By: Alyssa Bowen
Editor’s Note: Alyssa Bowen was in her fourth year of medical school when she completed the FACTS elective. The course expanded her understanding of natural family planning methods and opened the door to a conversation with a friend who uses a fertility awareness-based method (FABM): the TwoDay Method. She interviewed Olivia* about her encouraging personal journey with FABMs and the impact they have had on her life in medical school and beyond.
How Olivia Discovered FABMs
Olivia is a medical student who has painful, irregular cycles due to polycystic ovary syndrome (PCOS) and likely endometriosis. Her treatment has included hormonal therapy with combined oral contraceptive pills (OCPs), additional pharmaceutical treatment, and surgery to remove ovarian cysts. She participated in the FACTS elective, which opened a new pathway for her to understand her health and cycles better. She acknowledged the course content about the female cycle being the 5th vital sign for women was enlightening. She made the decision to stop taking OCPs and start cycle tracking in an attempt to become better attuned to her body. Mostly, she wondered if she would ovulate without hormonal treatment and hoped to be able to track her ovulation patterns. Olivia decided to use the TwoDay Method to avoid pregnancy and track her cycles.
Olivia “participated in the FACTS elective, which opened a new pathway for her to understand her health and cycles better.”
The TwoDay Method
The TwoDay Method is a well-researched FABM that uses the presence or absence of cervical secretions as a reliable predictor of fertility/ovulation. The TwoDay Method asks two simple questions to assess fertility status: did I note any secretions today and did I note any secretions yesterday? If a patient notes secretions either today or yesterday, she is considered fertile.
The science behind this method is based on the fact that fertile cervical fluid must be present for a female to become pregnant, and this fertile fluid is present leading up to and at the time of ovulation. By monitoring cervical secretions, a patient is able to identify her fertile window. Therefore, if someone is using this method to avoid pregnancy, the couple would refrain from sexual intercourse on any days when she answered yes to either question. Noting cervical secretions today or yesterday would imply she is likely fertile on that day and, thus, able and more likely to conceive. The TwoDay Method has been studied in a variety of settings around the world and was found to be approximately 96% effective with correct use with a pregnancy rate of 3.5 per 100-women years. [1] [2]
“The science behind the TwoDay method is based on the fact that fertile cervical fluid must be present for a female to become pregnant, and this fertile fluid is present leading up to and at the time of ovulation.”
Olivia chose this method because she thought it would work best given her irregular cycles. She also felt it would be the easiest method for her to learn while juggling the hectic schedule of a medical student. She tracks her cycles on paper, noting days of bleeding and other symptoms as well. While she did not have formal training in this method, she learned about it during the FACTS course and felt well informed enough to start it for herself.**
Surprising Impact of FABMs
After using the TwoDay Method for many months, Olivia noted multiple positive outcomes. Having felt intimidated by FABMs in the past, she found using the method simpler than she originally perceived. Using the TwoDay Method has helped her understand herself better. It also provided a foundation to discuss treatment options with her OB/GYN physician and to manage her anxiety.
By tracking her cycles and using this FABM, Olivia identified that she is likely ovulating in the majority of cycles without OCPs. This has given her hope that the other medical treatments she started are helping her condition, and that she won’t have to stay on OCPs long term. Olivia also discussed with her physician her decision to stop OCPs and use the TwoDay Method, which opened a conversation about the management of her symptoms and the need to evaluate the root cause.
Olivia has had anxiety for many years. Although she thought her mental health issues could be related to her cycles, she was unable to investigate this due to her cycles being “managed” through OCPs, and some symptoms being masked. Through tracking her cycle with the TwoDay Method, she was able to identify that her anxiety and dysphoria worsened significantly during her post-peak phase (right after ovulation) and throughout her luteal phase. This discovery enabled her to formulate a treatment plan with her primary care physician to start taking anxiety medication during that time, which has improved her overall quality of life.
“Through tracking her cycle with the TwoDay Method, she was able to identify that her anxiety and dysphoria worsened significantly during her post-peak phase (right after ovulation) and throughout her luteal phase. This discovery enabled her to formulate a treatment plan with her primary care physician … which has improved her overall quality of life.”
Olivia has found significant benefit from using an FABM and will continue to use one as long as it’s feasible. She may switch to the Creighton Model when she has more time to devote to proper training on the method. Following the TwoDay Method has helped Olivia understand her medical conditions better, and she wishes more women were educated on this topic so they could experience the same kind of empowerment she has gained through FABMs.
Future Physicians Value FABM Education
Given the breadth of research backing them, Olivia was surprised fertility awareness-based methods are not included in the current medical school curriculum. We agreed this content is lacking in conventional medical school education, despite how much our future patients could benefit from their doctors having a foundational understanding of FABMs.
It was a privilege to learn through the FACTS elective and my interview with Olivia about the evidence-based fertility awareness-based options that are available for individuals and couples. I look forward to providing my patients with information about all their options over the course of my career.
*Names were changed to respect the privacy of the interviewee. All information is shared with permission.
** Editor’s Note: The FACTS elective teaches the importance of obtaining formal education from a trained FABM instructor for best results, particularly when using these methods to avoid or achieve pregnancy. The FACTS Directory provides a searchable, national database of physicians, clinicians, and fertility educators trained in the various FABMs as a resource for the medical community as well as patients.
References
[1] Arévalo, M., Jennings V., Nikula M., and Sinai I. (2004). “Efficacy of the new TwoDay Method of family planning”. Fertility and Sterility 82(4):885-892.
[2] Institute for Reproductive Health. TwoDay Method: A new method of family planning. Georgetown University. Retrieved from https://www.factsaboutfertility.org/wp-content/uploads/2018/08/2-day.pdf
ABOUT THE AUTHOR
Alyssa Bowen
Alyssa Bowen is a fourth-year medical student at Midwestern University Chicago College of Osteopathic Medicine in Chicago, IL, where she also completed a dual-degree Master of Science in Precision Medicine. She is completing a fellowship in Osteopathic Manipulative Medicine and plans to pursue residency in obstetrics and gynecology.
She enrolled in the FACTS elective to gain a better understanding of natural family planning methods and improve her ability to inform patients of all options available to them.
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