Many believe that fertility awareness methods (FAM) only work for women with “regular” cycles—which means they are ineffective for women with conditions like polycystic ovarian syndrome (PCOS). But that’s a common misconception. Fertility awareness methods have come a long way since the “calendar method” and the Rhythm Method. FAM, also known as evidence-based forms of natural family planning (NFP), not only work for women with PCOS, but they can help these women better understand and manage their PCOS symptoms.
I was put on the birth control pill when I was 18, after five years of irregular cycles, mood swings, and heavy, painful periods. I wasn’t given a diagnosis—just a vague statement that, “irregular periods run in your family, and the pill will help.”
I took the pill obediently for about ten years, switching prescriptions once or twice along the way. Occasionally, I’d hear things online about the side effects of the Pill, but I didn’t experience any of the short-term ones and tried to push the thought of the long-term effects out of my head. After all, no natural method would work with irregular cycles, right?
Wrong.
As I started investigating, I read more about fertility awareness methods and the plethora of charting options available for women to better understand their cycles. At first, I thought that FAM wouldn’t work for me; after all, my symptoms couldn’t be treated with a chart and a pen — and could they really help for someone with what seemed like an impossible, unpredictable cycle? Then, I learned about NaProTechnology (Natural Procreative Technology), also known as “NaPro,” which suggested that if I chart my symptoms over the course of a cycle, doctors could help treat the hormonal problems underlying my irregular periods. The idea was not to mask the symptoms with birth control drugs but to work with my natural cycle and heal the root problem. I decided to give it a try.
I learned to chart my cycles with the Creighton method (the medically supported method backed by NaProTechnology doctors) and, sure enough, my charts revealed some problems. My charting instructor referred me to an OB-GYN who was also certified in NaPro, and that doctor took a thorough medical history and ordered a series of blood tests to check my hormone levels. Finally, at the age of 29, I had a clear diagnosis: PCOS. (This wasn’t the end of my reproductive health journey; later I also received a diagnosis for endometriosis, the final piece of the puzzle. But learning I had PCOS was the first step toward finding real solutions.)
The treatment for PCOS? For many doctors, it’s the Pill—but only to cover up symptoms. For NaPro medical practitioners, it’s a more targeted approach that’s directly aimed at treating your body’s root problems. In addition to providing a chance of healing for my actual problem, NaPro interventions are far less likely to cause side effects or health problems that many experience from hormonal contraceptives.
What is PCOS?
Polycystic ovarian syndrome (PCOS) is a hormonal imbalance that can cause a variety of symptoms including cysts on the ovaries, long cycles (meaning a long time between periods, not long periods), acne, chronic fatigue, anxiety and/or depression, insulin resistance or type 2 diabetes, and hair loss or excessive hair growth. PCOS, as a condition that interferes with ovulation, is the most common cause of infertility in women.
PCOS primarily affects three hormones: androgens, insulin, and progesterone. Androgens are known as male hormones, though both sexes naturally produce them. Women with PCOS tend to produce more androgens than women without PCOS, and it’s the high levels of androgens that cause acne, hair loss, and/or excessive hair. Insulin helps the body process glucose (sugar); women with PCOS tend not to respond to insulin like we’re supposed to, which can raise blood sugar and insulin levels (which can, in turn, raise androgen levels, creating a vicious cycle). Finally, progesterone is the hormone that’s dominant at the end of a woman’s cycle. It maintains the uterine lining and supports pregnancy, and without it, women with PCOS can have heavy or irregular bleeding and difficulty becoming pregnant or sustaining a pregnancy.
How charting your irregular periods with a FAM can help diagnose PCOS
Women who chart with a fertility awareness method can find hints of PCOS in their charts. My fertility awareness instructor referred me to a NaPro physician because of my long cycles, the appearance of double peak days, and my brown spotting at the end of my cycle (just before my period—an indicator of low progesterone).
After seeing my chart, my doctor suspected PCOS based on my symptoms and my medical history (including hypoglycemia). She sent me to a lab for a series of blood tests on certain days of my cycle (which I could identify, because I was charting). The levels of each hormone at those particular times in my cycle suggested to her that I probably had PCOS, as well as low progesterone, which was causing the spotting at the end of my cycle. Later, an ultrasound would confirm that I did have some cysts on my ovaries—another sign.
How is PCOS treated?
My doctor prescribed a bioidentical form of progesterone for days 3 through 12 after peak day on my cycle chart—a targeted approach that gives me only the hormone I need, only when I need it. She also recommended that I take myo-inositol, a naturally occurring chemical that is often used to treat PCOS and, particularly, to help with the insulin resistance and fertility problems that can come with it. Finally, she recommended an anti-inflammatory diet: no gluten, no dairy, and no processed sugar. Along the way, I continued to chart not only my biomarkers, like cervical mucus, but all my physical and emotional symptoms.
Nowhere in my treatment did my NaPro doctor prescribe the birth control pill. As it happens, hormonal contraception can make PCOS worse by allowing the hormonal dysfunction underlying it to worsen. Fortunately, targeted hormonal treatment, along with lifestyle and diet changes, can make living with PCOS more manageable.
I have found a lot of symptom relief from my treatment plan. Now, I rarely have cycles that are longer than the normal length, and my blood sugar is well managed. What’s more, my chronic fatigue (I had double the fatigue due to my additional diagnosis of fibromyalgia) is so much better, to the point where my improvement was noticeable to others. I was also able to get pregnant (I’m due in June) — something I feared would never happen.
I’m still working on managing mood swings, but while charting can’t help your mood, it can help you understand when you tend to have bad days. It’s a relief to know that your seemingly out-of-the-blue weepiness is due to the hormonal changes you’re experiencing, than to attribute some other meaning to it. I believe that if I’d been working on managing my symptoms during my 20s rather than staying on the pill, I would be better equipped to handle them now.
How to get started with fertility awareness when you have irregular periods
If my irregular periods and other symptoms sound familiar to you, there are many resources that can help you. This page can help you identify a fertility awareness method that might work for you—irregular periods and all. And if the first method you try doesn’t work for you, you can always try another. I started out by using the Creighton method, and now I use FEMM. They’re both excellent, and are similar in that they work well with medical management of symptoms. (Disclaimer: I am in the final weeks of earning my teacher certification through FEMM.)
One important caveat: No matter the method you choose, find an instructor. You may be able to get an overview of the science behind a method by simply reading on your own, but working one-on-one with an instructor to go over your charts each cycle will help you learn about your own body and identify symptoms or patterns that may indicate an underlying problem or condition. You can look for an instructor and, if needed, a NaPro or FEMM physician, here. Once you’ve increased your knowledge about your health, you can manage it on your own (and with your partner, if you have one, and your doctor). If you’re like me, you’ll find yourself more empowered, educated … and healthier than you’ve ever been before.
Additional Reading:
The emotional effects of PCOS: The lies it tells me, and how I battle them
Understanding the Surgical Techniques Used to Address PCOS
What an Irregular Period Means, and How the Pill Doesn’t Help
When it Comes to Irregular Periods, Fertility Charting Works Better Than Birth Control
