Ep.130: Convincing your OBGYN to use Fertility Awareness Methods, with Dr. Marguerite Duane

There are incredible benefits to using fertility awareness based methods (FABM) for reproductive health and family planning, but not all OBGYNs, midwives, or clinicians are on board. Why is this the case? Is there something "iffy" about FABMs? Is natural family planning (NFP) actually just the rhythm method? Yikes! Dr. Marguerite Duane, co-founder and executive director of FACTS about Fertility shares the science behind FABMs, why your physician may not know about them, and practical tips and resources for getting them on board and educated. We need more medical professionals knowledgeable and educated in areas of restorative reproductive healthcare -- not only for our own needs, but for future generations. Join us as we take the first step together!

NOTE: This episode is appropriate for all audiences.

GUEST BIO:
Dr. Duane, a board-certified family physician, is co-founder and Executive Director of FACTS about Fertility, an organization dedicated to educating medical professionals and students about the scientific evidence supporting fertility awareness-based methods (FABMs). Dr. Duane trained as a Creighton, FEMM and NeoFertility Medical consultant, and a TeenSTAR educator. She received her M.D. degree from the State University of New York at Stony Brook and completed her Family Medicine residency at Lancaster General Hospital in Pennsylvania. She received a Bachelor of Science with Honors and a Master of Health Administration degree from Cornell University. In 2022, Dr. Duane completed a primary care research fellowship at the University of Utah earning a Master of Science in Public Health.

SHOW NOTES:
FACTS About Fertility Research

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Transcript

Caitlin: 0:06

Welcome to the Woven Well Podcast. I'm your host, Caitlin Estes. I'm a certified fertility care practitioner with a master of divinity degree. Each episode will cover a topic that helps educate and empower you and your fertility while honoring the deep connection your fertility has with your faith. Let's get started. Welcome back to the Woven Well Podcast. Our show is designed to give you practical natural fertility resources that can help in your everyday lives. We talk about family planning, infertility treatments, reproductive health concerns and more. And one thing that comes up again and again is the importance of a supportive medical professional in your community. But what if there isn't one? What if you don't know of a medical professional who encourages fertility awareness methods or knows how to utilize them for your health? What if you have a physician that you love, but they're clueless when it comes to these specific topics? Well, I've invited Dr. Marguerite Duane to talk with us about these questions and help us learn how to encourage OBGYNs to incorporate fertility awareness methods into their practices. Dr. Duane , a board certified family physician, is co-founder and executive director of FACTS about Fertility, an organization dedicated to educating medical professionals and students about the scientific evidence supporting fertility awareness based methods. Dr. Duane trained as a Creighton, Femm, and NeoFertility medical consultant and a Teen STAR educator. Dr. Duane, welcome to the show.

Dr. Duane: 1:40

Thank you so much, Caitlin, for having me. I'm delighted to be here today.

Caitlin: 1:43

I'm really excited about what you have to share because I know that this is a big issue for a lot of women, but I mentioned your role as co-founder and executive director at FACTS about Fertility. Would you share with us a little about what your organization does?

Dr. Duane: 1:56

Sure. So FACTS About Fertility is an organization that I co-founded in 2010 with another family physician, Dr. Bob Motley. And originally we were called the Fertility Appreciation Collaborative to teach the science. And our name really talks about what we do. We want to educate the medical community, both physicians, nurse practitioners, midwives, pharmacists, students, residents, anybody in the healthcare professional community about the science, underlying fertility awareness based methods, female cycle tracking, and how this can be used by women to monitor their health and in conjunction with their medical professional to help them better identify, diagnose, treat, and manage a wide range of women's health conditions. Also, we want to educate the medical professional community about the effectiveness of these methods from a family planning perspective. So we believe that through education we can help both the individual patients and the medical professional community develop a healthy appreciation for fertility. We want to collaborate with our medical colleagues from all disciplines, OBGYNs, family medicine, women's health and nurse practitioners, midwives, PAs, et cetera , to teach the science. That's our focus. Our goal is to share the FACTS about Fertility.

Caitlin: 3:23

What you do is incredibly important. This is absolutely necessary. I think that more and more women are interested in natural approaches to fertility, and they're wondering why don't more OBGYNs know about or value fertility awareness methods? There are so many benefits to their use, but women are often given kind of an eye roll or deer in the headlights look from their medical professionals. Why do you think that is?

Dr. Duane: 3:54

You know, that's absolutely true and the reality is that we as medical professionals simply do not learn this information. This is not a part of the standard curriculum, whether it's in medical schools or nursing schools. It's simply not covered. And so I encourage your listeners to, to give grace to the medical professionals that are providing your care because they simply may not know this. For me personally, the only reason I learned about it when I was a resident is I happened to have a senior resident who was trained in the Creighton model. And when we were on OB call one night and I was doing what any good intern does on an OB call, I was getting all of my postpartum patients ready for discharge by writing their birth control prescriptions because that's what we were advised to do. My senior resident said, did you know there's some forms of family planning that women can use that have no medical side effects? And I said, what are you talking about? Like every form of family planning, whether it's IUDs or birth control pills or condoms even, they all have side effects. And she said, no, women can actually learn to chart the signs of their fertility, whether it's cervical mucus or basal body temperature, to identify when they're fertile and when they're not. And I was like, what are you talking about? I had never heard this. I thought to myself, why didn't I learn about this when I was in medical school? Right? This seems like basic reproductive physiology. And then I thought, why didn't I learn about this in college when I went to the student health center with painful periods and the only option that was offered to me was the pill? And I was like, but I don't, I don't need birth control. They're like, but this is the best treatment. And I thought, why didn't I learn about this when I was a teenager going through puberty? And the reality is, this information up until very recently has not been made widely available. And so that was in the year 2000 when I was a resident. A few years later, I pursued training in the various methods. And then in 2010 when I was on faculty at Georgetown University, I had the opportunity to teach a small group class on any topic related to healthcare . And I thought, why not teach a small group of medical students about natural methods of family planning and female cycle charting? And so I did, and the feedback from the students was so overwhelmingly positive. They're like, why didn't I learn about this before? Why isn't this a part of our basic reproductive physiology curriculum? This is something every medical student should learn. And I thought, they're right. This is something every medical student should learn. But the reality is, is we don't. That is what inspired us to form FACTS. What's interesting is when we started FACTS in 2010 , there was a study published that very same year that looked at OBGYNs and family physicians, the two physician specialties that provide the majority of women's healthcare. Only three to 6% were familiar or knowledgeable about modern evidence-based natural methods or fertility awareness-based methods of family planning. So what started in 2010 with an elective at Georgetown has grown into FACTS and has led to us reaching medical students from over a hundred different medical schools all over the world, but it's still the only elective of its kind. It's still the only course of its kind. Now refer them to our FACTS about fertility.org website because this is our goal to help educate about all of the natural evidence-based methods and their role in women's health and family planning.

Caitlin: 7:27

This is so incredibly important. And as you have worked with hundreds and thousands of medical professionals of different types over the years, what have you found to be the most impactful in changing their minds about this?

Dr. Duane: 7:42

It's very simple. Sharing the science. We start out with like, this is normal reproductive physiology. This is how the female cycle works, and this is how the male reproductive system works. We teach them the basic science. We teach them how throughout the course of woman's cycle, the cyclical changes, hormonal changes she experiences are manifest in external observations, signs that a woman can learn to track. The rising estradiol leading up to ovulation will result in the production of fertile-type cervical mucus that a woman can observe. When she gets closer to ovulation, it'll trigger an LH surge. Sometimes that can be detected, oftentimes can be detected with an LH monitor , by using urinary hormone test strips. Once a woman ovulates and her progesterone levels rise, this will cause a change in her cervical mucus, which she can then observe and it can also result in a rise in her basal body temperature. So we teach the students that a woman's external observations of her cervical mucus, her basal body temperature and her urinary hormones, these daily external observations create a daily diary that reflect the internal hormonal changes. We oftentimes will invite or encourage students to learn to chart themselves. And when they see what's happening in their own bodies, it's astounding to them and they have the reaction that many women have. Like, how have I never noticed this? I never knew that that discharge was normal. I always thought it was something that was wrong, perhaps a disease or perhaps poor hygiene. And I didn't understand this. So the students are really blown away by the science. What's important to know, what I explained to my medical colleagues, that the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics both recognize the female cycle, the menstrual cycle, as a fifth vital sign. And so to really be able to utilize it as a vital sign, we need women to learn to chart their cycles. And then the students say, why aren't we learning this in our reproductive physiology and pathophysiology courses? Like all they're really often taught is that if a woman comes to them with irregular cycles, abnormal bleeding, painful cycles, like I had presented to my student health center, the recommended treatment of course is hormonal birth control, synthetic hormones, maybe an IUD. What we help them to understand is that that actually doesn't treat any of those underlying conditions, and it doesn't help get at the root cause of why is she having irregular cycles. Perhaps she's having irregular cycles because she has polycystic ovarian syndrome, and that would be manifested in her chart by lots of days of mucus. But maybe she has irregular cycles because she's under a lot of stress or not eating enough or overexercising. This may result in very dry cycles. Again, looking at the chart is going to help tell us, and then the treatment plans are going to be different. So when we teach the students that charting the female cycle can help you get at a more accurate diagnosis and a more targeted treatment and not simply suppress the symptoms, which is what synthetic hormones do, they're blown away and they're like, we need to do this. Women deserve this, and this is what we want 'em to understand. Women deserve better.

Caitlin: 11:18

Hmm . I know that I have clients and listeners who are just itching to be a part of this because I think patients have the potential to cause a lot of positive change. So what can we be doing as those of us who are actually in the doctor's office talking with these medical professionals, what can we do to encourage this change and encourage our physicians to invest more in fertility awareness methods?

Dr. Duane: 11:49

Yeah, so again, I would start by giving grace to your medical professionals. If they look at you and they're like, what is this? They don't have a clue. You know, perhaps you bring your chart to your physician and they look at this , and this means nothing to me. I don't, I don't know how to read this. So like, I understand, like my understanding is this is not routinely taught in medical schools. FACTS actually did a survey a few years back where we surveyed women about their experiences talking with their clinicians about their use of fertility awareness based methods. And many of them said their doctors didn't know. You know, some were, you know, ignorant, but open. Some were obnoxious and mocking. You know, a third of patients said they've had doctors laugh at them, you know, midwives, one of them for like, well, you can't do that. That's the rhythm method, honey. And it's like, no, no, the rhythm method was developed a century ago. What I'm doing now, charting with a modern fertility awareness based method is based on the science. And there are organizations that teach this rooted in the science. Again, I encourage your listeners to use the factsaboutfertility.org website as a resource. We have a fantastic article on there that's called Fertility Awareness Based Methods for Women's Health and Family Planning. This is a peer reviewed article in a medical journal that is available for free for download on our website. If you click on learn more and research, you can click on the link and I'll provide it to you so you can provide it to your listeners. This is a summary of the evidence supporting the use of these methods, not only from a family planning perspective, both from a preventing pregnancy perspective and in helping couples to achieve pregnancy, but also all of the women's health applications. So saying, you know, I realize this may not be something you're familiar with. Here's an article that goes into the science supporting the use of these methods. Some medical professionals, like I said, may refer to this as the rhythm method. Some people may assume that, you know, women are using it from faith-based purposes, and many people choose to use these methods because it aligns with their faith. Some people choose to use these methods because they're concerned about the environment and all the synthetic hormones that are in the environment, regardless of why you choose to use a natural method. These are rooted in science. And so we would encourage you to encourage your clinician to learn more at FACTS. Not only do we have research articles, and we've got blogs that summarize the latest research, but we have online continuing medical education courses. We have introductory webinars that are available for both medical professionals and patients alike. I mentioned the FACTS about Fertility explained. We have a medical presentation on fertility awareness based methods for family planning. We also have one called the Female Cycles, the fifth vital sign, again, highlighting the medical benefits of using these methods. And then we've got full online continuing medical education courses. So we encourage you to connect your medical professional, your OBGYN, your midwife to FACTS and our resources. And we also recognize this is hard because the way we're trained in medicine, again, is that female fertility is a problem to be solved. And if you're struggling with infertility, women are often automatically referred for IVF . Again, IVF seeks to bypass the underlying cause and not treat the root problem. So we encourage you if your doctors are not open to learning more about restorative reproductive medicine, we encourage you to learn and work with restorative reproductive physicians and medical professionals . Again, on our FACTS website, we offer a resource called the Physician Clinician Educator directory for people to find physicians that are trained. There are other services that offer fertility awareness based trained physicians. There's the NaProTechnology website, there's the FEMM website, there's my Catholic doctor. These all offer links to doctors that are trained in many of these natural methods. But at FACTS, our focus is on reaching all medical professionals with the science, supporting all of the evidence-based methods. So if you're looking for a one one-stop shopping, one place to send medical professionals, we certainly invite you to refer them to the FACTS about fertility.org website. And at the very least, share some of the latest research that we're publishing to help them understand the science and how this really is a fifth vital sign that can truly make a difference in the lives of women and men.

Caitlin: 16:26

Thank you so much for sharing ways that we can make a difference as patients and how our medical professionals can get more involved in fertility awareness methods. I know it's really going to make a difference.

Dr. Duane: 16:37

We, we hope so. And again, although our target audience is the medical professional community , um, we certainly invite those who are not medical professionals or not educators who want to learn more to, to certainly visit our website and, you know, stay connected. And if you need help finding a medical professional, please reach out to us. You know, we want women to receive the best care. And part of why we started FACTS was the fact that when we started some of our early research studies, we found that there were less than a thousand medical professionals trained in these methods. Now, in the last five years, we've trained nearly a thousand medical students in all of the methods. So this is our goal that there will be a fertility awareness based method or restorative reproductive medical professional in your community. Until then, if you need help in finding one, send them our way. You know, if you yourself want to learn more, take advantage of our webinars, refer your medical professionals to our courses. We're doing a virtual conference, on Saturday, October 19th , that will touch on each of the restorative reproductive methods like Creighton and Femm , NeoFertility, Marquette. So it's a great opportunity. We even are going to talk about integrative medicine and a functional approach to healthcare. So it's a great opportunity to refer physicians or clinicians that might be skeptical about one method to have exposure and learn about all of the methods. And so we certainly invite your listeners to learn more, reach out, help us, help you educate the medical professionals that you're working with to understand the beauty of tracking the female cycle so they may come to appreciate fertility and hopefully collaborate with FACTS to teach the science to even more medical professionals and students in the future.

Caitlin: 18:27

Absolutely. Thanks so much for being here.

Dr. Duane: 18:29

You're welcome. Thank you.

Caitlin: 18:32

Listeners. I really believe that our actions today can have a positive impact, not only for ourselves, but even for future generations. So we can do our part in gaining knowledge about our cycles, incorporating it into our reproductive healthcare , and then passing this information on to others. So even if you don't yet have a medical professional who can do this, that doesn't mean that you can't begin learning a fertility awareness method yourself. Behind the scenes of woven well is woven natural fertility care, and we teach the Creighton Method, and we would love to invite you to learn more about it yourself. Check out the link in the show notes for our upcoming introductory sessions where you can learn more about what it is, how it works, and what it tells you about your own reproductive health. Want to give us feedback or ask a question from today's episode? You can actually send us a text message. Look in the show notes for the link to do that as well. As always, thanks so much for listening as we continue to explore together what it means to be woven well.