Recently, a young woman told me she wanted control over her body and had an IUD implanted by another physician. My thought was that now the IUD had control over her fertility, not her.  Despite giving her information that the IUD is an abortifacient and that with charting she would be educated and therefore in “control” of her fertility, she wanted to keep the IUD. Furthermore her soon to be husband had no input into something that he rightfully should have a share. Before this family is even formed, it is divided.

When charting, women are taught how to record the menstrual flow and cervical mucus flow. Extensive research has proven that these markers accurately reflect a woman’s physiology.  For instance, cervical mucus is produced in response to the rising estrogen levels in the preovulatory phase of the cycle associated with follicle enlargement. The amount, quality, and number of days of estrogen mucus is highly important.  After ovulation, there is a dramatic change in the cervical mucus, reflective of the decreased estrogen levels and increasing progesterone levels.  Progesterone levels should rise and fall in a specific curve after ovulation if there is no pregnancy. If there is a pregnancy, the progesterone levels will continue to rise along a particular pattern.

What does this mean? It means that trained medical personnel can target blood tests, ultrasound, and appropriate surgical procedures at the correct time of the cycle and more accurately interpret the results. For couples suffering from infertility, this information is greatly beneficial in finding the cause of infertility.  As important are the benefits for teenagers and single women.

For example, my 19 year old patient spots and bleeds almost every day and has been irregular since she started her periods at age 11. She has a period only occasionally which would include 3-4 heavy days of flow, totaling 10-11 days of menstruation, all of which is abnormal.  Previous physicians offered only birth control pills. Very little workup was done and no diagnosis was offered.

After teaching her how to chart, testing revealed she was developing polycystic ovarian syndrome (PCOS) which is associated with insulin resistance, high blood pressure, infertility, and endometrial cancer, and is one of the most common endocrine disease of reproductive age women. Birth control pills would only mask her symptoms and cause many side effects.  Instead, she is now under treatment with cooperative progesterone replacement (progesterone at the correct time of the cycle) and metformin, both of which help to treat the disease and not mask it.

Several of my other young patients ranging in age from 16 to 23 years old suffer from premenstrual syndrome (PMS).  This is a serious disease because of the association with miscarriage, post partum depression, and premenstrual dysphoric disorder, in addition to the highly disruptive effects PMS has on relationships and health.  Studies demonstrate these patients have abnormally low progesterone levels in the 5-7 days prior to menstrual flow, exactly when the woman experiences the debilitating symptoms. Replacing progesterone at the correct time of the cycle reduces symptoms and can help to prevent early miscarriage.  Additionally, these patients are generally the ones who suffer from post partum depression and are greatly helped with progesterone treatment in the early post partum period.

Another group of my patients are infertile women in their 20’s and 30’s who are married but describe menstrual irregularities from their teen years.   Almost 100% of these women were put on chemical contraceptives as treatment for their abnormalities and most of them later contracted HPV which required minor surgery that can affect fertility.  Here were missed opportunities to not only diagnose and treat early in a disease process, but also to teach young women an authentic vision of their fertility.

An authentic vision of fertility incorporates an integrated view of the person who lives not in isolation but part of a family and society at large.  And therein lies the key to the superiority of charting as an approach to women’s reproductive healthcare.  Through chastity and education, a young person learns respect and knowledge that can be shared and not merely controlled in isolation.  Family relationships are encouraged by having mothers attend teaching sessions and exams.  Later, spousal relationships are fostered through shared responsibility and communication.  Additionally, women are not exposed to the chemicals found in contraceptives associated with cancer, hypertension, and blood clots. Instead, accurate diagnosis and treatment provide ways to restore normal physiology without side effects.

Charting is an unrealized gem that allows all women to participate in their healthcare confidently, while maintaining their dignity as integrated whole persons.


Originally published: May 2017

Author: Dr. Gretchen Marsh, Family Practice Physician and Fertility Provider with MyCatholicDoctor

Editor: Samantha Wright, Marketing Director with MyCatholicDoctor

Gretchen V. Marsh, D.O.

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