Other Charting Considerations

Continuous Discharge - Yellow Stamp Management

A woman who observes mucus every day, and experiences few or no dry days is advised to discuss her situation with a HRHP to get help in making sense of what she is observing.  We call this situation continuous mucus and it requires special management to indentify fertile and infertile days, as well as to rule out any serious health concerns associated with continuous mucus patterns. Experience has shown that by working with a HRHP a woman in this situation is able to learn to confidently identify her fertile and non fertile days, and her HRHP can facilitate her receiving any necessary medical referrals and/or care.

Part of the management for continuous mucus is the use of yellow stamps. Yellow stamps are used to indicate discharge that has been identified as infertile based on identification of a BIP (basic infertile pattern) within the continuous mucus discharge. Violet and purple stamps are used for identification of the "true" mucus pattern.  When a woman has cervicitis or cervical extropion, is breastfeeding or in the early weeks postpartum, or has recently stopped using hormonal contraceptives are the situations when a woman may experience a continuous mucus pattern. Each of these situations is discussed below.

Cervicitis and Continuous Discharge

Cervicitis is an inflammation of the cervix. Both the internal and external regions the cervix may be affected. Most commonly cervicitis is caused by an infectious organisms, that that may or may not be sexually transmitted. The continuous discharge a woman notices when she has cervicitis is a combination of cervical discharge produced by the cervix to protect itself, and other cellular products that are produced in the body’s attempt to fight the infection. Once the infection is healed the continuous discharge disappears. The type of mucus discharged in the presence of cervicitis is generally yellowish, and sticky-pasty or gummy. Cervicitis can be either acute or chronic. Chronic cervicitis may lead to cervical erosion, a condition in which the cervix becomes ulcerated and eroded.

A Cervical ectropion (eversion, pseudoeversion) is easily seen during a routine pelvic exam. They are most commonly seen among women who are teenaged, pregnant, using hormonal contraceptives, or are DES daughters. The internal cells the cervical canal invert to the outside surface of the cervix, and become exposed to the acidic vaginal environment. When these cells are exposed to this acidic environment they become irritated and inflamed. This causes the cervical crypts to discharge mucus to protect the cells—a self healing action on the part of the body. This protective discharge occurs most particularly during the non fertile days of the woman's cycle, when the Type E estrogenic cervical mucus with its alkalinizing ability is not present. Thus a woman with an ectropion will experience mucus discharge continuously throughout her cycle. The mucus that is discharge to protect exposed cervical cells may resemble peak type mucus, though tends to be less slippery and cloudy or opaque, and rarely crystal clear. Most cervical ectropions self-heal through a process called metaplasia, wherein internal cervical cells are replaced by external cervical cells. Sometimes a few internal cells remain on the outside surface of the cervix encased in mucous pockets, which are called nabothian cysts.

It requires careful assistance from her HRHP for a woman to differentiate her BIP while she awaits her body’s healing from cervicitis, cervical erosion, or ectropion. The HRHPs is trained to use a special set of criteria to help a woman recognize the difference between discharge due to cervicitis, ectropion or eversion and cervical mucus patterns associated with ovulation.

Essential sameness question - "Is today's mucus essentially the same as yesterday's mucus? 
Yes or No

The Essential Sameness Question (ESQ) is one management technique for women with continuous mucus discharge. It helps them identify their "true" mucus pattern. They will learn to understand and interpret their Basic Infertile Pattern (BIP). A "true" mucus pattern will be no longer than 9 days. Any other days where mucus is experienced may be identified as a basic infertile pattern. This must be clarified during follow-up with your HRH P. The woman singles out the days of her "true" mucus pattern by identifying the point in her cycle at which there is a change from one type of mucus to a different type of mucus. If sometime during that day she has experienced mucus, the question she asks herself at the end of the day before she charts, is: "has today's mucus been essentially the same as yesterday's mucus"? She may have experienced mucus the day prior or maybe two days ago. She must refer to the last day she had mucus when asking the essential sameness question. She answers the question Y-yes or N-no, and notes it on her chart with the rest of the day's observations. For this type of situation it may also be helpful for the woman to note on her chart both the most fertile sign of the day as well as the sign she saw the most often that day. This will help her and her HRHP at follow-ups to sort out a BIP. Usually by the time a woman has done 3 cycles of essential sameness question she will be able to identify with confidence her "true" mucus pattern.

Breastfeeding / Postpartum and Continuous Discharge

For two reasons a woman may experience continuous discharge during the breastfeeding or postpartum period: her cervix may still be healing from the delivery or there may be arousal fluid present.

If a woman's cervix has been damaged during the birthing process it may take several weeks or even months to heal. Until then a woman may be instructed by her HRHP to use yellow stamp management to interpret her fertile and non fertile days.

Part of the body's response to the suckling action of the baby at the breast is the production of arousal fluid. Since a child may be nursed many times a day in the early months it is possible to mistake this arousal fluid for cervical mucus. With the help of her HRHP she can learn to recognize the difference between arousal fluid and cervical mucus.