Director’s Note: During this Thyroid Awareness Month, former FACTS elective student David Talarico shares an enlightening interview with Rachel* and Adam* that explores the connection between thyroid health and fertility, as well as the role a fertility awareness-based method (FABM) can play in pinpointing abnormalities. Once again, it highlights how charting the female cycle can serve as the fifth vital sign by enabling a woman to identify the link between her symptoms and her cycle. Through the FACTS elective we hope to train the next generation of physicians to fully appreciate the value of charting the female cycle with fertility awareness-based methods – just as Rachel’s practitioner did.
Meet Rachel and Adam
Rachel and Adam* began dating in college, got married, and now shared their FABM journey with me one evening as their four children slept. Rachel first learned about FABMs during a college class, while Adam learned about them when they took a course together with the Couple to Couple League (CCL) as part of their preparation for marriage. CCL trains couples to teach the sympto-thermal method and has the mission to “inspire, educate and support couples in family planning” through means that are “natural, effective, [and] healthy.” [1] Both Adam and Rachel knew they wanted to use a natural method for family planning because of their shared Catholic faith. After a positive experience with the method taught by CCL, the couple became CCL instructors themselves to pass on what they had learned.
Using FABMs a Couple
Rachel and Adam enjoyed going through the CCL course together as a couple and being taught by another couple. They learned the sympto-thermal method, in which a woman learns to chart her cycle using a combination of cervical mucus observations, daily basal body temperature recordings, and optional cervical position. It has an effectiveness rating for avoiding pregnancy of 98-99% with perfect use and 98% with typical use, comparable to commonly used contraceptives [2,3,4]. They chose the sympto-thermal method because it allowed them both to participate in the charting process, offered two biomarkers to track, and was cost effective compared to some other methods. It took the couple some time to gain confidence in the method due to myths surrounding FABM effectiveness, but they have found it to be a good fit for them.
“They chose the sympto-thermal method because it allowed them both to participate in the charting process, offered two biomarkers to track, and was cost effective compared to some other methods.”
The couple also discussed some of the benefits and challenges of using FABMs in their marriage. From the beginning, using FABMs was always a shared process. Adam kept the book and chart on his side of the bed and had to ask Rachel regularly for her information to track her cycle. One benefit of charting together was that it required regular communication with one another about their goals for achieving or avoiding pregnancy. For the first year of their marriage, the couple used FABMs to avoid pregnancy. Then after an initial struggle with trying to conceive, they used FABMs to space out their four children – each born two years apart. Regarding some of the challenges with FABMs, the couple admitted it was difficult to abstain from sexual intercourse during the potential fertile window, especially since a woman’s libido is highest during that time. However, Adam shared that his familiarity with his wife’s fertility does still create opportunities for romance in their marriage.
“One benefit of charting together was that it required regular communication with one another about their goals for achieving or avoiding pregnancy.”
The Menstrual Cycle at the 5th Vital Sign
Beyond family planning, charting with FABMs also gives Rachel new insights into her health. This supports the position of the American College of Obstetricians and Gynecologists that affirms that the ovarian menstrual cycle is a vital sign for a woman’s health [5]. Rachel finds herself much more in tune with how different phases of her cycle affect her health physically and emotionally, allowing her to work with her cycle rather than fight against it. Knowing her baseline also helps her to identify abnormalities. For example, she has learned to notice subfebrile temperature elevations prior to a sickness. Sharing another anecdote, Rachel told us how she once visited the hospital with right lower quadrant pain. When asked if she could be pregnant, Rachel shared that had just ovulated according to her charting. After advocating for herself, her doctors were shocked to find that her pain was caused by a ruptured ovulatory cyst as seen on imaging, exactly as Rachel’s charting had already indicated.
“Charting with FABMs also gives Rachel new insights into her health… allowing her to work with her cycle rather than fight against it.”
One of the most interesting stories of the role of FABMs on Rachel’s health came early in their marriage. After one year of charting to avoid pregnancy following their wedding, Rachel began to notice abnormalities in her charts. She brought them to a physician assistant trained in FABMs who noted delays in temperature shifts and low basal body temperatures. The clinician decided to do a thyroid work-up that identified a one-centimeter papillary thyroid tumor – thyroid cancer. Thanks to Rachel’s charting and the knowledge of her practitioner, the thyroid cancer was removed while still asymptomatic and before spreading elsewhere. The couple believes firmly that a woman’s body speaks through the cycle. Now as FABM instructors, they have even referred women to seek physician treatment of conditions identified through abnormal charting.
Hopes for the Future
As instructors, Adam and Rachel enjoy teaching others about FABMs to promote these methods more widely, and it also allows them to witness the benefits of FABMs in their own marriage. They believe that not only do couples benefit from this information, but that women should be taught these methods as teenagers to help them understand their bodies and health better. They also hope that the medical community will continue to explore FABMs as effective options for women in avoiding pregnancy, treating infertility, and both diagnosing and managing women’s health problems.
* Names have been changed to respect the privacy of the interviewees. All information is shared with permission.