I’ve had people call me a liar for saying I was thrown out of the doctor’s office during my 6-week postpartum checkup. “There’s no way that’s a true story,” they’ll say. “Professionals don’t act that way.”
But I’m not sure what else you would call it when the nurse ushers you out of the exam room, trying to shove unwanted condoms in your diaper bag, as she quips, “Don’t come see me in three months when you’re pregnant again– I won’t take you as a patient.”
I cried in the elevator and on the subway all the way back home. I didn’t know why she would treat me this way, when all I had done was ask where I could learn how to navigate postpartum Natural Family Planning (NFP) while I was breastfeeding.
I turned to my pastor for NFP resources, but he was unable to help me
As a Catholic woman, I’ve certainly had my fair share of issues with lack of access to information about NFP within the Church. After this less-than-stellar appointment with the nurse, I turned to my parish priest for suggestions and he said, “Oh. To be honest, I’m not really sure how you’d find someone to teach you that. I’ve never had anyone ask.” But with a few exceptions, I have mostly found that pastors and fellow parishioners have never been hostile to my desire to use NFP– they have just been ill-equipped or misinformed about how to support me.
My encouragement to others who’ve been dismissed for using NFP
That’s a very different issue from what I have experienced time and time again with my doctors here in Massachusetts, who have occasionally taken it upon themselves to berate my personal family planning decisions and refuse to offer assistance.
So, as I think about sharing my own NFP story, I simply want to invite any woman who is reading this article–especially those who feel dismissed or judged by your doctors–to know that you’re doing really heroic work, and that despite what any dismissive medical professional may tell you, charting your cycle can be an incredible gift to your health!
That was an aspect of cycle charting that was not on my radar when I first learned about NFP, so I offer the following thoughts in the hopes that they might encourage you to persist with charting and not get discouraged if one doctor (or, two… or three…) are rude and don’t seem to “get it.”
I’ve charted my cycle for 15 years, through many life seasons
I’ve been charting now for over fifteen years, and have been teaching the Boston Cross Check Method for over a decade. During that time, my husband and I have navigated seasons of trying to avoid pregnancy and trying to conceive, postpartum transitions, repeat miscarriage and secondary infertility. The NFP chart has been there through all those things. But a few years ago, my NFP chart saved me a lot of costly medical procedures, time, and–quite literally–headaches.
Migraines have been part of my life for decades
For my entire life, I have been susceptible to migraines. I got my first migraine when I was only three years old. It’s the first vivid memory I have, because the pain was so intense. Debilitating migraines were never a regular occurrence, but would just pop up occasionally as I was growing up. As a young adult, though, I began to observe that I frequently experienced “silent” migraines. These episodes of visual and mood disturbance, fatigue, dizziness, and other aura symptoms would last for days or even sometimes weeks at a time. They’d occasionally present with a headache, but even without that I could easily say that my migraines were interfering with my ability to function. It was time to get some help.
As a woman, the first thing a neurologist will often assume about migraines is that they are tied to your menstrual cycle. For many women, this is the case! The only time I noticed a complete lack of migraines was while breastfeeding, which did suggest a hormonal component– but because I had been charting my symptoms along with my cycle for years, I was very confident that something else was going on.
The first neurologist I saw (for the record, a female doctor) wouldn’t even look at my chart. I tried to pull out the Read Your Body app on my phone and explain what I saw in my migraine patterns relative to my cycle phases, but she waved her hand and looked down her nose at me. “Get that silly nonsense out of my face,” she said. “That won’t tell us anything.”
She told me to take birth control, even though it’s contraindicated for migraines with aura
I allowed her to proceed with the rest of our exam but when she told me my best option was to start hormonal birth control, I informed her that I would not be booking a follow up appointment. (Side note: ACOG and WHO have stated that due to increased risk of stroke, migraines with aura should be “an absolute contraindication to the use of combined hormonal contraception” [1].)
My second neurologist also didn’t know what to do with my cycle chart, but he listened well
The second neurologist I saw (for the record, a male doctor) didn’t really know what to make of my cycle chart, either. But his attitude was very different. Instead of essentially shooing me away, he said, “Interesting. Can you tell me what all of these things on your chart mean?” I showed him how my cervical fluid, temperature, and hormone monitoring told me where ovulation was happening in my cycle.
I then showed him the markings and notes I had included about migraine symptoms–with and without headache pain–over the course of multiple months. We agreed that there seemed to be “clusters” of migraines happening, but sometimes they occurred in the follicular phase and other times they occurred in the luteal phase. The patterns strongly suggested that, even if hormones might have been contributing, my cycle likely wasn’t the main issue.
Hormones weren’t the primary cause of my migraines with aura
This doctor then talked me through all of the steps we had just effectively sped through in his normal process of diagnosis, which began with the assumption that migraines in his female patients were due to menstrual cycles. He didn’t recommend birth control, and instead got curious about the postpartum reprieve I had experienced. If it wasn’t likely the hormones, what else could it be? He asked me about whether my diet or supplements had changed while breastfeeding, and I shared that for a time I had been taking a magnesium-calcium supplement while I was nursing. It was like a light turned on as he smiled and said, “Aha! That’s where we’ll start.”
Many doctors aren’t educated on the cycle as a fifth vital sign, and my NFP story is proof
For this particular vignette, the conclusion is a happy one, because I have found success with a magnesium regimen and have since been diagnosed with a chronic condition which explains why I often found myself magnesium deficient [2]. I know, however, that many of my NFP-using friends and clients have not been quite so lucky in their experiences with doctors; so, I hesitate to draw the conclusion that all you need to do is persist, and eventually a doctor will take you seriously. Unfortunately, our medical system is deeply lacking in education and training on the value of the menstrual cycle as a diagnostic tool, a fifth vital sign of overall health. Patients who are regularly talked down to, argued with, or even thrown out of offices (because yes, that does happen) may eventually be bullied into silence and quiet acceptance of issues that deserve care and attention.
Here’s how to advocate for yourself with a doctor who doesn’t know about NFP
It is exhausting to feel like we as women need to advocate for basic care sometimes. I know that frustration firsthand. So if that’s where you find yourself, I hope my NFP story shows you you’re not alone. Here are a few resources to keep you going:
- FACTS About Fertility not only offers training for medical professionals about fertility awareness methods of family planning, but they also have a shop where you can purchase materials to share with your doctors. The #ShareTheFACTS Folder even comes with a letter to physicians that you can politely hand over for their own educational benefit.
- The FertilityScienceInstitute, FEMMHealth, and MyCatholicDoctor are a few of the growing directories online to help connect patients with providers who will take a Restorative Reproductive Medicine (RRM) approach to cycle health.
But just remember–your doctor doesn’t need to be trained in RRM to listen to you! That’s a basic professional and personal courtesy. So in cases when you may not feel equipped to articulate what you’re experiencing with your chart, I find it very helpful to work with a certified NFP instructor who can make sure you are charting accurately, and coach you on what to say to your physician about certain symptoms you’re having. Even if they won’t look at your chart, being able to articulate: “I experience XYZ symptoms exclusively during the luteal phase of my cycle” can be a great first step in getting them to pay attention and take appropriate steps to help.
Additional Reading:
What’s the connection between migraines and hormones?
How fertility awareness helped me find solutions for hormonal migraines
References:
[1] Edlow, Andrea G, and Deborah Bartz. “Hormonal contraceptive options for women with headache: a review of the evidence.” Reviews in obstetrics & gynecology vol. 3,2 (2010): 55-65. [2] Domitrz I, Cegielska J. Magnesium as an Important Factor in the Pathogenesis and Treatment of Migraine-From Theory to Practice. Nutrients. 2022 Mar 5;14(5):1089. doi: 10.3390/nu14051089. PMID: 35268064; PMCID: PMC8912646.
