Top 5 Reasons to Teach your Clients to Chart their Cycles (Episode 652)

Full Transcript: Episode 652

Lisa Hendrickson-Jack: This is the Fertility Friday Podcast, episode number 652. In today’s episode, I’m going to be going through the top five reasons why you should be teaching fertility awareness to your clients.

If this is your first time tuning in, I’m Lisa Hendrickson-Jack, certified fertility awareness educator. And I’ve been teaching women to chart their menstrual cycles as a vital sign for over 20 years. I’m the author of The Fifth Vital Sign, co-author of Real Food for Fertility, also the founder of the Fertility Awareness Institute, where we teach women health professionals to use the menstrual cycle as a true vital sign in practice.

My message for the past 20 plus years has been the same. We should be using the menstrual cycle as a vital sign because there’s so much more that we can learn when we track our cycles accurately. So let’s go ahead and jump into today’s episode.

If you’ve been a longtime listener of the show, then you may already be sold. You may not need to have more reasons why women’s health professionals should be teaching their clients to chart their cycles. But today I wanted to talk about some of the most compelling reasons that I think you should be based on some of the current data that we have that we can look at.

The first point I think is a surprise to basically no one, but it needs to be said. Most health professionals were never trained to teach charting. So most women never learn it.

Just in general, as women, whether you are a health practitioner or not, we as women have not been taught to track our menstrual cycles. And very few of us have really learned much about it.

What makes it more disturbing is that most women’s health professionals who are trained, who are credentialed, who have various certifications, it is just not a standard part of any type of women’s health training program. When you work with health professionals that have been trained and certified in fertility awareness-based methods, these are professionals that took it upon themselves to go outside of their certification programs to actually learn this information.

In one recent survey of 329 health providers from U.S. family planning clinics, fewer than one in four said that anyone in their clinic had any formal training in fertility awareness. And only about half of these practitioners could answer four basic cycle questions correctly.

When patients asked about fertility awareness, the most common response was to basically equate it with the rhythm method and essentially dissuade the client from using it. Because ultimately, calendar-based methods, the rhythm method, are not the same as modern fertility awareness-based methods. And so if that’s the extent of your training, then you’re definitely not equipped to support your clients in that respect.

This is just one of many studies that gives us a glimpse into the level of education and training that health professionals, whether it be doctors or nurses or midwives or insert health professionals, get about fertility awareness charting. But suffice it to say that it’s just not something that is a standard practice.

As a women’s health practitioner, if you get specialized training in fertility awareness-based methods, then you set yourself apart. Especially for clients who are wanting to transition, who are wanting to use this as their primary birth control method, who are wanting to learn to time sex accurately for conception. When they’ve asked potentially multiple other practitioners or sought support and been dissuaded and discouraged, now more than ever, your clients really need you to step up and sort out this information.

There were two quotes that stood out to me from the study that I mentioned. One was that, quote, “clinicians reported providing verbal and written information to clients who requested FABMs,” fertility awareness-based methods. “However, few clinics reported having training and education around FABMs on site.”

So although there were some of these providers who actually did provide some level of information to clients, the majority did not have any training or education available to clients on site.

And the second quote gives us some insight as to how practitioners feel when put in the situation of being asked about this type of information when they know they haven’t really been trained. One survey respondent said, quote, “Lack of education. I don’t feel I have enough training to give accurate information on all the different NFP,” natural family planning, “methods,” end quote.

So at least this respondent was honest, because many practitioners, even though they don’t necessarily have the information, they are still going to say all kinds of things about it and dissuade clients from using it. But it really does give us some insight into the lack of education.

The second point, I think, is a really interesting point because of the advent of so many different charting apps. When I first started charting back in the dark ages, there weren’t even smartphones. There were no charting apps. They didn’t even exist. And fast forward nearly 25 years later, and we just have an incredible overflow of all of the tech.

But what’s really interesting is that even though we have all of these charting apps, most women who track their cycles are still basically using their tracker as a calendar. In a study of 484 women at a gynecology clinic, and this study was published in Healthcare, 77% of app users used it to track their period dates only. And interestingly, 41% only even opened it during their period.

When you’re in the fertility awareness world, it can seem like everybody is tracking their cycles and everybody understands their mucus and all of that. But that’s just not true. The average woman has not been taught basically anything about her menstrual cycle.

And this app study, like I said, gives us a really interesting insight, because even though thousands, if not tens of thousands, if not hundreds of thousands of women worldwide are using these period tracker apps, you would think that the average woman has a much greater understanding of her cycle as a result. But this study shows us that the vast majority of women, 77% in this particular study, were using it only to track periods.

Now, I’m not knocking tracking your period. We should all be tracking our period. When I have clients who come to me with plenty of years’ worth of only period tracking data, I look at it as a gift. So I am certainly not putting that down.

But this is another reason why, as a women’s health professional, you should be teaching your clients to track their cycles. You can gain some valuable information from simply tracking your period. But how much more valuable information can you gain when you actually have your client tracking not only their period, but their cervical mucus, when they’re ovulating, their luteal phase data, all of the different aspects of the menstrual cycle that give us so much more information that would allow us to actually use the menstrual cycle as a vital sign and diagnostic tool in practice.

This is a huge area of opportunity for you. That means a significant portion of the women that you work with are already tracking their cycles, but using it to only like 1% of the true capacity that they could be. So as a women’s health professional, this is an incredible area of opportunity for you. And I would argue that it’s a very compelling reason why you should be introducing this concept and encouraging your clients to take it even further.

I pulled two quotes that I thought were interesting because it kind of shows what the researchers were thinking about this. Now, as I mentioned, the majority of women are simply using this as a calendar to note when their periods are coming or have come.

The first quote: “Many rely on calendar-based assumptions that do not account for individual variation in cycle length or ovulation timing. Such predictions may be inaccurate when used for contraception or conception, whereas methods incorporating physical biological indicators, including basal body temperature, cervical mucus, or luteinizing hormone may provide more reliable estimates,” end quote.

This quote is a little bit wordy. But ultimately, what it’s saying is that when you are using this information with a very basic, if any, understanding, and you’re using these apps that are also then providing a prediction, if you’re tracking only your period, and then it’s also predicting when you’re ovulating, then of course, it is not going to be accurate in terms of actually identifying your fertile window.

And the second quote relates to the first quote, because it says, quote, “Clinicians should explain that calendar-based fertility predictions may be inaccurate and should not be treated as definitive for conception or contraception.”

Now, again, these points are accurate. This also shows where the opportunity lies for women’s health practitioners. If you have a woman who is using a tracking app and tracking only her period, and it is giving her predictions of when she should try to conceive or when she should avoid, identifying her fertile window, then it is not going to be accurate.

But there is an incredible opportunity for you as a practitioner to welcome her into this knowledge and show her the next step. The first step is just noting when your periods are happening. The next step is starting to identify cervical mucus patterns and tracking basal body temperature, and really starting to gain that confidence in confirming when the fertile window is and confirming ovulation, as well as understanding the different phases of the cycle.

There’s so much opportunity there for professionals that want to help your clients take this to the next level.

Okay, a third point that I think is also really important. As a practitioner, you may assume that if your client tells you that she’s tracking her cycles or she’s tracking her ovulation, that means that she really does understand what’s happening in her cycle. But that is not necessarily what it means.

The third point is that most of your conception clients are likely timing sex incorrectly. Let me say that again for effect. Most of your conception clients are likely timing sex incorrectly.

Now, this is for a variety of reasons. One, the charting apps that we just mentioned that provide these predictor dates that are not necessarily based on the actual fertile window, which would largely be related to cervical fluid production prior to ovulation. But in addition to that, most cycles are not 28 days with day 14 ovulation. Most cycles are not following the pattern that the majority of women are basically looking for and expecting to see.

There was one study of over 600,000 cycles from over 124,000 women who were using the Natural Cycles app. Now, this is a huge data set. One of the great things about the modern era that we live in with all these tracking apps is that we do get a lot of app studies that give us a tremendous amount of data.

In this particular study, like I said, over 600,000 cycles, over 124,000 women who are using this app, out of those cycles, only 13% of those cycles were actually 28 days long.

It’s hilarious. Now, that is not a surprise to me, but doesn’t that show you how few women are actually having 28-day cycles with day 14 ovulation? The first half of the cycle before ovulation ranged from 10 to 30 days, which again is a surprise to no one who actually charts their cycle or teaches charting. But for many women, this could be shocking information.

I would love to do that survey. If you had to guess, what percentage of the time is the menstrual cycle 28 days? Well, according to this study, 13%. So that means that 87% of the time, it isn’t.

And so if your clients are then basing their timing for conception on this same idea that the cycle is always 28 days, that we’re always robots and that ovulation is always day 14, how many women have sex specifically on day 14? How many women are only testing for mucus or LH testing around day 14 because they assume that it has to be around that day? How many women stop even paying attention after day 15 or 16 because they assume ovulation has already happened? Well, you won’t know until you teach your clients to chart and you can see it for yourselves.

Now, of course, there were other interesting data points in the study. When you do look at large data sets like this, it is quite consistent what you see. So this study is actually not revealing anything new. You can look at studies looking at the length of women’s cycles going back decades, and they’re in really great alignment.

The average cycle length typically falls somewhere around 29 days. And that makes a lot of sense. But even though this is the average, the actual range varies quite a bit. And this is normal. It’s not uncommon or even problematic for there to be some cycle variation or fluctuation.

And it also doesn’t mean that she can’t use fertility awareness-based methods effectively for contraception. It simply means that she needs to learn how to chart her cycle. She needs to snap out of what I like to call rhythm method thinking and start to observe what’s really happening in her cycle from day to day.

A direct quote from this study: “These findings demonstrate that the widely held belief that ovulation occurs consistently on day 14 of the cycle is not correct.” Wow. Amazing. I’m glad that they finally figured this out.

Another quote from the study, the researchers say, quote, “In order to identify the fertile period, it is important to track physiological parameters such as basal body temperature and not just cycle length.”

Another interesting finding from the study was that the luteal phase was surprisingly not always 14 days long. Wow, what a concept. I just respond that way because when you spend time looking at actual charts from real human women, you just know that this is how it plays out. We are not robots. We have fluctuations. Our cycles are affected by stress. Our cycles are affected by changes in diet, changes in health, all kinds of different factors.

And so the researchers even demonstrated that even if you have a cycle that appears consistent, even if the cycle appears to be around 28 days from cycle to cycle, that does not mean ovulation happened on day 14. I’ve seen 28-day cycles where ovulation happened on day 21.

If we really want to understand what’s going on, we have to look under the hood of the car, if you will, and really start having our clients chart their cycles so we can ascertain more than just, “Oh, your cycle was this long.”

Another compelling reason why, as a women’s health professional, you should be teaching your clients to track their cycles is that women who track their fertility signs tend to get pregnant faster, especially when they combine these signs together.

There was a recent study of 5,688 women who were planning to get pregnant. These study participants were both in the U.S. and Canada. The research paper was published in Fertility and Sterility.

Now, what’s interesting is that women who had tracked any fertility sign had 25% higher odds of conceiving in any given cycle. And women who combined signs together, so they’re watching the day of their cycle, cervical fluid, LH testing, had 48% higher odds.

What this study tells us is that when we educate our clients, when we ensure that they are cycle literate, when we teach women how to identify when in their cycle conception can occur, how to identify that fertile window, which days are best and optimal for conception, then we are actually increasing their odds of conception.

Again, the study is quite interesting because the odds were 25% higher for just tracking any sign and nearly 50% higher for women who were tracking multiple signs. And if we want to say that in another way, because sometimes the message kind of gets lost in the statistics, it’s that women who were tracking their cycles conceived sooner. They had a shorter time to conception. That’s where they get these numbers where they’re saying they had a higher percentage chance of conceiving per cycle. They were more likely to conceive sooner than women who were not tracking their signs.

Now, one thing I’ll always say is that timing is not the only reason why couples struggle to conceive. And so obviously there are couples who do track their cycle consistently and are timing sex correctly, and conception isn’t happening. But one of the important things to note is with charting, we can identify and kind of rule out what it is.

One thing I always say about timing is that without accurate timing, nothing can happen, because there is only a small window. Scientifically speaking, the fertile window is six days, the five days leading up to ovulation plus ovulation day itself. And outside of that window, there’s a reason why fertility awareness-based methods have an efficacy rate as high as 99.4% with perfect use. And that is because outside of that fertile window, pregnancy is not possible.

So if we don’t hit the window ever, then the chances of conception are nil. But that certainly doesn’t mean that timing is the only factor.

If you’re a women’s health professional working with clients who are trying to conceive or planning to conceive in the future, if you’re able to teach them accurate charting and you’re able to help them to correctly identify their fertile days and understand how their cycle works, then you’re significantly improving their chances of conception. And if there is an issue, an underlying issue that is interfering with or preventing them from conceiving, then they will be able to identify it far sooner than if they didn’t have this accurate information.

Okay, I have one more reason why, as a women’s health practitioner, you should really be incorporating cycle charting as part of your education and teaching for your clients, why you should be teaching your clients to chart their cycles. And the reason is this. Her charts show you whether or not the changes that you are recommending are actually working.

One of the ways that we think about using the menstrual cycle as a vital sign is typically being able to look at the chart passively and say, okay, if I see this pattern, it reflects this issue. And of course, there’s a lot of room for that. We teach our practitioners how to do that. So there is a certain aspect of passively looking at the cycle and saying, okay, these patterns are associated with these issues, and helping you to identify underlying concerns.

But there is a second aspect of using the menstrual cycle as a vital sign that is more interactive. And this is what we teach our practitioners in our Fertility Awareness Mastery Mentorship.

When you’re able to first teach your clients how to chart and get them charting in a standardized way, then what you end up having is you end up seeing what is going on. And the first chart that you chart with a client in a standardized way, we refer to that as the baseline chart.

What happens from there is you can identify what’s really going on. You put it all in context. You can look at her history, all of the things that you need to identify what you’re really seeing.

But then the second piece of it is, okay, so you know her history, you have some ideas of what to do next. You start to support her. She starts to make some changes. When you’re able to have her continue tracking through that process, you’re able to actually identify if what you’re doing is working.

There are times when you may have a standard protocol that you give to every client that has this issue, and some clients respond really, really well to it and others don’t respond at all or barely respond. So the chart can be used not only to identify issues, but to show you whether the changes that you are making, or that you are encouraging your client to make, are working.

And then when you see how they’re responding, you’re able to adjust. And this creates a level of personalized care that is incredibly unique for women’s health practitioners and their female clients. This is not something that we can generally do without repeated blood testing throughout the whole cycle. Or what other way could we monitor hormonal changes so closely in such a minimally invasive way?

Cycle tracking really does offer a very unique tool for practitioners that is unlike any of the other tools that you typically are using. Because again, this is something that you teach your clients, they learn how to do. And once they learn how to do it, it’s a skill they’ll have for their entire reproductive lives. And it’s a very non-invasive way to actually track what’s happening. Because of course, what’s happening in the cycle is a reflection of what is happening hormonally.

To summarize the top five reasons that you should be teaching fertility awareness to your clients as a women’s health professional, the first is that very few health professionals have training in this area, specialized training. Many people know a little bit about charting, but very few are actually trained, specialized, certified to teach a specific method to their clients. And so as a women’s health professional, this is one way to really set yourself apart from the pack.

The second point is that most women who track their cycles are really only tracking their periods. They’re using their charting apps as calendars only, and they’re leaving so much information on the table. If you have clients that are already tracking, that means they’re already interested in learning more about their cycles and understanding their bodies. And that’s a huge missed opportunity if you don’t support them to take it to the next level.

Point three is that the vast majority of your clients are not ovulating on day 14 or having 28-day cycles all the time. In today’s episode, we touched on this, and I shared the information from the paper to show that only 13% of those over 600,000 cycles actually hit 28 days.

But there are deeper implications for practitioners, even when it comes to lab testing. How many women are sent for testing on day 21 or a specific day of their cycle when we have no idea if ovulation even occurred? We’re just wasting everyone’s time. We’re just sending them willy-nilly based on this idea that ovulation always happens on day 14.

How many women conceive and they’re asked when their last menstrual period was, and then it’s just assumed that ovulation must have taken place on day 14, and therefore they’re given a due date based on that? So there’s a lot of implications here as a women’s health practitioner as to why you should be teaching your clients to chart their cycles and why you yourself should be educated about these points.

Now, of course, the fourth point is very compelling because research shows that women who track one or more fertility signs are much more likely to conceive faster. So this is a huge point, especially for those of you who are specifically working in the field of fertility and who are supporting your clients to conceive.

And the final point, I think, for me, is the most powerful thing that we teach in our Fertility Awareness Mastery Mentorship, which isn’t simply to use the cycle to identify things, but to actually use it as an interactive tool that helps to give us feedback on how well our recommendations are working and allows us to tailor our approach specifically to the client in front of us. Because even the best protocols work differently on different clients, and the cycle tracking allows us to really understand how this is specifically working for the client in front of you.

I hope that you enjoyed today’s episode. I’m hoping that if you work with clients on a regular basis, that you are now thinking of all the different ways that you can incorporate cycle tracking into what you’re doing with clients.

Whether you’re already working with clients, reviewing charts in your practice, or whether you’re thinking about diving into it, we’ve created an incredible resource for women’s health professionals called How to Interpret Virtually Any Chart Your Client Throws at You. You can grab your free copy over at fertilityfriday.com/chart. That’s fertilityfriday.com/chart.

If you enjoyed today’s episode, one of the best ways that you can show your support and appreciation is to leave a review and rating on Apple Podcasts. The Fertility Friday Podcast has grown over the years because of listeners like you, because of our Fertility Friday community, because our listeners share the show with their friends. They share it with their practitioners. They share it all over the place, far and wide. And they share the resources that we’ve created, The Fifth Vital Sign book, Real Food for Fertility. Truly, it has been because of you that this show has spread far and wide. And so I thank all of you for being a part of the Fertility Friday community.

As we all know, when you are evaluating a new podcast, that is one of the first things you look at. You look at their ratings and reviews to see what people are saying about it. And at this point, we have well over 700 reviews. And I would so, so appreciate it if you took the time to leave a rating and review on Apple Podcasts.

With that said, I hope you have a wonderful week, weekend, whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.