Editor’s Note: This lived experience interview highlights a patient’s journey with fertility awareness-based methods (FABMs) and her eventual diagnosis of premenstrual dysphoric disorder (PMDD). The piece offers insight into the challenges of delayed diagnosis and the potential of cycle charting to inform clinical conversations and support earlier symptom recognition.
This interview was conducted by a student enrolled in the FACTS elective, who requested to remain anonymous to protect the interviewee’s privacy. In keeping with this request, this piece is published without an author byline, photo, or identifying details. Given the importance of amplifying patient perspectives and the relevance of this topic to both clinicians and learners, we are pleased to share this contribution. If you are interested in sharing your story with one of our elective students, please let us know here.
*Patient’s name was changed for privacy
In the early 1990s, Mrs. Smith was faced with the challenge of choosing a birth control method in her new marriage. Initially, she tried hormonal birth control pills, which she was unable to tolerate in the long term due to extreme moodiness. Years later, she would be diagnosed with premenstrual dysphoric disorder (PMDD). She also tried spermicide, which again, she could not tolerate. Her OBGYN gave her no other alternatives. If she was not ready for a baby yet, she was told to return to the pill, use condoms, or continue with the spermicide.
Mrs. Smith, a lifelong student and learner, remembered reading about the women’s cycle in her physiology textbook. Eager to understand more, she reread her textbook and then another. She remembered her friend was taught a method that did not use any medications, condoms, or gels. The method was called the Billings Ovulation Method, although she did not recall the name at the time. [1]
Mrs. Smith, a lifelong student and learner … remembered her friend was taught a method that did not use any medications, condoms, or gels. The method was called the Billings Ovulation Method.
With her friend’s help and her textbooks as an aid, Mrs. Smith began charting her cycles. She recalls checking her cervical fluid throughout the day and putting a sticker on a calendar based on her observations at the end of the day. She remembers refraining from intercourse during her period and when her cervical mucus became wet.
Unfortunately, Mrs. Smith recalls being dismissed by physicians because of her family-planning method. Still, she used this method successfully for nearly 20 years to avoid and achieve pregnancy. [2] She said she felt unseen and unheard by her physicians.
“It’s science. I don’t understand why they didn’t understand,” Mrs. Smith said.
Mrs. Smith recalls being dismissed by physicians because of her family planning method … (although) she used this method successfully for nearly 20 years to avoid and achieve pregnancy.
Mrs. Smith reminisced about the moment she was ready to have a child a few years into her marriage. She knew based on the cervical fluid in her chart that she was in her fertile window. She successfully became pregnant on her first attempt. Years later, she used her chart to successfully become pregnant after the second attempt. She stated that this method worked for her. She had predictable regular cycles, and her supportive husband liked that she was not experiencing the extreme mood swings she suffered while on birth control pills.
Because Mrs. Smith never received formal training about how to track her cycle and its health, she was unaware that charting could be used as an aid in understanding her mental health in relation to her menstrual cycle. Mrs. Smith was diagnosed in the early 2000s with PMDD. This condition went untreated for many years until a physician prescribed an antidepressant for her symptoms.
PMDD
Symptoms of PMDD include affective symptoms, such as irritability, depression, anxiety and somatic symptoms, including decreased interest in activities, difficulty concentrating, fatigue, decreased appetite or overeating, hypersomnia or insomnia, a sense of feeling out of control, and breast tenderness or bloating. [3] These symptoms begin approximately five days before a woman’s menstruation.
FABM Applications in PMDD
Standard treatment of PMDD includes oral contraceptives and antidepressants, most commonly selective serotonin reuptake inhibitors (SSRIs). [3] Charting can help estimate ovulation timing, which may guide further hormonal evaluation. A trained clinician can assess hormone levels throughout a woman’s luteal phase. Women with PMDD may demonstrate altered estrogen and progesterone patterns during the luteal phase. [4]
Charting can help estimate ovulation timing, which may guide further hormonal evaluation.
Altered hormone patterns charted may be associated with variations in the luteal phase. Trained clinicians may aim to stabilize hormone levels during the luteal phase, though the evidence is mixed. Another medication option that has been studied for PMS and PMDD is Naltrexone, a medication commonly used for opiate withdrawal. [5]
Mrs. Smith was amazed that her chart could have been used for the diagnosis and management of her PMDD. She feels strongly that women should be diagnosed and supported much sooner than she was.
Editor’s Note: Follow the links to learn more about the benefits of charting the female cycle and the use of FABMs to diagnose and treat PMS and PMDD.
- How PMDD Affects Cognition and Behavior: A Systematic Review
- Diving Deeper into Premenstrual Dysphoric Disorder: The Benefits of Charting
- NaProTechnology Benefits and Applications for Modern Women
- FABMs to Diagnose and Treat PMS: A Medical Expert’s Perspective
- The Surprising Dynamics of Luteal Phase Hormones in Premenstrual Dysphoric Disorder
- Tracking Emotions with an FABM Leads to Empowerment in PMDD
References
[1] Delangue AF. La méthode Billings [The Billings method]. Louvain Med. 1972;91(4):211–215.
[2] Pallone SR, Bergus GR. Fertility awareness-based methods: another option for family planning. J Am Board Fam Med. 2009;22(2):147–157. doi:10.3122/jabfm.2009.02.080038
[3] Hofmeister S, Bodden S. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 2016;94(3):236–240.
[4] Yen JY, Chang SJ, Long CY, et al. Early- and late-luteal-phase estrogen and progesterone levels of women with premenstrual dysphoric disorder. Int J Environ Res Public Health. 2020;17(15):5419. doi:10.3390/ijerph17155419
[5] Chuong CJ, Coulam CB, Bergstralh EJ, O’Fallon WM. Clinical trial of naltrexone in premenstrual syndrome. Obstet Gynecol. 1988;72(3 Pt 1):332–336.
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