Menstrual Cycle and Basal Body Temperature in Endometriosis

Regarding basal body temperature and menstrual cycle?

Hello Doctor, I have been diagnosed with endometriosis and started taking Yaz Flex birth control pills on April 30, 2021.
I understand that this medication can be taken continuously for up to 120 days, but I have experienced light bleeding each month.
Therefore, I stopped taking the pills for four days and then resumed.
On August 9, 2021, after stopping the pills for four days and restarting, I suddenly felt some numbness in my hands and feet, which raised concerns about a possible blood clot.
I decided to stop the medication again in preparation for pregnancy on August 21, 2021, but I experienced bleeding again, resulting in two instances of bleeding last month, both due to stopping the medication.
I would like to ask how to accurately calculate my next menstrual period.
I experienced bleeding again on September 8, 2021.
If I calculate based on the date of August 21, 2021, my menstrual cycle seems too short.
I started preparing for pregnancy on August 26, 2021, and have been tracking my basal body temperature to determine my ovulation period, but my luteal phase is less than 10 days.
Can a chocolate cyst cause insufficient progesterone secretion? Or could it be related to just stopping the birth control pills affecting the short luteal phase? I initially thought the bleeding this month might be implantation bleeding, but the amount is almost the same as my regular menstruation, so it seems unlikely.
During the treatment for the chocolate cyst, I have been advised by a traditional Chinese medicine practitioner to take saffron along with Yaz Flex.
The right ovarian cyst has decreased in size from 5 cm to 4 cm.
Do you think this increases the chances of successful pregnancy? Four centimeters still seems significant.
If I attempt natural conception, is there a risk of ectopic pregnancy or cyst rupture affecting the baby? Would it be better to undergo surgery first? I apologize for having so many questions.
Currently, I am in Japan, and due to language barriers, I often have communication issues with Japanese doctors.
When I suggested trying for a natural pregnancy, the doctor was reluctant and preferred immediate surgery.
However, after observing that the medication has reduced the cyst size, they agreed to let me try for six months of natural conception, and if that fails, surgery will be performed afterward.
Lastly, I would like to ask if it is safer to freeze my eggs before or after the surgery, considering my condition.
Thank you, Doctor! I apologize for taking up so much of your valuable time.

Emily, 30~39 year old female. Ask Date: 2021/09/10

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if it is below 5 centimeters, generally observation is sufficient and surgery is not necessarily required.
If you want to conceive, just let things happen naturally and avoid taking contraceptive pills, as they may prevent pregnancy.
Wishing you good health.

Reply Date: 2021/09/10

More Info

Understanding the menstrual cycle and basal body temperature (BBT) in the context of endometriosis can be quite complex, especially when considering factors such as hormonal treatments, the presence of ovarian cysts, and the desire to conceive.
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, which can lead to various symptoms, including pelvic pain, irregular bleeding, and infertility. In your case, you have been taking Yaz Flex, a hormonal contraceptive that can help manage endometriosis symptoms by regulating menstrual cycles and reducing the growth of endometrial tissue. However, the experience of breakthrough bleeding while on this medication can be concerning and may indicate that your body is still adjusting to the hormonal changes.

When you stop taking hormonal contraceptives, your body may take some time to return to its natural cycle, which can affect your BBT and ovulation patterns. Typically, BBT rises after ovulation due to increased progesterone levels, and a sustained high temperature indicates a healthy luteal phase. If your high temperature phase is less than 10 days, it could suggest a luteal phase defect, which may be influenced by the presence of endometriosis or ovarian cysts, such as chocolate cysts (endometriomas). These cysts can disrupt normal ovarian function and hormone production, potentially leading to insufficient progesterone levels.

Regarding your concerns about calculating your menstrual cycle after stopping Yaz Flex, it is essential to note that the first day of your period after stopping the pill is considered day one of your cycle. However, if you experience irregular bleeding, it may complicate tracking your cycle. It’s advisable to monitor your BBT consistently to identify patterns that may indicate ovulation. If you notice a sustained rise in temperature, it may suggest that ovulation has occurred.

As for your question about the risk of ectopic pregnancy or cyst rupture while trying to conceive naturally, it is important to discuss these concerns with your healthcare provider. The presence of a 4 cm endometrioma could pose risks, but many women with endometriosis successfully conceive. However, the risk of complications, such as cyst rupture or ectopic pregnancy, should be evaluated based on your individual health status and the characteristics of the cyst.

If your healthcare provider is hesitant about allowing you to try to conceive naturally, it may be beneficial to seek a second opinion, especially if you feel that your concerns are not being adequately addressed. The decision to proceed with surgery versus attempting natural conception should be made collaboratively with your healthcare team, considering your overall health, the size and nature of the cysts, and your fertility goals.

Regarding egg freezing, it is generally advisable to consider this option before undergoing any surgical procedures that may affect your ovarian reserve. If you are planning to freeze your eggs, consult with a fertility specialist to determine the best timing in relation to your surgery and overall treatment plan.

In summary, managing endometriosis while trying to conceive requires careful monitoring of your menstrual cycle and BBT, open communication with your healthcare provider, and consideration of your options for preserving fertility. It is crucial to stay informed and advocate for your health, especially when navigating complex medical decisions.

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