January 13, 2021
By Nicholas Burstein

Editor’s Note: This unique interview with a physician trained in both the Creighton Model and FEMM brings to light the impact fertility awareness-based methods (FABMs) can have on someone’s life, both personally and professionally. Nicholas Burstein, a fourth-year medical student, interviewed the physician while on Part B of the FACTS two-week online elective, Fertility Awareness for Women’s Health. As more students continue to enroll in the FACTS electives, we feel honored to meet their educational needs during the pandemic and overjoyed to know this experience will impact their entire careers, as with Dr. M.

Introduction

I recently sat down with a NaPro and FEMM-trained physician, Dr. M, to discuss her journey with fertility awareness-based methods. After finishing the month-long FACTS elective course, I was curious to learn more about how women can use FABMs to understand their bodies better. During my studies, I noted an emphasis on the use of FABMs for family planning as well as treatment of common reproductive health conditions such as PCOS and endometriosis, but not as much focus on how FABMs help women to manage illnesses outside of the reproductive system, such as immunological or neurological issues. During our conversation, I learned about Dr. M’s use of FABMs to manage her own health concerns—painful periods, premenstrual syndrome (PMS), and migraines—and how her personal experience with FABMs guides her approach to help her patients heal.

Early Struggles 

Dr. M struggled with severe pain during her periods, PMS, and associated migraines in her late teens and early 20’s. At the time, she didn’t see the connection between her cycle and her migraines. In fact, she was mostly concerned with the severe menstrual cramps that would leave her bedbound, sometimes for multiple days. In high school, she would rest, take naproxen, and battle through the pain. Now in college with a rigorous premed course load, she couldn’t afford to lose multiple days every month to pain.

Predictably, when she sought help at the college health center, they offered the birth control pill. Dr. M wasn’t a big fan of taking medications, and she wasn’t sexually active. She was also concerned about the idea of taking a daily medication for a condition that caused symptoms 2-3 days a month. Despite these reservations, she decided to try the pill, as she was truly suffering as a result of her cramps.

Initially, the pill worked. The cramps improved significantly and she had less bleeding. Six months went by and things looked good, until a day she will never forget.

“This was devastating to a 20-year-old girl. One of my friends was like, ‘You’ve got this huge bald spot on the back of your head!’ I remember looking at it in the mirror, and it measured the diameter of a baseball. Completely bald.”

Dr. M was suffering from a complication of hormonal birth control called alopecia areata, a condition where the body’s immune system attacks the hair follicle and causes spots of baldness, commonly on the scalp.

“I was totally freaked out!” she said.

So, Dr. M looked up the drug information and realized this was a possible side effect of the pill she hadn’t been told about. Upset and concerned, she returned to student health, where they seemed unsurprised by her new bald spot and confirmed it was probably from the birth control pill. When she inquired about what to do, the doctor suggested she continue on a different birth control pill despite this adverse effect … and about the bald spot, have a dermatologist do steroid injections.

“So, you’re saying the solution is to inject steroids into my scalp? This just does not make sense. There has to be a better solution,” she thought.

Dr. M didn’t see the logic in continuing to expose herself to the side effects of the pill, which was quite literally causing her hair to fall out, and to combat that with yet another steroid hormone. She chose to stop the pill altogether, loaded up on naproxen, and resumed her battle against painful cramps. Her hair eventually grew back.

The Power of FABMs

A decade later, Dr. M was a family medicine resident and learned about FABMs and charting. At this point, she was a physician with a better understanding of what was causing her cramps, and she now knew her migraines might be associated with her cycle. A nurse who was teaching Dr. M to chart her cycles suggested a new approach. She mentioned they needed to track her luteal phase and time the dose of naproxen to a couple of days before the end of the luteal phase in order to prevent or minimize her cramps, which were caused by a buildup of prostaglandins. By timing the naproxen correctly, she could get ahead of the cramping before it even started!

“So, I started doing that and it was literally life changing,” Dr. M said joyfully.

She would still get mild cramps, but it was nothing debilitating like it used to be. Charting her cycle allowed her to be so much more functional. Furthermore, tracking her cycle helped her manage her migraines.

“I noticed that if I drank wine during the second half of my luteal phase, I would get a migraine,” she recalled.

Dr. M noticed if she didn’t get enough sleep during the second half of her cycle, this would also trigger a migraine. So instead of going to a park as was her practice after a night on call at the hospital, she applied the knowledge gained through charting and would choose to nap instead. Charting empowered her to take better care of herself, and she learned to manage her cramps and migraines.

Her husband found her charts useful as well. She explained he would notice when she was nearing the phase of her cycle with a propensity for symptoms, and he would make an effort to lower any stressors at home. 

An FABM-Trained Physician 

Dr. M has used her personal experiences to guide how she views medicine and how she counsels patients. Laughing, she explained,

“I’m not against medications, but I joke with my patients that it’s easier to get gold out of Fort Knox than to get antibiotics out of me.”

She recalls struggling with asthma as a child and needing to take oral prednisone regularly. Of course, she knows there are times when one must rely on medications. Yet, she’s learned that being aware of your body and, in the case of women, charting the cycle provides much insight into what is going on with your body, and it can empower you to make changes that really impact your health. Recalling a study that showed women athletes perform better mid-cycle than in the luteal phase, she hopes more research is done to explore how women’s bodies and health change throughout their cycles.

We spoke about how the average time to diagnosis for endometriosis is twelve years. Dr. M finds this unacceptable and notes how charting enables her patients to recognize medical issues earlier in their course. Part of the reason for the delay in diagnosis for endometriosis is that women’s complaints are often not taken seriously. Charting and FABMs place some of the power back in the hands of women so they can be more involved in managing their health and advocating for themselves.

One thing is for sure about Dr. M; she will never dismiss a patient who has a side effect, no matter how minor, as she thinks back to the bald spot she got from the pill. She added,

“For women and women’s health, the development of the pill in the 60’s was seen as empowering and provided more options. However, at the same time, it was halting to the development of better diagnosis and treatment of a range of women’s health issues. It’s like, ‘Oh, you have painful periods? Here’s the pill. You have irregular cycles? Here’s the pill. You have acne? Here’s the pill.’ But what are the hormonal or physiologic changes causing the painful periods, the irregular cycles or acne?”

When wrapping up, I told Dr. M this conversation really resonated with me. When I entered puberty, I developed bad acne and irritable bowel syndrome, which I still feel had a hormonal component related to puberty. I wish back then I had some way of tracking the changes my body was going through in the way women can track their cycles.

Dr. M’s response about charting for men really surprised me. I think her reply sums up the kind of doctor she is, how thoughtful she is about the complexity of the human experience, and how being an FABM-trained physician adds to her perspective when helping her patients. She said, 

“For younger boys, I tell them to chart their emotions.”

Author Bio: Nicholas Burstein is a fourth-year medical student at Touro College of Osteopathic Medicine. He recently completed both FACTS electives and is applying for family medicine residency.

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