Bias Against Fertility Awareness in Medical Settings (Episode 543)

Full Transcript: Episode 543

Lisa: This is the Fertility Friday Podcast, episode number 543.

Today I’m sharing another brand new episode in our FAM Practitioner series. I’m sharing my interview with Emmy, and at the time that we’re recording this, we are about eight and a half months deep into our FAM program. And Emmy, who I’m interviewing today, is in the midst of her practicum. And she shares so many interesting aspects of her story in today’s episode.

Emmy has an interesting perspective on all things related to the menstrual cycle due to her work as a surgical technologist. So she has this interesting window into the medical side of things. And that has certainly led her to question the validity of a medical-only approach. I suppose you could say that it’s led her to see some of the limitations of relying exclusively on medicine.

And one of the things that I’ve always shared — my perspective when it comes to seeking support when you have a specific health issue, whether that be a specific issue related to your menstrual cycle, hormone health, fertility, thyroid health, etc. — is that it’s really important for all of us to have medical doctors. But the best results that I’ve seen with my clients occur when my clients have a team. And so the medical professionals represent certain members of that team. But there are times when it’s also helpful to see a functional medicine provider, someone who is trained in root cause medicine. It’s helpful to see someone who has a functional approach who also specializes in the specific issue that you have. It can also be helpful to work with a coach — so someone who specializes exclusively in fertility, if fertility is what you’re struggling with, or whatever the specific issue is — an advocate, a fertility awareness educator, someone who can help you with a specific aspect of it and give you more time and attention than can ever be possible in your doctor’s office. Some of us benefit from nutritionists, some of us benefit from having acupuncture. Others see incredible benefits from bodywork, things like Arvigo Therapy or Mercier, and the list really just goes on.

Emmy also had a background in fertility awareness before she joined the FAM program, so she also shares her perspective coming into the FAM program already with fertility awareness knowledge and specific training in that area.

So before we jump into today’s episode, I want to share a little bit about Emmy. Emmy Poole is the woman behind She Is the Moon, a women’s wellness practice. She is a Maya Abdominal Practitioner and soon-to-be Fertility Awareness Educator. Emmy also works as a surgical technologist and gets the unique perspective of seeing the inner workings of the body — literally. This unique perspective has led her to see things like adhesions, fibroids, misaligned uteruses, and so much more. It has made her even more passionate about Maya Abdominal Therapy and fertility awareness, in hopes to help women seek other options before deciding to take the surgical route. It is Emmy’s goal to help educate women about their bodies — to teach them things we should have been taught — and to help them claim back their bodily autonomy through education and reconnecting with their bodies. So without further ado, let’s go ahead and jump into today’s episode.

Lisa: And I’m excited to be here today with Emmy. Emmy is one of our current FAM practitioners — as we are recording this, we are towards the end of our program, actually. I think I just said in class that we have exactly one month left before our program officially ends. So I feel like this is a great time to chat, and you’ve kind of gone through the full gamut at this point. So thank you so much for being here.

Emmy: Thank you so much for having me. You are such a legend in the FAM world. I’m so stoked.

Lisa: Oh, you’re so sweet. Well, I’m really excited to have you. And I mean, even before we started recording, I was thanking you for coming on the show, because I know that not everybody is comfortable sharing their personal story. Of course, all of the listeners and myself — these are some of my favorite episodes. So I always love being able to facilitate these conversations. So with that said, I want to go ahead and jump in and ask one of my absolute favorite questions, which is — tell us about your first period. And I’d love just to hear a little bit about your story and your experience of what led you to this place now where you’re wanting to dive into fertility awareness.

Emmy: Yeah, my first period was probably around 11 years old. My poor mom — I love her to death, but she did not really educate me at all, or we actually didn’t even talk about it at all. I didn’t come to her, she didn’t come to me. It was just kind of this like unspoken thing where, honestly, for the first period or two, I literally just used toilet paper because I didn’t know anything. And then I remember one day pads just appeared in the bathroom, and I was like, oh, I guess I use these. So the beginning of my cycle — or the introduction to it — was not ideal. I don’t blame my mom at all. It’s obviously a generational thing. She didn’t really know how to go about it, so no hard feelings there. But it was pretty normal from what I can remember. I didn’t have crazy PMS. It was super heavy, but that seems kind of normal for that age, and it was pretty painful. I would throw up every once in a while, but I kind of grew out of that as I got older.

I didn’t go on hormonal contraceptives in high school. They were kind of forced upon me when I joined the Coast Guard in boot camp at 19. I wasn’t even sexually active, and they were just like, “Hey, you need to take these.” And I was like, “What?” But you know, you’re young in the military — you have to kind of do what you’re told. So I didn’t really ask any questions and I just kind of took them, but it kind of never really felt right. I would kind of just stop taking them, and then when I became sexually active I would take them again, and then if I didn’t have a partner I would stop taking them. And I really had an awful, awful experience on all types of birth control. I’ve been on every type. I’ve been on three different pills, I tried the ring that goes inside, I’ve been on the copper IUD — which was horrific — and then the last thing I had was the Implanon, the implant that goes in the arm. I had one of those, and then I got it replaced, and I was finally just like, I’ve had enough of this. None of this is working. I’m miserable. My periods are unpredictable. I’ve been through too much with this. There’s got to be a better way. And my friend’s a nurse practitioner, and I literally had her take it out at her house on her bed — she had never taken one out before — and I was like, get this thing out of me. And that was the last time I was on hormonal contraceptives. And I don’t know how I always try to go back to the moment when I found out about FAM and I found out about your podcast and your book — The Fifth Vital Sign had just come out — and that just opened my whole entire world and blew my mind completely. It was honestly like it was just placed in my lap and I was like, here, there is a better way. So that’s kind of the beginning of all this.

Lisa: Wow. Well, thank you for sharing all of that. I mean, it’s a whole lot of information and a whole lot of years. What you described — not having used birth control and then having to use it as part of the Coast Guard and then trying all the things — about what duration of time was that?

Emmy: So 19 to about 32.

Lisa: Okay.

Emmy: Yeah. The pill was very on and off. Probably my mid-twenties was very on and off. And then when I was getting out of the military, I wasn’t going to have any health insurance, and I was like, well, I guess I should try to find a more long-term option. So that’s when I tried the copper IUD, which only lasted about two months. And then I did the implant, and then at around 32 I was like, okay, I’m done.

Lisa: What I do appreciate about the podcast is just putting out those experiences, because I think that now we’re past the time when it’s controversial to talk about the pill. I feel like when I first started my podcast — so around 2014 — at that time, when you were talking out against the pill, people would get upset. They would say things like, well, if you talk about the side effects, you’re going to dissuade women from using it. But what the research tells us is that about 50% of women come off of whatever pill they’re on within a year. So your experience — it’s not that everybody tries everything and finds that nothing works, but a lot of women have. And I’ve spoken to so many women in my programs over the years who have had experiences similar to yours — okay, I’ll try this pill, I’ll try this one, fine, the pills aren’t working for me, I’ll try the ring, okay that’s not working, I’ll try the IUD, fine, that didn’t work, let me try the implant — so although it might seem rare, it’s not.

Emmy: Yeah. I mean, I have met maybe one or two women who’ve never had a problem with birth control. That’s so few. It’s crazy.

Lisa: So, since you were on a variety of different contraceptives, could you share a little bit about some of the side effects you experienced — or what were some of the worst ones? What prompted you to keep switching, and what prompted you to eventually stop?

Emmy: So the pill just made me — I didn’t even know who I was. It was like, who is this person? Just insane is the only way I can describe how I was on the pill. So then I tried the NuvaRing, and I just didn’t like having to put something in and take it out. And then the IUD — the cramps I had with the IUD were unlike anything I have ever felt in my whole entire life. From pretty much the second I got it put in — you know, they always say, “Oh, it hurts so bad, like I saw stars.” I almost blacked out. It was so painful to get put in. And then from the second I walked out of the office, I would randomly get these insane cramps that would take my breath away. I’d have to stop what I was doing. I thought, this just happened, it’s going to go away — but it never went away. I would just get these debilitating, sharp cramps. And I bled so much. I cannot believe I didn’t bleed out. It was insane. So I was like, this is not working. And then the Implanon was basically constant spotting, just all the time. It’s hard to have any sort of sex life or any sort of regular life when you don’t know what’s happening and you’re basically constantly bleeding a little bit. And it always felt like these synthetic hormones — I shouldn’t be doing this. In the back of my mind, I knew it just wasn’t right. So that’s when I was finally like, find a better way. I’m not doing this anymore.

Lisa: I mean, it’s always frustrating to hear these stories. With the copper IUD, for women who have a good experience and love it, they really love it. So they’re ambassadors and cheerleaders for it. And if it works, that’s great, because it’s a non-hormonal method. But part of the reason they created the progestin-releasing IUDs is because the copper IUD is known to make periods heavier and cramping worse. So if you already had heavy and painful periods, someone should have told you that you may not be the best candidate for this particular method, because those side effects are right in line with what’s most common on the copper IUD. And with the implants — the Implanon and hormonal IUDs are progestin-releasing — and the most common effect of these progestin-releasing options is the spotting, the irregular bleeding, especially within the first six months. And I don’t know if women are adequately prepared for that, or if enough care and attention is spent on just telling women what to expect from these options.

Emmy: Yeah, I agree with that. It feels like every single doctor — it’s like they’re not allowed to actually go over the side effects that are more likely to happen than not. It’s like they feel like if they tell you what really might happen, you’re not going to want to take it. So they’re like, it’s totally safe, it’s totally normal, everything’s going to be fine. Or if you tell them your concerns, it’s, “No, it’s not from that, it’s got to be from something else.” Not one doctor gave me a real breakdown of the side effects and how likely they were. And when I told them about them, no one said, “Yeah, you’re right, that could be from the birth control.” It was always something else. So that’s super frustrating.

Lisa: That’s because what you experienced — especially with the implant and with the copper IUD — those are the most common side effects of those two types of birth control. But obviously, this is a systemic problem, and that’s one of the reasons why we’re here doing something different. So share a little bit about your experience when you discovered fertility awareness.

Emmy: Yeah, so I was unbelievably uneducated about my body — to the point where I literally thought ovulation happened after your period. I did not understand our bodies, our hormones, anything at all. Even when I was on birth control, if I had unprotected sex — which is the whole point of birth control — I would freak out and use Plan B. So yes, I was very, very uneducated. So listening to your book completely blew my mind. I wanted to get on the rooftops and shout from them to every woman to hear this stuff about our bodies and how incredible they are. I was immediately hooked. I got Taking Charge of Your Fertility — I went on Facebook and looked for FAM groups, and a lot of people recommended it. So that was the first method I ever used. And then I was so in it and so obsessed that I wanted to become a practitioner or an instructor. So I went to Symptothermal Pro and they offered an instructor course. It wasn’t very well done — probably more me than them — everything was reading, a lot of information all over the place, and I don’t do well in that kind of learning environment. So I never actually ended up finishing it, but I was still like, this is what I want to do. I cannot stop thinking about FAM, I cannot stop telling anyone who will give me two and a half seconds to talk about it. And that’s how I found your course. There’s literally nothing more empowering than FAM.

Lisa: I mean, it gives options when before you didn’t think you had any. So share with us what your experience was like adapting to charting. Were you using it as your primary birth control method?

Emmy: I did use it as my primary birth control method. At this point I had gotten the implant out. I believed in my body, I believed in the method, because it all made sense — it is biology, it’s how our bodies work. And I actually found it quite easy to adapt to it and use the mucus and the temps. I will say for the first two years I had no egg white mucus or no super fertile-quality mucus. And I would actually ovulate around day 11 for like the first two years, and I would often have 15 to 17-day luteal phases. But now I’m more in the normal range. I was so into it that I found it very easy to adapt and learn.

Lisa: As you said, especially for the women who I’ve worked with over the years who had such a negative experience with birth control, it can often be like a ray of light — you know, you don’t have to rely on these things anymore. And one of the things you had mentioned was your experience with the medical system. In your case, you were using birth control — was that purely for contraception, or were you ever using it for any type of issue?

Emmy: No, I was always using it for birth control. I never even thought that it could help me with anything else, because it seemed to make everything worse. I couldn’t imagine trying to take it for something to make something better. And as we were talking earlier, I do work in the medical system as a surgical technologist. So I work with GYN surgeons all the time. We see IUDs being put in all the time, and a lot of uteruses coming out, and a lot of tube-tying. And I do struggle working in those rooms, because I do try to talk to the doctors about FAM. And I have yet to meet one that says, yeah, it works. It’s until-it-doesn’t thinking. That enrages me — they clearly know nothing about the method. It’s probably rhythm-method thinking. And they’re not even interested to hear about it. And that’s what frustrates me the most, and why I’m trying to get out of that system. I want to be that in-between person that says, hey, there are other ways before maybe these more extreme ways — let’s try this first and let’s see if it works for you.

Lisa: Yeah, I mean, it’s challenging where the systems collide. I’ve had to take a step back over all the years and kind of think about where I stand. Because I think when you first discover all this information, it can feel so egregious. The doctors can feel like they’re just awful human beings. And I don’t think that’s what’s really happening. If we learn a little bit about the medical system, you quickly discover that doctors do generally speaking receive very little, if any, education about fertility awareness-based methods. And that is ultimately the root of the problem. In standard medical training, if you’re lucky, your doctor may have received an hour of education around fertility awareness-based methods. And you can imagine that in that hour, they were not told about how effective they are or what a great alternative they are — they were likely discouraged from it.

And after speaking to a number of doctors on the podcast, what I gathered is that doctors tend toward methods that have basically no or very little input by the user — the set-it-and-forget-it methods, such as the IUD or the implant. Because if you have very little user involvement, you’re going to have in most cases a higher degree of efficacy. So it seems as though the medical system prioritizes efficacy over all other factors. But when you’re dealing with a human woman, efficacy is important — but it’s not the only factor. In your case, you wanted an effective method, but you did not want to bleed every day, and you certainly did not want to have pain that left you doubled over. So efficacy needed to be on the table, but it couldn’t be to the exclusion of all other factors. And I feel like that is where the conversation breaks down — because fertility awareness-based methods are on the other end of that spectrum. They are entirely user-dependent versus these methods that are entirely based on the device working. So I understand your frustration. You work around these medical professionals — what do you think is the solution?

Emmy: I don’t know. I totally agree with what you’re saying. I know they’re not educated on it whatsoever. I wish they could just be a little more open-minded, because there are going to be women who say, “I’m not going back on hormonal contraceptives.” So then they’re left with what — nothing? It would be nice if providers could at least be open-minded enough to say to those women, okay, here are these other options and here are ways you can learn them. I’m not saying every doctor needs to be able to teach FAM — that’s completely unreasonable, they’re already overwhelmed. But to have a relationship with a FAM educator or practitioner would be incredible. Unfortunately, at this point, it’s a lot of dismissal — “that doesn’t work” — instead of “wow, that’s really interesting, let’s have more of a conversation about this.”

Lisa: Yeah. And I think it’s just really helpful to understand where doctors are coming from, because if you don’t understand, then it just becomes frustrating. My analogy for this would be going to Burger King and getting mad when they don’t change your oil. Like, you’re standing in front of the till yelling, “You’re going to change my oil today!” And the woman’s like, “You’re at Burger King — can you order a burger or get out of the line?” I think this is the mindset we have to have when approaching conventionally trained medical professionals. We have this historical fantasy that medical doctors can do everything and know everything — nutrition, FABMs, all of it. And even that puts undue pressure on them. But there’s also another edge: doctors aren’t known for being the most humble individuals. They’re known for having big egos and pretending to know things they don’t, and dismissing things they don’t really understand. And because they have so much weight in our world, you can have a client who goes to a doctor and comes back completely confused and stressed out because the doctor told her it was only a matter of time before she got pregnant because fertility awareness methods don’t work.

I don’t know that we have the solution in the sense that we’re not going to change all these medical doctors overnight — they were trained in a system that does not encourage FABMs as a protocol, because we’re still operating on 1940s thinking that fertility awareness is the same as the rhythm method. And even when you look in the research, you have to have a keen eye. Sometimes research shows really low efficacy rates for FABMs, but they’re lumping in all methods together — they might be including women who use charting apps with no knowledge of anything. They’re not really defining what fertility awareness-based methods actually are. But we do have really solid research coming out. We do have educators, medical doctors, scientists, and researchers who are making the case that fertility awareness-based methods is an umbrella for many distinct, evidence-based approaches — mucus methods, symptothermal methods, and more. I do think we’re making very slow progress. But I really think it starts with education. Clients need to understand what allopathic medicine is — a pill for every ill — that’s their modality. We need to recognize that we shouldn’t expect them to do things that are not within their wheelhouse.

Emmy: Absolutely.

Lisa: Because hey, if you want to challenge me — go to your doctor’s office and try to convince them that fertility awareness methods are the greatest thing since sliced bread. And when you come out of the office crying, we can still talk. I’ve come out of doctors’ offices crying too, because it’s sometimes so hard just to get heard, just to get your point across. And I really wish it wasn’t that way. What I will say is: I know there are doctors listening. We know there are amazing physicians and practitioners out there who have taken the time to learn about fertility awareness-based methods. And you are the hope. We are not trying to slight all doctors as a category — but we have to be honest. We can’t pretend like a lot of women haven’t had a lot of negative experiences in medical offices. So if you are a medical professional and you’re listening — you are our hope. We love you. Keep doing your thing.

Okay, there’s one thing I want to go back to. When you shared your experience of your first period and you mentioned that your mom and yourself didn’t have a conversation about it at all — and at some point pads appeared in the bathroom and then you never talked about it again — you’re not the only one I’ve spoken to who had an experience like that. You kind of started with, “I had no background, no knowledge of my body.” Was that tough for you? Was it difficult, or was it just how it was?

Emmy: It was just how it was. It just seemed fine. I have a very good relationship with my mom and my parents. It just — that’s something that was never really talked about. And it definitely didn’t bother me. It just seemed kind of normal, because that was just what I grew up in.

Lisa: I just ask because there are so many different ways this comes about. I’ve had conversations with women where it was their older sister who shepherded them through it, and women who didn’t even know what periods were and thought they were going to die. So I find it fascinating just to hear the different experiences. Well, as we start wrapping up, I want to ask you a couple of questions. For someone who’s a women’s health practitioner thinking about jumping into FAM — what would you want them to know, given that you’re nearly through your experience?

Emmy: Definitely do it. I remember one of the first lessons we did in this program, you talked about how you kind of had imposter syndrome about how could you possibly teach women about FAM who had already been tracking. I was like, yeah — what are you going to teach me? I’ve been doing FAM for like four years, I already know all about mucus. And then — here are the mucus categories. Oh my God. What are these? Like, blew my mind. I was completely humbled. Even if you’ve been doing FAM or teaching FAM for years with other methods, this program is so in-depth, and it’s so much more than just about FAM. It’s about health in general. There are so many things we can learn from our cycles. As you say, it’s the fifth vital sign — the color of our mucus, how much our temps rise — it can tell us so many more things about our bodies. And it just really opens a window to so many things. So if you’re on the fence: do it. You will learn so much. It’s absurd.

Lisa: Well, thank you so much for sharing that. That is definitely something I thought of when I was first teaching. I remember the first time I had a client who had been charting for three years and I thought, what can I possibly teach her? But it turned out the answer was: a lot. So it’s interesting also that you had already taken most of a fertility awareness educator program, and as you know, we do have other members in the program who have graduated from fertility awareness educator programs. When they jump in, they’re thinking, “I won’t learn anything about the fertility awareness part, I just want to learn the other stuff.” But they always learn kinds of things they didn’t know, because there’s just a lot to know. Welcome to my rabbit hole — I always say that. And then another question for you: given your experience in the program, where do you think you’re going to go with this?

Emmy: Yeah, so I started a small business — a little women’s wellness business called She Is the Moon. And I would love to offer this as part of my business to women. My biggest passion is to bring back bodily autonomy. Don’t give your power to doctors or to someone else for them to tell you what’s wrong with you. You live in your body, you feel the things you feel, you observe the things you observe. So nobody can tell you how you’re feeling. A lot of women — oh, the doctor told me this, but I don’t feel this — but they’re still going to listen to the doctor because they’re a doctor. So this is definitely something I’m wanting to offer in my practice, just to spread the word. I’m so excited about all this, and I just want to teach anyone who will let me. Be the change you want to see in the world — those are words I live by, because I’m impatient. I’m not interested in waiting until all of the decision-makers decide that this is important. So I’m really excited.

Lisa: That has been one of the most rewarding parts of creating the FAM program — to just sit back and watch what our practitioners do with this information. I would not have thought that this is where it would have led. And what is the most exciting piece of it is how much deeper of an impact — because now we’re literally creating an army. A FAM army.

Emmy: I want to be part of that army.

Lisa: I love it. At the end of the day, I believe that’s how you make change — at the grassroots level. And I believe it already has made change, which is even more exciting. So — for anybody who is wanting to learn a little bit more about you and what you do and where they can find you, let us know all the places.

Emmy: So I’m located in Marin County, California — in the Bay Area, specifically in the city of Novato. That’s where my practice is. I also do Maya Abdominal Therapy. You can visit my website at www.sheisthemoon.org. And for anyone interested in possibly learning FAM from me, we can do that over the internet — I can work with you from anywhere in the world. You can also visit my website for that. And then I have an Instagram: She Is the Moon Marin — M-A-R-I-N.

Lisa: Awesome. Well, I’ll make sure to link all of those places in the show notes for anyone who’s on the go. And I just want to thank you so much for being here, Emmy. This has been just a great conversation. I always say that even though we were together for almost a full year, I feel like I always get to learn so much when I do these episodes and go deeper into your story. And I know that your episode and your experiences will inspire — and also possibly piss off a little — but also inspire. The challenges that we go through are so frustrating, but at least with this medium, it allows us to share, so all the other women who’ve gone through the pill scenarios and all the things know that they’re not alone. So thank you so much.

Emmy: Thank you so much. This is mind-blowing to be here because I’ve listened to like every episode. I can’t believe I’m going to be on — I’m like starstruck.

Lisa: Amazing. We’re so thrilled to have you.

Thank you for listening. If you enjoyed today’s show, please share it with a friend. You’ll find the show notes page for today’s episode over at fertilityfriday.com/543.