By: Anastasiya Boutko
Director’s Note: Anastasiya Boutko, a former FACTS elective student, interviewed a Creighton Model user who had been using fertility awareness-based methods (FABMs) to track her cycle for nearly five years. The Creighton Model user, Anna*, shared her reasons for pursuing FABMs, from her infertility diagnosis to the power of charting in uncovering cycle irregularities and underlying endometriosis. If you have used FABMs and would like to share your story with one of our elective students, let us know here!
Anna, a woman in her mid-30s, and her husband have been struggling with infertility for about five years. The couple first went the “typical” infertility route, trying both intrauterine insemination (IUI) and in-vitro fertilization (IVF) only to undergo multiple failed attempts and a miscarriage. With a growing feeling that she was merely being given medications without any answers about her infertility, Anna decided to seek other options. She found a physician trained in fertility awareness-based methods (FABMs) and began her charting journey with the Creighton Model.
“With a growing feeling that she was merely being given medications without any answers about her infertility, Anna decided to seek other options and found a physician trained in fertility awareness-based methods (FABMs).”
Creighton Model FertilityCare practitioners teach users how to observe and record their cervical fluid in a standardized and systematic way, while also noting other patterns such as dry days and bleeding. This model can identify phases of fertility and infertility while also helping couples uncover potential health issues.
Anna has been charting for more than a year now. She stated that the charting was overwhelming at first but became easier with practice. To make the process easier, the couple decided to split up the responsibilities: Anna checked her cervical mucus and her husband recorded her daily observations on the chart. Sharing the responsibility for charting helped Anna feel less overwhelmed and gave the couple a sense that they were able to “conquer it together.”
After Anna began charting, her Creighton-trained physician noticed Anna was experiencing brown bleeding before each onset of her menses. Prior to her introduction to FABMs, she had not realized this was abnormal and had never inquired about it. Her periods had always been pretty regular and pain-free, deemed “normal” during her previous health appointments. Her only complaint was significant bloating during her menses, and it had been disregarded by previous physicians who considered the symptom typical.
Anna’s brown bleeding, bloating, history of gluten sensitivity, and the results of her hormone panel all suggested a possible endometriosis diagnosis. After an exploratory laparoscopy confirmed the presence of endometriosis, Anna underwent surgical removal of the lesions. Now, six months after the procedure, Anna commented that she feels like a new person. She no longer experiences bloating during her menses, lost 10 pounds without making any changes to her already healthy diet and feels better overall. Although the couple still has not conceived, Anna is grateful to have been introduced to FABMs. She and her husband remain hopeful that she will become pregnant.
“Anna’s brown bleeding, bloating, history of gluten sensitivity, and the results of her hormone panel all suggested a possible endometriosis diagnosis.”
FABMs and Natural Family Planning (NFP) are often merely considered a “natural” way to avoid or achieve pregnancy. However, it is very important for patients and physicians alike to understand the utility of monitoring the menstrual cycle as a window into a woman’s health. The FACTS elective highlighted the role of the menstrual cycle as a fifth vital sign. Menstrual irregularities can indicate hormonal imbalances, nutrient deficiencies, gynecological diseases, and infections. Charting helps identify certain patterns and trends in each woman’s menstrual cycle. Although different methods prioritize different biomarkers, the Creighton Model considers the total length of the cycle, length, and bleeding pattern of the menses, cervical mucus pattern, peak day, and length of the luteal phase. All these elements combined can help uncover issues such as polycystic ovary syndrome (PCOS), endometriosis, and premenstrual syndrome (PMS), and facilitate treatment — as it did for Anna.
“FABMs should not be viewed as an adjunct or a supplement, but rather an essential part of women’s health to be made available to all women during health visits.”
Anna’s story is one of many where a reproductive issue overlooked by prior doctors was finally addressed by a FABM-trained professional. Hearing her story and those of other women made me realize how important it is for more physicians to be familiar with FABMs and refer patients in the right direction. Ideally, FABMs would be part of every standard Ob/Gyn or family medicine appointment. FABMs should not be viewed as an adjunct or a supplement, but rather an essential part of women’s health to be made available to all women during health visits.
*Names have been changed to respect the privacy of the interviewee. All information is shared with permission
ABOUT THE AUTHOR
Anastasiya Boutko
Anastasiya Boutko is a fourth-year medical student at Chicago Medical School at Rosalind Franklin University in Chicago, IL. She completed her undergraduate education at Ryerson University in Toronto, Canada. She plans to do her residency in radiology but is extremely interested in health equity and education outside of the field. She enrolled in the FACTS elective to gain a better understanding of natural family planning methods.
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