July 8, 2020
By Natalie Santa-Pinter

Editor’s Note: This interview with a patient exemplifies how these interactions bring home to medical professionals the facts about fertility awareness-based methods (FABMs), opening their eyes to the science and benefits, and leaving them thirsty for more. Natalie Santa-Pinter conducted the interview as a third-year medical student. Invariably, our students leave the FACTS 2-week online elective amazed at how much they have learned about these versatile, safe, effective, evidence-based methods.

The FACTS elective continues to grow in popularity, so much so that we are launching a second online elective this fall! Our original elective covers the basics about each FABM when used for family planning, while the new elective addresses the applications of FABMs to diagnose and manage women’s health conditions like infertility, endometriosis, polycystic ovarian syndrome (PCOS), and more. You can learn more about the two FACTS electives and sign up here.

Fertility Awareness and the Medical School Curriculum

In medical school, we hear a 2-hour lecture on the birth control options available to our patients. We cover all of them: hormonal implants and pills, patches, IUDs, spermicides, barrier methods, and more. Included in the presentation is a very brief recognition of one natural method (the “rhythm method”), which is quoted as having the lowest success rate and is, thus, not worth learning.

But wait, I thought. A natural method … without any side effects? Of course, I wanted to learn more! So when I had the opportunity, I signed up for a FACTS elective through Georgetown University School of Medicine. In this course, I discovered that, indeed, currently distributed data does incorrectly state that FABMs have a 24% failure rate. Yet, diving deeper, we realize this number is based on recall data (not a prospective study) with most responses claiming use of the “rhythm method,” which is extremely outdated and uses retrospective data to predict future fertility.

Learning the Evidence Behind FABMs

On the other hand, modern fertility awareness-based methods use scientific evidence and are far more effective in avoiding or achieving pregnancy. Among others, these methods include the Billings Ovulation Method, which relies on a woman’s identification of fertile mucus, and the SymptoThermal Method, which utilizes mucus observations and temperature checks to pinpoint ovulation and fertile times of a woman’s cycle. With this knowledge, I began to wonder what it was actually like to use these methods. Were they difficult to learn? How did couples have the strength to abstain? Wasn’t it just asking people to learn something that a pill could take care of? Here’s what I discovered.

During the FACTS elective, I surveyed 12 women about their experiences using FABMs. I then met with one of them, Monica, a 31 year-old married woman with a 1 year-old daughter. We have been friends for a few years, so I knew she practices natural family planning (NFP), having learned about it from her sister. Monica explained she and her husband hoped she would get pregnant soon after getting married, but they wanted to space their children. Using fertility awareness helped the couple to conceive in her very first ovulatory cycle of marriage! Many people think fertility awareness is about avoiding pregnancy. I learned that couples who struggle with infertility can use FABMs to achievepregnancy quicker than on their own.

Monica began charting her cycles six months before marriage. Her main reasons to use FABMs involved a desire to avoid synthetic hormones, since she “did not think it was healthy to block or alter” her natural ovulatory cycle. Monica is right. I learned through the FACTS elective that for every year a woman takes synthetic birth control, her cervical glandular S cells (the cells that produce estrogenic mucus, which is vital for sperm survival) aged by two years.* This may ultimately make it more difficult for a woman to conceive a child in the future.

FABMs Have Good Data Behind Them

Most FABMs have perfect use failure rates of <1%, with typical use failure rates of <5%. One such method, the Creighton Model, utilizes what it calls “NaProTechnology” to diagnose and treat irregular cycles and causes of infertility like luteal phase defects, endometriosis, and PMS, among others. This is invaluable for women who want to know the underlying causes of their menstrual problems and desire more targeted treatment, rather than a pill to cover up their symptoms. It seems there’s a need to educate medical professionals about the science and effectiveness of FABMs so they can provide them as an option to patients who desire them.

Where are Men in the Fertility Awareness Equation?

“Okay, so what about your husband? What does he think about all this?” I asked Monica. Thankfully, Monica’s husband is extremely supportive of her decision to use FABMs, as were the majority of the partners of the 12 women I surveyed. He helps by charting her observations at the end of each day, which Monica says is nice because then all the “work” and responsibility to avoid pregnancy doesn’t fall on her. She believes this causes them to share the role of deciding whether or not to avoid intercourse.

During days of fertility (only about 6-8 days per cycle), the couple considers together whether they are willing to conceive a child at that time. This increases their communication, support, and brings new ways for them to express love for each other when they decide to abstain from sexual intercourse. Studies show couples that use FABMs have a significantly lower divorce rate (<1% for some methods) than the national average. Couples also report an improvement in their sex lives and relationships, and women express feeling more respected and less used by their partners. For a birth control method that doesn’t require artificial hormones, these are compelling positive “side effects” of FABMs!

The Practical Versatility of FABMs

Like many other women, Monica has not limited herself to one FABM. Years ago, she began charting with the Billings Ovulation Method, a cervical fluid-only version of fertility awareness. She later combined and then switched to the Creighton Model, which also uses cervical fluid signs but is more time-intensive to learn and practice. She likes Billings because it is simpler, while Creighton is more demanding because it is thorough, with “100 ways to describe mucus.” This is sometimes frustrating for a working woman with a busy schedule who just wants to know quickly and easily if she is fertile or not. Also, since she is weaning her 1 year-old daughter off breast milk, Monica’s fertile mucus signs are harder to analyze, as most women experience in the postpartum phase. During this phase, she doesn’t trust either method very much and wants a more definitive test of her fertility. This led her to start using the Marquette Model, which utilizes the ClearBlue Fertility Monitor to detect rising estrogen, and an LH surge to predict and pinpoint ovulation.

While Monica says charting her cycle postpartum is one of the most difficult aspects of using FABMs, she is upset that neither her OB nor her primary care physician are familiar with these methods. She wishes she had a medical professional who understood NFP and could help her figure out the postpartum phase.

Hope for Medical Training in Fertility Awareness

From my perspective, there is clearly a lack of awareness about FABMs, especially in the Midwest. Women want more options when it comes to family planning, and every woman deserves to know the basics of how her body works. Women are only fertile a few days out of the month, so why do we put them on birth control for their entire cycle? Those who have had debilitating side effects from artificial hormones are begging for another way to manage their fertility. It would be ideal if medical education — from medical school to residency — implemented more training in the field of fertility awareness so we may offer our patients more options. I am glad I had the opportunity to take this online elective and hope to be able to counsel, treat, and support my patients who choose to use FABMs in the future.

*Editor’s Note: The statement about the effects of synthetic birth control on cervical glandular S cells is based on Erik Odeblad’s research, which we summarized in a series of blog posts in January 2017. For Part 1 of the series, please follow this link: What your cervix is telling you – Part 1: The basics. You will find Part 2 of the series here.

Author Bio: Natalie Santa-Pinter is a third-year medical student and class president at OU-TU School of Community Medicine in Tulsa, Oklahoma. She plans to specialize in pediatrics, family medicine, or Med-Peds. She was very grateful to find and take the FACTS elective. In fact, she recently joined the FACTS ambassador program to broaden her horizons about FABMs and raise awareness in her region.

Learn More about FACTS Online Electives!

This fall, FACTS will offer two 2-week online electives to educate medical students and other health professionals about the important applications of modern FABMs. Click here to learn more or to register.


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