There is an FABM for every person in every stage of life

By: Taylor Boyd, DO

Director’s Note: This month, we share two impactful interviews with real fertility awareness-based method (FABM) users that highlight the versatility of these methods. In today’s patient interview, former FACTS elective student Taylor Boyd reminds us that women can use FABMs when breastfeeding. Different methods and biomarkers serve women differently across the reproductive lifespan. This is why it is so important for medical professionals to be familiar and knowledgeable with all evidence-based FABMs. At FACTS, we strive to ensure that current and future medical professionals have the opportunity to learn about all evidence-based FABMs through our elective and Part A of our CME course. To better understand how these methods may be used across various stages of life — including while breastfeeding or in the postpartum period — check out Part C of our CME course. For an intro to using ecological breastfeeding to prolong anovulation, start with our blog on lactational amenorrhea and fertility.

Melody* knew she wanted to use a natural family-planning method to achieve and avoid pregnancy when she married her husband. She began charting her cycles using the S ympto T hermal M ethod (STM) about six months before she was to be married. Initially, their goal was to avoid pregnancy, but as luck (or divine intervention) would have it, their wedding day fell on her peak day. She and her then fiancé discussed and prayed about whether to have intercourse on their wedding day, knowing there was a higher likelihood of becoming pregnant. Spoiler alert: I interviewed Melody a year and nine months after her wedding as she played with her one-year-old son.

While Melody liked the STM method, it became more difficult to use once she was postpartum and breastfeeding. The STM method looks at a woman’s cervical fluid secretions and basal body temperature to determine a woman’s cycle and fertility window. During the six months of charting prior to her pregnancy, she became more in tune with her body and improved her ability to analyze her cervical mucus to determine fertility. However, she always had some doubt as to whether she was interpreting her fluid secretions correctly, which became more difficult to interpret after having her son.

“The STM method looks at a woman’s cervical fluid secretions and basal body temperature to determine a woman’s cycle and fertility window.”

In the postpartum period, Melody breastfed regularly and continues to breastfeed even now 12 months later. She bed-shares with her son, which also enables her to breastfeed more frequently throughout the night. Because of this, she is still amenorrheic, anovulatory, and notes mostly non-fertile type mucus or overall dryness. Lactogenesis, or the mammary cell differentiation and the process of milk production in the mammary glands, is stimulated by prolactin released by the anterior pituitary in the postpartum period. This disrupts the GnRH secretions from the hypothalamus and decreases the estrogen in a woman’s body, preventing ovulation and drying up her cervical fluid secretions as well.[1] As her mucus patterns became more difficult to interpret postpartum, Melody wanted a more objective method of natural family planning (NFP), which led her to the Marquette Method.

The Marquette M ethod has a breastfeeding/postpartum protocol that relies on urinary hormone observations. Melody now checks for estradiol and luteinizing hormones (LH) in her urine every morning, which she’s done for nearly a year. In the protocol for breastfeeding moms, women check these two hormones daily and the monitor reads these hormones as either “low”, “high,” or “peak” to signal possible ovulation. If no peak hormones have been identified in 10 days, the woman is to reset her monitor to artificially start a new cycle. When using this to prevent pregnancy, the couple is to abstain on days that read “high” or “peak” and have intercourse on days that read “low.” So far, Melody has not seen any “peak” hormones but is starting to see more consistent “high” hormones, which could mean that ovulation is soon approaching. Overall, Melody loves the objectivity of this method. It has allowed her to lean into the beauty of breastfeeding and see her body and hormones respond to how she is taking care of her son.

“Melody now checks for estradiol and luteinizing hormones (LH) in her urine … daily and the monitor reads these hormones as either “low”, “high,” or “peak” to signal possible ovulation.”

Although Melody desired a fertility awareness-based method (FABM) that didn’t rely solely on her interpretation of her body’s biomarkers, she still found the overall experience empowering. It helped her connect with herself, her husband, and her faith. By charting her cycles, even while still anovulatory, she better understands her own emotions and the changes in her body. Using these methods has encouraged Melody and her husband to be intentional with one another and have continual conversations regarding their desire for children. They have gained a new respect for the value of the marital union and their sexual relationship. Most importantly, she is empowered through the active part that she is taking in creating life.

“God made me a woman for a reason and made me this particular way, and through this, I feel like I’m working with Him,” Melody said.

“By charting her cycles, even while still anovulatory, she better understands her own emotions and the changes in her body. Using these methods has encouraged Melody and her husband to be intentional with one another and have continual conversations regarding their desire for children.”

While there have been many positives to her experience with NFP, there are also some challenges. For one, because the Marquette Method requires monitoring urinary hormones, the cost of the fertility monitor and the test strips can become expensive. In fact, this is one reason Melody says they may have to suspend using Marquette in favor of a less expensive option in the future. While she has support from her friends, partner, and her Marquette Method practitioner, she has had less-positive experiences with OBGYNs. She could tell that they doubted her choice and tried to push more conventional methods of birth control. She wishes more OBGYNs were familiar with these methods to better support women in their doctors’ offices. Lastly, abstaining from intercourse can be challenging, especially when the fertile window may not be clear. For this reason, Melody emphasized the importance of having a supportive partner. Despite the challenges, Melody has found a way to prevent pregnancy that not only aligns with her beliefs, but is empowering both her and her husband.

*Names have been changed to respect the privacy of the interviewee. All information is shared with permission.

References

[1] Neville MC, Morton J, Umemura S. Lactogenesis. The transition from pregnancy to lactation. Pediatr Clin North Am. 2001;48(1):35-52. doi:10.1016/s0031-3955(05)70284-4

ABOUT THE AUTHOR

Taylor Boyd, DO

Taylor Boyd earned her DO degree at Ohio University Heritage College of Osteopathic Medicine in Athens, OH and is a first year family medicine resident at Dublin Methodist Hospital. She completed her undergraduate education at the Ohio University, receiving a Bachelor’s degree in Chemistry. She is interested in practicing comprehensive, preventative medicine in a rural environment and teaching at a medical school. She enrolled in the FACTS elective to have a full understanding of natural family planning methods and practical ways to educate patients about these methods and empower them to make informed decisions regarding their reproductive options.