By Chris Galletti
October 2, 2018
Editor’s Note: This summary of conversations with users of fertility awareness based methods (FABMs) is part of FACTS’ Interview Series through which we highlight some of the benefits and challenges of non-hormonal methods of family planning. Although FABMs may not be for everyone, most women who hear about these modern, evidence-based methods are intrigued and want to learn more. Once educated, many women choose to try a method, discover they learn a great deal about their bodies and fertility, and benefit in many other ways, feeling empowered and healthier. These patient interviews by a 4th year medical student highlight some of the versatility and many applications of FABMs.
During this 2-week elective rotation, I was fortunate to interview multiple women about using FABMs. Each interview had a different context and represents the various needs and concerns of women and couples as they approach FABMs.
Charting and the Creighton Model in PCOS
A 38 year-old Hispanic woman and mother of six presented to a family medicine clinic for a routine follow-up. Her past medical history was relevant for endometriosis, iron deficiency anemia, and polycystic ovarian syndrome (PCOS). She had been diagnosed with PCOS years ago, after a transvaginal ultrasound revealed multiple small ovarian cysts during a workup for anovulation.
This woman uses the Creighton Model to chart her menstrual cycles. The standardization of cervical mucus recordings built into the Creighton Model made her move to another state easier, since she found a physician trained in the Creighton Model who could understand her menstrual cycles right away. By studying her charts, her new physician noted a history of cycles lasting up to 40 days, with brown bleeding at the end of her cycle. This prolonged luteal phase with end-cycle bleeding suggested an unstable uterine lining, perhaps due to low progesterone or possibly endometriosis.
To help stabilize her luteal phase, she was given progesterone intravaginal suppositories each cycle beginning on the third day post peak until her next menses. Her menses had also been heavy for the first 3-5 days, leading to mild iron deficiency anemia, for which she took daily oral iron supplementation. At this visit, we ordered a CBC with iron studies to assess her anemia.
When she was first diagnosed with PCOS, her original physician recommended oral contraceptive pills, which the patient declined. With progesterone supplementation to support the luteal phase and using charting to assess progress, the patient’s menstrual cycle normalized. Also, the patient intentionally lost nearly ten pounds, which has helped her cycles remain more consistent. This woman has been able to space six pregnancies through charting. At this time, she and her husband are avoiding pregnancy, as they are happy with the size of their family.
Some Benefits of the Sympto-Thermal Method
A 30 year-old woman and mother of two presented with her 6 year-old daughter for a well child check. She was using the Sympto-Thermal Method to avoid pregnancy, but was open to having more children in the future. She noted her preference of a natural method of family planning, and hoped to avoid taking medications or undergoing any procedures. She finds the Sympto-Thermal Method to be fairly straightforward, and prefers this method because the basal body temperature provides an additional sign of her fertility status.
When asked what she would want from medical professionals concerning FABMs, she mentioned education. She wishes more healthcare professionals were knowledgeable about FABMs. She also would like better patient education to combat all the misinformation available to patients, and more accurate and accessible information about the quality and efficacy of FABMs.
A Medical Student’s Perspective
I enjoyed having honest and open discussions with patients about FABMs. They found it refreshing to learn about a natural method of family planning. They were also frustrated that medical professionals have neglected to educate them about FABMs.
I am happy to be a small part of the solution to educate patients about FABMs. I believe we need to focus on having quality education for patients, which means navigating the misinformation from various sources. We need to have evidenced-based, patient-literate handouts available for those who are interested. The FACTS website has patient education handouts for the various methods. I think an even more concise handout on the principles of cervical mucus and the menstrual cycle would be beneficial.
In addition, there needs to be more access to certified instructors of the various methods. This is very limited in many areas, and telemedicine may be the only option for some couples. There should also be support networks for couples using FABMs, so they can learn from each other in their charting and use of their method of choice. My hope is to continue to learn how to advocate for and teach FABMs in the office, where time is limited and skepticism is high.
Editor’s Note: We appreciate hearing medical student perspectives on FABMs and what they feel is needed to educate both patients and medical professionals. As an organization, we are addressing many of these needs that we, too, have identified. We are committed to fulfilling our mission to educate healthcare professionals in fertility awareness so they can educate their patients with these modern, evidence-based, safe, and effective alternatives for family planning. If you are interested in learning more, please sign up for a FACTS webinar.
Author Bio: Chris Galletti is a fourth year medical student at FSU College of Medicine in Tallahassee, FL. He is pursuing a career as a family medicine physician. Chris recently completed the FACTS medical student elective and will serve as a FACTS ambassador this year.
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