It takes about seven days after ovulation for implantation to occur, so a luteal phase shorter than this makes pregnancy unlikely. Ideally, you need the luteal phase to last around 14 days," says Dr.

According to the American Society for Reproductive Medicine, a typical luteal phase lasts 12 to 14 days but can range from 11 to 17 days. Clinically detected luteal phase deficiency is defined as a luteal phase lasting less than 10 days. Other signs of a luteal phase defect include spotting and repeated early miscarriages.

The solution often lies in fertility drugs like Clomid clomiphene or progesterone suppositories. So, if you are diagnosed with a luteal phase defect, know that it's typically a treatable problem, and you'll likely have little trouble conceiving once it's corrected.

Interestingly, research also shows that while short-term fertility may be lessoned for those with a shorter luteal phase, conception rates after 12 months of trying are often similar to those with longer menstrual cycles.

Spotting between periods can happen from time to time. But if you're experiencing regular spotting before your period starts every month or having lots of breakthrough bleeding between cycles, your hormone levels may be slightly off balance. Spotting is more common during the first few years after your period starts and as you approach menopause.

Or alternatively, if estrogen levels are too high," explains Dr. If you're having lots of mid-cycle bleeding, you might consider trying an at-home hormone test and taking the results to a health care provider.

They can review your test results and determine what type of treatment you might need to increase your chances of getting pregnant. Numerous things could be at play if you are having regular periods but not getting pregnant.

Missed periods, abnormal flow, cycle length, and spotting are all period symptoms that could signal an underlying issue affecting your fertility. The good news is once a problem is identified, you can work to remedy it. What causes amenorrhea? Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Heavy menstrual bleeding. Centers for Disease Control and Prevention. American College of Obstetricians and Gynecologists.

Menstrual cycle length and patterns in a global cohort of women using a mobile phone app: Retrospective cohort study. J Med Internet Res. Your menstrual cycle. Office on Women's Health. Diagnosis and treatment of luteal phase deficiency: A committee opinion American Society for Reproductive Medicine.

Prospective evaluation of luteal phase length and natural fertility. Fertil Steril. Use limited data to select advertising. Create profiles for personalised advertising.

Use profiles to select personalised advertising. Create profiles to personalise content. Use profiles to select personalised content. Measure advertising performance. Measure content performance. Understand audiences through statistics or combinations of data from different sources.

Develop and improve services. Use limited data to select content. List of Partners vendors. Digital self-tracking, compared to paper-based tracking or memory-relying surveys, supplies standardized records and scalable collection methods.

Typically, digital self-tracking of fertility-awareness body signs offers an interesting option for clinicians or researchers interested in changes of a variable of interest for example level of pain or occurrence of a given symptom across the menstrual cycle, or in the overall changes in menstrual rhythmicity.

For investigations requiring a precise assessment of hormonal levels or ovulation timing, additional tests would be necessary until the accuracy and precision of methods using FAM digital records can be established. The long term and yet very precise recordings presented in this study support the idea that the menstrual cycle, like other biological rhythms, is a vital sign whose variations inform about overall health status.

Models could also be established to investigate potential sub-fertility causes anovulation, recurrent early pregnancy losses, etc. More generally, such data and tracking apps, combined with tracking of other coexisting symptoms, health indicators or behavioral markers, enable the exploration of the menstrual dimension of the course of chronic diseases.

Many menstrual symptoms associated with the pre-menstrual syndrome PMS , such as mastalgia breast pain , or disease, like migraine that can exist in a menstrual or non-menstrual form, have been shown to be associated with steroid hormones although the exact causes have not been elucidated yet.

distinct forms of symptom expression in the population. It is likely that users of such applications already have an increased awareness of their cycles, and this study suggests that these digitally self-tracked observations potentially present an opportunity to facilitate the dialog between patients and their clinicians, helping them to make informed decisions based on quantified indicators.

Extended Materials and methods can be found in the Supplementary Materials. To briefly summarize the methodology used in this study: datasets were first filtered to keep cycles of users using the apps for fertility awareness purposes, i. to self-identify their fertility window, for at least 4 cycles.

Data were then aggregated to describe the overall observation patterns. Finally, a Hidden Markov Model HMM was defined and used to detect ovulation time and assess the reliability of this estimation.

Two de-identified retrospective datasets were acquired from the Symptotherm foundation www. org ; Switzerland and Kindara www. com ; US upon receiving ethical approval from the Canton Geneva ethical commission CCER Genève, Switzerland , study number — These two apps were selected as they both ranked high in a study comparing the performances of apps marketed to avoid pregnancy using FAMs, 11 as their privacy policies specified the use of their de-identified datasets for research purposes and as their user pools were very large or diverse geographically and culturally.

Sympto was released in and is available worldwide in eight languages English, French, German, Italian, Spanish, Polish, Russian, and Bulgarian. Kindara has been released in and is available worldwide in English.

Both organizations de-identified their datasets before transferring them to the authors. Both apps are available on iOS and Android platforms and are available as free simplified or paid apps. All features used in this study are available in the free versions of the apps.

Kindara provided a random subset of their overall pool of users with at least 4 logged cycles users, 2,, cycles while Sympto provided observations from their long-term users at least 4 cycles tracked with the app and from users who provided their weight, height and menarche age 13, users, 79, cycles.

Both apps offer similar FAM tracking options but differ in their design and user experience Supplementary Fig.

A description of the datasets fields is provided in Table 2. Kindara K is primarily marketed to women who wish to achieve pregnancy and does not provide feedback to users in terms of the opening or closing of their fertile window.

Sympto S is marketed as a family planning tool that can be utilized to plan or avoid a pregnancy. The Sympto app provides feedback to their users based on their observations, indicating when they are potentially fertile, very fertile or infertile.

The key differences between these two apps are i the algorithmic- S vs. user- K interpretation of observations, ii the per-cycle S vs. per-user K definition of fertility goals users wish to achieve, iii the criteria for the onset of a new cycle, i. self-assessed or automatic, based on first day of reported bleeding K , and iv the resolution at which users can report their observations Table 2 , Supplementary Material.

Given that these are self-tracked data, missing data is a frequent issue, and many cycles within the datasets provided by the app were not suitable for the analyses of this study. We followed an iterative approach in which we first inspected the raw datasets and identified patterns or behavior that were inconsistent with the aims of the study for example, on-going cycles.

Finally, the HMM was used to estimate ovulation and, for the reports of cycle length, follicular and luteal phase durations, only cycles in which ovulation could reliably be estimated were kept Fig.

Sympto: 39, cycles; Kindara: , cycles denote cycles of regular users of the apps in which FAM body signs have been logged. Typically, cycles with long tracking gaps or in which only the period flow was logged were excluded. S defined as ovulatory cycles by the STM algorithm of Sympto, i.

K cycle length was at least 4 days longer than the total number of days in which bleeding was reported. Detected temperature shift was at least 0. The uncertainty on the ovulation estimation as provided by the HMM framework developed here was lower than ±1.

For each standard cycle, the tracking frequency was computed as the number of days with observations in that cycle divided by the length of the cycle. For both app, observations of all standard cycles were summarized by cycle-day. For the temperature, as the important feature to detect if ovulation has occurred is the relative rise in temperature, a reference temperature was computed for each cycle.

This reference temperature was identified as the 0. Relative temperature measurements were then computed as the difference between the logged temperature and this reference temperature. The distribution at a resolution of 0. The FAM body-signs are considered to reflect the hormonal changes orchestrating the menstrual cycles.

The study was focused on understanding the extent to which these tracked cycles were consistent with previously described menstrual cycle physiologic changes, and the extent to which it was thus possible for app users to estimate timing of ovulation.

Hidden Markov Models HMM are one of the most suitable mathematical frameworks to estimate ovulation timing, due to their ability to uncover, from observations, latent phenomenon, which in this use include the cascade of hormonal events across the menstrual cycle.

HMM have also been previously used for analysis of menstrual periodicity. The HMM as implemented in this study describes a discretization in 10 states of the successive hormonal events throughout an ovulatory menstrual cycle.

The HMM definition includes the probabilities of observing the different FAM reported body signs in each state emission probabilities and the probabilities of switching from one state to another transition probabilities.

Emission probabilities were chosen to reflect observations previously made in studies that tested for ovulation with LH tests or ultrasounds, 6 , 8 , 27 while transition probabilities were chosen in a quasi-uniform manner Supplementary Material.

The ovulation estimations were robust to changes in transition probabilities but not to variations in emission probabilities Supplementary Fig. Once the model was defined, the Viterbi and the Backward—Forward algorithms 47 were used to calculate the most probable state sequence for each cycle Supplementary Material and thus to estimate ovulation timing, i.

Finally, a confidence score was defined to account for missing observations and variation in temperature taking time in a window of ~5 days around the estimated ovulation day Supplementary Material.

The ten states, defined as a discretization of the hormonal evolution across the cycle further details in Supplementary Material , are:. Further information on research design is available in the Nature Research Reporting Summary linked to this article.

Data are however available from the authors upon reasonable request and with permission of Sympto and Kindara. Lamprecht, V. Natural family planning effectiveness: evaluating published reports.

Article CAS PubMed Google Scholar. Peragallo Urrutia, R. et al. Effectiveness of fertility awareness-based methods for pregnancy prevention. Google Scholar. Marshall, J. Cervical mucus and basal body temperature method of regulating births field trial.

Lancet , — Article Google Scholar. Moghissi, K. Prediction and detection of ovulation. In: Modern Trends in Infertility and Conception Control eds Wallach, E.

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Duane, M. The performance of fertility awareness-based method apps marketed to avoid pregnancy. Board Fam. Dreaper, J. Women warned about booming market in period tracker apps - BBC News. BBC Moglia, M. Evaluation of smartphone menstrual cycle tracking applications using an adapted applications scoring system.

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Perfect-use and typical-use Pearl Index of a contraceptive mobile app. Identification and prediction of the fertile window using Natural Cycles. Health Care 20 , — Alvergne, A. Do sexually transmitted infections exacerbate negative premenstrual symptoms?

Insights from digital health. Health , — Pierson, E. Modeling individual cyclic variation in human behavior. Liu, B. The World Wide Web Conference. Barron, M. Expert in fertility appreciation: the Creighton Model practitioner. Neonatal Nurs. Templeton, A. Relation between the luteinizing hormone peak, the nadir of the basal body temperature and the cervical mucus score.

BJOG Int. Article CAS Google Scholar. Case, A. Menstrual cycle effects on common medical conditions. Spencer, E.

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Lenton, E. Normal variation in the length of the follicular phase of the menstrual cycle: effect of chronological age. Normal variation in the length of the luteal phase of the menstrual cycle: identification of the short luteal phase.

Presented at the Thirty-Second Annual Meeting of the American Fertility Society, April 5 to 9, , Las Vegas, Nev. For example, a patient may want to discuss the length of her cycle or her experiences with pain or extreme bleeding during her cycle.

In addition, tracking the cycle is key to predicting ovulation, which can inform decisions about when to have sex, whether the intent is to avoid pregnancy or become pregnant. Women and couples become more familiar with the signs of ovulation and the pattern of the menstrual cycle to understand how to plan sexual activity to avoid pregnancy or become pregnant.

Fertility awareness-based methods FABM involve a woman learning to recognize the signs of her fertile days, which are the days of each month in which she is most likely to become pregnant conceive. Based on her intentions, she may plan to have unprotected sex during this time in order to conceive, or she may choose to avoid pregnancy by not having sex or by using a barrier birth control method, like condoms, during this time.

Infertility is defined as not being able to become pregnant after having regular intercourse sex without birth control after one year or after six months if a woman is 35 or older. Infertility is common. Out of couples in the United States, about 12 to 13 of them have trouble becoming pregnant.

About one-third of infertility cases are caused by fertility problems in women and another one-third of infertility cases are due to fertility problems in men.

The other cases are caused by a mixture of male and female problems or by problems that cannot be determined. Most cases of female infertility are caused by problems with ovulation. Ovulation problems can be caused by hormone imbalances from a variety of causes.

Although less common, blocked fallopian tubes can also cause female infertility. If the fallopian tube is blocked due to infection, surgery, or other problems, then sperm cannot reach the egg to fertilize it.

Other less common causes of fertility problems in women can include physical problems with the uterus or uterine fibroids , which are non-cancerous tumors made of fibrous tissue and muscle cells that develop on the walls of the uterus.

There are a few different causes for male infertility. Erectile dysfunction is when a man cannot get or keep an erection get hard for sex.

Without an erection, it is difficult for a man to release sperm inside the vagina — and, therefore, difficult to get a woman pregnant. These big veins heat and cool the testes.

The average cycle is Researchers at University College London teamed up with a contraceptive app called Natural Cycles to analyze more than , menstrual cycles of more than , anonymous app users based in the United States, United Kingdom, and Sweden. Aimee Eyvazzadeh.

Kimberly Gecsi , program director of OB-GYN at University Hospitals Cleveland Medical Center, sees the same unnecessary concern from patients. With much of the current generic fertility advice based on the inaccurate assumption that a day cycle is standard and healthy, women are set up to worry unnecessarily, according to Eyvazzadeh.

Since ovulation, which takes place halfway through a cycle, is so important for pregnancy, concerns can often stem from struggling to conceive. After getting married, Kim Arseneault went off birth control and started trying for her first child with her husband.

But after tracking her ovulation closely, it turns out the myth of the day cycle was to blame. She says the assumption that she was ovulating based on a day cycle not only caused feelings of self-doubt, but meant a slightly longer road to pregnancy.

Alyse Gray started tracking her cycle because of a diagnosis of premenstrual dysphoric disorder PMDD , which causes severe pre-menstrual depression and anxiety. Her suggestion to pinpoint ovulation: monitoring your basal body temperature BBT with an easy-to-use tracking device.

Spotting is lighter than a period and may indicate that you have an underlying condition. Call your doctor if you experience abnormal vaginal bleeding. Learn when a light period is nothing to worry about, and when it may be the sign of something more serious.

After ovulation, some women have a shorter luteal phase, making it harder to get pregnant. Here are the causes, symptoms, and treatment options.

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Unsure about taking a bath or shower when you're on your period? Here's why it's no big deal. Narrative texts were applied around the themes, with verbatim quotes used to illustrate the text and effectively communicate its meaning. This study received human subjects approval from the Institutional Review Board at the University of California, San Francisco, USA and Jaramogi Oginga OdingaTeaching and Referral Hospital Ethical Review Board, Kenya.

Participants gave written consent. The study involved adolescent mothers, mothers aged 20—49 and fathers all who had children below 5 years.

Adult women were on average 25, adult men 35 and adolescent women 18 years old Table 1. More men completed secondary or tertiary education than women.

All respondents were Christian. Adult women had a mean of 2. A majority of the inhabitants were involved in fishing, small scale entrepreneurship or subsistence farming as sources of livelihood.

A small proportion of the residents were in formal employment such as teaching, nursing, civil service and other services. Poverty levels were high with most of the residents surviving on less than a dollar a day.

Respondents received most of their information through school, non governmental organizations NGOs , family or friends. Friends were the most common source of information for women, who at times received accurate information from friends, more so than from school.

Commonly, when a girl first started getting her menses, other girls told her that this meant she could now become pregnant. As is clear in the quote from the following woman, confusion mixed with underlying shame made it hard to reach out to friends for information and support:.

I would want to hide it from her my friend because I feel embarrassed. It is just embarrassment because the first day I talked to her about it I did not know what was happening to me. I could hear us being taught but I did not think I had reached that age. So I was forced to ask her.

She explained to me and told me I had attained that age and so every month I would have my periods and in case I missed my periods any month it would mean I had become pregnant.

Maria, 28, married woman, 2 children. Women also mentioned talking with other women about menstruation, and its link to fertility, most frequently co-wives or sisters.

I normally ask her co-wife because she gets pregnant frequently hence make her have many children. I do ask her why she gets pregnant like almost immediately after delivery. And she tells me that immediately after delivery she gets her monthly period.

I talk to her about such kinds of things and I tell her that after giving birth to my baby who is 8 years now, I stayed 4 years without getting my monthly periods Mona, 25, married woman, 3 children. Women who felt that they had not received information blamed lack of close female friends or relatives, for example, in the quote below where a woman lived with her grandmother and therefore did not have information until she learned about it in school.

The problem is that I grew up with my grandmother and she never told me anything about menstruation. At times a girl could soil her dress then I would ask to know what happened.

But the school contributed a lot in teaching me about menstruation. Akoth, 23, Married woman, 3 children. A few men discussed how they learned about menstruation from their wives.

A few described how, since they had been married at such a young age, they were already married when their wives first experienced menses and they told their husbands about it, so they learned of it then too.

Other men mentioned male friends and elders as key sources of information. I asked one of my friends if women experience menses and he told me that women must experience menses. Every month a woman must experience menses and a woman who is not experiencing menses could be having a problem, you need to take her for treatment.

I then asked him that what problem could be there. John, 25, married man, 1 child. One man discussed in detail the information that he had received in school, which was actually misinformation about the relationship between menstruation and pregnancy.

R: In school we were being taught during a subject called health science. We were told that when a woman is on her menses, a few days to end the menstrual cycle if she engages in sexual intercourse with a man then she can get pregnant… When she is about to clear her menses.

I: You were taught in health science that if a woman finished her menses immediately after that if she engages in sex then she can get pregnant? R: We usually talk, in fact even when this one began and went on for one week, I told him my period had gone on for a whole week in the previous month and this month I had not got my period.

He told me to just wait. R: No, he lives far. We meet once in a while. But when I first started having my period he knew the dates; if I told him he would know. After delivery I hear your cycle can change. R: He would tell me when I know my period is close I should not visit him [laughter] because anything can happen.

Another potential source of information about menstruation, especially the link between fertility and menstruation could have been at health facilities, or even at the time of antenatal care visits ANC or delivery.

However, in our study while most women were asked about their LMP during their first ANC visit, they received no other related information, even why they were being asked that question. Younger women were more likely to go to their first ANC visit later in pregnancy, and they cited denial about being pregnant, fear of being scolded by staff or being attended to by male staff, and a general belief that people looked down upon them if they went to the health facility too early, as reasons not to go.

The reason why I feared to go for ANC when I was expecting my baby, is that there were male staff at the facility. I was imagining that I was going to find the same male staff there, so it was making me more worried.

When I was expecting baby in , I just remembered the male staff and it was not easy for me. But when I came I found there were some changes …The male staff were not there, there were sisters, and they were sisters that you can even share with them your ideas.

Auma, 21, married woman, 2 children. I went to the clinic later when the pregnancy was 5 months…. I was afraid because I was going to a certain clinic in Kibera and they were very harsh…The clinic staff, they wanted the exact date when one conceived, which I did not know.

And that is what made me fear. That is what made me take long I went after 3 months then stayed much longer before going back. Awino, 24, married woman, 2 children. Although most respondents knew there was a relationship between menstruation and pregnancy, accuracy of information was very poor.

A few respondents did generally have the correct information, however, they were a little unsure and hesitant about the exact details. As one woman explained:. There are some days after your menses that you cannot get pregnant, they are called safe days something of the sort.

Achieng, 31, married woman, 1 child. Most respondents believed women could become pregnant during menstruation or in the few days before and after.

She always tells me when she is experiencing menstrual cycle. Ojwang, 25, married man, 1 child. Another man explained that he also believed women could become pregnant the few days before her menstruation, as well as during and after.

R: To get pregnant for a mother in that menstrual period, with my understanding it is before seeing that blood and after seeing that blood before seven days.

R: It is that before the mother sees that blood, the blood will come and by that time it is still not bleeding and maybe you are having sex and it will find when that egg is mature and in that pregnancy maybe an outcome. Sometimes the woman has experienced periods and has completed the periods, but before seven days after ending the periods, she can also conceive at that time.

Odhiambo, 26, married man, 2 children. Interestingly, men and women acknowledged some confusion about the relationship between the timing of menstruation and when a woman could get pregnant, discussing how they had heard different information from various sources.

Some men are the ones who do say that if a woman is experiencing her menses that is the time he needs to have sex with her to make her pregnant and some are saying that when she is on her menses she is dirty, such that he cannot have sex with the woman.

Women also expressed fear and stigma about their menses, especially fear that it would occur while they were at school or other public settings. When we were going to school some girls could have blood stains at the back of their dresses and that used to worry me a lot.

There was a time when I had gone to visit my Aunt and it happened to me. I: You have said that whenever a girls dress would be stained at the back it would cause you a lot of worries. R: It was worrying because at times it could happen when you are in class and the boys would make fun of it so I used to imagine that the same thing would happen to me.

Mona, 25, married woman, 3 children. Many women tried to track their menstruation, primarily calendars. Some men and women both said that they memorized the date. Some women specifically asked their partners to help them remember the date.

Additionally, many women struggled with irregular periods and some stated that they did not know the date of their last menstrual period LMP when they became pregnant, highlighting the need for support for women in tracking their periods. R: Safe days I think being a woman they know how to calculate this, they know the time they are safe.

R: It is important if you are free with your wife talking to her, both of you are free with each other and she can tell you anything on her body and you can also tell her anything on your body, but I think it is important for one to know.

When you know time she is experiencing her menses, then you have sex and she get pregnant and you know that date she has gotten pregnant, you know there are women who are not even aware when they get pregnant and the pregnancy will come as a surprise to her until she is told by other women that are you pregnant and she will say that I am not pregnant.

One woman discussed that her husband thought she was using her period as an excuse and made her show him the evidence blood before believing her. Women were interested in simple tools to track menstruation, and highlighted a need for privacy.

Many women were interested in simple tools like a journal or calendar on paper that they could mark in, with some noting that illiterate women could potentially use that. Some women already used their phones, by setting an alarm although other women felt that an alarm was a potential breach of privacy.

Some had concerns of a phone because could easily be lost or stolen or that someone else could see phone, including children, who were seen as more technology savvy. You know our kids nowadays they have become active especially on phones because they would want to know almost everything and they would want to know everything on the phone.

Otieno, 35, married man, 5 children. Other respondents saw the benefit of a phone since it was something they already had and were using, and that it had the potential to provide other types of health related information as well.

A few respondents even gave suggestions about how a phone could be used to help women, as described below. Yes when you hear that alarm ringing in the phone and you see the picture of a moon indicating, it will act like a message, when you open that message you get all the information that you should be prepared like this, this is what the menstruation period says, you should act like this, you should be clean, pads it tells you like that.

Oguda, 26, married man, 2 children. Overall, however, due to privacy concerns and lack of comfort, most female respondents felt that something like a calendar that they could mark more privately and more easily hide would be more beneficial to them.

Additionally, few respondents had smart phones, and therefore even if there was a mobile option, it would have to be very simple. Notably, a few of the adolescent mothers worried that their parents would be suspicious of something unusual on their mobile phones, and therefore felt that it was not a safe option.

Furthermore, the source of information is not often a health provider or school, but rather family or friends. Our findings support other studies from LMICs that women most often seek information from female family members, and that these relatives, as well as other sources such as teachers in schools, are not able to provide accurate information [ 21 ].

Better education to both men and women, perhaps through standard approaches of school, but also utilizing times when women are already at health clinics, such as for ANC, could help improve understanding.

The current school curriculum taught in Kenya introduces basic human reproduction or sexuality related content in upper primary levels and secondary education detailed reproductive health education is covered. This relates to knowledge on sexuality and high rates of pregnancy among early education drop outs compared to those with secondary and higher education.

More detailed information may be needed in both primary and secondary schools on these topics. The first ANC visit, since LMP should already be discussed, may be a missed opportunity to educate women about why providers ask about, and the importance of, gestational age. The time of delivery, family planning or any other postpartum visits which should occur but rarely do could also provide opportunities to provide women more detailed information about their fertile window and menstruation more generally.

However, much information already needs to be covered at all of these health care visits, potentially limiting these visits as viable information exchange opportunities. Fear of poor person-centered interactions with health care providers, or past negative experiences, appear to be contributing to late ANC attendance, and can impact future health care utilization, again highlighting the need to consider other avenues for education.

Community level health workers and facilities and social networks are currently the dominant source of information, so finding mechanisms to improve knowledge among the nodes of social influence is key. Previous studies have called for strengthening community health workers, however, there is little evidence as to the efficacy of this approach [ 21 ].

Our findings add to the existing literature on stigma around menstruation, which previously was collected only from adolescent girls—this is clearly an issue that spans age and sex.

Thus, approaches to provide support to women must include both options of privacy as well as opportunities to engage their partners if desirable. Addressing stigma and gender norms early on with younger generations could help improve the situation for couples in the future. It is essential to challenge the pervasive wave of excitement about mobile technology to ensure that such approaches are appropriate for women today for the specific health need.

Perhaps in the future, as gender norms and stigma around these issues fades, there will be an even greater opportunity to provide support to women through mobile technology. Lower tech options also have great potential to be socially acceptable, easily adapted, and cheaply and widely disseminated and scaled up.

Lower tech options should not be neglected as we think about how to best provide information and support to a diversity of women today. That being said, tools such as mobile phones for helping women and potentially their partners track menstruation are of interest to people in this setting.

Fears about privacy still persist, and the phone overall feels like a more vulnerable method to most respondents. This highlights the need for personal codes or other carefully designed tools that will ensure privacy.

Despite the potential for mobile phones to provide this resource, in this population and for this topic, careful consideration must be given to design. As with all research, there are limitations to these findings. Data were collected only from one ethnic group in one region of Kenya, and therefore may not be representative of views and experiences of men and women in other communities in other parts Kenya, especially urban areas, or to remote parts of the country.

Additionally, all respondents already had children, so they may have had higher knowledge or lower than respondents who did not. Also, all respondents had a preterm birth, so might be different, and likely more at risk of having low information about menstruation, than other respondents.

Finally, we did not capture the perspectives of male adolescents, who may have more interest in smart phone technology and also differing levels of knowledge than older males or adolescent women. Simple tools, both mobile and not, to help women track menstruation, capitalizing on health care contacts and addressing norms and knowledge through social networks have potential for improving knowledge and practices about menstruation and fertility.

In our study setting in rural Western Kenya, the smartest option might be very low-tech, and must take into account both technology itself but also comfort with that technology by the population of interest.

Empowering women and men in rural setting with accurate information could help reduce unplanned pregnancies and aid in identifying preterm births, as well as providing women with awareness and knowledge about their bodies and health, aside from pregnancy and childbirth.

The authors would like to acknowledge the generous support of the Preterm Birth Initiative at the University of California, San Francisco, funded through the Bill and Melinda Gates Foundation.

We would also like to thank Nicole Santos and the rest of the Preterm Birth Initiative team at UCSF for their support. Finally, we would like to thank the participants of the interviews for their time and sharing their experiences.

Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Article Authors Metrics Comments Media Coverage Peer Review Reader Comments Figures. Abstract An understanding of menstruation and its relationship to fertility can help women know the gestational age of any pregnancies, and thus identify preterm births.

Introduction Understanding the relationship between menstruation and fertility is essential for helping women and their partners plan pregnancies and avoid unintended pregnancies [ 1 , 2 ]. Methods and materials This qualitative study was carried out in among the communities around the shores of Lake Victoria in Bondo, Siaya County, Western Kenya.

Results Demographics The study involved adolescent mothers, mothers aged 20—49 and fathers all who had children below 5 years. Download: PPT. Sources of information about menstruation Respondents received most of their information through school, non governmental organizations NGOs , family or friends.

As is clear in the quote from the following woman, confusion mixed with underlying shame made it hard to reach out to friends for information and support: I would want to hide it from her my friend because I feel embarrassed.

Maria, 28, married woman, 2 children Women also mentioned talking with other women about menstruation, and its link to fertility, most frequently co-wives or sisters. I talk to her about such kinds of things and I tell her that after giving birth to my baby who is 8 years now, I stayed 4 years without getting my monthly periods Mona, 25, married woman, 3 children Women who felt that they had not received information blamed lack of close female friends or relatives, for example, in the quote below where a woman lived with her grandmother and therefore did not have information until she learned about it in school.

Akoth, 23, Married woman, 3 children A few men discussed how they learned about menstruation from their wives.

John, 25, married man, 1 child One man discussed in detail the information that he had received in school, which was actually misinformation about the relationship between menstruation and pregnancy. I: When she is about to clear her menses?

R: I mean if she clears today and tomorrow if she has sex then she can get pregnant I: You were taught in health science that if a woman finished her menses immediately after that if she engages in sex then she can get pregnant?

I: Do you talk to him boyfriend about your monthly period? He told me to just wait I: You told me you use a calendar. Does your boyfriend help you track your period? After delivery I hear your cycle can change I: So how would he react when you would tell him about your menses before you delivered?

R: He would tell me when I know my period is close I should not visit him [laughter] because anything can happen I: What did he mean by that? R: We can get a baby Sharon, Adolescent mother, age 18 Another potential source of information about menstruation, especially the link between fertility and menstruation could have been at health facilities, or even at the time of antenatal care visits ANC or delivery.

Auma, 21, married woman, 2 children I went to the clinic later when the pregnancy was 5 months…. Knowledge about the relationship between menstruation and pregnancy Although most respondents knew there was a relationship between menstruation and pregnancy, accuracy of information was very poor.

Achieng, 31, married woman, 1 child Most respondents believed women could become pregnant during menstruation or in the few days before and after.