Director’s Note: On Monday we featured research exploring the role of stress and elevated cortisol in various anovulatory cases, including the setting of functional hypothalamic amenorrhea. Today’s interview shares the account of one woman’s experience with amenorrhea and anovulation as she suffered from a combination of stress, overexercising, and underconsuming calories. With the guidance of a physician trained in fertility awareness-based methods (FABMs) and the practice of charting, Jane* was able to restore her cycle and improve her overall health. At FACTS, we encourage our colleagues to expand their knowledge about the myriad applications of these methods, especially family physicians who may counsel women just like Jane. In addition to our online elective, we are delighted to offer an online CME course and both in-person and virtual conferences for everyone.
Meet Jane*
As Jane and I sat down with our steaming mugs of coffee in hand, trying to keep warm on a windy spring morning, I recalled the many conversations we had shared over our years of friendship. This time felt distinctly different. Jane had recently gotten married, and I knew it had always been her dream to have children and build a family with her husband. Yet, like many successful young women who face increasing pressure to prioritize their careers and delay childbearing, Jane was nervous that she would not be able to conceive now that she finally felt ready.
She is not alone in this fear.
Jane grew particularly concerned about her fertility in the months leading up to the wedding because she stopped having her period. The combination of increased exercise, decreased caloric intake, and stress had resulted in the development of functional hypothalamic amenorrhea (FHA). After consulting with a physician trained in fertility awareness-based methods (FABMs), Jane began using the Marquette Method to track her cycles. With Marquette, women typically track a combination of cervical mucus and urinary hormones, but Jane opted to track urinary hormones in combination with daily basal body temperatures (BBT). She was also instructed to increase her caloric intake and reduce exercise intensity to a moderate level to restore a healthy body fat level.
“My doctor explained that the beauty of FABMs is that they focus not only on getting pregnant, but first and foremost on making the woman’s body ready to nurture a growing child. We had to optimize my health before I could have a healthy pregnancy.”
After a few months of diet and lifestyle changes, as well as daily hormone and BBT tracking, Jane finally observed the indicators of her fertile window on the hormone monitor. She and her husband were then able to conceive their first child. Despite going nearly a year without having a period, the Marquette Model allowed Jane to realize her dream of becoming a mother without further delay.
Not Alone
In an era where the average childbearing age for first-time mothers has risen from 24.9 years old in 2000 to 27.3 years old in 2021 (per the Centers for Disease Control and Prevention), the inability to conceive has become an increasingly common concern. While Jane’s case was complicated by her amenorrhea, even women with regular cycles are surrounded by messaging about assisted reproductive technologies (ART). Bombarded by this content, many wonder whether they will be able to conceive without them.
“In an era where the average childbearing age for first-time mothers has risen from 24.9 years old in 2000 to 27.3 years old in 2021, the inability to conceive has become an increasingly common concern.”
As physicians, we must do more to educate women on their natural cycles and fertility. Young women deserve to understand their cycle, not only for its role in reproduction but as an indicator of underlying health issues — from stress to polycystic ovarian syndrome to endometriosis. By teaching our female patients about their cycles from an early age, we can empower them with body literacy, facilitate their health monitoring, hasten diagnoses, and offer future options for preventing and achieving pregnancy.
“By teaching our female patients about their cycles from an early age, we can empower them with body literacy, facilitate their health monitoring, hasten diagnoses, and offer future options for preventing and achieving pregnancy.”
A Balancing Act
Finding a balance between career and family and between body image and health present a challenge for the modern woman due to endemic societal pressures. Yet, the more comfortable women become with the natural rhythms of their bodies, the more confident they will feel taking charge of all aspects of their reproductive goals.
An oft-overlooked piece of this puzzle are FABMs. Not only are FABMs science-backed methods that can help couples achieve pregnancy, but they are also side effect-free methods for preventing pregnancy that have effectiveness rates comparable to other user-based methods of family planning. Furthermore, a wide range of methods using various biomarkers are available, and can be customized to each woman, her individual needs, and her relationship.
*Names have been changed to respect the privacy of the interviewee. All information is shared with permission.
