Why Doctors Don’t Recommend Fertility Awareness Methods (Episode 569)

Full Transcript: Episode 569

Lisa Hendrickson-Jack:

This is the Fertility Friday Podcast, episode number 569.

In today’s episode, I’m covering an interesting question. Why your doctor isn’t recommending fertility awareness-based methods and also why your doctor may not be as open to fertility awareness based methods. So, one of the challenges with discovering fertility awareness is that when you start charting your cycles and you start becoming more literate about your body, have more body literacy, you have a better understanding of your cycles, many women have this natural seemingly natural inclination to then race to their doctor. And whether it’s that they were, you know, taking the pill before and they’re wanting to come off. And this is something I’ve talked about before, feeling the need to ask permission from your doctor or inform your doctor that you’re coming off hormonal contraceptives. So going there and kind of expecting to have your doctor’s blessing or something for either having your IUD removed or coming off of hormonal birth control. And often that is not, you know, the response that the doctor’s not giving you their blessing or happy about it. They’re often really concerned actually and wanting to discourage you and I’ve spoken to many women who’ve even said their doctor laughed at them and told them that you know fertility awareness doesn’t work and you know that there’s something we call people who use fertility awareness that parents right that old joke that’s not that funny and a lot of women are really alarmed by this really confused by this and you know often they had a really good relationship with their doctors so it kind of feels like it came out of the blue like why are they behaving this way.

And so in today’s FAM research series episode, I’m going to go through a study, an interesting study that was published in the Kansas Journal of Medicine. And the study is called Physician Disposition Towards Non-Invasive Non-Hormonal Contraceptions. That’s like a the titles are always, you know, leave something to be desired, but essentially they are looking at fertility awareness based methods and they’re looking at what are doctor’s true reactions to them. And so they did a survey, surveyed a number of doctors and what’s interesting is that they provide the qualitative and quantitative data here. So they’re providing the actual stats and all of that, but they’re also providing some excerpts from what the physicians actually said. And so we’re going to get into some of that. And I think it’s really helpful. It does mirror many of the experiences that I’ve heard from variety of clients over the years, women, members of the fertility Friday community. But again, it’s I think there’s just something interesting about seeing this type of research being done and seeing it in study form so that you can actually have that it’s it’s not just you. It’s not just that you had this experience. We can actually now look at the data and say okay and then try to draw some conclusions as to why it is that way. So without further ado, let’s go ahead and jump into today’s episode.

All right. So, the stated goal of the study, the stated intention from the researchers was to really better understand how physicians think about non hormonal versus hormonal contraception, especially fertility awareness-based methods. So, again, it’s really nice when you can find research that’s specifically on this topic because it’s not always the subject that has the most abundant research studies on it. But that’s the stated intention and what they did is they surveyed. So in the end they had 79 physicians complete the survey. So they had sent it out to more but they had 79 who actually completed it. And they actually when we look at who they sent the survey to, they were sending them, you know, not to students necessarily, but they were sending them to actual MDs. And they sent specifically to doctors specializing in family medicine, internal medicine, obstetrics, and gynecology or pediatrics.

So the pediatrics inclusion I found to be interesting because if you’re working with children I would assume that you’re just not as likely to talk about contraception. Maybe that’s the wrong assumption. So interestingly right that they included pediatrics and that my kind of question about that is shown in the data because ultimately the pediatricians are not necessarily recommending it but it’s not because they don’t agree or disagree. It’s mostly because it’s not necessarily relevant for the majority of their patient population. So that’s an interesting choice, but they did for the most part include medical doctors. And so it does still give us a really interesting overview.

So a couple interesting stats. You know, the researchers shared that an estimated 3% of contraceptive users in the United States use fertility awareness based methods. So, you know, 3% that’s not unexpected. I feel like that’s in line with what I would anticipate even a little bit higher. But even though it’s it’s a small percentage, I mean, the United States is over 300 million people, probably closer to 400 million people. So that’s a significant number. And I think that even though it’s a small percentage, the reason that more research is being done in this area is because it’s becoming more and more of a thing. The higher that percentage goes, the more people that are looking at non hormonal, non-invasive fertility awareness based methods, the more that doctors have to deal with this, right? And so I believe that this is the reason why we’re seeing some of these interesting research papers come out because more and more doctors are finding that they have to deal with this. And so the medical establishment is trying to kind of sort out how they should be responding.

So they looked at the questionnaire looked at several key areas. So there’s a lot of useful data. 60% of the respondents of the survey, they recalled being taught fertility awareness, taught about fertility awareness based methods or natural family planning in medical school. Over the years, I’ve had the pleasure of interviewing a number of physicians on the show. And although they may recall being taught something about it, it doesn’t mean that they received any type of high-level education. Physicians’ knowledge about fertility awareness-based methods are pretty basic at best and I would say based on the study results as we’ll get into most often not complete. So even if they had a class or it was talked about in a class the way that from again from my interviews with doctors it’s like you learn about hormonal birth control. So that’s the whole thing, right? So it’s heavily taught that hormonal birth control is the answer basically to all period related issues. And so because the goal is to have physicians to prescribe hormonal methods and there’s even more of a kind of push to the long acting methods. So like the IUD or the implant, things that don’t require the input of the user. So if you have an IUD inserted or if you have an implant inserted, it’s just the efficacy is based on the device. So as long as you have it inserted, there’s no room for user error.

So there is certainly just this tendency to want to focus on methods that don’t involve like the user can’t mess them up. So even the hormonal birth control like the pill, you can forget to take it and all that. So some of these other methods like the ring and the patch, you know, many physicians may tend toward some of those methods because again there’s less of a chance that the user could screw it up. And obviously fertility awareness based methods are on the complete other end of the spectrum because they 100% depend on the user. So there’s a number of reasons why physicians may not be inclined to prescribe these methods, but that’s something to be thinking about because often fertility awareness-based methods may be presented kind of at the end, right? It’s like these are the methods that work. These are the contraceptive methods with the highest efficacy and then they lump fertility awareness-based methods into the rhythm method and say these are the methods that are ineffective and they don’t work.

And so that definitely is reflected as we get deeper into the results of the study where there certainly is a predisposition for medical doctors to not really think of these methods as effective again because of incomplete education around them because if you lump in the rhythm method with an app that people are just saying that you know I use an app and then it gets counted in data as a fertility awareness based user then you’re going to have a high failure rate because they’re not using any type of method. So we’ll we’ll continue but 60% of the respondents as I mentioned recalled actually being taught something about it which means 40% do not. So according to this study 40% of the medical doctors didn’t actually recall being taught anything about fertility based methods. So that’s really important. I mean that’s 40%. Like that’s almost half.

And so if this study, if this survey is representative of a person’s average experience, it means that you may be charting your cycles and bringing your charts to your medical doctor hoping for some sort of acknowledgement of what you’re doing. And again, if we go based on the results of the survey, there’s a 40% chance that your doctor was taught literally nothing about fertility awareness-based methods in their medical school experience. So you can reflect on that. And this is why we have to be aware that your medical doctor does not specialize in this unless they have. Right? So if medical doctors who have specialized in fertility awareness based methods, they intentionally take subsequent training outside of their medical program. And so if that didn’t happen then not an expert.

So 96% according to the survey were quote familiar with the changes in cervical mucus that occur throughout the menstrual cycle. So even though only 40% recalled being taught anything 96% were very familiar with the changes in mucus and 99% were familiar quote with the changes in basal body temperature that occur throughout the menstrual cycle. So again reflect on that for a minute. 40% didn’t even recall learning anything in their medical school, but like 99% are like, “Yeah, I understand temperature.” And 96% are like, “Yeah, I understand mucus.” So, there’s a theme that runs through this of overconfidence. Maybe just something to do with the ego thing that I’m going to I’ll just kind of gloss over that for now.

46% of the respondents reported that they had patients that use fertility awareness-based methods for contraception. So this is interesting because again they’re just it’s whether they’re aware of it or not whether their patients are comfortable talking about that with them whether they’ve created an environment where the patient would even say anything because I mean if you think about it some doctors are they have a certain bedside manner where you would actually feel quite comfortable and even if you know that it’s not their preference for birth control there are many of us have had the experience where you have this doctor who’s really you know open-minded and respects patient choices. And so even if it’s not necessarily something that they would recommend, you would still feel comfortable telling them about it and they would still be respectful to you about that. And there’s other doctors who might have such a negative whole aura around them around this kind of stuff that you might not even feel comfortable saying it. So I feel like that’s interesting as well.

But 46% said, “Okay, yes, I have patients I know that who are using this.” 33% were unsure and 21% said, “Nope, I don’t have any patients using this at all for contraception.” So, you take that what it is. And so, a couple interesting points here as we continue to make our way through this data.

Participants were asked if they included fertility awareness-based methods in their contraceptive counseling. So, this is super interesting. And of the 84 respondents who answered this question, 42% said yes, 24% said sometimes, and 34% said no. So this is where we get some insight. So according to this study, there was a decent amount of physicians who said that they included fertility awareness-based methods in their contraceptive counseling. I feel like that was even higher than I thought. But again, as we get into the data, we get a little bit more nuance because it’s not that these physicians are recommending it across the board to say like to everybody. And I’m not arguing that that would even be the most appropriate thing to do because there are plenty of women who are not interested in fertility awareness based methods. There’s plenty of women for whom, you know, using a fertility awareness-based method wouldn’t go along with their phase of life and that kind of thing.

So, absolutely, I’ve never said that everyone should be using fertility awareness based methods. What I’ve always said is that everyone should be aware of them. And in a perfect world, we’d be aware of all of the choices so that if a person doesn’t jive with hormonal contraceptive, if they’ve had some side effects and they are wanting to know what other options are that they would at least have that kind of perspective. But I thought that was really interesting because I don’t think it means 42 based on the data, which we’ll get into some more of it, but I don’t think it means that 42% of these doctors are like every patient are always outlining it, but that they do include it when they see fit. Like when they think it’s appropriate for a specific type of person, they are talking about it. They’re open to talking about it. And then of course the 34% like no, never like they just it’s not a thing that I would ever talk about.

So there was an interesting kind of breakdown of some of the responses of the survey. And what they did is they once they would have these physicians answer these questions, they would ask them kind of give them a table or give them a series of questions and to have them select like, okay, so what are the reasons that you’re not including fertility awareness-based method in your contraceptive counseling? So for the participants who said I sometimes talk about it and the participants who said I never talk about it, they were like, “Okay, so here’s a list of possible reasons. Check the ones that are like the most like why are you not using them?” And unsurprisingly at the very top of that responses the most frequent response that was given was that they felt that fertility awareness based methods were ineffective. So for the users who said never that was like just absolute top.

So the doctors who do not recommend it their biggest reason was that they don’t think they’re effective. They think they’re totally ineffective. And even the users who recommended it sometimes that was one of the reasons although it wasn’t as strong of a response. So another like the sometimes users also said that patient values. So for those who recommended it sometimes but not others they’re going to recommend it like when the patient includes it but they may not it might not be their preference.

So that kind of goes back to that example I gave earlier of a physician who respects their patients choices, may not always agree with it, but if their patient really values it, then they’re going to say, “Okay, you know, it might not be my preference, but if this is something that’s important to you, I’m going to be okay with that to the degree that I can.” And then there were some there’s a variety of different answers, but I think there’s a variety of different reasons. So some of them said it’s not really applicable to my patients. Some of them said they need to have motivated patients. So they’re not necessarily recommending it because some of their patients may not have that desire because obviously it’s a self-driven method. It’s a user dependent method. It’s not going to work if you’re not going to chart and check and be consistent.

So those doctors who never recommended it were more likely to bring up that they were unaware of fertility awareness based methods, that it was unscientific. I already mentioned the ineffective which most of them were going to say, or unsure of the efficacy that was a much smaller percentage and so there was a good mix but again these are not surprising but I think it’s useful to go through some of these reasons why they’re not recommending it so that we can have a better idea of where they’re coming from.

One thing to consider is that when we talk about these negative experiences that many women have had with their medical doctors or their healthcare providers and we’re talking about, okay, they want to use fertility awareness, they’re not encouraging that. They’re saying it’s not going to work and all that kind of stuff. It can really feel like the doctors are doing this for a malicious reason, you know, like they don’t care about me. They don’t understand. And they’re trying to push these drugs on me. But at the end of the day, I don’t think anyone goes into med school because they want to like harm their patients. I mean, there’s some wild cases out there, but obviously that’s just not the reason that most physicians are in this profession. It’s a lot of work. The educational requirements are very steep. And so I believe that the vast majority of physicians do have their patient’s best interest at heart in a way. But I think that again they’re coming from it from a certain perspective. And the more we can understand that perspective, the more that we can advocate for ourselves, the more that we can choose which if you see that your values are not aligning with a certain physician that you can, you know, try to find a different doctor.

I think that it’s really important for us to understand where they’re coming from. So they’re coming from a school of medicine where they were taught that efficacy is the most important value. And so for many physicians that’s how they come out of med school. So they want you to use the most effective method. But for many women the highest value may be your health. It may be to be free of side effects. It may be to have some degree of body literacy. It may be that you have a personal value where you don’t really have a preference for hormones. And so sometimes it’s just that the values don’t align.

So whereas your physician may value efficacy over everything else and they may downplay the side effects because that’s a thing that is very common even in the literature, some of the previous episodes that I’ve shared recently go into that right in a lot of depth about how the side effects are really downplayed oftentimes. And so that’s something to consider. But then there’s also some practical concerns. So one of the really interesting results of this study: of the 35 respondents that stated that they always include fertility awareness-based methods in their contraceptive counseling, less than 25% correctly identified the typical use efficacy of FABMs later in the study.

So, just like chew on that for a minute. So they looked at specifically the participants of the study who said that they always include fertility awareness based methods in their contraceptive counseling. These would be the doctors who are a lot more aware of it, a lot more open to it and are actually kind of like pro-fertility awareness based methods. If someone’s always including it in their contraceptive counseling, then that means that they’re obviously like open to it, right? And they’re the favorable audience to this concept. But even in that particular pool only less than 25% correctly identified the correct typical use efficacy. So then imagine what that percentage would be for the doctors who never recommend it.

What they did say was that only 23% overall of the participants correctly identified the typical use efficacy range of FABMs as 77 to 98% effective. So what this means is that the vast majority of the medical doctors who completed the study significantly underestimated the efficacy of fertility awareness based methods. They really left med school with this impression that they just don’t work and potentially that they’re all the same.

Interestingly, even when we start a new class of our fertility awareness mastery mentorship, one of our first modules is fertility awareness based methods because it’s really essential when you’re jumping into this field and starting to teach charting that you are aware of the different types of charting methods. Because as soon as you start talking about okay I’m teaching charting now, you can learn to chart with me, then you are going to attract some people who have experience with charting and potentially have some gaps they want to fill or some holes in knowledge. And so if you’re going into this field and you don’t have a good solid understanding of other fertility awareness based methods, what types they are, what kinds they are, then you will have a kind of a steep learning curve when you start having clients come in that have learned different methods, right?

But what’s interesting is that when we go through that training and when we go through that module, our practitioners who are obviously familiar with charting, many of them have charting experience. So, not all of our new practitioners have charted before extensively, but I would say at least 50% have some charting experience generally speaking. And so, these are again, these are professionals, women’s health professionals with a keen interest in charting. Potentially, they’ve done it themselves, but the majority haven’t heard of all of the different fertility awareness based methods and aren’t necessarily even educated about, oh, I didn’t even know that this type of method was a thing or this type of method was a thing. And so again, think about that in terms of medical school, right? So this data from the study would indicate that the majority of physicians, even the ones who are encouraging and open to promoting fertility awareness based methods to their patients, the majority still are not fully educated about the efficacy.

That’s why we’re hanging out here and that’s why I’m talking about it and kind of focusing on it because again what I’ve always said is that your doctor is an expert in what they studied in medical school but we can’t expect our physicians to be experts in everything. You don’t expect your physician to be able to put siding on your house, right? So it’s not really fair for you to expect them to be an expert in every possible facet of health. So similarly to you shouldn’t expect your physician to be an expert in nutrition because they don’t have an extensive nutritional training in medical school.

So the opinions of the doctors who responded to the survey definitely ranged because they were asking those questions of agree, disagree, strongly like you know what I mean like where would you put yourself on this graph and so the opinions of the doctors ranged from fertility awareness based methods should not be recommended at all in practice. So there was a small percentage of doctors who said like I don’t think that they even should be recommended at all because they’re ineffective. They’re unscientific, right? That kind of thing whether they’re too complex for patients to manage effectively. So a number of doctors felt and agreed that you know they’re just too hard for my patients to do like this is not something that is going to work for them. There was a decent number of physicians who agreed that it is always in a patient’s best interest to use a hormonal method.

So there was a pretty strong response to the question of patients often overestimate the efficacy of fertility awareness-based methods. So again, we’re looking at their perspective, right? So this study is showing us the physician’s perspective. So I just spent what five minutes talking about how the physicians themselves were like unaware of the true efficacy and in the whole study, they only 23% of the respondents correctly identified the range of effectiveness for fertility awareness-based methods. So the people that don’t even know how effective they are are agreeing strongly that the patients are overestimating the efficacy. So I would say this again really highlights so that you know where they’re coming from.

So just to go through a couple more of these questions to get a sense of how the physicians reported that they felt confident in their ability to educate patients about at least one fertility awareness-based method. I find that to just be astonishing. So yeah it was almost 75% like quite a high percentage of awareness based methods when only 23% actually can correctly identify the efficacy. It is amazing. So again really overestimating their knowledge there.

The vast majority of physicians reported that they felt fertility awareness based methods were helpful in assisting their patients to achieve pregnancy and a decent percentage felt like it did help in terms of their chances of achieving pregnancy. So they also provided a few sample responses from these qualitative data which I did appreciate.

So here is just a response from a doctor who has a favorable perspective on fertility awareness based methods: “It is highly effective and empowers the woman to know her own body and communicate with her partner about that and their sexual activity. Though I may not discuss this with patients, I also feel that it is best for the community as a whole and the only moral option for family planning.”

“In my contraception lecture in med school, the lecturer made the point that the less daily control a woman had in the family planning method, the more effective it was. For example, the IUD is highly effective because it does not require that a woman remember it. I think many providers shy away from fertility awareness-based methods because these methods necessarily place the control on the woman. However, for many women, the increased control is increased empowerment.”

So again, that shows you another kind of snippet at why this particular practitioner has a favorable response. Now, interestingly, you get so much data in their answer because I’ve already mentioned that I’ve heard this from doctors. You know, they’re taught that the methods that you should recommend are the ones that require the least, if any, involvement of the woman herself because it’s like we can’t trust her to do any of this stuff. So, we need to stick an IUD in her so that the birth control is just going to work regardless of what she remembers to do.

So to give another example, so those were the doctors who provided a favorable response. Then the second set of answers were from physicians that said sometimes. Physician A says: “I offer better, more effective forms of contraceptives first. If they decline or show an interest in fertility awareness based methods then we discuss.” And physician B says: “Sometimes it does not seem like certain patients have the mental capacity to handle tracking their cycles.”

And then the last example would be from the physicians who replied no. Physician A says: “Because people who use natural family planning are called parents.” Literally that was the response on the survey. And physician B said: “Some biases against these practitioners. Some in the community view some parts of natural planning as a voodoo medicine or at least I do sometimes.”

So this is what this is again a sample response that they included in the study itself. So the first one was obviously I don’t think it’s going to work. It’s not effective. Right? Because this particular physician is saying because people who use natural family planning are called parents. Basically saying if you use it, you may as well be not using anything because it’s the same. You’re just it’s just a matter of time until you get pregnant. It doesn’t work. It’s not effective. Come on, stop wasting my time. Let’s get you on a real method, right?

And there may be, it’s not just physicians, we shouldn’t be just calling out doctors. There’s plenty of people in every profession that have varying knowledge of fertility based methods. So many women think, okay, well, if I go to a nurse practitioner or a midwife or a naturopath, surely they’re going to be totally open to it. And again, it depends on the person. You may have a better chance that these other practitioners have a better knowledge of these areas, but it’s not always the case. It really depends on the individual practitioner.

And then the other response I thought was really interesting and really insightful because this is not something that I had really thought of reflected on. And Dr. B says that there’s some bias against the practitioners who do recommend it. And people view it as voodoo medicine. Sometimes I think it’s a voodoo. So I’m not going to recommend it because I’m not one of those crazy people who recommend voodoo. And there’s so much science behind fertility awareness based methods, but apparently we’re calling it voodoo.

So the survey kind of outlined three potential archetypes in terms of your doctor’s openness to fertility awareness based methods. So the first would be the kind of most ideal: if a doctor’s really open to it and they really kind of positive about it then that would make it the easiest and you could work with the doctor like that. Obviously if they feel like it’s a really good method and they really get behind it and they really understand it, they’ve really had some education around it. Yes, great. The doctors who fall into the other category that are open to it but it’s not necessarily their preference — I feel like you can also work with those doctors because even if your specific choice is not exactly what they would decide they are at least respectful of it.

But depending on the situation and what you want in terms of a relationship with your doctor or healthcare provider, if you have somebody who’s basically making a joke about it, laughing about it like, “Oh my goodness, I would never recommend that. What do you call these people who use these ineffective methods? You call them parents.” It might be that if this is something that’s really important to you and you don’t align and you find that they’re not being respectful and they’re really heavily discouraging you because in their world, they don’t even see it as a legitimate method at all, then maybe it’s just depending on what that how that relationship is, you could try to like find a different provider, right? Like someone who is going to respect your choices.

And then someone who’s kind of again in that really negative like my goodness I can’t recommend it because the other doctors are going to look at me funny and frankly I think it’s crazy. Again that type of if you find yourself in an office with somebody who has those perspectives I feel like one of the takeaways here is that it seems like the majority of doctors based on the study at least would either be okay with it or like they wouldn’t necessarily discourage a patient who was really motivated to do it, who was somewhat educated about it and was fairly committed to it.

So it seems like based on the results of the study, there’s a lot of doctors out there who even if it’s not their preference, they still feel like okay, if this is something the patient really wants and they’re willing to do it and take the effort that they would be open to it according to this particular study. Now obviously a huge limitation of the study is that there were 79 respondents. That’s a fairly small sample size and I don’t think we can say that it’s reflective of the entire field of medicine, right?

So just to kind of wrap it up, I mean, this study provided such an interesting oversight about this question of why is it that many doctors are not recommending fertility awareness based methods and why is it that so many doctors may have a negative perspective. It provided a really good mix of quantitative and qualitative data. It provided us with some statistics as to what percentage of doctors are recommending, according to this small study, what percentage of doctors never recommend. And then it also provided us with some qualitative data as to why that they don’t. It didn’t give us a full complete view of everything, but it gives us some interesting insights that can really help us to make decisions.

I think a big takeaway though is that some doctors really are not open to it at all and they probably are not going to be. It’s not about doctors needing education. I remember years ago having a conversation with Dr. Margarite Dwayne and the founder of FACTS, the Fertility Awareness Collaborative to Teach the Science. And Dr. Dwayne is doing something that I think is great, right? She’s educating medical doctors and bringing fertility awareness to university campuses, medical schools, and kind of being that change that we want to see. And I remember her sharing something along the lines of her decision to educate students. A lot of her work is designed to educate medical students — medical students before they have gone into years and years of practice, before they’ve really solidified their views.

And so I’m paraphrasing here. I don’t want to take her out of context or say anything wrong, but the impression that I got from that conversation was that it’s well known that once you have a doctor who’s been in practice for, you know, 25, 30 years, they may be less open to learning new things, right? They already have a pretty strong belief that they know a lot of the things already. And so if you’re wanting to actually make progress in the medical field, the way to do it is to teach the residents and the medical students when they’re early in their careers where they still have an openness to learn certain things and they haven’t gotten to the point that they have all this experience and practice and they’re not really open-minded to these new ideas.

And that’s something that always stuck with me because again, the goal for me if I go into a doctor’s office isn’t to change their mind or educate them or like you could try, you know, but I feel like that’s not necessarily the best approach. Just personally, I just I don’t think that that’s the best approach because your doctor already went through a significant amount of education, training, and expense to get to where they are. So for you to come in and say, “Okay, you need to go learn all this stuff.” I don’t know how that’s going to work. And so I feel like you decide what’s best for you and there’s plenty of doctors that would be open to learning more and you kind of figure out on a case by case basis. But I feel like the results of the study for me would indicate that you want to find somebody who’s at least open to it.

And then if you find someone who’s not, don’t waste your time at trying to educate them because the one thing again another thing that really stood out to me was how much the doctors in the study overestimated their knowledge. And so what that means is that even if they’re wrong, they’re really confident that they’re right. So even if they totally have the effectiveness completely wrong because they never learned about it at all, like they didn’t even remember learning about it in their class, they still think they’re right. Even if they literally said that they don’t remember learning about it at all, it was like the vast majority felt like they could teach you how to use one of the markers of fertility and teach you about at least one method.

So yeah, so I think this is huge, huge takeaways and pick your battles would be the theme here and understand where they’re coming from and if you’re not getting anywhere, just like with my hairdresser, I wasn’t going to try to educate her on how to cut hair. I was just going to try to find someone who knew how to cut hair properly and would actually listen to my requests as opposed to trying to like re-educate the person who didn’t do it right. So, think of the hairdresser example if any of you have had these negative experiences and stay hopeful because a lot of doctors are at least open to this and I feel like that is wonderful and encouraging and that is the note I’d like to end on.

So, thank you so much for being here with me today and going through this study data with me. I really feel like one step at a time, we can change this whole industry. We can really change the face of women’s health care by continuing to just increase awareness about fertility awareness based methods. This is the reason that I do what I do, why I share this podcast every week, why I teach women’s health professionals now to really support women in this way because I feel like this is the change that we need. This is how we change the face of women’s health care.

If this episode has inspired you and you can think of somebody who would benefit from hearing it, the share link is fertilityfriday.com/569. And with that, I want to wish you a nice weekend whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.