Connecting the Dots for Hormonal Health
By: Jacqueline Story-Remer, MD
Director’s Note: As we celebrate National Marriage Week, we highlight the story of Jen,* a mother of four who is pleased with FABMs for their diagnostic utility and their unifying role in her relationship with her husband as a fertility team. She is passionate about “couples being in it together,” but also notes the challenging conversations and mindset shifts required to use FABMs for effective family planning. Dr. Jacqueline Story-Remer, a former FACTS Elective student, conducted this interview and noted the myriad applications of FABMs. Jen said she hopes that the coming years will see continued integration of these methods into the larger medical community’s standard of care.
Meet Jen & Her Journey
Jen* is a happily married mother of four children and a devoted user of the Marquette Model. She is also currently learning to use the Creighton Model as a diagnostic tool for her health. She is incredibly grateful for her experiences with fertility awareness-based methods (FABMs) for both family planning and health monitoring and has even started providing Marquette Model introduction classes to couples at her church.
Beginning in her early teen years, Jen experienced premenstrual mood symptoms and heavy, painful periods. Like many others, Jen was placed on oral contraceptive pills (OCPs) to “fix” her symptoms. Although she notes OCPs did improve some of her menstrual symptoms, she realized years later that they may also have been the cause of digestive issues and depressive symptoms that improved once she stopped OCPs. Furthermore, the OCPs masked possible signs of endometriosis, and she continues to seek answers to address this common painful condition.
During her third pregnancy, Jen began to grow curious about her body and persistent symptoms, so she started looking for options. She hoped to find the root cause of her concerns and sought resources to learn more about her cycle. In the beginning, Jen largely taught herself, aided only by podcasts, various apps, and social media. Her exploration eventually led her to adopt the Marquette Method, which she values for its simple and effective utility in the postpartum period.
One month after weaning off breastfeeding, Jen found herself in the emergency room in severe pain. By this time, her Marquette charting had already revealed abnormal luteal phases, likely signaling a larger medical issue. She has since connected with a Napro Physician who helped regulate her progesterone and facilitated a diagnostic workup with the aid of Creighton charting.
Frustration with the Current Status Quo
Discovering FABMs has made it easy for Jen to “connect the dots” with her hormonal health. The standard medical approach originally led Jen to believe that PMS was synonymous with being a woman. As she reflected on her experience of being prescribed hormonal contraceptives at such a young age, she shared her frustration with the current status quo. Jen expressed disappointment that she was never informed about the full spectrum of possible side effects of OCPs or about alternative options, such as FABMs for health monitoring. Clinicians never attempted to isolate a medical cause, and she was not aware that OCPs could conceal clues pointing towards a larger medical issue — one that FABMs later uncovered. Additionally, she felt unprepared for the hormonal changes caused by the OCPs. In her experience, she found that getting on or off the pill was a tough process, both emotionally and physically, and many women have no idea what to expect.
“Jen expressed disappointment that she was never informed about the full spectrum of possible side effects of OCPs or about alternative options, such as FABMs for health monitoring.”
Jen, however, does not believe in a one-size-fits-all approach to health, noting that hormonal contraceptives may be the right decision for some women depending on their situations. However, her story highlights how the current structure of reproductive healthcare falls short in providing patients true informed consent. Patients like Jen are entitled to information about the possible consequences of OCPs, as well as the alternatives that exist.
It Takes Two: Becoming a “Fertility Team”
Jen feels incredibly fortunate that her husband has been supportive, curious, and engaged throughout her FABM journey. She is passionate about “couples being in it together.”
Jen noted that it can be a challenging adjustment as couples start to use FABMs for pregnancy avoidance. It requires a completely “new mindset to have windows of time for sex.” To use FABMs for family planning, both partners need to be on the same page and support one another.
“It’s a whole new lifestyle that you agree to as a couple,” Jen explained. “Definitely a more complex conversation.”
That conversation can be a very powerful one, though, as it enlightens, unifies and brings couples closer together in many areas of life. “Couples can make it their own,” Jen added, by choosing a method to help them achieve their goals and maintain intimacy in their relationship.
“It’s a whole new lifestyle that…enlightens, unifies and brings couples closer together in many areas of life.“
Given her own experience sharing her FABM journey with her husband, Jen now strongly encourages both partners to attend the introductory Marquette sessions. Inviting both partners to take part in the conversation creates a much more understanding, open, and loving environment for both parties.
FABMs for All
Although she has been pleased with her experience using the Marquette Model for family planning, Jen recently started charting with Creighton to aid her diagnostic workup.
She noted the pros and cons of each method: “Creighton is great to address the medical side of things, but it is very detailed and at times hard for a busy mom.”
Jen’s observation demonstrates the myriad applications of FABMs, and the way these methods can be chosen and modified to complement different goals, lifestyles, and stages of life. The existence of multiple evidence-based FABMs allows every woman or couple to find the method that is right for them.
Jen is incredibly grateful for the healthcare professionals and individuals raising awareness about FABMs, and she encourages FACTS to keep spreading the word. Jen’s journey is one of the countless stories that shows the critical role of FABMs as health monitoring and family-planning tools. Unfortunately, barriers still exist for their widespread recognition and use. As physicians, we have a responsibility to promote FABMs, encourage research, and educate other healthcare professionals. Our goal is to continue improving accessibility and approachability of FABMs for women and couples while further integrating them into standard medical care. I hope that FABMs will soon be recognized as an integral part of healthcare and incorporated into the greater medical community.
“Jen’s journey is one of the countless stories that shows the critical role of FABMs as health monitoring and family-planning tools and she encourages FACTS to keep spreading the word.”
*Names have been changed to respect the privacy of the interviewee. All information is shared with permission.
ABOUT THE AUTHOR
Jacqueline Story-Remer, MD
Jacqueline Story-Remer, MD is a second-year Family Medicine resident at Northwestern Lake Forst Hospital, Lake Forest, IL and a recent graduate of Rosalind Franklin University of Medicine and Science – Chicago Medical School. She completed her undergraduate degree in Biology, with minors in Chemistry and Psychology, at the University of New Mexico. She enrolled in the FACTS elective to discover how fertility awareness-based methods (FABMs) can be used for family planning and for aiding in the work up of common conditions causing infertility and menstrual irregularity. Jacqueline hopes to pursue a career in reproductive health and family planning and feels fortunate to have learned about FABMs as a tool for her patients.