HOW TO USE FERTILITY MONITORS LIKE OPKS, MIRA, INITO — IN WAYS THAT WORK
I LOVE using hormone monitors — just not the way you think.
So, just today I peed on a MIRA stick and felt genuinely excited about what it would tell me. Not because I worship at the altar of biohacking, or think data is better than lived experience. But because I already knew what was happening in my body and I was pumped to use technology to confirm and share that info with my doctor to really dial in my Hormone replacement treatment (HRT).
You can do similar things for fertility! But, let me back up.
I'm 47. Decidedly NOT trying to have a baby and firmly in perimenopause. I have endometriosis that was surgically ablated three years ago when I also had an IUD and an endometrial ablation. I was done TTC and didn’t really want to deal with the irregular bleeding that was likely coming in perimenopause (typically periods get more frequent, then more spaced out before they ultimately stop). An IUD plus a lining ablation insured my lining wouldn’t cycle or shed ever again. Cool. The IUD I chose also contains a tiny bit of progesterone. This often inhibits the ovaries from ovulating (at least for the first year or so when it’s fresh). And that’s just what it did for me.
No period. No ovulation. No endo pain. Lovely!
But the perimenopause brain fog and memory lapses still felt all too real, and my ovaries were still ultimately on their perimenopause journey. So about a year after my surgery, I added hormone replacement therapy (HRT) — a 0.025mg estrogen patch twice weekly and 100mg of oral progesterone at night.
And for a while, the brain fog started to lift, my sleep was a bit better, my cycles were still shut down. I felt great! This was a BIG win, because my endometriosis lives on my sacral nerves, so when it's active I get sciatica-like pain that radiates down my hip and leg. Sometimes the pain with get so severe it felt like I was getting electric shocks down my leg.
That pain had totally disappeared! I thought I was on a smooth path to menopause. Insert clasped hands pumping in the air with total celebration.
You see what’s coming, right?!
Bodies Be Bodying
As I moved into year three post IUD and surgery, I started noticing a pattern. I'd get this surge of libido — nice, but definitely more like 30 year old Nicole. Then, not too long after the “randy phase,” my breasts would get sore — my dog jumping up on me wasn’t so sweet. Then I woke up with the hip pain, the inflammation, the nerve pain lighting up my left side like someone was pressing on a bruise I didn't know I had. My back felt like it needed to crack in half, but couldn’t budge. It peaked, then disappeared. When it happened, I’d lay on the floor stretching and say to my fabulous husband, “I totally ovulated this month. If I had a period, I’d be having a period RIGHT now.”
Of course, I didn’t have a period (because, see notes above about shutting that sh*t down!), but I knew. Despite the IUD and HRT, my body’s internal hormones from my ovaries (endogenous hormones) had kicked in and (at least for that month) run the show. My IUD was getting older, maybe it just wasn’t enough. So I waited.
Rinse and repeat. Same pattern.
Using Fertility Monitors Strategically: MIRA for Confirmation, Not Confusion
But, being me, I wanted hard data to confirm. So when I was in peak breast tenderness during one of these cycles, I used my MIRA device — a little at-home hormone monitor that measures actual hormone levels in urine, not just LH surges like a regular ovulation predictor. I tested my progesterone, figuring if it was just from my nightly pill (taken 12+ hours before the test), it should be relatively low, and if I’d ovulated there was a decent chance I’d catch it higher than my HRT could possibly cause.
And I was right. My progesterone was >30. That's corpus luteum (endogenous) progesterone, not oral supplement progesterone. I was still ovulating pretty regularly, producing my own hormones, and those cycles were triggering my endometriosis symptoms to return.
As I’m writing this post, I’m once again in the thick of it. Last week, libido. This week breast tenderness, pain ramping up. This morning I tested again. Estrogen 285, LH 3, progesterone >30. Yep, ovulation confirmed, luteal phase in full swing, body doing its thing despite my best pharmaceutical efforts to convince it otherwise.
Why Most People Use OPKs, MIRA, and Inito Backwards (And How to Fix It)
Now here's why I'm telling you this story: Be it for perimenopause or TTC, I see so many people use hormone testing and fertility monitors backwards.
They feel clueless, confused, or worried, and so they test. They have numbers without any context or education, and now they're more confused because they never learned the important first part — how cycles actually work and how to read their body symptoms. So they get a bunch of numbers from tests, or see random lines on OPKs, and it’s often NOT textbook. In a textbook world, I definitely shouldn’t have the reading I get if you only look at what I’m doing on paper. But the readings totally make sense when it comes to messy, variable, human bodies.
Common Fertility Monitor Patterns That Aren't ‘Textbook’, But Are Totally Normal
If you have PCOS: You might have an LH surge that is weak but lasts a long time. OR you might totally miss a strong LH surge on your OPK because it's so random and late you're not testing on the right day, in the right way, by using your body clues to dial in timing. These are very common ovulation predictor kit patterns when it comes to PCOS. Watching estrogen and progesterone give you a lot more data too.
If you have diminished ovarian reserve (DOR) or are older and TTC: You might have higher estrogen in your luteal phase (like me) or elevated LH as early as cycle day 5. If you're just testing hormones without understanding how anything works, or how to listen to your body symptoms, this will feel like a HUGE problem. In both cases it's totally fine and actually quite common, but you won't get pregnant if you just keep fixating on the textbook pattern you read about online and don’t know what’s up!
Beyond overall person-to-person variability: (ie. PCOS vs no PCOS, age 42 vs 32, endo vs no endo), we ALSO have individual variations cycle to cycle. Like, when I was super sick with influenza for all of November I didn't have this ovulation pattern. But the month after I felt better? Voilà. Back at it.
And it all makes sense and is wise in a weird way. My body still running the show is a sign of how robust my ovarian function still is at nearly 48 years old. That tracks, as I have PCOS and my AMH has always been high. It's just a bummer that it feeds into my endo cycling and brings my pain cycle back.
When I saw today’s progesterone reading on my MIRA I didn't feel defeated or confused. I felt vindicated. My body was telling me a story, and the technology confirmed I was reading it correctly. Now I can have a much more productive conversation with my OB about next steps — maybe increasing my progesterone dose, maybe switching to a different formulation, maybe just managing symptoms strategically since I'm likely only a handful of years from menopause anyway.
I'm not outsourcing my power to a specific test or to my doctor. I'm bringing my own expertise about my own body to the table.
And this is what I want for you, too. Not to buy expensive monitors or become obsessed with numbers. You absolutely don't need a Mira or any other device to understand your cycle. But I want you to learn the basics of your hormonal feedback loops so thoroughly that you can recognize the signals in your own body. To know what ‘follicular phase energy’ feels like versus ‘luteal phase heaviness’. To notice your fertile window not because an app told you, but because your body showed you. To track your patterns with curiosity instead of anxiety.
And then, if testing would be helpful — to confirm ovulation, to troubleshoot irregular cycles, to gather data for treatment decisions — you use it strategically. As a tool in your hands, not an oracle you're consulting for permission to trust yourself.
The Right Way to Use Fertility Monitors: My Approach vs The Standard Approach
My Approach
Confirms what you already know
Empowers you with self-knowledge
Helps you advocate with providers
Holistic - body + data together
Strategic and intentional
Body literacy first, data second
Tool in your hands
Context-rich interpretation
Curiosity-driven exploration
Works with your knowledge
Standard Approach
Confuses with decontextualized data
Externalizes power to the test
Won't tell your doctor much without context
Reductionist - just the numbers
Reactive and anxiety-driven
Data first, body knowledge absent
Fear-driven searching
Attempts (and fails to) replace your knowledge
Learn Your HPO Axis: The Foundation of Smart Fertility Tracking
Let’s use technology wisely. Let’s learn our bodies’ language first. Let’s track patterns, notice symptoms, form hypothesis. Then — and only then — use testing strategically to confirm what we already suspect, or to gather more specific data for conversations with our providers. Let’s let the amazing tech SERVE us and our wholeness of body, mind, quality of life, and fertility goals.
This is all exactly what I teach in my Nursery module of The Baby You Want online program as well as in my clinical practice! Before we ever start talking hormone testing or optimizing hormone protocols, we talk about:
The HPO (hypothalamic-pituitary-ovarian) axis and hormonal feedback loops
Why and how estrogen builds
How, when and why LH triggers ovulation
How progesterone transforms the lining and supports implantation
How hormones create the symptoms you feel — like the fertile cervical fluid, the libido shifts, the breast changes, the mood and energy changes — the emotional landscape of your cycle
How to track these patterns, not obsessively, but curiously — the way you'd learn and track your environment and the weather if you were planning a garden
When you understand the basics — the beautiful, elegant feedback system that is your hypothalamic-pituitary-ovarian axis — then you can look at your messy, real-life body and start to see the patterns. You can form hypotheses. You can test them if you want to. You can have informed conversations with your providers instead of just handing over your symptoms and hoping they'll decode them for you.
And here's what nobody tells you: It's actually pretty amazing — and even fun!
So whether you're trying to conceive, managing perimenopausal chaos like me, a combo of both, or just wanting to understand why you feel the way you feel at different points in your cycle, the work is the same: learn your body's language first, then use all the tools and technology available as confirmation and support, not as replacement for your own understanding.
Your body’s already telling you everything you need to know. My job — whether in my clinic, in my programs and courses, or through this blog — is to help you learn to listen. And I promise, once you start listening, it's genuinely wonderful to discover how much your body has been trying to tell you all along.
Nicole
FAQs
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Use fertility monitors like MIRA and Inito strategically for confirmation, not daily obsession. First learn your body's patterns - track cervical fluid, libido changes, and energy shifts. Then use monitors periodically to confirm ovulation, troubleshoot irregular cycles, or gather data for provider conversations. Test when you already suspect something is happening based on your symptoms, not randomly throughout your cycle.
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OPK and fertility monitor results vary widely based on individual factors. If you have PCOS, you might have weak but prolonged LH surges or miss surges entirely due to timing. With diminished ovarian reserve or advanced maternal age, you might see elevated LH early in your cycle or higher luteal phase estrogen. These variations are normal and workable - the key is understanding your unique patterns, not matching a textbook.
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Regular OPKs only detect LH surges to predict ovulation. MIRA and Inito are more advanced fertility monitors that measure actual hormone levels (estrogen, LH, and progesterone) in urine, giving you quantitative data rather than just positive/negative results. This allows you to track multiple hormones throughout your cycle and see actual hormone concentrations, not just surges.
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No, you don't need expensive monitors like MIRA or Inito to understand your cycle or get pregnant. Learning to read your body's signals - cervical fluid changes, libido shifts, breast tenderness, energy patterns - is the foundation. Fertility monitors are optional tools for confirmation or troubleshooting, not requirements. Many people conceive successfully just by tracking body literacy signs.
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PCOS commonly causes non-textbook OPK patterns. You might see weak LH surges that last longer than typical, multiple false surges, or miss the actual surge entirely if testing timing doesn't align with your irregular cycle. Some people with PCOS have elevated baseline LH, making standard OPKs difficult to interpret. Understanding your body symptoms alongside testing helps navigate these variations.
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No - obsessive monthly tracking often creates more anxiety than clarity. Use fertility monitors strategically: get a baseline when first learning your cycle, check progress after making lifestyle or treatment changes (give it 3-4 months), troubleshoot specific issues, or confirm ovulation when trying to conceive. Constant tracking can trigger stress responses that actually harm fertility by keeping you in fight-or-flight mode.
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I’d much rather a person invest in a high quality way to test multiple times at home than get one snapshot through the mail. It’s a lot more holistic and helpful to use testing as a tool vs a definitive answer.
Nicole Lange
LICENSED ACUPUNCTURIST
HOLISTIC FERTILITY EDUCATOR
Just some thoughts in a tender time.