Marquette Method for Postpartum Charting (Episode 303)

Full Transcript: Episode 303

Lisa: Welcome to the Fertility Friday Podcast, your source for information about the Fertility Awareness Method and all things fertility. I’m your host, Lisa Hendrickson-Jack. I’m the author of The Fifth Vital Sign and the Fertility Awareness Mastery Charting Journal. I’m a certified Fertility Awareness educator and holistic reproductive health practitioner with nearly 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormonal health, and optimizing the menstrual cycle without hormones. I’m outspoken about hormonal birth control and its impact on fertility and overall health because you have the right to know how your body works and how artificial hormones disrupt that natural process. I host live coaching programs to help you achieve optimal fertility and health because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies. I’m also a wife and mother of two beautiful boys. I know, I know, I’m a busy girl, but I managed to fit it all in. This podcast is designed to empower you to take full control of your cycles, your fertility, and your overall health. And I’m so excited that you’re here with us today.

…certain limitations when you’re relying primarily on cervical mucus, as you are in the symptothermal method. In the symptothermal method, you’re using a combination of your main three fertile signs: cervical position, cervical mucus, and basal body temperature. But for some women in the postpartum period, it’s either not practical or not possible for them to actually rely on mucus. When they have more of an atypical mucus pattern, it can be challenging. And in those types of situations, you really have to look for a different way to be able to identify the fertile window. So we will be diving into Marquette and how it differs from the symptothermal method in today’s episode. So without further ado, let’s jump into my interview with Dr. Barron.

And I’m very excited to welcome back my guest, Dr. Mary Lee Barron, to the show. Dr. Barron is a wife and mother of three. She’s a nurse practitioner and a Marquette Method and NFP teacher in St. Louis. Dr. Barron received her PhD from St. Louis University, is an FNP and an Associate Professor in the School of Nursing at Southern Illinois University Edwardsville. Additionally, she directs Marquette Fertility Education, offering direct patient care services and research in natural family planning. She has published over 20 peer-reviewed journal articles, and she’s authored numerous book chapters and co-authored guidelines for nurse practitioners in ambulatory obstetric settings, which won an American Journal of Nursing Book of the Year Award. Obviously, Dr. Barron has been very busy and is very well experienced in the area of natural family planning and fertility awareness. So I’m very excited. Welcome to the show, Dr. Barron.

Dr. Barron: Thank you, I’m glad to be here.

Lisa: Well, I’m really thrilled to have you back to the show again, for the listeners who didn’t hear our first episode — I’ll make sure to link that episode in the show notes page. We were also talking about Marquette in the general sense, and the reason I asked you to come back to the show was because I wanted to talk about the applications for Marquette in a few different situations. One example would be when women are maybe not comfortable checking their cervical fluid, or for whatever reason it’s just not working for them, and other situations where traditional mucus and temperature — symptothermal methods — don’t actually work for them. When I reached out to you, I mentioned that I had a client the mucus method couldn’t work for during her postpartum period when she was breastfeeding, so I’m really excited to jump into all of that today. And so for the listeners who perhaps haven’t heard of Marquette before, or they haven’t listened to our previous episode, did you want to share a little bit about your background and what brought you to this point, really focusing on Marquette and the teaching that you do in this area?

Dr. Barron: Okay, so I initially trained with the Creighton Model. I did the double program as a teacher and a medical consultant back in 1998, and I did teach that for about five years, but I’m an early developer of the Marquette Method. That is because I wanted to offer more tools to women and to couples to make natural family planning very user-friendly. The idea behind the Marquette Method is that it’s delivered only by healthcare professionals. We teach cervical mucus characteristics because mucus is obviously a key sign of fertility. We teach about hormonal monitoring technologies, which initially was the Clearblue Fertility Monitor, but over this length of time there are other tools available — I recently did a study looking at the Wondfo LH strips to see how they compared in performance with the Clearblue, and I’ll talk about that. And then we do teach basal body temperature. The idea behind Marquette is to empower women and couples to use what works for them. The other thing we do is give them support. Our current charting technologies are online, or Excel files, and we do have an app. Traditionally we meet with a couple, if we’re teaching them in person, three to four times, and then as they need to be seen. We do have teachers around the country who teach by Skype or by phone, and we have an online class discussion taught by a certified Marquette teacher out of the Marquette Institute for Natural Family Planning. There’s no reason someone in a rural area couldn’t access a Marquette teacher — there’s actually an interactive map of teachers around the country now.

Lisa: Well, and you mentioned that you first trained in the Creighton Method. For the listeners who aren’t familiar with that, did you want to just share briefly what the Creighton Method is? As you know, I teach the Justisse Method, and the Justisse Method in many ways was derived from the Creighton Method but adds in the temperature. Maybe you could just share about that and how Marquette differs.

Dr. Barron: Okay, so the original ovulation method was Billings. In 1976 the Creighton Model was developed at the Pope Paul VI Institute — it was associated with Creighton University, as Dr. Hilgers was on faculty there, though they’re independent of Creighton University. It’s a mucus-only method. The difference between Billings and Creighton is that Dr. Hilgers standardized the descriptors of mucus with numbers and letters and changed the way you detect sensation, which is external — most of the other NFP methods use an internal approach to what the woman is feeling. Billings describes it by what she says, and then Marquette initially used a graphic representation of one through eight — that was Marquette Model 1, and some people still use that; it’s the one from our early research. We developed a simpler method of low, high, and peak for mucus observation. So that’s one way we differ, though it’s also a way we have in common with other methods — patients find it very easy to determine peak fertility with a simplified method. And then, the Clearblue Monitor was compared in 1999 in a study against ultrasound detection of ovulation, which is the gold standard, and it was 100 percent accurate in that study.

Lisa: As a teacher — do the monitors always show you the peak?

Dr. Barron: No, they don’t, and the monitor company says it’s about a 10 percent miss. We’ve been able to decrease that by very strictly teaching that you urinate into a cup and then dip the test stick into the urine — there’s no “urinating on the stick” approach, because you miss the peak more often when you do that.

Lisa: Well, so as a practitioner of a symptothermal method, I found that the vast majority of women — depending on where they are in their fertility journey or reproductive life — the vast majority of the women I work with end up being in a place where they’re actually cycling, whether they’re using the method for birth control or trying to conceive. A smaller percentage of my clients are in the postpartum stage and looking to organize that aspect of things. So when you’re cycling normally and you’ve got a pretty stable pattern, learning a more standardized way to monitor mucus makes such a huge difference for most of my clients. With the Marquette Method, it adds in technology, and a lot of my listeners have heard us talk over the years about different ovulation predictors, LH tests, and apps that predict fertility, but the Clearblue Fertility Monitor is a completely different thing. Could you talk to us about what the Clearblue Monitor is, why it was initially developed, and how it differs from a lot of the technologies we hear more about?

Dr. Barron: Okay, so in your menstrual cycle you have the rise of FSH, follicle-stimulating hormone, which triggers the rise of estrogen. The rise of estrogen triggers the surge of luteinizing hormone, LH, which causes ovulation, and then when ovulation occurs estrogen drops and progesterone rises. I teach my students FELP — FSH, Estrogen, LH, Progesterone — that’s the order the hormones need to be in for regular cycling and an indication of ovulation. The Clearblue picks up a urinary metabolite for the rise of estrogen and the surge of LH, and that’s how it differs from the typical LH strip sold on the market for ovulation predictor kits. The LH strip tells you the surge of LH, but it doesn’t give you the rise of estrogen. In the United States, the Clearblue is marketed for achieving pregnancy, so it builds a memory of the woman’s cycle and, based on that pattern, sets a threshold.

Lisa: So it reads her memory, but you can only test — I understand — so it’s memory of cycles, you’re not getting an actual estrogen number, you’re just getting a reading of high or low?

Dr. Barron: Right — the estrogen reading has to rise before you get the surge of LH, so in that sense it’s predictive of ovulation. It passes a certain threshold and then it goes into high fertility, and peak fertility also has a memory of how much this particular woman typically surges, so it can read whether a given surge is a good surge or a peak day. So it’s different in that it has an algorithm based on the memory of the numbers that came before. A woman tests with the monitor and she can test until she gets to her first peak day. The next day is also considered a day of ovulation risk, because you get two peak days — that’s because once you get the surge of LH, it can take as long as 36 hours for the egg to actually be released, and as you know, all NFP methods use a three-day count after the peak day.

Lisa: Right — that’s the reason. So when she gets to that second peak day, there’s no need to do any more testing for that cycle?

Dr. Barron: Correct. And the two most fertile days of the menstrual cycle — this comes from a study, I believe from the mid-90s, by Wilcox and Baird, looking at thousands of charts — are the day before ovulation and the day of ovulation, which points to why cervical mucus is so important, because that’s when the sperm are being nourished by the cervical mucus.

Lisa: Okay, so it all kind of fits together there. But I always think it’s important for women to really appreciate — because we have a culture that’s very much “you’ve got to figure out when ovulation day is and have sex on that particular day” — that although we can look at percentages based on research on how pregnancy occurs relative to intercourse five days before versus four days before versus three, what I always tell my clients is we don’t want to consider the days in the pre-ovulatory phase more or less fertile, because you can’t be more or less pregnant — you can only be pregnant or not — but it is helpful to understand your fertile window, which is essentially the length of sperm survival.

Dr. Barron: Yes. Sperm can live up to about five days, so your fertile window is six days: the day of ovulation and the five days previous.

Lisa: Absolutely. What I really appreciate about the Clearblue Fertility Monitor and the Marquette Method is that it’s giving you this additional piece of information. Depending on when you’re charting and when you really get a sense of your cervical fluid, your cervical fluid would, in many cases, mirror what’s happening with the Clearblue Fertility Monitor, because your cervical fluid is happening because of that same estrogen.

Dr. Barron: Right, so it is true that it’s nice if it would mirror, but there are women who are discordant — meaning their cervical mucus peak is three or four days ahead of when the monitor says they’re peaking. I’ve seen it come before and I’ve seen it come afterward, but more often it’s ahead — we describe that as discordant. Women shouldn’t get the idea that they’re fully in control, because they’re not, but this is something the monitor can flag: if there’s a discordant peak, and somebody’s trying to conceive and their peak is actually later than they thought, that’s a very helpful thing to bring to a healthcare provider. The cervical mucus is a key sign, but it isn’t always matching, and that tells us information we need to have.

Lisa: Well, let’s talk about some of the situations where it doesn’t match. I can share a few that I’ve seen, and I’m sure you’ve seen several different types simply from working with the monitor. For example, I’ve noticed that a certain percentage of women who come off hormonal birth control take several months before they start to see mucus again. Even though they’re ovulating, they’re not really producing mucus — I’ve seen cycles where they’re not producing any for the first few cycles, and I’ve worked with women who produce very little for several months post-pill.

Dr. Barron: Right, and there’s a research study — a Gnoth study, the first author being German — that looked at post-pill cycles. The average time for the return to what you’d expect a woman to be able to do was nine cycles. Ninety percent of women were back to “normal” within nine cycles. Fifty-seven percent of women ovulate in that first cycle off the pill, but their post-peak phases were at least 30 percent inadequate, so it’s not a good idea to try to get pregnant on the first cycle off the pill — it’s really a good idea to wait two or three cycles before trying to get pregnant, to allow the cervix to regenerate. Because the birth control pill contains progestin, not progesterone, the mechanism is that the endometrium is too thin to receive a fertilized egg. As an NFP teacher, I tell people to anticipate about six cycles of being erratic before things really come together, because that’s what I’ve witnessed in the charts. So the Clearblue Monitor isn’t recommended for the first cycle off the pill. After that first cycle off the pill, they can start using the monitor, and the monitor is very reassuring — either confirming that you did ovulate or reflecting that you didn’t. The monitor is programmed to run only 20 tests per cycle and then stops asking, so the woman has to reprogram the monitor at the start of the next cycle.

Lisa: Well, I really appreciate you taking us through that — the Gnoth study is one I find myself quoting often, because it’s one of the unique studies that wasn’t looking specifically at time to pregnancy; it was measuring cycle parameters in detail and allowed us to see the natural progression. Anyone who works in this field and sees a lot of clients knows this information, because we see it play out.

Dr. Barron: The sad thing is that almost all of the other artificial contraceptive methods never tell you about return to fertility — they don’t look at the effect on the cycles after you stop. There’s a book on contraceptive technology that discusses Depo-Provera, which I personally view as a really harsh medication, one of the most disruptive when it comes to the delay in the return of natural fertility. That resource notes that if a period hasn’t returned within a year of stopping Depo-Provera, the woman needs a workup, though on average it can take about two years to return.

Lisa: And so one of the challenges with mucus-based methods — obviously appreciating the distinction with post-pill cycles — is that for women who fall into that category where they’re not really seeing a normal, healthy cycle of cervical fluid, it typically does resolve, but women can get really nervous when we talk about how the pill can affect the cycle post-pill. It’s helpful to note that most women do rebound fairly well. One of the challenges is that for a woman who’s avoiding pregnancy and relying primarily on cervical mucus to confirm her fertile days, if there’s an actual issue with mucus production — whether related to the pill, or a history of cervical surgeries or cervical dysplasia — it’s possible to get pregnant in any cycle where ovulation occurs.

Dr. Barron: That’s right.

Lisa: So if you don’t have mucus as the heads-up, you need to work with somebody who can help you figure that out — you have to be very conservative in the pre-ovulatory phase, but that’s where the Clearblue Monitor comes in as a way to test the hormones directly, so you have another piece of information to help confirm the fertile window.

Dr. Barron: That’s right. And the other thing about cervical mucus as a key sign — if you’re not having cervical mucus at all, that requires medical evaluation, because it could represent other disease states. We always have to remind women that it isn’t just about reading mucus, it’s about making sure it’s there.

Lisa: Okay, so another area — the breastfeeding woman — we were sort of talking about that.

Dr. Barron: Right, the monitor is, let’s say, “dumb,” and we’re “smart” — the monitor is programmed to do one thing, marketed to help achieve a pregnancy. So when we use it with breastfeeding women, we’re artificially giving the monitor a cycle to read, so that we have a protocol for the women to use and how to test with the monitor during breastfeeding. They really need instruction and follow-up with a teacher during that time, because it isn’t a straightforward thing. Some women come to a Marquette introductory session, and think, “okay, she told me about the method, I can just do it,” but learning natural family planning with a teacher is far superior to trying to read a book and do it — it’s experiential learning, like learning to drive a car. You can’t just read a book and drive; you learn with a coach. It’s particularly important, when you’re doing a breastfeeding protocol with the Clearblue Monitor, to have a teacher guide you.

Lisa: Well, let’s break it down a little bit. Quick review — when you’re cycling, you test your urine, and as you mentioned, it’s designed to help achieve pregnancy, so it’s measuring when your estrogen is rising, and if you’re trying to conceive you have sex until you’ve ovulated. But if you’re trying to avoid pregnancy — can you share, just before we transition into breastfeeding, an understanding of how it’s used for birth control? We already talked about the fertile window — research tells us sperm can live up to five days plus the day of ovulation, so we have a six-day fertile window. Does the Clearblue give us information about estrogen so that the whole window is captured?

Dr. Barron: Yes, it is predictive. What we tell women is that on the first day of high fertility on the monitor, they abstain — they know their day’s fertility in the morning. So they abstain from the first day of high fertility through peak plus three.

Lisa: Okay, so you’re taking your morning urine, and at the beginning of the day you know where you are?

Dr. Barron: Right, and the difference between that and basal body temperature is that you get this prediction, but the monitor also has a six-hour testing window — so if Lisa has to get up at six in the morning with her kids to get them off to school, and everybody sleeps in on Saturday, six a.m. is her first morning urine test the first day she uses the monitor, and the next day she has between three a.m. and nine a.m. to test. You don’t have to test at exactly the same time every day the way you do with a thermometer.

Lisa: Well, and I suppose the other big difference between basal body temperature and this approach is that basal body temperature gives you no predictive information — it’s only retrospective.

Dr. Barron: Correct, it’s retrospective. I think it’s still important — I don’t want to bash it.

Lisa: No, I get it — the temperature is very important, for example for women who only use LH strips to confirm. I’ve done an entire episode on ovulation predictor kits. What’s really important when you’re trying to conceive is to time intercourse at the right time, but also to make sure you don’t stop too soon — you want to confirm ovulation. That brings up a practical question for women who have multiple peaks, or women who have PCOS — how do we use the Clearblue Monitor for a woman who, for example, has cervical fluid a couple of times before she actually ovulates?

Dr. Barron: Well, the Clearblue is not recommended for somebody whose PCOS isn’t controlled, because women with PCOS tend to have erratic LH activity. A woman with PCOS often has insulin resistance, and metformin lowers those insulin levels, which allows the hormonal balance to return to normal and lets her return to cycling. Before we really understood that, when metformin came on the market, it was listed as having a “side effect” of pregnancy — but it’s not a side effect, it’s the main action of the drug, because it lowers insulin. So after taking metformin for about three cycles or so, a woman can go ahead and use the monitor like anyone else, once the underlying condition is being treated.

Lisa: Well, and I’ll just point out, I’ve done a few episodes on PCOS, so for anyone who wants to learn more: fertilityfriday.com/pcos. And metformin is one of the options for sensitizing the body to insulin. I think that’s important to know, because one of the challenges with technology in general — and you said it already, that the monitor is “dumb” and we’re “smart” — is that a lot of women misinterpret having multiple patches of cervical fluid, or multiple positives on an ovulation predictor kit, as meaning they’re ovulating multiple times, when really their body is gearing up to ovulate but, in a condition like PCOS, isn’t responding and isn’t actually ovulating until it reaches that true peak. So it sounds like if you’re using the Clearblue Monitor, you’re getting information about estrogen and then information about LH — does that then confirm ovulation?

Dr. Barron: No — a progesterone stick confirms ovulation. There’s one called Proov that’s now on the market; you can order a set, I think seven sticks. It isn’t something that would be used lightly, but it’s very helpful and it has been researched. It correlates to a threshold of 5 nanograms of progesterone, which is a post-ovulatory expected level, matched against serum levels. It’s especially useful with PCOS, with luteal phase deficiency — meaning inadequate post-peak phases — and with ovulation defects. In the study I recall, 82 percent of the women had ovulation confirmed at that threshold, matched up against serum levels. Ultrasound detection of ovulation is the gold standard, but it’s expensive and inconvenient, so this was a match-up with serum, which has been around for a long time. I also want to go back to LH strips — there are a lot of OPK kits on the market, and I did a comparison of the Wondfo LH strip and the Clearblue. I chose the Wondfo because there was a Canadian study on what concentration threshold best predicts ovulation, and 25 was the level that best matched detection by ultrasound. The Wondfo threshold is 25, same as the Clearblue, but with some other drugstore brands, I checked with the company and found they’d set their threshold at 38 — which means that even though a woman may still be ovulating, she could get a negative reading when it should be positive.

Lisa: Do you see the difference there? So knowing the brand really matters. With LH strips — similar to how you described the progesterone strip — it’s measuring for a threshold level of luteinizing hormone, so if you have a strip with a higher threshold, you could potentially get a false negative if your levels didn’t quite hit that height.

Dr. Barron: Yes.

Lisa: I think it’s really interesting to learn how all of these things actually work, because for most people who buy a kit and use it as directed, you don’t necessarily get those specific details about the product.

Dr. Barron: Right, but as a researcher I have to be very interested, so that I can pass that information on to women — which is kind of why I’m doing this podcast anyway.

Lisa: Well, I wanted to go back — when I asked whether the Clearblue confirms ovulation, you mentioned that because it’s not testing for progesterone, only estrogen and LH, one way to confirm ovulation would be the new Proov strip, another would be a blood draw at your doctor’s office, and ultrasound is the most accurate. I also wanted to ask about basal body temperature, because you mentioned that when you’re teaching Marquette, you also teach mucus, but you also teach BBT.

Dr. Barron: We do — and remember, we empower a couple to use what works for them. So the information I give couples about temperature: generally, skin-sensor thermometers are not as accurate as an oral thermometer. I’d avoid ear thermometers, because they can vary by as much as one degree from ear to ear. I tell people you can buy a ten-dollar electronic thermometer at a drugstore, and that’s usually pretty reliable — you do want to use an oral one. There are women who vary a lot, and for them I’ll have them use a vaginal reading, because sometimes that’s more stable and more readable. I looked into this years ago and published an article about the problems with basal body temperature charts — a lot of it comes down to interpretation, erratic entries in the chart, and couples having difficulty with the routine. If you think of a couple with young kids getting up in the middle of the night, that can be disruptive to a temperature reading. Illness, stress, thyroid issues — if there isn’t a good rise, or if there’s a very short luteal phase, those are things that can affect temperature readings. That doesn’t mean temperature doesn’t have a place — it does — it just has more limitations than some of our other fertility tools. Getting a good thermometer is probably key. And then there’s the human factor: the woman who takes her temperature while sleepy, thinks “I’ll chart it later,” and either doesn’t chart it or can’t remember it accurately. There is a place for the thermometers that record directly to an app — that’s probably a good option — though some of them are prohibitively expensive; there are devices out there in the $500 range, whereas the Clearblue Monitor costs around $125 on Amazon.

Lisa: Well, I think with any method there are always advantages and challenges — there are advantages and challenges with checking mucus, with everything. I really appreciate going through this, especially because when you’re using technology, the technology is there to gather a certain type of information — it’s not there to interpret that information for you. With PCOS, for example, women with PCOS are known to have rapid LH pulses, meaning they produce more luteinizing hormone, so a monitor might give more frequent “peak” readings, but that doesn’t mean the tool is the one interpreting what that means for you. So now that we have a general sense of how the monitor works — that it’s telling us when we’re entering the fertile window, and that we have other ways to confirm ovulation has happened, all of which are really trying to get at the same thing, understanding what’s happening hormonally — let’s go back to the breastfeeding question. When you’re not cycling, because you’ve had a baby and you may be breastfeeding, it’s basically like having a really long pre-ovulatory phase, and you don’t know in advance whether it’s going to be four months, six months, eight months, or twelve months. So enter the Clearblue Fertility Monitor — could you share a general sense of how it’s used in that phase, and how that differs from the traditional approach of checking mucus? You really can’t rely on temperature at all during that phase, since temperature doesn’t tell you anything until after you’ve already ovulated for the first time.

Dr. Barron: Right — so we teach about lactational amenorrhea, but American women don’t often meet the criteria you need to rely on that method alone, which is having a baby under six months old, exclusively breastfeeding with no supplementation, and really using the breast for pacification. If menses hasn’t returned within that six-month window under those conditions, lactational amenorrhea is about 98 percent effective for avoiding pregnancy — but American women often don’t meet that criteria, because they pump, go back to work, and so on. So with breastfeeding, the way we use the monitor is that we artificially create cycles — we might run 20 tests, re-trigger the monitor, and start testing again, using a test stick every day, depending on the protocol, and reading the day’s fertility with the monitor. We’re telling the monitor how long the “cycle” is, essentially by manually advancing it, and the couple only has relations on days where the monitor reads low fertility. Now, if the monitor reads high fertility — which will happen, because women in the postpartum period do see mucus patches like that — it’s worth knowing that roughly 60 percent of women have a bleed and didn’t ovulate, and about 40 percent ovulate and then have a bleed, so having a bleed doesn’t necessarily mean ovulation has already happened; an ovulatory bleed can happen before fertility has fully returned. Have you heard the term “Irish twins”?

Lisa: I certainly have.

Dr. Barron: Those are babies born about 10 to 12 months apart — women who probably ovulated and didn’t realize they were fertile again so soon. The earliest recorded ovulation I’ve heard of — I heard this at a Creighton Model training years ago — was a bottle-feeding woman who ovulated at day 27. When you’re fully breastfeeding, though, it’s typically about 56 days before you’re not ovulatory.

Lisa: Yeah, I think that’s really important for women to know, because it’s so variable — you can’t really predict in advance, especially with your first baby, how breastfeeding is going to go, and if something happens and you’re not able to continue breastfeeding, your fertility can return quickly.

Dr. Barron: Right, you do have to be on it. And women can go through a lot when they’re anxious to breastfeed and it doesn’t work out — we want women to be able to do this if they want to breastfeed. As a nurse practitioner, when I’m working with people, I want to give them the right advice to be a good breastfeeding support — you don’t want an advisor in this whole thing who never breastfed themselves; you really need to talk to somebody who knows what’s going on with breastfeeding.

Lisa: Yeah, well, as a woman who did breastfeed, the older women in my life who did breastfeed were very supportive, and the ones who didn’t breastfeed couldn’t really understand why I would push through it — I had a lot of difficulty initially with my first child, it was very painful, my son had to have a tongue-tie release, there was a whole process to it. For anyone witnessing it, they might have wondered why I’d put myself through all of that pain and struggle, when you could just use a bottle. But for women who did do it, they get it, whereas some who didn’t do it just don’t understand.

Dr. Barron: Well, on the other side, it’s never about inflicting guilt — if breastfeeding doesn’t work out, babies grow up fine either way, and that’s okay. You put the baby first, because that’s really what she’s doing, putting the baby first. We women are inflicted with enough guilt about things already — you don’t need to add more. Here’s one more thing I like to share with the women, because I was a childbirth education teacher for much of my career, and I like to bring the men into this conversation too: when a woman is breastfeeding, she has high prolactin levels — prolactin being the hormone needed to produce milk — and prolactin suppresses estrogen, which is why she wouldn’t ovulate, because you need that estrogen rise to trigger LH. So when a woman’s estrogen is suppressed, she could care less about having sex — it has nothing to do with anything psychological, she’s not rejecting her partner. You can get her interested, but you have to try harder — be a little more romantic, a little more thoughtful, which doesn’t necessarily mean bringing home flowers; it might mean doing the dishes.

Lisa: It might be.

Dr. Barron: It might be — definitely could be. I want the men to hear this directly from a healthcare professional, but women should know it too. Emotionally, there’s often no closer time for a couple than right after they’ve had a baby, even though that closeness doesn’t always turn into physical activity for her — but she might be more receptive to that kind of thoughtfulness. It’s a matter of being thoughtful and understanding the hormones, and knowing it’s nothing psychological.

Lisa: That’s so important, and I really appreciate you saying that, because I think a lot of women feel like they’re supposed to have that drive all the time, and feel guilty when they don’t have it for a period of time postpartum. So I wanted to go back to the breastfeeding scenario briefly — let’s put it in perspective. For a woman using a traditional mucus method, since you really can’t use temperature if you’re trying to avoid pregnancy postpartum, because temperature will only tell you retrospectively that you’ve already ovulated —

Dr. Barron: That’s right, it’s retrospective.

Lisa: — postpartum is where a lot of women run into challenges. A lot of women use fertility awareness relying basically on temperature only, because a lot of women struggle to understand mucus, potentially because they learned primarily from a book, and it’s different when you’re cycling because you have ovulation and then the cycle starts again. So a lot of women successfully manage their fertility while largely using temperature and not really the pre-ovulatory phase. For women who didn’t get a good grasp on mucus, being thrown into a postpartum, mucus-only situation, checking daily, without at bare minimum a very specific mucus categorization system, can be really challenging — how do you tell the difference between arousal fluid and mucus when you’re breastfeeding, and so on. If you don’t have that support to work it out, a lot of women are left not knowing what to do. So what I appreciate about the Clearblue Fertility Monitor is that it’s testing for the hormones directly, regardless of what’s happening with mucus.

Dr. Barron: For the hormone, correct.

Lisa: So it sounds like — and what you mentioned is really interesting — the monitor is intended for a cycle and to be used in that pre-baby stage, and what you’re describing is essentially programming it, tricking the machine, because you’re really having this one very long cycle that spans several months, and you’re manipulating it however you need to in order to keep testing every day.

Dr. Barron: Pretty much — there are little variations on that protocol we’ll work through with women, and I don’t want to go too deep into that because it’s so individual, but generally you should think of it as testing every day. Sometimes we use the LH strip as a double-check method, and there is a place for the LH strip as a double-check in most forms of the Marquette Method.

Lisa: Interesting. And so, that’s something where some women are successfully able to use mucus-only methods postpartum —

Dr. Barron: Yeah, they are.

Lisa: — it works fine if you have a typical mucus pattern where you’re dry all the time and then see mucus when you go into fertility, that’s fairly straightforward.

Dr. Barron: But there’s a lot of women who aren’t like that, and postpartum is a different time for your body — different hormonally — so some women may see something every single day, and in those cases it can be more challenging.

Lisa: That’s really interesting, because with the Clearblue Monitor, checking every day, urinating into a cup, using the strips, you’re really getting a scientific heads-up when your estrogen rises. So it’s possible, as you mentioned, that a woman may have bleeding and not have ovulated — but does it mean that when months go by and she finally gets that indication on the monitor that estrogen is high, so she’s in her fertile window, is it possible she doesn’t necessarily ovulate the very first time estrogen is high?

Dr. Barron: That’s right, that’s possible.

Lisa: Yeah, but similarly with all fertility awareness methods — and I recognize this is quote-predictive technology — you can’t necessarily predict ovulation, so you always have to treat that estrogen rise as fertile, because you are fertile for that time, and what I like about it is that it mirrors what mucus is intended to do — a way to measure what’s happening hormonally. So what I appreciate is that it gives you another tool to essentially test for the same thing.

Dr. Barron: Correct.

Lisa: Well, we’ve covered so much today, Dr. Barron — I really appreciate you taking us through all of this. Actually, I had one last question I wrote down — a practical question about the strips. The fertility monitor costs a hundred and something dollars, so are the strips sold separately, and do you have to continue purchasing them?

Dr. Barron: Yes, and everything’s available on Amazon — you get a package of 30 strips for about $38 to $40, and if you’re spacing them out over cycles, that will last three or four months, at about $1.20 to $1.25 per strip. So I tell people you’ll spend more on coffee every month than on fertility monitoring strips. And the other thing to know is that the Wondfo LH strips — that’s the only brand I recommend — you get 50 of those for about $14, and you have the ability to test in the morning and the evening, because LH actually comes out of the brain twice a day. In my study, a good percentage of women actually had their peak on the strip the evening before it was positive on the monitor, but there was really good agreement overall between the strips and the monitor — the Clearblue picked up peak 86 percent of the time and the strips 93 percent of the time, which surprised me; the strips actually performed a bit better.

Lisa: That’s very interesting, and I think for some women the cost would be a big factor if they’re always going to need the strips, but for other women, having that additional tool, that additional way to confirm the fertile window, is valuable. This is why, on the podcast, I’ve interviewed a number of different fertility awareness and NFP practitioners who teach different methods — I have this idea that we should all unite, because when I was first coming into this field there was a lot of divisiveness, a lot of “my method is the only method.”

Dr. Barron: Totally, and it’s ridiculous, because ultimately your client is going to choose what works best for them, so it’s helpful to put the pitchforks down and have a better understanding of the different aspects of the different methods — especially when I have a client whose specific situation prevents them from being able to check mucus, and there are other challenges — we can really be informing our clients about the different options so they can choose what’s going to work best for them.

Lisa: That’s right, that’s what we should do. Well, I’ve kept you long enough — thank you so much for being here. Can you share with us where our listeners can go to find out more about you and what you do?

Dr. Barron: My website is marquettefertilityed.com. It lists the teachers in the St. Louis area, along with my email and other information. For Marquette nationwide, go to nfp.marquette.edu — that will take you to the Institute for Natural Family Planning at Marquette, and from there you can find out if you have a local teacher, or view the interactive map of teachers.

Lisa: Well, thank you for that, and you’ve published a number of studies — if there are any particular studies you feel would be really appropriate for our listeners, I’d be happy to link them on PubMed in the show notes.

Dr. Barron: Well, one I’ll send you a link for is called “Finding the Fertile Phase,” and it’s in a maternal-child nursing journal — I’ll send you that link.

Lisa: Okay, perfect, thank you so much.

Dr. Barron: Okay, Lisa, you take care now.

Lisa: 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/303. I hope you enjoyed my interview with Dr. Barron — what a great opportunity to talk about the Marquette Method and expand our understanding of different fertility awareness-based methods. I think it’s really interesting that this method utilizes the hormones specifically, measuring the surge and estrogen that precede ovulation, because when you’re using the symptothermal method, in a sense your mucus is giving you that same information about your hormones — when you’re cycling normally, with healthy cervical mucus production, your mucus mirrors what’s happening hormonally. With the Marquette Method, it gives you an alternative when you’re not able to rely on your mucus patterns. We covered a lot of the common myths in today’s episode about postpartum charting — it is possible to successfully use fertility awareness-based methods postpartum, but it’s always important, especially if you’ve never charted before, or if you charted previously but primarily for conception and weren’t fully comfortable with mucus, to seek support from a trained educator during the postpartum period so that you can become confident and really understand how the method works, in order to use it effectively to prevent pregnancy. You want a clear understanding of the rules, and if you’re relying on mucus, you want to understand how to differentiate between the different types of cervical fluid you might see — there’s arousal fluid, there’s semen, there are all kinds of things to navigate. And if you’re not able to rely primarily on cervical fluid, it’s helpful to know that Marquette offers an option where you’re reading the hormones directly, so you have a way to understand exactly what’s happening in your cycle. We’ll be talking about the Marquette Method in the Facebook group, so if you’ve used it before, or have questions, join us at fertilityfriday.com/community — we’ll have a thread there for today’s episode. I want to thank all of you for tuning in to the show. If you know somebody who would really benefit from listening to today’s episode, please share it with them. And if you’ve been enjoying the podcast, I would love it if you left a review on Apple Podcasts — I read all of the reviews, and it really makes a difference; it helps people find the show and know what to expect. I really appreciate all of your support and all of you being part of the community. And of course, as always, until next time, be well and happy charting.