September 14, 2023

Even Instructors Need Medical Consultants: Using FABMs in a Rural Area with Limited Access

By: Kelly Carlson, DO

Director’s Note: This patient interview conducted by Dr. Kelly Carlson, a former FACTS elective participant, shares the story of how one woman fell in love with fertility awareness-based methods (FABMs), because they provided options and instilled confidence in her own body. Through FABMs, she found both healing and empowerment. She decided to pursue training in a sympto-thermal method of fertility awareness, which she now incorporates into her wellness coaching business. Dr. Carlson’s interview also highlights the challenges that many women face in finding FABM-trained physicians and medical professionals, particularly in more remote areas. To increase access to FABM services, consider applying to be listed in our directory if you are a FABM-trained medical professional or educator. Or check out our Directory to find a physician or educator near you!


Meet Lizzie

Lizzie* is a busy wife and mom who runs her own wellness business focused on promoting natural health. Born and raised in a rural town, she recently moved back to be closer to her roots. Growing up, Lizzie knew of natural family planning (NFP) methods because her mother used the rhythm method. Although she realized the rhythm method was not perfect,  Lizzie still preferred a hormone-free option for family planning and was willing to accept a potential unintended pregnancy. When she finally encountered modern fertility awareness-based methods (FABMs) as part of her marriage preparation classes through her church, she was amazed at the effectiveness rates. Lizzie learned the Sympto-Thermal method — which has a 98% effectiveness rate with typical use and more than 99% with correct use — and has used it for eight years.

“Women aren’t given options or true informed consent about family planning.”

From the onset of menstruation, Lizzie suffered from painful, irregular cycles with intermenstrual bleeding. As a teenager, she felt that something wasn’t quite right with her cycles, but when she voiced her concerns to her physician, she was simply given birth control pills and told that this would “fix the problems.” There was no discussion of potential side effects, nor were any alternative treatments presented. She recalled being frustrated by the lack of options offered to her. She took the pills for six months, eventually stopping them because she didn’t like the way they made her feel. However, after stopping the pills, her menses did not return for over a year. She realized this was not natural and any possible underlying problems had not actually been fixed. Eventually, she learned to live with her symptoms, accepting them as her version of normal. She never mentioned it to another physician again. Looking back, Lizzie lamented, ““Women aren’t given options or true informed consent about family planning.”

“Being aware of her cycle allowed her to get to know her body on a whole new level. “It is really powerful; more women need to be aware of this.”

After taking the SymptoPro class during her marriage preparation, Lizzie fell in love with charting. She felt that being aware of her cycle allowed her to get to know her body on a whole new level. “It is really powerful; more women need to be aware of this.” As she continued to learn to chart, she began to observe signs that indicated irregularities in her cycles. Through her interest in wellness and natural remedies, she found various supplements to support her cycles. As she tried new interventions, her chart has been a helpful tool to monitor the impact on her cycle. By tracking her cycle and using supplements, Lizzie was able to optimize her cycle and eventually conceive when the time was right for her family.

Connecting Mind, Business, and Spirit

After using FABMs for a little over a year, Lizzie identified a need she believed she could fill. She had always been passionate about nutrition, wellness, and optimizing health through natural interventions, and her work with breastfeeding mothers helped her recognize the connection between overall wellness and fertility. She enrolled in a course to become a SymptoPro instructor, which has now enabled her to teach other women how to track their cycles so they can better understand their fertility. This allowed her to bring fertility awareness to her wellness business. More recently, she was also able to step into a teaching role within her church as the director of the SymptoPro method classes for the very marriage preparation courses that sparked her own fertility-awareness journey.

Satisfied young farmer woman standing with crossed arms in front of combine harvester in corn field

Comfort and Frustration: Challenges with Charting in a Rural Area

As we discussed Lizzie’s charting journey, I asked her how things have changed since taking the instructor course. Specifically, I was curious whether she ever reaches out to educators with questions about her own charts. She replied that once she started teaching, she no longer felt the need to reach out for consultations on her own charts anymore. However, the challenge has been finding medical professionals that understand charting in her local area. She confided that she has had two early miscarriages over the last year — which she might not have even known about had she not been charting. Since the miscarriages, her cycles have been irregular.

“Tracking my recovery is helpful for easing my worries, but it also lets me know when to get help, ”Lizzie explained.

About a month after her most recent miscarriage, she presented a physician with her charts and expressed her concerns. Unfortunately, not being trained in charting or FABMs, the physician “just brushed it off because they didn’t understand it and said it was a normal healing process after a miscarriage.”

She left the appointment disappointed and expecting more.

“The need for FABM-trained healthcare professionals in rural areas is just as great as anywhere else.”

This encounter was one of the biggest takeaways from our conversation for me as a resident physician. More healthcare professionals need to be aware of FABMs, even if only to acknowledge the evidence-based science behind the methods and to refer patients to a clinician who is trained in FABMs. Trained practitioners are especially crucial in rural areas where care in general is often limited. My conversation with Lizzie revealed just how much education still needs to happen in the medical community. The need for FABM-trained healthcare professionals in rural areas is just as great as anywhere else.

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



Kelly Carlson, DO

Kelly Carlson, DO is a family medicine resident at Forbes Hospital – Allegheny Health Network, in Pittsburgh, PA. She graduated from Ohio University Heritage College of Osteopathic Medicine in Athens, OH in 2023. She participated in the FABM elective during her fourth year and enjoyed the elective so much she joined as a FACTS Student Ambassador to continue learning. She will be pursuing NeoFertility medical consultant training this fall and looks forward to educating her co-residents, physicians, and patients about the benefits of FABMs.

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