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How Is First Day Of Menstruation Identified?

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Posted on Sat, 15 Nov 2014
Question: Can you please confirm:
1: If you start your period at 5pm is it classed as Day 1 of your cycle or is it the day after you class Day 1?
2: My GP did Progestorone test the Day 21 to confirm ovulation which came back at 30, he says I have ovulated and that is good, what should the range be from and too to know you ovulated?
3. Is the test good on day 21 as my cycle will either of been 26 days if day 1 of cycle is the day I started at 5pm or 27 days if you class day 1 as the day after.
4. FSH on Day 3 was 4.2
5. Do you see I conceive a baby naturally? I do have regular periods ranging from 25-27 days.

Many thanks for your help and I look forward to hearing from you asap.
doctor
Answered by Dr. Shanti Vennam (39 minutes later)
Brief Answer:
Detailed below.

Detailed Answer:
Hi,

Thanks for posting your query.

Here are your answers:

1. The first day when the bleeding is seen is classed as 'day 1', be it anytime of the day. Only if it happens at midnight, can you consider it to fall on the next day.

2. The Progesterone test is done to calculate the approximate day when ovulation may have occurred and also how well is the endometrial preparation done to receive an embryo should conception occur. A value of 30 nmol/l suggests that ovulation has occurred and also that the endometrial preparation is fine. Values more than this suggest the possibility of more than one follicle ovulating. A value of 3 nmol/l suggests that ovulation has not occurred while the range of 3-30 nmol/l suggests that ovulation has occurred either 10 days earlier or less than five days before, and if it did occur between 5-10 days earlier, the endometrium is not sufficient to hold any product of conception.

3. The test is good for cycles of 26-30 days. It is done 7 days post-ovulation. As mentioned earlier, day one is the day when you start bleeding or spotting.

4. FSH levels are assessed along with estradiol levels measured simultaneously and if these values are associated with low estradiol levels, then it is suggestive of good follicle function heading for ovulation.

5. If all other parameters like tubal patency, male factor etc. are normal, you have every chance for spontaneous conception. Please time unprotected intercourse around ovulation at least on alternate days. Ovulation usually happens two weeks prior to the onset of the next period.

Hope I have clarified your query. Please feel free to contact for further information. i will be happy to help.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shanti Vennam (11 minutes later)
So my progesterone level is good and suggests I do ovulate?
Everything else is fine with me and my husband but we are not consistent with intercourse.
Now I understand I do ovulate we are go to try harder and be more consecutive
doctor
Answered by Dr. Shanti Vennam (4 minutes later)
Brief Answer:
Yes, you are right.

Detailed Answer:
Hi,

Thanks for writing back.

Your progesterone level is good and indicates that you may have ovulated. Please pursue patiently as patience is often seen wanting in many couples trying for a baby.

Wish you all the best.

Please get back if you need any more clarifications. I will be ready to help.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shanti Vennam (7 minutes later)
It worries me as I am 39 that I won't conceive naturally
doctor
Answered by Dr. Shanti Vennam (17 minutes later)
Brief Answer:
With all normal parameters, need no worry.

Detailed Answer:
Hi,

Thanks for writing again.

Since you have all normal parameters, you need not worry about getting natural conception. The only fact here is that since you are at an advanced age, your ovary may contain lesser number of good ova and hence you should seek assistance earlier than those much younger, instead of wasting those precious ova.

Hope you understand the situation. It is time to manage things actively and not sit back and worry.

Hope your query has been clarified. Please get back if you need any more suggestions. I will be available to help.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shanti Vennam (5 hours later)
I really want to conceive naturally, do you really see this can happen for us? I am overweight but have lost 2 stone, currently weighing 16 stone 7 pounds, so currently still overweight but still trying to lose more weight. My husband has cut down from 30 cigarettes a day to 10 cigarettes and drinks within the alcoholic guidelines (lager or bitter) other than a Saturday.

I have seen a Gynaecologist who sees no problems in me conceiving and says I have a good egg reserve for my age. I have attached some reports to help you answer my questions. My Gynaecologist says I do not have PCO as my blood work is all good. My own GP is also not concerned. I am going to bed every night crying thinking I will never conceive naturally.

Please don’t ask my partner to have a semen analysis done as he doesn’t want this and says if it is meant to be it will happen naturally. Can I have an infertility check to see if I am in working order without my husband attending?

I usually have a regular bleeding pattern 26-28 day cycles. Never have pain or any kind of problem. This cycle I spotted on day 13 and 14, Clearblue fertility monitor went to 3 bars on day 17 and 18, but my cycle has been unusually long to 34 days, where I am on average 27 days. Is there something wrong with me or am I panicking too much? All I want is to get pregnant naturally, with no intervention is this possible?
At the end of the day all I want is to be a MUM, do you please see this possible my reports and see it can happen naturally?

I can’t afford anything privately it will have to be on NHS my own GP won’t refer me as he thinks I am panicking over nothing.

1. Is my FSH on day 3 of 4.2 normal?

2. Do you agree the fertility monitor is a good diagnosis for ovulating?

3. Do you see I can conceive naturally?

4. Can I have a infertility check for myself and if so how do I go about this?

5. Any suggestions please to help me achieve what I really want.

6. Am I stressing out too much?
If Clearblue fertility monitor shows 3 bars do I:

1. Ovulate
2. Release an egg
3. Should I conceive naturally
Everyone seems to be getting pregnant at the drop of the hat and poor me is still here trying. I want a baby so much.

Do you see I have PCO or do you see all be fine.
Another thing that confuses me is Fertility Monitor shows Ovulation, but Ovulation strips do not. I think I am getting myself into a Frenzy and should just use the Fertility Monitor and forget ovulation test strips. What are your thoughts please?
doctor
Answered by Dr. Shanti Vennam (25 minutes later)
Brief Answer:
Please attach reports.

Detailed Answer:
Hello,

Thanks for writing again.

Please attach the above mentioned reports so that I can comment further. Apart from this, I feel that there is no need to get too much anxious about conceiving naturally. You still have ample time and meanwhile continue with the regular exercise. Please also see that your husband comes off smoking and drinking completely as the quality of semen can be affected.

As per the reports mentioned, they are normal. Fertility monitors should be interpreted in the context of their practical application, which is not always possible. Ovulation can be confirmed only through visualization by follicular studies; ovulation tests can only detect the LH surge and they do not confirm ovulation.

Finally, I would like to say that every couple has a different fertility status based on several factors like medical implications, psychological aspects, frequency and timing of intercourse and so on. Please do not compare with others. Anxiety can badly hinder your chances of natural conception. You need not undergo any further investigation and if you wish to do so, the doctor would insist on couple testing, which you say is not possible. So, just fall back on natural methods for the time being before taking any further assistance.

Hope all your queries have been answered. Please contact if you need any more help. I will be glad to do so.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Shanti Vennam (4 minutes later)
My husband does have children so he should be fine. I know it is different with different couples. I will attach reports now. Thank you
doctor
Answered by Dr. Shanti Vennam (23 minutes later)
Brief Answer:
Sonogram may be repeated.

Detailed Answer:
Hi,

Thanks for writing again.

I have gone through the reports. The earlier sonogram revealed simple bilateral ovarian cysts which may have caused the inter-menstrual bleeding. The latter sonogram raised suspicion of polycystic ovaries.

In the current scenario, you may repeat the sonogram to see if the cysts are still persisting and if the ovaries are polycystic. To establish PCOD, further investigations like complete hormone profile, serum DHEAS levels, AMH levels and antral follicular count should be done. Management can be based on the findings.

Though your husband had children earlier, the quality of semen does not remain the same throughout life, it dwindles as age advances. Several techniques are available to improve the quality of the semen available for fertilization.

I would ask you to get some clarification after discussing with your consultant on further investigation needed and management. If PCOD is diagnosed, treatment can be ensued early on and this gives very good result. Please do not worry, the prognosis is good.

Hope I have clarified your query. Please contact if you need any more suggestions. I will be happy to help.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Shanti Vennam (1 hour later)
I have had all the above tests mentioned and my Gynaecologist discharged me as he was happy that everything was ok and I can conceive naturally
doctor
Answered by Dr. Shanti Vennam (8 hours later)
Brief Answer:
Wait for sometime.

Detailed Answer:
Hello,

Thanks for writing again.

If everything has been done and is fine, then you need not worry. Just wait and watch for natural conception to happen, while trying sincerely at least for six months. You can seek help later.

Hope all your queries have been clarified.

Wish you good health.

regards,
Shanti.V.
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
Answered by
Dr.
Dr. Shanti Vennam

OBGYN

Practicing since :1989

Answered : 7664 Questions

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How Is First Day Of Menstruation Identified?

Brief Answer: Detailed below. Detailed Answer: Hi, Thanks for posting your query. Here are your answers: 1. The first day when the bleeding is seen is classed as 'day 1', be it anytime of the day. Only if it happens at midnight, can you consider it to fall on the next day. 2. The Progesterone test is done to calculate the approximate day when ovulation may have occurred and also how well is the endometrial preparation done to receive an embryo should conception occur. A value of 30 nmol/l suggests that ovulation has occurred and also that the endometrial preparation is fine. Values more than this suggest the possibility of more than one follicle ovulating. A value of 3 nmol/l suggests that ovulation has not occurred while the range of 3-30 nmol/l suggests that ovulation has occurred either 10 days earlier or less than five days before, and if it did occur between 5-10 days earlier, the endometrium is not sufficient to hold any product of conception. 3. The test is good for cycles of 26-30 days. It is done 7 days post-ovulation. As mentioned earlier, day one is the day when you start bleeding or spotting. 4. FSH levels are assessed along with estradiol levels measured simultaneously and if these values are associated with low estradiol levels, then it is suggestive of good follicle function heading for ovulation. 5. If all other parameters like tubal patency, male factor etc. are normal, you have every chance for spontaneous conception. Please time unprotected intercourse around ovulation at least on alternate days. Ovulation usually happens two weeks prior to the onset of the next period. Hope I have clarified your query. Please feel free to contact for further information. i will be happy to help. regards, Shanti.V.