By: Maryam Ali
Editor’s Note: Polycystic ovary syndrome (PCOS) is a leading cause of anovulation and infertility in women. Maryam Ali was on the FACTS fertility awareness elective when she interviewed a patient we’ll call Matilda.* Her story brings to light the significant benefits of teaching patients to track their cycles using fertility awareness-based methods (FABMs). For Matilda, these benefits included improved nutrition and overall health, restored ovulation and, thus, the ability to conceive her three children. The combination of charting her cycles and changing her diet made all the difference for this patient who is now an advocate and educator, ensuring other women and couples learn about these potentially life-changing interventions. We invite you to learn more about the effects of lifestyle on fertility by participating in Part G of our CME course and by registering for our October Virtual Conference Lifestyle for Healthy Cycles.
Meet Matilda
Matilda is a 27-year-old mother of three children who offers a compelling account of managing polycystic ovary syndrome (PCOS) using fertility awareness-based methods (FABMs). Her experience highlights how cycle charting, dietary changes, and support from a knowledgeable instructor empowered her to improve her reproductive health and fertility, leading to conception.
From masking symptoms to a diagnosis
At 16, Matilda sought help from her primary care physician (PCP) for irregular cycles and was prescribed oral contraceptive pills (OCPs). OCPs are commonly used to “regulate” cycles, but they didn’t work for her; instead, they caused mood swings, anxiety, and weight gain. This early experience underscored the potential negative mental health impact of OCPs during adolescence, which may have lasting implications. Furthermore, Matilda realized that while OCPs may have masked her symptoms, they didn’t address the root causes of her hormonal imbalance, such as anovulation. This realization prompted her to explore alternative treatments that offered deeper insights into her condition.
At 18, Matilda discovered FABMs and began charting her cycles using the Creighton Model, a system that tracks fertility markers like cervical mucus to identify ovulation and hormonal patterns. [1] Through charting, she realized she was experiencing 40- to 60-day cycles without ovulation. Despite maintaining a normal weight, she experienced hirsutism and acne. These symptoms, combined with her irregular cycles, led to a formal diagnosis of PCOS.
The return of ovulation
Switching to FABMs was a turning point for Matilda. Charting gave her a better understanding of her body’s natural rhythms and how PCOS disrupted them. Her observations helped her identify patterns and empowered her to make lifestyle changes. She found that modifying her diet, particularly by cutting out sugar and processed carbohydrates, significantly improved her cycle, resulting in the return of ovulation. Alongside metformin and myo-inositol, which are commonly used to improve insulin sensitivity, these lifestyle adjustments helped restore her cycles and supported her fertility.
“Charting gave her a better understanding of her body’s natural rhythms and how PCOS disrupted them. Her observations helped her identify patterns and empowered her to make lifestyle changes.”
An FABM for every season
After getting married at 20, Matilda transitioned to using a sympto-thermal method, which adds basal body temperature (BBT) tracking to cervical mucus observations, offering an additional cross-check to confirm the window of fertility. [2] This method proved successful, as she conceived three children, each within seven months of trying. She attributed her success to FABMs. Two months postpartum, Matilda temporarily paused charting while nursing with a plan to resume tracking her cycles when no longer breastfeeding.
Reproductive health gains through FABMs
One of her most significant realizations was that OCPs often act as a “band-aid” solution for women with PCOS. While OCPs may superficially “regulate” cycles, they fail to address the underlying hormonal imbalances and do not promote ovulation, which is a vital sign of health. She recalls her frustration when her PCP, who was unfamiliar with FABMs and questioned why ovulation was important to her. This interaction emphasizes the need for medical professionals who understand FABMs and reproductive health beyond OCPs.
“While OCPs may superficially “regulate” cycles, they fail to address the underlying hormonal imbalances and do not promote ovulation, which is a vital sign of health.”
Matilda now advocates for FABMs as a diagnostic and management tool for PCOS, and for the value of working with instructors and medical professionals trained in these methods. FABMs offer a personalized, observational approach that provides a more accurate understanding of fertility. She also learned that fertility and pregnancy should not be left to apps alone, as they are often inaccurate for women with irregular cycles. Inspired by her journey, she became a Creighton Model instructor to help other women facing similar problems. Her advice to women with PCOS is to begin charting as soon as possible and to be patient.
Matilda also highlights the importance of having a strong support system throughout this journey. Managing PCOS and fertility can be emotionally and mentally taxing, especially with long, irregular cycles. For her, it was critical to have the support of her husband and her instructor to stay motivated and patient with FABMs. She encourages other women to build a similar support network to help them through the challenges of managing PCOS.
Valuable Insights
Matilda’s experience offers several important insights into FABMs and PCOS. It demonstrates the potential of FABMs to serve not only as a natural family planning tool but also as a diagnostic tool. By tracking physical markers of fertility, Matilda was able to detect her anovulatory cycles, identify patterns, and make lifestyle changes that improved her reproductive and overall health.
One of the most striking aspects of her story was the profound effect of dietary changes on her cycle, particularly eliminating sugar and processed carbohydrates. This underscores the role of metabolic health and, specifically, the need to address insulin resistance in the treatment of PCOS. While OCPs may offer a short-term solution to manage symptoms, addressing metabolic issues and promoting ovulation were essential to enable Matilda to conceive.
“One of the most striking aspects of her story was the profound effect of dietary changes on her cycle, particularly eliminating sugar and processed carbohydrates. This underscores … the need to address insulin resistance in the treatment of PCOS.”
Her experience also raises broader questions about how medical professionals typically approach PCOS and cycle regulation, often relying on OCPs as a short-term fix. Matilda’s caution against using fertility tracking apps further emphasizes the limitations of relying on technology for reproductive health, especially when initially charting cycles. Most apps are designed with standard cycle lengths in mind, which may not apply to women with conditions like PCOS. Matilda’s advice to be patient with FABMs rather than attempting to force control over cycles is crucial to achieve long-term success with these methods.
Matilda’s story illustrates the empowering nature of FABMs for women with PCOS, as they offer a comprehensive, individualized approach to manage reproductive health. Her journey shows how FABMs, combined with lifestyle changes and a strong support system, can provide women with the tools they need to restore fertility and improve overall health. Her experience is also a reminder of the importance of patience, persistence, and support in navigating the complexities of PCOS.
* Names have been changed to respect the privacy of the interviewee. All information is shared with permission.
References
[1] Fehring, Richard J., Donna Lawrence, and Connie Philpot. “Use effectiveness of the Creighton model ovulation method of natural family planning.” Journal of Obstetric, Gynecologic, & Neonatal Nursing 23.4 (1994): 303-309.
[2] Ruíz, O. I. “The symptothermal method.” Proceedings of the International Seminar on Natural Family Planning and Family Life Education. Hong Kong University Press, 1990.
ABOUT THE AUTHOR
Maryam Ali
Maryam Ali is a fourth-year medical student at Philadelphia College of Osteopathic Medicine in Suwanee, GA. She has a passion for advancing health equity, integrating faith-based approaches into medicine, and delivering care to underserved communities. She enrolled in the FACTS elective to expand her personal knowledge of natural family planning methods and to gain the skills needed to share these approaches, helping women feel more empowered in managing their health and reproductive decisions.
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