By: Vanessa Duffie
Editor’s Note: As Polycystic Ovary Syndrome (PCOS) Awareness Month comes to a close, we are highlighting the story of a woman who struggled with irregular cycles since she was a teenager and was diagnosed with PCOS more than a decade later. As an adolescent, Cara* was not familiar with fertility awareness-based methods (FABMs) and didn’t realize the broader applications for reproductive health monitoring and diagnosis, according to an interview with Vanessa Duffie, a former FACTS elective participant. Like many women who learn about these methods, Cara benefitted from this knowledge both to facilitate a diagnosis of PCOS and later begin building a family. At FACTS, we strongly believe every woman should have access to this information from a young age, so join us TONIGHT for our adolescent webinar, Know Your Body!
From Struggling Teen to Motherhood
Cara*, a FertilityCare Practitioner (FCP), shared a long history of menstrual abnormalities beginning as a teenager, including menstrual bleeding every two weeks throughout her adolescent years. Despite a suspicion that this was abnormal, her embarrassment surrounding the topic of menstruation prevented her from discussing this with anyone, including her mother ━ a pediatric nurse practitioner. Then, throughout her twenties, Cara experienced menstrual bleeding once every two to three months. Although she eventually discussed these issues with her family physician and an endocrinologist, her labs came back within normal limits. She received no further testing or treatment.
Cara was first exposed to natural family planning (NFP) or fertility awareness-based methods (FABMs) during graduate school through a Catholic community. Her peers were couples using NFP for family planning purposes in accordance with their faith beliefs. Despite her correct assumption that charting her own cycle might help her personally, none of her peers even mentioned these methods as a means of reproductive health monitoring. After getting engaged herself, she started working with an NFP educator and began charting with the Creighton Method. Eventually, she learned she was suffering from Polycystic Ovarian Syndrome (PCOS). Knowing that her sister was diagnosed with PCOS and her mother struggled with fertility issues, she finally had an answer after more than a decade of worries.
Unfortunately, she received the news just before her wedding, and she and her husband later struggled with infertility. After trying to conceive for nine months and then suffering a miscarriage, she sought the help of a Natural Procreative (NaPro) physician and received treatment. Finally, she was able to get pregnant and gave birth to a set of healthy twins. During the pregnancy, she completed training as a Fertility Care Practitioner (FCP) in the Creighton Method. Today she continues to teach the Creighton method to patients, especially single women interested in exploring their reproductive health.
While reflecting on her journey towards motherhood and becoming an FCP, Cara relayed her frustration, certain that if she had begun charting earlier, she could have prevented years of unnecessary anxiety, the added stress of receiving a difficult diagnosis so close to her wedding, and her subsequent infertility struggles. She believed that starting conversations about normal cycles earlier may have prompted her to feel more comfortable in discussing her concerns with others. Though she was also in a unique situation, having been exposed to NFP, she was not aware that those methods could be used as a means of reproductive health monitoring. As a mother, she hopes to introduce her daughter to FABMs when she is older. As a healthcare professional, she spoke about the potential impact of improving fertility awareness during adolescence.
“Cara relayed her frustration, certain that if she had begun charting earlier, she could have prevented years of unnecessary anxiety and her subsequent infertility struggles.”
Potential Impact of FABMs During Adolescence
Cara noted that Premenstrual Syndrome (PMS), PCOS, and endometriosis are just a few common debilitating menstrual abnormalities that can significantly affect quality of life for adolescents. For example, many teen girls miss school or sports due to the unbearable abdominal cramping sometimes associated with endometriosis or PMS. Early diagnosis and treatment, either with surgery for endometriosis or bioidentical progesterone for PMS can significantly alleviate symptoms. By using FABMs to get to the root cause of menstrual abnormalities and develop a targeted treatment, adolescents can return to living life fully and symptom-free. Moreover, this would ensure the long-term benefits of correct hormonal balance, including better brain, breast, heart, and bone health.
“By using FABMs to get to the root cause of menstrual abnormalities and develop a targeted treatment, adolescents can return to living life fully and symptom-free.“
Regarding the anxiety surrounding poor reproductive health, Cara argued that it may be less stressful for girls to learn about their cycle at a younger age when they are not actively trying to conceive or desire pregnancy. Currently, NFP is largely seen as exclusively for couples actively trying to plan a family and commonly sought out by couples experiencing infertility concerns. As Cara’s story relays, comprehensive, early cycle awareness education on the value of charting, whether for family planning or reproductive health, could prevent unnecessary confusion and worry.
Cara argued that having a functional understanding of normal bodily processes will empower adolescents to speak up when something is abnormal and feel more confident in their exploration of an uncomfortable subject for many teens. Furthermore, they may be more empowered to make decisions in line with their personal belief system.
Parental Roles and Navigating Hesitancy in Adolescent Charting
Cara believes that parental involvement alongside education in working with patients under the age of 18 should always be encouraged. In the case of hesitant parents, Cara responded that parental education, patience, and empathetic understanding are key. Cara emphasized that the role of a FCP is not to influence or suggest behaviors, but to give patients the information that can help them make the best, most informed decisions for themselves.
Advice for Medical Students and Closing Thoughts
Cara’s best advice to medical students was simple: Learn about FABMs! Whether a patient presents for contraception, a desire to achieve pregnancy, or with a reproductive health issue, it is significantly beneficial if their physicians know that there are methods available with long-term physical and mental health benefits. There should be greater awareness of these methods among the healthcare community and she hopes more medical professionals will establish relationships with a local FCP or other FABM educators. Beyond just having this awareness, future physicians also have the option to get trained in a certain FABMs and use restorative reproductive protocols in their work directly with patients. She is hopeful that courses like the FACTS elective and CME course will educate more of the medical community so that patients of all ages can benefit from a deeper understanding of the female cycle and FABMs.
“Whether a patient presents for contraception, a desire to achieve pregnancy, or with a reproductive health issue, it is significantly beneficial if their physicians know that there are FABMs available with long-term physical and mental health benefits.”
*Name has been changed to respect the privacy of the interviewee; all information is shared with permission.
ABOUT THE AUTHOR
Vanessa Duffie
Vanessa Duffie is a pediatrics resident at Eastern Virginia Medical School/Children’s Hospital of the King’s Daughters in Norfolk, Virginia. She received her B.S. in Psychology from the College of William and Mary and her medical degree from New York Institute of Technology College of Osteopathic Medicine (NYITCOM). She plans to pursue outpatient pediatrics with a professional interest in patient and family centered care, adolescent medicine, and child abuse prevention. She completed both sections of the FACTS elective to become more educated on ways best to support her future adolescent patients and their families.
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