December 27, 2021

By Laurence Lea Lacar 


25 Years of Success with the Sympto-Thermal Method: An Interview

Editor’s Note: This interview is a celebration of the joy and peace that using fertility awareness-based methods (FABMs) can bring to individuals, couples, and families. Laurence Lea Lacar was a medical student when she interviewed this couple to learn about their twenty-five years of using the Sympto-Thermal Method (STM). Despite multiple challenges along the way, including serious medical conditions that contributed to their choice to use FABMs, the couple persevered, grew closer together, and even decided to become teachers of the Sympto-Thermal Method. Their story points to the various ways FABMs can enrich people’s health, relationships, and families.


I enrolled in a two-week elective with FACTS to learn more about fertility awareness-based methods so I could expand my clinical toolbox of offerings for my future patients as an aspiring Ob-Gyn physician. During the course, I had the honor of speaking with a couple about their experience using FABMs. We learned about the different options available with greater than 95% (even up to 99%) efficacy to avoid pregnancy with correct use. One of these FABMs was the Sympto-Thermal Method, and it focuses on observing cervical fluid and basal body temperature changes over time to predict periods of fertility. Christy and Michael* were delighted to share their journey using this method and the significant role FABMs have played in their lives. 

Health is Wealth

Christy was no stranger to natural family planning (NFP) growing up. In fact, her parents were natural family planning teachers and users themselves. When she and Michael got married twenty-five years ago, they took a course on NFP with Couple-to-Couple League, and have used the Sympto-Thermal Method for family planning ever since. 

People choose to use natural family planning or fertility awareness-based methods for various reasons. Some women say they chose FABMs for their health, due to comorbid conditions or to prevent pregnancy. Others choose FABMs to have a better understanding of their bodies, to manage irregular cycles and menopause, to stay “organic” and more “natural,” because they’re affordable or align with their faith, and more. Christy chose to use FABMs for all these reasons, and particularly because she felt it was a safer option for her health. Since she was diagnosed with type 1 diabetes, she was already at an increased risk for heart attacks and strokes, so why add to this risk by taking hormonal contraceptives?

The Sympto-Thermal Method Met their Needs

Christy placed her health first. She needed to focus on controlling her blood sugars, so the couple worked together to plan her pregnancies. Choosing an FABM fit all their needs. Using STM, they were able to successfully avoid pregnancy until twenty-one years ago when they planned for the birth of their first child. 

Christy continued to use the same method for family planning even while breastfeeding. Yet, things got tough when Christy was diagnosed with thyroid cancer sometime after the birth of their second child. She underwent surgery and radioactive iodine treatments while raising their two young children. Christy and Michael were even more cautious about becoming pregnant during this fragile time until her mind and body recovered enough to support a pregnancy. Eventually, she got pregnant with their third son at age forty. Christy even continued to chart her cycle through perimenopause. 

Multiple Benefits of FABMs

Michael has been very supportive of Christy’s NFP journey. In fact, he has played an active role by helping interpret charts with Christy. From his perspective, the whole process of learning about NFP was intriguing. “I was won over right after that first class!” he said, speaking about their first course with Couple-to-Couple League after their engagement. Coming from a scientific background, he found it interesting to learn about the physiology and hormones of the menstrual cycle. Additionally, he was happy about the health benefits for Christy and that NFP matched their religious beliefs. 

“This is great!” he recalls thinking. “We can totally do this!” From this experience, he now has a better understanding of both Christy’s health and women’s health in general. Furthermore, he was inspired to be more cognizant of his health, so he began taking supplements and visiting his doctor regularly. His sensitivity and active pursuit of understanding through the process of using an FABM have contributed to more effective communication in their relationship. They both laughed when Michael said, “If you can talk about mucus together, you can talk about anything together.” 

Eighteen years ago, Michael and Christy were inspired to become teachers with Couple-to-Couple League. 

Not Always Easy

Using natural family planning has not been without its challenges. As with their students, the main challenge the couple has faced while using this FABM was the need for abstinence, especially when needed for long periods of time. For Michael and Christy, it was especially difficult to practice abstinence while keeping up with charting when Christy was diagnosed with thyroid cancer. Even so, this couple is the type to face trials head on. Christy’s drive to educate herself helped her overcome difficulties and guide others with theirs. “Michael was a rock for me,” she added. For Michael, a firm anchor to his religious beliefs and a perspective of any obstacles as mere sacrifices for the good of their relationship kept him going. “I wanted the best for Christy,” he said. 

Christy remarked that, as teachers, they have to overcome misconceptions such as the belief  “that NFP is equivalent to the rhythm method.” Also, they noticed some of their students feeling hesitant to trust the Sympto-Thermal Method. Some couples even switched methods, preferring to incorporate fertility monitors, as in sympto-hormonal methods such as the Marquette Model and FEMM. While sympto-thermal and sympto-hormonal methods are both efficacious as birth control, there is a caveat of the sympto-hormonal methods being more costly due to the monitors. 

Some peers in Christy and Michael’s circle had the problem of having an Ob-Gyn physician who was not supportive of their use of NFP. Fortunately, Christy’s Ob-Gyn doctor was supportive despite not utilizing the methods in his clinical practice. 

Another challenge for them was adjusting to evolving technology, especially with their role as teachers. It was interesting to hear about the evolution of their journey using STM. When they took their first class in 1995, they used paper charts and mercury thermometers. Over time, they upgraded to a digital thermometer. Most recently, Christy attempted to use an app they teach their students to use, but decided to return to the familiarity of paper charting. Eventually, the couple did incorporate the use of an online calendar. The Couple-to-Couple League also provides students with an updated manual that allows them to have some of their questions answered outside of class. Training to teach through Couple-to-Couple league is free, while classes cost around $145 for students with an app available for a subscription. Although the options for recording the data have changed, the basic principles of observing biomarkers remain the same. 

By charting daily for twenty-five years, Christy and Michael have kept up their practice for over 9,000 days throughout different stages in their lives. The next step will be teaching their sons about NFP when they are ready. Christy and Michael are truly a success story for FABMs in a world that has yet to fully understand and appreciate these methods. “We call ourselves ‘myth busters’ for that,” says Christy. “People say you can’t use [NFP] when you’re nursing, you can’t use it if you have a serious medical condition, you can’t use it during perimenopause. And we were like, ‘Yeah? Well, we’ve done it!’”

The Hippocratic Oath and FABMs

What immediately struck me from this interview was how empowered this couple was from their use of an FABM. Having a greater understanding of Christy’s reproductive health allowed them to take charge of their lives as a family and strengthened their relationship. I’ve learned that using a fertility awareness-based method can be a team effort, as was the case with Christy and Michael. This is especially true compared to the more isolating responsibility of a woman to manage a hormonal contraceptive. Also, FABMs are more flexible to whatever the woman’s needs are at the time (e.g., ready for a family or not). These methods motivate users to be mindful of their desires yet remain disciplined.

One of the main principles of our Hippocratic Oath as physicians is to respect autonomy. I’ve learned that FABMs not only respect autonomy but also pave the way for it.

This foundation encourages users to educate themselves and supports people like Christy who are motivated to do their research to learn more. As a future Ob-Gyn physician, I’ll have the opportunity to empower my patients to take their health into their own hands. I intend to use my training to help women choose the option that is ultimately best for them. 

The FACTS elective reminded me that investing time to educate patients will pay off throughout their lives. With patience, we as clinicians are poised to partner with people to create lasting impact. Moving forward from this positive experience, I plan to educate myself on the variety of FABM methods using online resources and mentors with whom I connected through the course. Based on the supporting evidence of their effectiveness and the satisfaction I observed in FABM users throughout the FACTS elective, it is clear that FABMs will be a useful tool in my future practice.

* Fictitious names were used to protect patient privacy, and all information and quotes are shared with permission.


Laurence Lea Lacar

Laurence Lea Lacar conducted this interview as a fourth-year medical student at the University of Hawaiʻi John A. Burns School of Medicine in Honolulu, Hawaiʻi. She aspires to be a general obstetrician gynecologist who can empower patients to understand their reproductive health and find the best treatment options to fit their lives. She found it enlightening to learn about FABMs as ways to avoid pregnancy and also to diagnose and treat disease. She hopes to pursue further training to confidently offer FABMs as options for her patients.

Pin It on Pinterest