by Amylynn Smith
In the Spring of 2011, after numerous blood tests and countless doctors visits, my nurse practitioner looked at me and said, “I don’t know why you aren’t getting your period. I know you may not want to take birth control pills again but at this point I don’t have anything else to offer you.” I remember wanting to burst into tears. I was repeatedly told that it was not healthy for me to go six months without having a period. I had taken birth control pills in the past, but it only proved to be a temporary solution. I did not want to start taking them again without knowing what was wrong. There seemed to be no answers as to why I was not getting my period and so there were no clear solutions either. I left that appointment feeling hopeless!
“I don’t know why you aren’t getting your period. I know you may not want to take birth control pills again but at this point I don’t have anything else to offer you.”
Soon after that tearful day, I shared my story with a close friend. She recommended I see a woman who could teach me how to chart the signs of my cycle using the Creighton Model FertilityCare System. I did not know what to expect, so I emailed this FertilityCare practitioner and soon after that she called me at home to get more information about my cycles. She asked questions similar to my nurse practitioner but her responses were hopeful and significantly different from what I heard my nurse practitioner say. I made my first appointment, and within a few weeks I was charting my cycle.
What we learned from my chart
Charting my daily observations provided my practitioner with valuable information to help me identify and manage my PMS. Then, after a few months, she referred me to a physician trained in Creighton for further evaluation. This family physician began our first appointment by taking my medical history and then asked to review my chart. My doctor explained that she saw patterns in my charting that were very characteristic of polycystic ovarian disease and that I was probably not ovulating. As she proceeded to explain how she came to those conclusions by looking at my chart I again wanted to start crying, but this time because I felt grateful for answers. It was encouraging to see a doctor that could read my charts and see a pattern that revealed possible underlying causes for my sporadic periods. I left my first appointment with instructions to get specific blood work, and a treatment plan targeted to address my specific cycle abnormalities. After a few cycles of treatment, my PMS symptoms improved considerably and I started to have my menses on a much more regular basis.
Further work-up revealed additional hormonal abnormalities and now I am taking medications on specific days of my cycle to treat my low estrogen and progesterone levels. Fertility charting has facilitated management of my reproductive health issues because my doctor and I know exactly when I need to take which medications to more accurately treat my irregular cycles, as well as improve the quality and quantity of my cervical fluid. Now that we are trying to get pregnant, my doctors are optimistic that my husband and I have a very high chance of getting pregnant sometime over the next year, as we are treating the underlying causes of my subfertility. I am glad I learned to chart my cycle using a fertility awareness based method (FABM), because without these accurate observations I would not know where I am in my cycle and I would not be able to receive such targeted treatment.
It isn’t necessarily the physician’s fault
After my last visit with my nurse practitioner years ago, I felt a great deal of animosity towards her for not recommending that I learn to chart my cycle. However, I have since learned that medical professionals often do not learn about fertility charting or FABMs. I later learned that only 3-6% of physicians have accurate knowledge about FABMs¹. Many doctors may not even know that there are multiple methods available that couples can use for family planning or that women can use to better monitor and manage their reproductive health². I wanted to sink in my seat out of embarrassment for blaming my healthcare provider for withholding these viable options from me, when in reality she probably didn’t have anything else to offer me because she had never learned about these methods in school. I hope all healthcare professionals will take the time to at least learn the basics about FABMs by checking out the resources available at FACTSaboutFertility.org including the 1-hour introductory online presentation about how FABMs can be used for family planning.
What I wish more physicians knew
Charting has given my physician insight into the inner workings of my reproductive system and has enabled me to be an empowered participant in my own medical care. My doctors and I each have a very clear part to play in monitoring, diagnosing, and treating my reproductive health and it all starts with charting. I would encourage all physicians and other healthcare professionals to learn more about FABMs, so you can offer your patients a broader array of options to more comprehensively diagnose and treat a range of women’s health issues.
1. Choi J, Chan S, Wiebe E. Natural Family Planning: Physicians’ Knowledge, Attitudes, and Practice J Obstet Gynaecol Can 2010;32(7):673–678.
2. Manhart M. D., Duane M., Lind A., Sinai I., Golden-Tevald J. Fertility awareness-based methods of family planning: a review of effectiveness for avoiding pregnancy using SORT. Osteopathic Family Physician 2013; 5 (1): 2-8.