As I write this, I am 38 weeks pregnant with my second baby. I haven’t used any form of hormonal contraception for nearly 10 years now. I spent some time on the Pill. I’ve had two miscarriages, breastfeeding struggles (and successes); and a pregnancy with my eldest that was easy breezy, this one proving less so.
Along my journey, I’ve learned that women’s reproductive health can not be isolated to one experience or one chapter. Women’s reproductive health is, essentially, just health. Whether or not women reproduce, their hormones serve as a critical piece of their overall well being from puberty to menopause. And even then, events prior to puberty can set the stage for the reproductive years, and the reproductive years can have an effect on the post menopausal years. In other words, women’s health is an ongoing journey, and women deserve support, knowledge, and resources every step of the way.
Unfortunately, I’ve found that so few women get support, knowledge, and resources regarding their women’s health needs unless they go out of their way to find them. As a lactation consultant, I meet women who have just birthed their first (or second or fourth). They turn to me for advice. I often reiterate that while I may know the logistics of latching and managing supply issues, as well as examining oral structure, the mother is, in fact, the expert on her baby and her body. If this isn’t a skill a woman has been taught, it can feel scary. Postpartum is far too late for women to hear this message for the first time.
Fertility awareness education plays a key role in this. If women are educated about their menstrual cycle and period health from a young age, and supported throughout the reproductive years, fertility awareness can bridge all of the gaps in the various experiences of women’s health.
Learning to read your body
What exactly is fertility awareness education? In a nutshell, it’s all the things about women’s health that sex ed left out. While you may have been busy learning about various forms of contraception from the angle that “you will get pregnant . . .and die,” many girls are left with the gaping hole of not really understanding what their cycle is, how their hormones operate, and what that mysterious white-ish stuff is on their underwear that occurs periodically. (Spoiler alert, not only is it totally healthy, it’s really important to your period health!)
It’s a shame that sex ed is a one-time deal. A nervous classroom with awkward images and kids snickering is not a great environment for learning the ins and outs of women’s health. If you have retained anything from that awkward experience, it’s probably the fear of pregnancy and STDs. Sure, pregnancy is a big deal, and STDs are real health issues. But women are left with so many unanswered questions they didn’t even know they had. And along the way, there is a foreboding sense that a woman’s body is working against her.
In contrast, fertility awareness teaches girls and women about their period health. Sure, this eventually does entail knowing about when you can get pregnant, but it starts instead at an understanding and appreciation of your body’s natural health processes.
Fertility awareness equips women to live and breathe their health day to day, month to month, year to year. By charting a few simple cycle biomarkers—most prominently cervical fluid, but other biomarkers include waking oral temperature and other signs—women can know exactly when to expect their period, get a basic map of their hormonal health, and live more intentionally with their waxing and waning hormones throughout the month.
Further, with the right fertility awareness practitioner by their side, women can troubleshoot period health issues (like irregular or painful periods), and this information can even be used to effectively plan or prevent pregnancy down the road when women need it. Perhaps most importantly, fertility awareness teaches women confidence so they can make choices about their health and trust in their own expertise as the owner or their body.
My experience with birth control
For me, I fumbled my way through high school and early college knowing nothing more about my period than that it came about once a month. Luckily for me, I didn’t have any cycle issues. My mom was vaguely against hormonal contraception for young girls but didn’t really spell things out for me. I was horribly jealous of my girlfriends who did have that little prescription. They looked so mature and grown up pulling it out of their purse. “Oh I have to take my Pill!”
When I went to college, I finally marched down to the campus health center bluntly asking for a prescription for birth control. It seemed time for me, too, to “grow up” and “become a woman.” I spent some time on the Pill. My migraines worsened and my acne (which had been pretty non existent until then) decided to debut. But I had joined the club, and that felt good.
Since I was on the mini pill (which doesn’t include synthetic estrogen and doesn’t have a placebo week), I didn’t get a regular withdrawal bleed. (A withdrawal bleed is the pretend period that happens on some hormonal birth control; since you can’t have a real menstrual period without ovulation, which these forms of birth control suppress.) Instead of a regular bleed, my bleeding was completely erratic, and I never knew when to expect it. I took a lot of pregnancy tests during this season because I was petrified that the Pill had failed.
I was not alone in my fears. Studies have proven that while women like the idea of effective contraception, they don’t often trust pharmaceutical birth control. They can’t see for sure that it’s working, especially if there is no placebo bleed. It turns out, many women will opt for something non hormonal if they feel that they have more knowledge and control of it—even if that means in clinical studies the effectiveness numbers don’t prove as high. Fertility charting is a perfect example.
Having learned how to chart their menstrual cycle, women are granted the utmost knowledge and control, which is what results in the discrepancy between the “typical use” effectiveness of charting for pregnancy prevention and the “perfect use” effectiveness of charting for pregnancy prevention. Something like the IUD has very little involvement on the woman’s part and has a very narrow difference between perfect and typical use. What creates this gap is human involvement, which many women actually want.
How did my on-campus GYN respond to my fears? She made it profusely clear to me that one method of birth control wasn’t enough—I needed two at minimum. Even then, they both could fail. I lived in this weird in-between space, I was empowered by my birth control packet, but terrified it would fail me. While I never received answers that allayed my fears, I kept coming back to the campus health center with more concerns, frequently visiting with various new fears—do I have a yeast infection? A UTI? Are these side effects related to the Pill, or am I just crazy? I was always told something like, “You’re fine; but I can give you another prescription for something else if it makes you feel better. And here are some condoms, they can’t hurt.” Still, I never felt fine.
Becoming acquainted with NFP
Then I met the man who would eventually become my husband. He had learned about “this thing in Catholic boarding school called natural family planning.” I was dubious about it at first. I told him that “the Rhythm Method doesn’t work.” But I followed up later with fervent research on natural family planning, or what little existed online at the time. The first book I picked up was Taking Charge of Your Fertility by Toni Weschler, which I still recommend as the foundational literature for learning fertility awareness. I didn’t even finish my Pill pack that month. I threw it straight in the trash, found an instructor in the Billings method of fertility awareness (with decades of research making it more evidence-based than the 1920s’ Rhythm Method), and started charting my cycles. I knew I had struck gold.
I was in film school at the time and totally pivoted everything I was doing to pursue this work. I knew that if I struggled to find information about how my body worked, other women did too. I felt so gypped about basic female anatomical information that I was now learning years later than I wish I had. I had always thought I could get pregnant at any time, any way. I thought that stuff on my underpants (cervical fluid, a perfectly healthy biomarker of hormonal health) was surely a sign that I had some rare disease that made me a freak. I didn’t know ovulation or hormonal health were things you could, like, track.
So, what is cervical fluid?
While cervical fluid is something virtually every young girl and woman experiences, it isn’t commonly talked about. This 2014 paper, “The role of the cervix in fertility: is it time for a reappraisal?” concludes:
“The cervix is the door to the female reproductive system. Anatomically, it must allow sperm passage into the uterus through the endocervical canal and it must produce mucus to facilitate sperm entry. Immunologically, it must recognize and prevent pathogen entry. Further research is needed to definitively describe the likely inflammatory mediators that are in control, or in flux, at the cervical mucosal level.”
A recent poll commissioned by INTIMINA and conducted by OnePoll in the United Kingdom found that nearly 50 percent of women couldn’t even identify where or what their cervix was, let alone, identify different types of cervical fluid.
So, while it’s easy to think sex ed has been glossing over the topic of cervical fluid exclusively out of cringe factor associated with a mucous discharge (although I’m sure that’s part of it), it’s also something the reproductive science community is only just starting to understand on a microbial level. None of us would be here without cervical fluid, because women can’t get pregnant without it. At the very least, in the conversation about sperm meeting egg, we should educate teens about how none of this would be happening without the third ingredient of cervical fluid present.
This is just another example of the disjointed body awareness I experienced and that can occur over a woman’s reproductive life if she hasn’t learned fertility awareness. She may have never been taught about her cervix, but suddenly facing childbirth, it’s essential.
From self-knowledge to self-advocacy
I ditched the Pill and started charting my cycles nearly 10 years ago. A lot has happened in that decade. I became a fertility educator myself in the FEMM method, I got married, I have had pregnancies and ups and downs. But if it wasn’t for the foundation of charting, I’m not sure I would be able to advocate for myself throughout all of these different stages.
Now, since I feel empowered with this body awareness, I am a better self-advocate in my health care. If I don’t feel that a doctor is supportive of my choices and trusting me to be the expert on my own body, I find someone else. This translates to pregnancy, postpartum, and all the chapters that lie ahead. Doctors are invaluable in their tools and support, but no matter how many text books they’ve read or years they have spent in practice, they haven’t lived in your body with your genetic makeup, and I have come to believe care should be collaborative to include both your and the practitioner’s expertise.
Fertility awareness education is just the first step in teaching women to know and trust their bodies. I don’t mean trust that things will always go well—because they don’t always. But learning fertility awareness equips you to trust that you are the expert of your body and will know when something is off. In this respect, fertility awareness is a skill that translates to far more than just cycle tracking. The skill of body awareness enables women to navigate all of the hormonal changes they may encounter.
Body awareness vs. body blindness
The Academy of Obstetricians and Gynecologists (ACOG) guidelines for counseling adolescents recommends “routinely addressing contraceptive needs, regardless of the patient’s sexual activity,” “discussing and prioritizing the most effective methods like long acting reversible contraceptives (LARCs),” and “continual reassessment of sexual concerns, behavior, relationships, prevention strategies, and testing and treatment for sexually transmitted infections (STIs).” Nowhere in ACOG’s guidelines is a mention of education and support for normal maturation of cycles and period health development. It’s as if a teen girl is merely viewed as a pregnancy and STI risk.
I’ve come to view the current mainstream views of reproductive health as a position that can be boiled down to this: get on the Pill in your teens to prevent pregnancy or to “regulate” your period (which, indisputably, hormonal contraception can never do), stay on the Pill until you are ready to have a baby (if you are lucky to not experience infertility), and when you are done having babies consider a long term form of contraception like sterilization or an IUD.
But there are so many more nuances across the reproductive spectrum that aren’t included in this narrative.
And there’s so much body literacy and health empowerment that girls are deprived of along the way. Can you really be empowered if you don’t know all of your options? If you aren’t given support, education, and resources? Hormonal and cycle disorders, pelvic floor health, childbirth, lactation, postpartum support, mental health, to name a few, are some examples of facets of women’s health that get lost in the narrative of focussing solely on pregnancy achievement and avoidance. Many women feel like a marionette puppet, with their actions and health governed by their doctor or prescriptions. But they may not know that they have other options, or that their cycle doesn’t have to remain full of fears and mystery.
In many Facebook groups surrounding a myriad of women’s health issues, I often read women are afraid to “challenge their doctor” when it’s clear that their doctor is not supporting and meeting their needs. I am forever grateful that fertility awareness has given me a voice so I can collaborate with all of my care providers. From my OB to my midwife to my primary care doctor, even my daughter’s pediatrician, I feel empowered. And frankly, every woman deserves that.