National Eating Disorder Awareness Week
Redefining “Normal:” FABMs as an Advocacy Tool
By: Kathy Ordas, DO
Editor’s Note: This week marks National Eating Disorders Awareness Week, and we are featuring an interview with Nora,* a woman whose journey to fertility awareness began with overexercise, disordered eating, and painful, irregular cycles — and ultimately culminated in a diagnosis of endometriosis years later. Kathy Ordas, DO, a former FACTS elective participant, interviewed Nora about the utility of FABMs as a means of knowledge and self-advocacy to find medical professionals willing to listen and explore a comprehensive diagnosis.
Nora,* a 27-year-old nurse, was briefly introduced to fertility awareness-based methods (FABMs) during nursing school six years ago. Although she was not necessarily passionate about women’s health, she was surprised when, well into her career, she realized how fertility awareness could truly change someone’s health and life.
FABMs are methods used to track one’s cycle using biomarkers, such as cervical mucus, basal body temperature, or hormones detected in the urine. Nora used the Fertility Education and Medical Management (FEMM) method, learning to monitor cervical mucus and luteinizing hormone (LH) levels to track her cycle, fertility, and overall health. Many couples use these methods for natural family planning; however, these methods were a means of self-advocacy for Nora.
“FABMs are methods used to track one’s cycle using biomarkers, such as cervical mucus, basal body temperature, or hormones detected in the urine.”
As long as she could remember, Nora had experienced severe period pain every month. Knowing that her own mother had suffered from endometriosis, most medical professionals attributed Nora’s pain to the same disease, without making a formal diagnosis. Growing up, Nora was a very active athlete and often went months without having a period, which her practitioners deemed “normal” given the intensity of her training. As years went by, she learned to accept and adapt to the irregularity and discomfort of her menses until an entirely new category of symptoms arose.
In 2018, Nora started experiencing digestive problems while on an international trip, including abdominal pain and severe bloating. With the help of a menstrual-tracking app, she realized the timing of these symptoms aligned exactly with the days preceding her menses and during her mid-cycle spotting. Despite explaining this connection and her family history of endometriosis to medical professionals both overseas and back home, she was encouraged to undergo multiple extensive gastroenterology work-ups.
Left frustrated and feeling unheard, Nora decided to continue monitoring her cycles, certain that this would lend insight into her health. In early 2020, she learned about the sympto-thermal method, a category of FABMs that combines cervical mucus and basal body temperature changes to track a woman’s cycle. Nora also began reading books, including “Taking Charge of Your Fertility,” and listening to podcasts, such as “The Fifth Vital Sign.” She found a sense of empowerment in being able to understand her body better. Finally, she transitioned to FEMM in early 2021 and has been using this method ever since.
“Left frustrated and feeling unheard, Nora decided to continue monitoring her cycles, certain that this would lend insight into her health.”
Nora is confident that her increased understanding of the connection between her digestive symptoms and cycles kept her motivated to search for a practitioner that would listen. With all the data she had collected about her cycle and symptoms, she was eventually able to connect with endometriosis surgical specialists and formally receive an endometriosis diagnosis. During her excision surgery, they found endometriosis-related bowel adhesions that may have contributed to her abdominal pain.
Post-operatively, she has continued using FEMM both for her own cycle awareness and as a means of natural family planning with her husband. The self-confidence she gained led her to pursue FABM educator training, which she is scheduled to finish early next year. Through her training and certification, she hopes to be a resource for other women and to enable them to make their voices and concerns heard.
My conversation with Nora revealed that FABMs not only equip a woman with an intimate understanding of her body, but also increase trust in oneself and one’s intuition. Nora understood that her persistent symptoms, although common, were not normal. As a future pediatrician, her experience underscored for me the value of cycle awareness from a young age. While clinicians had quickly dismissed Nora’s lack of a period as “normal” due to her lifestyle as a long-distance runner, they both overlooked the importance of a healthy, regular cycle and entirely missed the fact that she was likely suffering from an eating disorder. Without exploring a patient’s entire history, a clinician could easily miss these early signs of nutritional deficiencies, as well as an opportunity for intervention and supportive counseling.
“FABMs not only equip a woman with an intimate understanding of her body, but also increase trust in oneself and one’s intuition.”
This conversation and the FACTS elective have inspired me to become a pediatrician who provides a safe environment for young girls to openly talk about the often-confusing changes during puberty and any concerns regarding their menstrual cycles. Health education in schools often teaches the bare minimum regarding reproductive health when, in reality, fertility and cycle awareness are prime indicators of overall health. Emotional and physical changes make adolescence a vulnerable time period and, yet, with the right support and resources, including FABMs, this period can be transformed into one of immense personal growth and discovery.
*Name has been changed to respect the privacy of the interviewee, and all information is shared with permission.
ABOUT THE AUTHOR
Kathleen (Kathy) Ordas, DO, is a first year pediatric resident at the University of New Mexico in Albuquerque. She hopes to use FABMs as a way to offer her female adolescent patients an opportunity to take charge of their reproductive health. She understands that reproductive health is often a “taboo” topic in schools and in many cultures. She believes understanding and optimizing women’s health can start in adolescence. Having never learned about fertility awareness-based methods before, she is excited to be able to incorporate these methods into her future practice and her personal life.