Doctors, It’s Time to Understand Fertility Better
The fact that I know more than some OB/GYNs about the science of fertility is a problem.
By now many have seen the Washington Post article, which chastises the ignorant women of the world for listening to the dangerous spoutings-off of TikTok folk who lambast the dangers of hormonal contraception and urge women to use the…gasp rhythm method, which is proven to fail and will result in untold unintended pregnancies and therefore also more abortions.
I wish I could have read that article and assumed the best. I wish I could have assumed that they had cherry picked a doctor who would feed them quotes perfect for clickbait and that this was an isolated ridiculous article in a sea of medical professionals who obviously do better.
But, as a woman, I’ve lived through too much of my own experience to deny the fact that this OB/GYN represents a lot of medical professionals out there who believe it is either contraception (for smart people who care about being responsible contributors to society) or the rhythm method (for the ignorant uneducated rest.)
Three Scenarios
One: I was seventeen years old and mentioned that my menstrual cramps were fairly painful each month. I was not sexually active, and yet I was put on a daily birth control pill to manage my menstrual symptoms. Did I understand what that pill was doing to my natural hormonal cycle each month? No. Did I gain weight and experience other side effects while I was on it? Yes
.
Then, in college, I was still not sexually active and was prescribed the Depo-Provera shot to address similar period symptoms. I was told this would stop my periods altogether! Miracle of miracles I could be free! What resulted was months and months of constant spotting, and one scenario where I experienced significant bleeding out of the blue and at a very inopportune time. I also felt extremely weird not having my cycle regularly. It was almost as if something inside me knew that my body wasn’t working as it should…
I couldn’t even count the number of women I know who share a similar story. At best, putting women who are having issues with their menstrual cycle on a pill is putting a band-aid on a larger issue.
In most other health situations that I can think of, doctors observe a patient’s symptoms, then systematically work toward figuring out the root cause so they can treat the root cause and resolve the issue for their patient. I have pondered the questions for years of why fertility symptoms are treated by default so often with the band-aid method. Hormonal contraception does not actually treat the root cause of many cycle irregularities, and Doctors aren’t actually treating women when they don’t know enough about fertility to research root causes and work to solve them. Women deserve better.
Two: I was four children in by this point, and had been seeing the same midwife team for a while for my general care between pregnancies. I had talked to them about the fact that I practice fertility awareness for my family planning. I know I had used those exact words because I intentionally opted out of the more religiously affiliated “Natural Family Planning” or NFP phraseology when answering their questions.
Months later, I showed up to a regular check-up appointment and the nurse doing my intake goes: “Are you still using the rhythm method?”
I wish I could have gone back and been more assertive about it, but I think I was so surprised at the moment and caught off guard that I awkwardly corrected her. But the fact is that my chart was inaccurate.
That moment also speaks to one of the main issues with the Washington Post article: that many people who literally specialize in women and childbirth and fertility don’t understand that the rhythm method is not the only option besides contraception. They live in a dichotomous world that doesn’t exist.
I’m assuming that many failures of the medical institution are at play here. The accountability probably lies partly with the individual practitioners who don’t do their research. Some of it might lie with medical colleges who likely don’t offer enough class time to the ins and outs of a woman’s cycle.
But the fact that I know more than a lot of these doctors is a big ole mix of frustrating and exhausting too. We’ve been practicing fertility awareness since about 2016 and we’ve had exactly two children in that time, both of whom we were open to having. The fact that I have not gotten accidentally pregnant in the four years since having our youngest is not a surprise to me, nor is it a stroke of good luck. I know each month when my body is getting ready to ovulate and increasing in estrogen. I know when ovulation is imminent and LH is surging. And I know when ovulation has passed because my progesterone rises.
The real, actual world that we exist in involves the options of contraception, the rhythm method, and any number of fertility awareness approaches that leverage the science of fertility. These approaches can not only assist families in avoiding pregnancy (at rates that match contraception) but also in achieving it if that is their goal (which can sometimes help women avoid needing more intensive fertility interventions.)
Three: My daughters. I am raising three girls in this world, and that has me thinking a lot about what we do to help young women understand what their bodies are doing.
As a girl myself, I was taught that fertility is a mysterious thing, that women menstruate about every 28 days and ovulate around day 14. I was taught that that is about all you can know about it. Girls today, in many cases, are still being taught these same things though they are all inaccurate.
I know that I will be looking for doctors for my girls who have put in the work to understand that a woman’s fertility is a good and healthy thing and who will help them understand and appreciate how their bodies function.
How helpful would it have been to learn that you can know when your period is going to start because your basal body temperature drops? I use the Oura ring and I can simply look at my BBT graph on the app to know what’s about to happen. It would have alleviated so much anxiety of getting caught off guard with a period starting when I forgot to bring the necessary supplies to school that day. Heck, it would have been helpful to simply have been told that cervical fluid is a normal, healthy thing to have and that there is a hormonal reason why the amount of fluid changes throughout the month.
We can do better in educating young women to read the language of their bodies, and to start off from the foundation that their fertility is healthy and good.
The Worst of All
But most of all, the Washington Post article is concerning because it frames women’s fertility as a problem to be solved. A burden to bear. A mystery that women are foolish to even try to solve without the help of a pharmaceutical product.
And I can’t help but think that is so incredibly backwards and harmful to women. Part of being a woman is being built with the potential to create new human life inside us. I straight up tell my daughters that our ability to do that is a superpower. That we can co-create with God to add more people made in His image to this earth. It's awesome. It’s a gift. It is something to be understood, not something to be treated.
Women who seek to understand their fertility are not using the rhythm method. We are not uneducated or ignorant. In many cases, we know more than our doctors about how the science of fertility works and we choose to work with our bodies, not against them to navigate planning our families. We are healthier for it.
I’ve said it before and I will say it again- fertility is among the only, if not the only bodily system that we artificially suppress even when (and sometimes especially when) it is functioning exactly as it should. We live in a time when we understand more about fertility than ever before in human history. We know the hormones involved and the physical symptoms of those hormones, both of which we can track!
Since the flawed charting at my appointment, I have switched to a practitioner who can look at my monthly charts and make sense of them alongside me. Someone who won’t ever offer me IUDs or the pill or the depo shot. It sometimes takes effort or a bit of extra drive time to find medical professionals who understand fertility well or who respect the choice to work with our bodies in a more natural way, but it is so very worth the effort.
I am hoping and asking other medical professionals, especially those who work with women, to at the very least read up on this subject. There are so many resources that are easy to find. The patient knowing more than the doctor is troubling. I urge those in the medical field to do better. And please do not take the Washington Post article as sound medical advice. No, I would not recommend the rhythm method. But the real ignorance lies with the doctor who says that’s the only option besides contraception that women have.
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I once started explaining an aspect of NFP to a friend. He stopped me and said with a slightly superior attitude, "I know all this stuff I'm a [ER] doctor". I didn't have the heart to tell him that being a doctor in relation to this stuff usually doesn't really mean much.
(He and his wife later misunderstood something about how NFP works post partum ("She never had her period!" "Uh, well, um...she doesn't have to to be fertile, man...") and had surprise twins. My husband thought the situation was hilarious).
Excellent article. Even from a young age, before I was taught about fertility awareness methods, I had the vague feeling that something was off about the idea of regularly taking medicine that stopped my body from doing the thing it was supposed to be doing, that it was healthy for my body to be doing. I remember too the skepticism I was met with when I refused the offer of the pill for cramps etc., or insisted that I didn’t need the pill (or anything else) for contraceptive purposes because I was purposefully choosing not to be sexually active. It hurt a bit to be honest that the decisions I was making, healthy and good decisions, were seen as backwards, problematic, or temporary beliefs I’d grow out of. Thank goodness though for support from others I knew and several different fertility awareness classes. I couldn’t believe how much about my own body had been withheld from me in a world that claims to be “sex positive” or focused on “bodily autonomy.” It was also incredible to see how much my fiancé (and later husband) gained a greater respect/awe for me as a woman when he learned about how my body worked and how different it was from his own embodied experience. And despite it not always being rainbows and sunshine, practicing fertility awareness has been an ultimate blessing and good for us as a couple. Thanks for writing and calling out the WP article, it made my blood boil when I read it.