cortisol levels with exercise and meditation may be helpful.

ovulation

Ovulation can be determined by arise of 0.4-0.5°C or 1°F. Sometimes,your temperature will drop suddenlyjust before ovulation due to the largeamounts of estrogen being secretedby the dominant follicle in the ovary.24-36 hours before ovulation occurs,a spike in LH (luteinizing hormone)may be picked up by a positive LHstrip or OPK (ovulation predictor kit)test. This may also be when younotice other signs of ovulation suchas breast tenderness or egg whitecervical mucus.

low luteal temperature

Ideally your temperature should rise 0.4-0.5° Celsius or 1 full degreeFahrenheit. A low luteal temperature rise indicates inadequateprogesterone secretion by the corpus luteum after ovulation or lack ofovulation at all. In Chinese medicine a low luteal phase temperaturerepresents a deficiency of kidney yang to propel the body’s warming yangenergy to a sufficient temperature. In Chinese medicine, this patterntypically indicates a yang deficiency, and incorporating yang boostingfactors such as moxibustion, warming herbal medicine, and food therapymay help. Avoid cold and raw foods (ice water, raw fruits, salads) andincorporate more warming foods (sweet potato, cinnamon, chai or jasminetea, chicken, lamb, ginger, walnuts etc.). Keep your feet warm andincorporate regular physical exercise into your lifestyle

slow luteal rise

A slow luteal rise means it takes a few days before your temperature risesto an adequate level post ovulation. It should only take one or two days foryour temperature to rise the necessary 0.4-0.5° Celsius or 1 full degreeFahrenheit. This pattern usually means there is inadequate progesteronesecretion by the corpus luteum after ovulation. It indicates a variety ofpatterns that ultimately stem from kidney yang deficiency (but may alsoinclude spleen qi deficiency, yin deficiency, or liver qi stagnationdepending on an individual’s pattern). Again this type of chart typicallyindicates a yang deficiency, and incorporating yang boosting factors suchas moxibustion, warming herbal medicine, and food therapy may help.Avoid cold and raw foods (ice water, raw fruits, salads) and incorporatemore warming foods (sweet potato, cinnamon, chai or jasmine tea,chicken, lamb, ginger, walnuts etc.). Keep your feet warm and incorporateregular physical exercise into your lifestyle.

short luteal phase

The luteal phase should preferably last at least 11 or 12 (even up to 15 or 16 isconsidered normal). If it lasts 10 days or shorter, then the corpus luteumwas not strong enough to produce a sustained amount of progesteronethat is necessary for implantation to occur. Even if you are not trying toconceive, having a short luteal phase is indicative of a hormone imbalancethat can have negative effects on one’s health. If the temperature rises foronly a few days, then ovulation cannot be confirmed at all. This pattern isindicative of kidney yang deficiency arising from a yin deficiency. InChinese medicine, many patterns are interrelated, and TCM theory statesthat yang is ultimately derived from the yin, and if yin is deficient, theremay not be enough substance to establish a healthy yang energy. Kidneyjing, yang, and/or yin tonic herbs may be helpful to improve the quality ofovulation as well as regular acupuncture sessions. Fertility drugs likeprogesterone may be helpful in this case. Supplementing the kidney yinstrongly in the first half of the cycle may also help a stronger kidney yangin the second half of the cycle.

long luteal phase

If there are positive signs of ovulation (temp rise, positive LH strip) and asustained temperature rise for longer than 14 days, then pregnancy islikely. Some people have luteal phases that are naturally 15 or 16 days longwithout pregnancy but it is uncommon.

early luteal phase decline

The luteal phase should have sustained high temperatures for as close to14 days as possible until the start of the next period, when the temperaturethen drops to follicular phase levels. If the temperature drops a few daysbefore the period starts, this could indicate inadequate progesteronesecretion from the corpus luteum. Sometimes premenstrual spotting isalso evident with this pattern. In Chinese medicine this usually indicatesspleen qi deficiency with kidney yang deficiency. In this case acupunctureand herbs that boost the spleen qi and warm the kidney yang are utilized. Moxibustion and warming herbal medicine, and food therapy may help.Avoid cold and raw foods (ice water, raw fruits, salads) and incorporatemore warming foods (sweet potato, cinnamon, chai or jasmine tea,chicken, lamb, ginger, walnuts etc.). Keep your feet warm and incorporateregular physical exercise into your lifestyle. For spleen qi deficiency, avoidanything too cold, raw, oily, or anything with dairy. Things that support themicrobiome and gut health as well as avoiding excessive worry andrumination (the emotions that damage the spleen) are great for boostingspleen qi.

unstable luteal phase

An unstable luteal phase is usually evident when the temperature eitherrises at ovulation and then continues to rise and drop throughout the restof the cycle (Sawtooth Pattern), or when there is a sudden and predictableplunge in temperature that occurs roughly one week after ovulation(Saddle Pattern). The Saddle pattern is due to a second, smaller surge ofestrogen during the luteal phase that may cause a sudden drop in BBT.Both of these patterns represent instability of the heart and liver qi alongwith kidney yang deficiency. Heart and liver qi instability refers to the“shen” in traditional Chinese medicine, or the mind spirit, which often hasemotional roots. This instability can manifest in the follicular phase, theluteal phase, or both. If the luteal temperatures or higher than normal for aluteal phase, heart or liver fire may also be a contributing factor. Stressrelieving practices like meditation and breathing techniques are wonderfulfor liver qi and heart qi instability. Incorporating enough downtime andrest is incredibly important. Yang boosting factors such as moxibustion,warming herbal medicine, and food therapy may help. Avoid cold and rawfoods (ice water, raw fruits, salads) and incorporate more warming foods(sweet potato, cinnamon, chai or jasmine tea, chicken, lamb, ginger,walnuts etc.). Keep your feet warm and incorporate regular physicalexercise into your lifestyle

troubleshooting What if I’m on hormonal birth control pill (ie the pill, hormonal IUD)? Inthis case you will not be ovulating and will not be able to record a biphasicchart.

What if I work night shifts? You shouldstill take your temperature upon wakingup after your longest, most restful sleepof the day, even if it’s late afternoon orevening.  If your shift work is variablethen temperature charting may not bethe most accurate tool for you.

What about traveling through time zones?Still take your temperature as soon as youwake up after 3-4 hours of restful sleep nomatter when that is during the day or youroriginal time zone. Just make a note that itmay be higher or lower than usual. If youtravel consistently throughout your cycle,temperature charting might not be the mostaccurate tool for you.

I’ve just come off the birth control pill, what should I expect of my BBTchart? Your ovulation may come back right away and be regular, or it maytake a few months to regulate. In addition, the pill can cause false hightemps up to several months after discontinuing. You may also notice thatyour luteal phase is shorter than it should be. This should resolve with time.If it doesn’t, consult with your general healthcare practitioner.

I’m getting bleeds but not a temperature rise, what’s going on? If yourtemperature is erratic throughout the whole cycle without a clear rise of atleast 0.4-5 degrees Celsius or one full degree Fahrenheit, it is likely that youare not ovulating at all. These periods re actually “estrogen breakthroughbleeding”, where your lining has built up over time and due to gravityrather than progesterone secretion, the lining is broken down and a bleedoccurs. I would recommend consulting with your general healthcarepractitioner if this occurs regularly.

about meAllison Locke is a licensed Acupuncturist and a registered member ofthe College of Traditional Chinese Medicine Practitioners andAcupuncturists of British Columbia as well as a fellow of the AmericanBoard of Oriental Reproductive Medicine. She is currently practicing as apractitioner of Traditional Chinese Medicine and Certified LaserTherapist at Acubalance Wellness Centre in Vancouver, British Columbia.

would you like to work with me further?

I’m currently available for appointments at Acubalance Wellness Centre inVancouver, British Columbia. I am also available to do free 15 minute phoneconsultations.  Please call 604-678-8600, visit acubalance.ca, or [email protected] for booking information.

references

Lyttleton, J. (2013).  The Treatment of Infertility with Chinese Medicine.Oxford: Churchill Livingstone. Weschler, T. (2015). Taking Charge of Your Fertility : the Definitive Guide toNatural Birth Control, Pregnancy Achievement, and Reproductive Health.New York: William Morrow, An Imprint Of Harpercollins.

ALL ISON LOCKE , R .TCMP , FABORM