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How to find the ovulation date after periods?

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Practicing since : 1999
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Hi, I used to have irregular periods due to low body fat which in turn caused some PCO symptoms. (presence of multiple follicles of 10 mm on ultrasound). Since I gained some weight I have had one regular cycle in the previous month. I am trying to track when my ovulation will occur (last month I had a 28 day cycle). I went for an ultrasound and on day 10 the largest follicle was 11 mm, on day 12 it was 15 mm and on day 14 it was 16 mm. Is the 1 mm increase in the span of 2 days too slow a pace for ovulation to occur? By the way I am not yet undergoing any treatment.

Thank you
Posted Wed, 21 Nov 2012 in Women's Health
Answered by Dr. Timothy Raichle 4 hours later
Hello, I would be happy to help you with your question today! I am sorry about the delayed response.

You are correct in that women with low body fat tend to NOT ovulate and NOT get there cycles with any regularity. This often occurs in extreme athletes and patients with eating disorders. Congratulations on getting to a more normal place with regard to your cycles!

Counting the first day of your cycle as day#1, then most women ovulate around cycle day #14 (assuming a regular 28 day cycle). Ovulation is accompanied by several measurable or noticeable symptoms:

1. A change in cervical mucus
2. Mid-cycle pain as one egg becomes larger and dominant
3. A surge in a hormone called LH (which can be detected using over-the-counter ovulation predictor kits)

In terms of looking at the follicular size as a predictor of ovulation, ultrasound can identify a large follicle as a round cystic structure that reaches a diameter of 16 to 30 mm prior to rupture and release of the egg. So with the follicle having reached 16mm on day #14, this very well might be normal given the range that I have presented. It may be that IF you were to look over the next few days, you might notice that it reaches between 20-25mm as it ovulates.

If you are not undergoing treatment, then the use of ultrasound to assess your cycles seems like "overkill". I believe it would be even more usefull to use ovulation predictor kits in conjunction with (or instead of) the ultrasound.

As far as the rate of growth of the cyst, this does sound appropriate in terms of the rate of growth, BUT, I am not sure what this is offering you in terms of making judgements about whether you are ovulating or not.

I hope that this discussion has not been confusing. Please ask me if you have any followup questions!

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