March 23, 2023

A Physician’s Personal Journey using FABMs:

An Interview with Dr. Molly

By: Nisha Mandla

Executive Director’s Note: This week we share an interview written by Nisha Mandla, a recent FACTS elective student and future OB/GYN who believes “it’s important to provide thorough and comprehensive gynecologic care.”  Therefore, she enrolled in the FACTS course to learn about fertility awareness-based methods (FABMs) to supplement her knowledge of traditional methods of contraception and infertility care. This interview with a first-year family medicine resident lends insight into the life of a physician who both uses these methods in her own life and plans to recommend them to patients.

Dr. Molly* grew up in a Catholic household and was familiar with the basic concepts of natural family planning through family and friends. However, because she was not sexually active, she never felt the need to start charting her cycle or exploring methods of family planning. Her mindset changed when she started medical school and began experiencing heavy brown spotting and severe cramping. These menstrual irregularities were associated with difficult bowel movements, dizziness, and lightheadedness. She suddenly found herself forced to skip classes, lying in bed most days of her period. Eventually, she reached a breaking point and went to a woman’s healthcare center where she was seen by a nurse practitioner. With very little work-up, history, or physical examination, she was offered the oral contraceptive pill (OCP). Although she preferred not to use hormonal birth control, she was told that it was her best option to address her symptoms.

After three months on the pill with no resolution of her symptoms, she returned for a follow-up visit. She had begun experiencing mood swings and severe depression. When she was again told that the pill was her best option, she decided to voice her concern. However, those concerns were dismissed by the practitioner, who warned Dr. Molly that she would continue to have issues if she did not continue taking OCPs. She realized at that moment that this practice was not the right fit for her, and she began looking elsewhere for care.

Through a network of friends, Dr. Molly was referred to a FEMM trained physician in the area. Beginning with her first visit, she received a lengthy and detailed history, physical exam, and lab work-up. The initial consult revealed elevated prolactin levels, and a follow-up MRI revealed a prolactinoma. She was immediately started on cabergoline and taught about the FEMM method of charting to evaluate her menstrual pattern. She was trialed on high dose NSAIDs timed 2-3 days prior to the beginning of her menstrual cycle and several vitamins which helped manage some of the pain, but her initial symptoms continued over the next year. Based on her symptoms and signs on her chart, Dr. Molly’s physician suspected she might have endometriosis, so she referred her to an FABM-friendly OB-Gyn. Dr. Molly was eventually diagnosed with endometriosis and, by the end of her fourth year of medical school, she traveled out of state to meet with an endometriosis specialist and underwent surgery.

Throughout this crazy process, Dr. Molly realized how lucky she was to have found her initial FEMM-trained physician because endometriosis commonly takes an average of 8 to 10 years to diagnose. Yet, thanks to the thorough work-up and appropriate referral from her FEMM physician, she was diagnosed and treated within four years. She happily got engaged in her fourth year of medical school and started using the Creighton Model of charting for family planning. She has since started her Family Medicine residency in Philadelphia and has been successfully charting her cycle for two years to postpone pregnancy until she and her husband are ready to grow their family. Additionally, she has continued to utilize FABMs to manage her health. After starting residency, she again experienced some painful symptoms and began seeing a NaPro-trained physician. She was pleasantly delighted that her doctor was immediately able to read and discuss her chart. Per his recommendations, Dr. Molly began supplements for her endometriosis, which drastically decreased her pain. She has also been staying active, eating an anti-inflammatory diet, and is confident that when she’s ready to get pregnant, her NaPro physician will be capable of supporting her family-planning goals.

“Dr. Molly realized how lucky she was to have found her initial FEMM-trained physician because endometriosis commonly takes an average of 8 to 10 years to diagnose.”

As a soon-to-be resident physician, I was curious to learn how and why Dr. Molly incorporated FABMs in her practice. Her personal journey has certainly influenced her views on FABMs and she’s grateful to have been cared for by various physicians trained in these methods. Without them, she believes she would have suffered with an untreated prolactinoma and endometriosis for many years. Therefore, she hopes to be a similar advocate for her future patients and investigate the irregular periods and infertility that many women and couples experience. As a first-year resident she has offered FABMs to postpartum patients in the hospital, as well as encouraged her patients to advocate for themselves at appointments with their OB/Gyns. Upon completion of her residency, she plans to make them an integral part of her practice as she continues to educate herself on the various methods. Although she began first with FEMM and was still using the Creighton Model at the time of our interview, she was considering switching to the Marquette Model for a more objective measurement of fertility.

“Her personal journey has certainly influenced her views on FABMs and she’s grateful to have been cared for by various physicians trained in these methods … she hopes to be a similar advocate for her future patients.”

I was touched by Dr. Molly’s story; I felt frustrated when she shared her experience of being dismissed by medical professionals, fear as she recounted her diagnosis of a prolactinoma, and joy listening to her successful endometriosis treatment. Our conversation made me both want to advocate for myself as a future patient and to provide better, more empathetic care than the physicians who refused to listen to Dr. Molly’s concerns. I hope to provide well-rounded care as an OB/Gyn and confidently offer FABMs as an option for family planning and medical management, whether a woman is looking for a method of contraception or an infertility workup. The FACTS elective and my conversation with Dr. Molly helped me take my first steps towards accomplishing those goals to be a physician my future patients will feel lucky to have.

“I hope to provide well-rounded care as an OB/Gyn and confidently offer FABMs as an option for family planning and medical management.”

*Names have been changed to respect the privacy of the interviewee and her family. All information is shared with permission.

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