In a recent study measuring anxiety among medical students about potential difficulties conceiving due to purposefully delayed childbearing, nearly 74% of female respondents “reported worrying about future fertility” [1]. The study researchers acknowledged that “delayed family building” has become “more commonplace in the medical field,” but regrettably, even amongst highly-educated people like these healthcare professionals in training, “knowledge regarding the individual factors that contribute to childbearing is limited” [2].
Female medical students aren’t alone. Tragically, many men and women lack even a rudimentary understanding of female anatomy and fertility, despite years of “comprehensive sex ed” classes in public schools. This lack of knowledge serves no one. Some who delay childbearing past their most-fertile years will consequently struggle to get pregnant, leading them to pursue costly fertility treatments like in vitro fertilization that necessarily commodify children and come with known health risks for both mother and child. Many don’t know when or how to seek help for reproductive issues like endometriosis that can lead to infertility.
Women deserve better than body ignorance, and many of women I interviewed for my doctoral candidacy research particularly cited charting their menstrual cycles as a basic healthcare tool every woman should be taught [3]. They found that when they learned to chart their cycles and know their bodies they became effective collaborators and active participants in their own healthcare, and this was especially impactful given each one’s struggles with infertility. They believe every woman seeking treatment for infertility should be taught to chart her menstrual cycles.
Every woman has a right to information about her own body
Each woman in my study sought NaProTechnology treatment for infertility, and many had previously sought treatment within the mainstream medical community. These women found NaProTechnology to be powerful because its requirement of charting their menstrual cycles helped demystify their individual fertility, hormones, and more and treat their infertility.
Through charting, Moya* was able to gain a gradual and detailed understanding of her body. She moved from a poor understanding of her cycle where she “assumed you count back 14 days from your period and that’s when you are ovulating” and where she “didn’t realize… that different people had totally different cycles” to a point when she could confidently identify the important events in her cycle.
“We discovered that my cycle was not the normal 28 to 30 days that I had always thought, but my cycle was much shorter, it was 25 days. I was ovulating on day 9 and 10 which was way off!… That’s the thing with the charting. Every month you could feel yourself getting closer and closer. Because every month I would say, “Now I know my cycle is not 28 days. Now I know that I’m ovulating on day 9. Now I can see the mucus.” I felt every month was a little bonus – that we were getting closer.”
Study participant Ivy believed that societal ignorance and silence about women’s bodies and fertility creates a disconnect in women between their own bodies and their very “selves,” and this disconnect predisposes them to approach infertility treatment from a disempowered position. She communicated that the knowledge charting provides is knowledge that every woman has a right to have as “it is basic female health care,” and she questioned why women are not taught about their cycles, including teenage girls in school.
“[Our fertility cycle] is very fundamental to who we are, and our physical and mental health, so I’m not quite sure why women are not taught about it in school, how their bodies work and what it all means. [A period] is not something that might happen to you, it’s something that happens every single month… So why women are not taught about that, other than the fact that they’re getting their period at some point in the month, is incredible.”
Ivy’s strong conviction about the empowering nature of fertility education is evidenced in her desire to teach her own daughters how to chart their fertility cycles in the future.
Charting and fertility awareness are basic tools of women’s healthcare
For Ruth, charting is not only necessary for women who are struggling with infertility and other gynecological issues, but ought to be an essential component of every woman’s basic healthcare. Similarly, Leah expressed that the knowledge charting provides is knowledge all women should be able to access. The knowledge she gained on her fertility cycle and reproductive health was something that Leah most appreciated about NaProTechnology treatment.
“What NaProTechnology offered me was just like a, you know, a cherry at the top of the whole cake because it was answering all the medical aspects. And as a human being, even though I’m not a doctor, I’m not connected with medicine at all, I still need to understand things, you know.”
Charting and fertility awareness as tools of empowerment
A common theme raised in this study is that of charting and fertility awareness as tools of empowerment. The knowledge charting gave Martha allowed her to understand symptoms she was previously confused about:
“It’s quite liberating to know that there is an explanation for these things, that I’m not just having a bad day and my hormones are part of this. To have that knowledge – I feel is very empowering.”
When speaking of her experience of charting and her use of NaProTechnology, Beatrice also offered a similar comment:
“It’s really powerful and I think it’s really massive, it’s an empowerment thing for women if you ask me.” She shared, “What a wonderful gift to be able to know when I’m fertile.”
For Julia, the “huge difference” between her experience of treatment in mainstream medicine with her experience of NaProTechnology was that she “was so much more educated by the time [she] got to [the NaProTechnology doctor]” after learning how to chart her cycle and to identify the information provided by her own body:
“[I was] not only educated in the way of biology and how everything works, but how MY body works. Because that’s a huge advantage, I think, with NaPro and charting. That you know exactly what’s happening in your body.”
Body awareness makes women collaborators and active participants in their own healthcare
Many research participants reported that charting equipped them to become active partners in their own healthcare through the knowledge they acquired and shared about their own bodies and symptoms. When women are empowered through fertility awareness to monitor their cycles and to be respected as equal partners in their own healthcare, evaluations and treatment for infertility can be better tailored to their needs and underlying issues can be more easily identified. Incorrect assumptions and “guess-work” surrounding a woman’s fertility cycle can come at a significant cost. For example, by not personalizing hormonal evaluations to fit a woman’s unique cycle, important lab work and tests can fail to produce any useful information, wasting time and money.
The education the women acquired during their NaProTechnology treatment often exceeded their expectations, allowing them to become informed and expert partners in their clinical encounters. For Nadia, being taken seriously in clinical consultations was a reason she appreciated NaProTechnology:
“I found I much preferred NaPro in the way people approached me and how every little detail matters. I was really kind of shocked by it, because when I was saying to the consultant [in mainstream medicine], ‘You know, sometimes I have pain in my left side, do you think it’s my ovary?’ He said, ‘Oh, that’s interesting’ and he completely ignored it. He didn’t take note of it at all.”
Some research participants found that their collaboration in their own healthcare wasn’t always welcome
Becoming an “informed” or “expert” patient through fertility awareness created unique tensions for participants in their clinical encounters in mainstream medicine. As I wrote previously, “One participant, Irene, noted that when healthcare professionals carried out a blood test to check her progesterone level, she already ‘knew it was in the wrong time’ because she had been charting her cycle, but she was not listened to.”
Similarly, indicators in Martha’s charting about when she ovulated were ignored by the mainstream medical doctor she originally saw for her infertility, leading to mistimed blood draws and useless lab results.
“I had started already doing observations [through NaProTechnology] for three months, so by then I already knew that my luteal phase was very short; it was only seven days, like on the borderline. So I knew my day of ovulation was not on the 21st day like the gynecologist said. She picked the 21st day and she said, ‘This is your ovulation day’ and I told her, ‘this is not my ovulation [date], this is my second phase, and it will not be relevant for what you are looking for’ and she didn’t take me seriously.”
The new body knowledge on the part of my research participants who learned to chart their cycles challenged the dominant traditions within reproductive healthcare, in which women, even women actively struggling with infertility, are not routinely offered such fertility education or encouraged to acquire it. But a key question from my study participants was, why not? Why is the empowerment of women through body education not a key goal of women’s reproductive medicine? Why aren’t women equipped to collaborate with Healthcare Professionals as equal partners through education about their own fertility cycles?
Every woman should learn to chart her menstrual cycle, especially if she struggles with infertility
For study participants, charting their cycles not only functioned as a health meter or diagnostic tool, but as a crucial way of enabling them to be active partners in their own treatment. It allowed them to be much more in control of their reproductive health, to understand their bodies, symptoms and underlying conditions, to better participate in decision-making, and it reduced feelings of vulnerability in the treatment process – all of which are key characteristics of an empowered patient. The empowerment of women through body knowledge does not have to be something they experience only when there is an issue with their fertility and reproductive health. As expressed by study participants, all women—especially those experiencing infertility— have a right to learn to chart in order to understand their own bodies, to be able to recognize key events in their own fertility cycles and to be key players in their general healthcare.
*Pseudonyms were used in the study.
References:
[1] Smith, D.G., Ross, A., HogenEsch, E. et al. Anxiety, attitudes, and education about fertility among medical students in the United States. BMC Med Educ 23, 147 (2023). https://doi.org/10.1186/s12909-023-04075-w [2] Laura Bunting, Ivan Tsibulsky, Jacky Boivin, Fertility knowledge and beliefs about fertility treatment: findings from the International Fertility Decision-making Study, Human Reproduction, Volume 28, Issue 2, February 2013, Pages 385–397, https://doi.org/10.1093/humrep/des402 [3] Butau, L. 2018. An Analysis of the Lived Experience of Infertility and NaProTechnology in the Context of Catholic Theological Ethics, University of Surrey, England.
