Empowered Through Fertility Awareness: A Patient Interview
March 25, 2021
By Michal Dusza
Editor’s Note:This week, we’re delighted to publish an interview with a patient by one of our international students who participated in the FACTS online elective this year. Michal Dusza, a fourth-year medical student from Poland, joined us to learn about fertility awareness-based methods (FABMs) of family planning and was excited to discover their medical applications as well. He chose this elective to gain insight and experience in diagnosing women’s health issues and was one of 178 students to participate since the fall of 2020. Dr. Marguerite Duane, cofounder and executive director of FACTS, teaches our elective through Georgetown University School of Medicine.
Below is the story of a young lawyer and her husband as they’ve walked together on the journey through endometriosis diagnosis and treatment. Along the way, FABMs empowered Cara with information about her body and equipped her physician with tools (starting with the female chart) to diagnose and manage the condition. Although the journey is not over, using FABMs has transformed the process, and continues to provide daily data about her biomarkers that can be used to monitor and adjust her treatment plan.
Meet the Couple
I had the opportunity to speak to Cara about her experiences with FABMs. She is an accomplished 34-year-old lawyer who has been married to her husband, Charles, for two years. Cara was exposed to natural family planning (NFP) from childhood through her parents, who were SymptoThermal Method instructors in her community. She began charting using the Creighton Model four years ago to better understand her body’s natural cycles and identify any abnormalities.
Since adolescence, Cara experienced exceptionally painful periods and heavy bleeding as well as tail-end brown bleeding that forced her to miss work and/or school every cycle. She found limited pain relief with acetaminophen. Knowing she would want children in the future, she knew she would have limited time to identify and tackle any issues. Thus, she decided to work with a physician trained in fertility awareness-based methods early on.
Why They Chose FABMs
The couple’s goals and beliefs in choosing fertility awareness-based methods of family planning were similar. They stem from their desire to avoid any side effects from artificial hormones. These family planning methods were also better aligned with their religious beliefs. Cara’s fertility physician preferred the Creighton Model for the purpose of charting and evaluating abnormalities. The couple also believed the Creighton Model would prepare them better to achieve pregnancy by identifying the fertile window.
Cara learned the basics of the Creighton Model from her physician and took additional classes from a certified instructor. She feels empowered by the knowledge gained through charting and better equipped to tackle her symptoms and treatment. She also reports better communication with her husband since using FABMs. While she actively maintains her charting on her own, Charles is fully aware and supportive of her ongoing treatment.
Charting and Surgery
Cara and her husband were aware there would be struggles ahead. She was diagnosed with endometriosis by her physician with the aid of Creighton Model charting. Two and a half years ago, she had her first laparoscopic surgery to confirm stage 3 endometriosis. A Natural Procreative (NaPro) surgical approach was able to confirm and resect endometriosis and discover an ovarian endometrioma as well. It took her over a month to recover from the surgery and, since then, she has noted vast improvement in her charting. The symptoms that were present from her teenage years have subsided significantly, and her quality of life has improved markedly as well.
Over the next two years since the surgery, she continued to work with her NFP physician on achieving pregnancy. During this time, a short luteal phase was identified via charting, low cervical mucus was noted, and she was diagnosed with a luteinized unruptured follicle (possibly due to adhesions from the first surgery). The NaPro surgeon performed a second laparoscopic surgery where adenomyosis was identified and all visible implants of endometriosis were resected.
Looking Ahead with Hope
Due to the problems with fertility, Cara and Charley plan to continue to work closely with their NFP physician. The plan going forward is for Cara to start taking letrozole (an aromatase inhibitor demonstrated to be effective to induce ovulation) once she has completely recovered from her recent surgery. She has been advised to implement a strict anti-inflammatory diet that eliminates alcohol and caffeine and reduces intake of gluten, sugar, and dairy. Cara and her husband have remained supportive of each other and focused on their family planning goals. The following months will be of enormous importance, as ovulatory induction will be performed, and her physician will try to establish the likelihood of achieving pregnancy despite relapsing endometriosis and adenomyosis.
Implications for a Physician’s Practice
It was a pleasure to speak with Cara about her story. She demonstrated great confidence and knowledge regarding her medical history and treatment plan. She was able to recognize a problem existed due to her consistent painful menses, and knew she shouldn’t leave it undiagnosed and untreated until attempting to be pregnant. She has remained optimistic during the entire ordeal and has praised FABMs for allowing her to gain understanding of her symptoms. She remains steadfast in her desire to implement natural planning methods for the purposes of starting a family.
As a future physician, what resonated with me is how empowered Cara became thanks to FABMs, which resulted in her actively participating in fertility monitoring and treatment. FABMs are wonderful tools for physicians to diagnose and treat and, for patients, they provide flexibility in regards to their family planning goals from one cycle to the next.
* Names were changed to protect the couple’s privacy.
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Fertility Awareness – Expanding Care for Women’s Health
On the heels of the success of our fall 2020 two-day CME virtual conference, we are excited to announce the details for our 2021 event. We are looking forward to this year’s virtual conference as an opportunity to connect with one another, to learn more about fertility awareness, and to explore timely topics in women’s reproductive health together. Expand your toolbox and join us in May! Click here for more details and registration information.
Conference highlights will include:
• FABM overview and their applications for:
– Hypothalamic Amenorrhea
– Thyroid Dysfunction
– Recurrent Pregnancy Loss
– Adolescence and Body Literacy
– Polycystic Ovarian Syndrome (PCOS)
• Fem Tech – NeoFertility and FEMM
• Functional Medicine in Women’s Health and FABMs
• Extensive Q&A with our expert panels
• CME Credit*
*AAFP CME credit is pending approval.
You are the reason FACTS exists, and we hope to see you in May!