When I had my first visit with an OB-GYN, I was already in my mid-twenties. I was blessed to avoid menstrual cycle issues as a teen and only scheduled a visit after getting engaged; I wanted to make sure everything was in working order before marriage and potentially having kids! While getting checked in with the nurse, I answered the usual questions about medication use and lifestyle. Then she asked me what birth control I use. “Oh, no,” I smiled, “I use NFP.” She looked at me and scoffed, “Well, then I guess we’ll see you again in nine months!”
Although I chuckled at the time with her, I find myself looking back on this experience with regret, thinking about all the things I could have said. I should have used this opportunity to explain to her the benefits of NFP, how it builds trust in my relationship with my husband (fiancé at the time), or how it is as effective as any other contemporary form of birth control. As a follow-up, perhaps via an online portal messaging system (which most health systems and doctor’s offices now offer), I could have sent her this resource from Frontiers in Medicine, or this brochure from Natural Womanhood, both of which are specifically geared towards medical professionals [1].
Your healthcare provider probably doesn’t hate FABMs—she just doesn’t know much about them!
Others, like Julia McElhenny, sound editor of Season 1 of The Natural Womanhood Podcast, and guest on Season 2 episode “FAM for Single Women,” have reported similar experiences to mine. In fact, based on informal polls, Lisa Hendrickson-Jack of the Fertility Friday podcast estimates that only 10% of women who use some sort of NFP method or other fertility awareness-based method (FABM) have had a positive reaction from their healthcare provider when revealing their family planning method of choice. The cause of this largely negative stance? There are, no doubt, many reasons, which NW writer Kristen Curran covered in detail, here. But it’s not a stretch to say that they likely all stem from lack of education on FABMs.
For example, according to this review article, only 4% of physicians have received any sort of formal training in FABMs [1]. Only 6% of physicians actually have knowledge about the true methodology and effectiveness of FABMs, even though knowledge of all the aspects of a woman’s menstrual cycle–ovulation as well as menstruation–is vital to understanding women’s health.
Share the benefits of FABMs with your provider
The truth is, cycle charting with a FABM can be a powerful tool providing a wealth of information to doctors who treat women. Cycle charts can be especially useful in identifying underlying reproductive issues, such as polycystic ovary syndrome (PCOS), fibroids, and endometriosis, which might be the source of infertility, pain, gastrointestinal problems, multiple pregnancy loss, and many other issues.
Furthermore, FABMs can be used both to avoid and to achieve pregnancy. Plus, many couples who use NFP or FABMs notice improved relationship health, communication, and sex life. But despite all of these benefits to physical, emotional, and relational health, the vast majority of healthcare providers know nothing of these medical applications and the various benefits of FABMs.
When your doctor says this, here’s what you should say
Both resources linked above are great handouts to share with your healthcare provider within or outside of an appointment with them. But what can you say in-the-moment? Let’s look at the most common objections your provider may raise in the office, and how to confidently respond to them during an in-person conversation.
The rhythm method is not up to date with “modern” science
Note that many doctors and other medical professionals will refer to FABMs as the “rhythm method.” This is a term coined for one of the first methods of charting a woman’s cycle, where a couple would abstain from sex on the average days of ovulation for the average woman with an average cycle. As you may have guessed, this was not a particularly effective method. It is, furthermore, outdated–the rhythm or “calendar” method was invented in the 1920s!
Modern FABMs, which use daily biomarker-based cycle tracking, far exceed the rhythm method’s scope and effectiveness. So, your doctor is right: the rhythm method is not up to date with modern science. But your FABM definitely is!
The rhythm method is not as effective as medical birth control
At this point, your doctor may humor you and accept that you use some sort of “new age” birth control. But more than likely, he or she will still believe that whatever natural family planning you’re using (although, again, FABM is the preferred term here because it’s about so much more than just planning babies) will be less effective than medical birth control. As recently as March of this year, the Mayo Clinic wrote that “In general, as many as 24 out of 100 women who use natural family planning for birth control become pregnant in the first year.”
But this data is based on the rhythm method, which, as we’ve noted previously, is outdated (and which is very different from modern, evidence-based FABMs and methods of NFP–some of which have pregnancy prevention rates as high as 98%)! Unfortunately, as we see with the Mayo Clinic article, most health professionals and websites tend to lump the rhythm method in with other FABMs when reporting the pregnancy prevention effectiveness rates. Make sure your doctor knows the difference, and knows that you know it, too!
Reality check: Evidence-based FAMs or FABMs can go toe-to-toe with hormonal birth control
In truth, the “effectiveness” of FABMs depends on what effect you’re trying to achieve: avoiding pregnancy, achieving pregnancy, or simply charting for your health. As far as avoiding pregnancy goes–since that seems to be the main concern of a doctor who would steer you away from a FABM–these methods can hold their ground with other commonly used forms of medical birth control. The Pill, condoms, and IUDs have a 9%, 18%, and 1% typical use rate, respectively, while the Sympto-Thermal, Creighton, and Marquette FABMs are 1.8%, 4%, and 7% effective with typical use.
Birth control–IUD, the pill, the shot, etc.–is better because it leaves little to no room for human error.
This objection may be true as far as the IUD or the shot goes, since you have little to no control over their effects once the shot or IUD is within your body. However, IUDs can have painful, if not excruciating, side effects, and the shot increases the risk of severe osteoporosis and of contracting HIV.
The Pill’s effectiveness, of course, still relies on a woman taking it every day, around the same time, and most women will slip now and then. The same could be true for FABMs, which do also rely on a woman meticulously charting her biomarkers and symptoms every day, whether that’s through cervical mucus checks, temperature checks, urine testing, or some combination thereof.
This is also an understandable objection to raise, considering that doctors, based on their wide-ranging experience with all different types of people, often assume the worst of their patients because many times a patient will not be fully honest with them. But what is different about FABMs is that, typically, both the husband and the wife are involved in the cycle tracking, and–what’s more–are generally more invested in their chosen method because of the benefit to their relationship. In other words, a woman practicing some sort of FABM may not be so likely to mess up, because she wants to do more than just avoid pregnancy; she wants to know her body.
FABMs only work for women with regular cycles, not with breastfeeding, menstrual irregularities, sickness/stress, etc.
According to the CDC, chronic conditions or cycle irregularities can complicate the use of fertility awareness-based methods or make them difficult to interpret. But quite the opposite is true. This is the GREAT thing about FABMs, because they’re not just useful for avoiding pregnancy, but for tracking real-time health data, too. In other words, they give a woman, and her healthcare provider, a great picture of her overall health.
Because a woman using a FABM makes daily biomarker observations (and does not rely on predictions of future fertility, as the rhythm method did), she can track (and her doctor can identify root causes of) cycle irregularities. That’s also why, depending on the biomarkers they track, various methods can be incredibly beneficial depending on the situation that a woman finds herself in (whether she’s breastfeeding/postpartum, dealing with infertility, in her teens, etc.). Finally, it should be pointed out that cycle irregularities are often first discovered via FABM use, and women can learn more about their bodies than they ever thought possible as a result.
Such knowledge gained from fertility awareness is invaluable for understanding a woman’s health, and hence, it is vital for doctors to learn about fertility awareness-based methods–and especially that they not steer women with irregular cycles away from using them, because these women may actually have the most to gain from using a FABM.
Fortunately, correcting the knowledge gap for healthcare providers is not difficult to do; as this encouraging study found, even a short, intensive introduction to FABM can help doctors feel more comfortable discussing these topics with their patients! Programs like this elective at Georgetown University’s medical school equip future doctors and other healthcare professionals to speak knowledgeably about natural family planning and fertility awareness-based methods.
Keep all of this in mind for your next trip to the doctor’s office
If you find yourself in the awkward situation of defending your choice to use a fertility awareness-based method to your doctor, midwife, naturopath, or nurse practitioner, remember to speak with confidence. You know your body better than the medical professionals in your life, especially if you are charting, and you likely have experienced firsthand the many benefits of using a FABM.
At the same time, remember that doctors typically receive little education about fertility awareness (though organizations like FACTS are working to change that!) and they may not always be open to “learning” from a patient. Be willing to give them some grace (and the benefit of the doubt), but also give them as much information as you can–what you know should be shared! Hopefully with better education and awareness (which might begin with empowered patients like you!) the medical community at large will soon come to embrace FABMs as the fantastic tool for monitoring the “fifth vital sign” of women’s health that they truly are.
References:
[1] Duane, Marguerite et al. “Fertility Awareness-Based Methods for Women’s Health and Family Planning.” Frontiers in medicine vol. 9 858977. 24 May. 2022, doi:10.3389/fmed.2022.858977Additional Reading:
Just say “no”?: 4 tips for talking to your doctor when she keeps asking you about birth control
