If you live in the Dallas-Fort Worth area, sign up for the Eric Genuis performance September 28th. It promises to be an inspirational afternoon.

​Bring a friend because all donations go towards the BOMA medical student education initiative and Eric’s prison ministry.

                Their blog says “the Mirena crash is real and affecting countless women.” They even quote a woman saying she felt “smothered with severe despair.” The website for Dolman Law Group in Clearwater, FL, may have mastered the SEO for the term “Mirena Crash,” but what does the term mean and is it real? Unfortunately, when I reached out to this law group (and holder of the first position on Google search) for additional information, their response was “we are unable to assist with the matter.” So then I went to the scientific literature, thinking surely there must be some published evidence for this condition. But that failed to produce any definitive results specifically related to the Mirena device. Finally, I thought that with the existence of so many blogs containing comments from women, clearly articulating similar symptoms and side effects after IUD removal, it must be a well-described side effect listed on the product insert. Once again, nothing about side effects after removal and not even a mention of depressive symptoms. So what can I tell you about this mysterious, apparently well-known but curiously undocumented side effect to removal of the Mirena IUD? Let me try to piece together the evidence and use a little scientific deductive reasoning.

What Is Mirena?

                Mirena is a progestin-releasing intrauterine device (IUD). It releases a progestin called levonorgestrel and is indicated for contraception lasting for up to 5 years or for treatment of heavy menstrual bleeding. After 5 years, the implant can be removed and a new device reinserted, providing another 5 years of “no compliance required” contraception. It is considered a long acting, reversible contraception (LARC) and is a progestin-only form of contraception. There are several published studies indicating that Mirena is safe and effective, but they do not address symptoms after removal. The device is supported by the published literature and the American College of Obstetricians and Gynecologists (ACOG). Stoddard et al. (2011) concluded that LARC, including the Mirena implant, “should be offered as the first-line contraception for most women.” An ACOG committee opinion states that complications of IUDs are rare and LARC is safe for adult and adolescent women. It goes on to say that offering it is essential to reproductive justice and equitable health care (ACOG 2018). The mechanism of action is stated to be multifactorial but mostly prevention of fertilization by thickening the cervical mucus and inhibiting sperm motility and capacitation (Stoddard et al., 2011). Those of us who have studied reproduction know that the term “multifactorial” means that it can also work by inhibiting implantation or disrupting development of an embryo (aka abortion). The implant contains 52 mg of levonorgestrel, which is released at a rate of 20 mcg/day. At this dose, some women will have ovarian activity with cyclic menstrual bleeding, some will have variable ovarian activity and irregular bleeding, and some will have complete suppression of ovarian activity (ESHRE Capri Workshop Group, 2001). The only data I could find about removal was a pilot study examining fertility after removal of IUDs. The study reported that pregnancy rates for former IUD and non-IUD users were no different, except for African American women, who experienced reduced fertility after removal (Stoddard et al., 2015).

Hormonal Effects on the Brain

                It is unfortunate that I could not find any scientific or medical documentation of mood or emotional symptoms after removal of the Mirena implant, while reporting of it is so prevalent on the internet. Nevertheless, there is evidence that hormonal contraception is associated with depression, and a recent review by Del Rio, et al. (2018) discusses how the lack of hormonal balance can affect a women’s brain. In a study of over 1 million women followed for 6.4 years in Denmark, all forms of contraception were associated with a higher incidence of first-time diagnosis of depression. Regarding Mirena users specifically, women actively using the implant had a 40% increased risk of being diagnosed with depression (Skovlund et al., 2016). The same authors published additional work in 2018 reporting on a half million women followed for over 8 years (Scovlund et al., 2018). The authors found that women who used hormonal contraception had a relative risk of 1.97 for suicide attempt and 3.08 for committing suicide compared to women who never used hormonal contraception. That’s a 97% greater risk of attempting suicide and 208% greater risk of committing suicide! Clearly something is going on here. Another study published in 2018 indicates that users of progestin-only contraception may have a greater risk of depression than estrogen-progestin combined contraception. Using reduced levels of the protein marker Beta-Arrestin 1 as a diagnostic indicator of depression, progestin-only contraception led to more mood disorder pathophysiology than either combined hormonal contraception or no contraception (Smith et al., 2018).
                The paper published by Del Rio et al. (2018) was previously summarized on our [HT1] blog by Santiago Molina, but it is particularly pertinent for understanding how both the administration and withdrawal of hormonal contraception can result in mood disorders. Steroid hormones organize and activate different actions on the central nervous system. They can modulate the activity of neurotransmitters, regulate neuron survival and proliferation, alter cell metabolism, or influence nerve impulse transmission. Collectively these actions determine how the brain functions. Furthermore, normal cyclic fluctuations in estrogen and progesterone cooperate to produce the physiological response appropriate for the proper stage of the women’s ovarian continuum.  The Mirena implant would alter this physiology in the following ways:

1. Normal fluctuations in hormones would no longer exist. As pointed out earlier, women have variable levels of ovarian activity when on the implant, making some women more susceptible to pathophysiology.
2. Synthetic progestins are slightly different in potency than natural progesterone and they are being administered at much higher doses than normal circulating levels of the hormone.
3. While on the implant, progestin levels remain constant for a prolonged period, and the body adjusts. When the levels are suddenly removed, the women’s body will not recover normal function for weeks or even months, leaving her in a state of hormonal deficiency. Since steroids also act on the nervous system, this is not unlike other drug withdrawal physiology, especially drugs that alter the central nervous system.

Nutritional Deficiency—Another Plausible Explanation?

                Oral contraception is known to depress levels of B vitamins (B6, B12, and folate), vitamin C, and zinc and to elevate levels of vitamin K, copper, and iron (Webb, 1980). While nutritional studies may not have been conducted specifically on women using the Mirena implant, it is likely that a similar alteration in nutritional status would occur. The B vitamin pyridoxine (B6) is responsible for converting the essential amino acid tryptophan into serotonin and is involved in the formation of GABA. Both serotonin and GABA are vital for normal functioning of the central nervous system. Furthermore, vitamin B6 deficiency is known to cause central nervous system abnormalities. Therefore, in addition to the effects listed above, if the woman has not been taking adequate B-vitamin supplementation while on hormonal contraception, a deficiency in vitamin B6 would exacerbate her symptoms because she would already have a shortage of neurotransmitters, resulting in anxiety and a loss of well-being.

Conclusion

                Taken together, the anecdotal and published evidence support the existence of a neurological condition called the “Mirena Crash.” It can severely reduce a women’s quality of life at best, and it can be life threatening at worst. It is hard to imagine why any women would want to take this risk, given the existence of an alternative method that is both effective and totally free of any side effects. The Billings Ovulation Method® does take some effort to learn and practice compared to the Mirena, but the effort is rewarded with a lifetime of body literacy that leads to a cleaner, healthier, and happier life.
 
References
​
ACOG (2018) Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices. ACOG Committee Opinion. Number 735, May.
Del Rio et al., (2018) Steroid Hormones and Their Action in Women’s Brains: The Importance of Hormonal Balance. Frontiers in Public Health. Vol 6, 141.
ESHRE Capri Workshop Group, (2001) Ovarian and Endometrial Function during Hormonal Contraception. Human Reprod. Vol 16, 7.  
Scovlund et al., (2018) Association of Hormonal Contraception with Suicide Attempts and Suicides. Am J Psychiatry. Vol 175, 4.
Skovlund et al., (2016) Association of Hormonal Contraception with Depression. JAMA Psychiatry. Vol 73, 11.  
Smith et al., (2018) Do Progestin-Only Contraceptives Contribute to the Risk of Developing Depression as Implied by Beta-Arrestin 1 Levels in Leukocytes? A Pilot Study. Int J. Environ. Res Public Health. Vol 15, 1966.
Stoddard et al., (2015) Fertility after Intrauterine Device Removal: A Pilot Study. Eur J. Contracept Reprod Health Care. Vol 20, 3.
Stoddard et al., (2011) Efficacy and Safety of Long Acting Reversable Contraception. Drugs. Vol 78, 8.
Webb (1980) Nutritional Effects of Oral Contraceptive Use: A Review. J. Reprod Med. Vol 25, 4.

​Dear fellow teachers and Billings Ovulation Method® practitioners and fans,
 
Now that school is back in session and the dizzying heat will soon subside, allowing our brains to reorient and our schedules to find a nice groove again, I want to write you a letter of encouragement. You are truly making the world a better place by continuing to share this incredible knowledge that was gifted to us by God through the work of Drs. John & Evelyn Billings.
 
Last year I was lucky enough to participate in the making and release of the film by Springtime Productions Sexual Revolution: 50 Years Since Humanae Vitae. The team travelled all the way to Australia and New Zealand to meet the adult children of John and Evelyn Billings. And we also interviewed Marian Corkill, Gillian Barker, and the enduring disciples of the groundbreaking scientists that gave us modern NFP. Also in the film are Abby Johnson, Mary Eberstadt, Steven Mosher, and Professors Janet Smith, Peter Kreeft, Robert P. George, Mark Regnerus, Helen Alvaré, Angela Franks, and Brad Wilcox. Drs. Marguerite Duane from FACTS, Pilar Vigil, Joe Santamaria, Day Gardner, and Fr. Tad Pacholczyk from the National Catholic Bioethics Center all make appearances, as well as Mother Teresa’s former assistant Sr. Hannah, MC.
 
In short, Sexual Revolution has achieved something very special by collecting and immortalizing the voices of the most important thought leaders in the counter revolution to the 1960s’ failed experiment that was thrust upon us by Margaret Sanger and her horrible Pill.
 
Many of you are aware of the predictions that Pope Paul VI made when he wrote his prophetic encyclical Humanae Vitae. He described a world in which men lost all respect for women—and today we are all aware of the #MeToo Movement and crimes like those committed by Jeffrey Epstein. We now live in a world where so few have self-control regarding their sexuality that somehow human slavery has become justifiable in the minds of many.
 
But we have the antidote. It’s called Natural Family Planning, and we’re not afraid to use it!
 
We believe that where sin abounds, grace abounds all the more, which is what drove us to make the film in the first place. Experts interviewed in the film describe the now-confirmed predictions of Paul VI in significant detail.  You need to hear what Steven Mosher from the Population Research Institute has to say about his work in China and the one child policy there. John Billings also describes the horrors he witnessed in India during their forced sterilization programs in his personal diary, which we were granted exclusive access for inclusion in the film.
 
Sexual Revolution is a strong tool for Billings Ovulation Method® instructors specifically. Many of you might not know that all modern FABMs are based on the research of John & Evelyn Billings and that we teach the original NFP method as perfected by the Billingses. Sexual Revolution profiles John & Evelyn’s journey, contrasted with profiles of Margaret Sanger and Dr. Gregory Pincus who gave us the Pill.
 
If you want a tool that will help you pull in new students, or something that will demonstrate without a doubt why NFP is important and why the Pill is evil and broken, we have done all the hard work for you in this beautiful documentary. All you need to do is hand your pastor a DVD or organize a screening of the film in your community. DVDs are now for sale right here on the BOMA-USA website. All proceeds support BOMA and administrative efforts. Email screenings@sexualrevolutionmovie.com if you’re interested in organizing a public screening. A license is not only very affordable; it can boost your visibility as an NFP teacher and community resource on this topic significantly.
 
I want to thank BOMA for their endorsement of the film. I know that many of us have come to be passionate about this method because we’ve witnessed firsthand the destruction caused by the sexual revolution of the 1960s—myself included—and I am so proud of you for showing up and trying your hardest to do something about it. The work you do is valuable. The work you do calls forth new eternal souls destined for sainthood. The work you do heals wounds, both relational and clinical, and even though I may not know you personally, you have my full admiration for continuing the legacy of Popes John Paul II and Paul VI and Drs. John & Evelyn Billings. May God bless you as you continue to fulfill your calling.

​Alana Newman
Narrator, Sexual Revolution: 50 Years Since Humanae Vitae
Founder, AnonymousUs.org and DealingwithDonorConception.com
Billings Ovulation Method® Instructor

​Erica and Kevin Jacobi with their four handsome boys

In this month’s spotlight we are featuring incoming board president, Erica Jacobi. We find Erica to have a very positive, upbeat personality and a can-do attitude!

Q.  First of all, congratulations on your new role as president of BOMA-USA!  What do you see as our opportunities and challenges in the next couple of years?

Thank you! Our previous board leadership has done so much to grow BOMA and develop us into a more polished organization, ready to support our network and grow the future of the Billings Ovulation Method® in the United States. Our opportunities and challenges going forward are one in the same. BOMA has a treasure to offer this country, but only if we can show that treasure to potential users. It is vital to make the Billings Method one of the methods that come to mind first when people think of natural, sustainable, and loving options for fertility awareness.

Q. Have you always been personally associated with Billings, or did you learn another method prior to Billings?

No, as a young woman I leaned a sympto-thermal method through my own research (aka Google!) and used that early in our marriage. Then after the birth of our first son, we struggled with accurate temperatures and ecological breastfeeding, which led us to Creighton. The Creighton Model quickly taught us how valuable having an NFP instructor is. The and the instructor’s support and willingness to answer detailed personal questions left us feeling far more confident than when we were self-taught. I’m a millennial, so Google is my go-to when learning something new. But I quickly learned the difference in success with having an instructor. That experience told me I wanted to be able to share that same confidence and become a teacher myself. My Creighton instructor encouraged me to investigate the Billings Method. After we saw its effectiveness, ease, and fit with modern day life, I was hooked.

Q.  What has your experience been like teaching Billings?

Teaching Billings has led me into new friendships. Making friends after the school-age years can be challenging! The small talk and looking for common interests are hard. How often do you meet somebody new and only talk about the surface-level topics? Talking about Billings requires deeper conversations about life and relationships. In a few meetings you share of your own life and theirs in topics you might not share as readily when meeting somebody new. Secondarily, as a teacher I get a front row seat to sharing in the joys and challenges in the lives of my clients, like navigating the struggles of delay in much wanted conceptions or sharing in the familiarization with the body’s changes postpartum and in times of change. Or conversely, there have been many times when I’m the first to hear about a positive pregnancy test or get to share in conversations about life with a newborn.  Teaching Billings allows me to hold the hands of my fellow women as we journey through life.

Q.  What words of encouragement would you give to someone who is thinking about becoming a teacher?

So many of us are already talking about birth control, spacing babies, breastfeeding, and fertility in casual conversations. Why not do it with the authority of a certified instructor? Again, I thought I knew what I was doing when I was self-taught, but teacher training changed so much.

Q. What is your “real job” outside of volunteering with BOMA-USA? Tell us about your family. 

Oh my, which job do you want to hear about? I’m a wife to Kevin, and we’re parents to 4 boys under the age of ten. I also have a job I enjoy at Tyson Foods. I love that working with food is something that impacts the world on so many levels and is always relatable. From the farmers to families, everybody is impacted by our food system.
We're a busy family of 6 living in northwest Arkansas. We work our way through the same challenges other Christian families face, trying to support each other's winding journey to sainthood. It's often everyday stuff. Sometimes, it means sticky messes and budgeting at home; other times, it takes the form of hiking or fishing in the beautiful outdoors. That support can even come from valuable alone time.

Q.  Looking forward, is there anything our teachers and/or general members can to do help us?

Participate! BOMA is offering a network for learning and fellowship, but I would love to see more participants join webinars, engage with BOMA on social media, and ask questions. You can start today by liking and sharing our Facebook page at https://www.facebook.com/billingsusa/ and forwarding this newsletter to your clients, friends, and family.

​After six years of dedicated service, Kristin Putnam, Eileen Wood, and Dr. John Worden are ending their terms on the BOMA board. These legacy members have been integral to shaping and maturing BOMA into the organization we know today. They’ve given us an invigorated, structured, passionate organization that the board and BOMA personnel are committed to continuing to cultivate. 
 
To help us continue the BOMA mission, we're excited to announce that two new board members, Christina Brown and Dr. Danielle Koestner, were nominated and, subsequently, appointed to the Board.
 
Christina (Christy) Brown and her husband, Paul, have been teaching the Billings Ovulation Method® since 2010. In describing her journey, Christy stated, “We liked how the method could stand on science alone. Billings is a strong witness to those coming to NFP from the natural/science side of things. We also believe it can open the door to the students thinking about the moral aspects of NFP and encourage them to grow in their faith.” Among her many talents, she is interested in supporting BOMA and finding ways to grow our teacher support network.
 
Dr. Danielle Koestner and her husband, Kyle, have been teaching Billings together for the last 6 years. She is a family doctor, which includes a lot of gynecological care. She brings a valuable physician perspective to the board and has a passion for making sure patients have easy access to fertility knowledge and charting support. She has taken the medical management seminars and has fully integrated FABMs into her medical practice for all women from menarche to menopause.
 
Please join us in celebrating those who have served and those who are just beginning to serve in a new capacity.

​The July 2019 edition of the WOOMB Bulletin is here. Please check out all the exciting new Billings happenings from around the world.

We recently contacted WOOMB to confirm what we should be quoting when asked about effectiveness studies for the Billings Ovulation Method®.

They sent an interesting document that starts off discussing the need to include the range of published studies that meet the requirements for medical evidence in relation to the design of the study. So, in other words, don’t just look at one study when quoting success rates.

The current standard way of reporting effectiveness rates of contraceptive methods is the Pearl Index. It gives effectiveness rates based on the number of pregnancies expected if 100 women used a given method for a year.

Studies on natural family planning and/or contraception will also refer to both user and method effectiveness. When method effectiveness is cited, it refers to perfect use, meaning users follow a particular method’s instructions exactly.

WOOMB states that the most accurate way of quoting contraceptive success rates is in “initiates.” The document explains, “That is, the first-time use including any learning period. The reason for quoting figures for initiates is that the effectiveness rates will improve the longer a group has been using a method because those who are likely to become pregnant may already have become pregnant and be lost to the study if the initial period is not included.”

​The following three international studies of the Billings Ovulation Method® produced method effectiveness rates in initiates:

            The World Health Organization (1978-1981)
            The Indian Medical Research Council (1996)
            The Jiangsu Health Institute in China (1997)

“The studies recruited women who had not previously used the Billings Ovulation Method® and recorded the pregnancy rates for those who became pregnant either during the teaching phase or after.”

Based on those studies, we can cite the Billings Ovulation Method® with a method-related pregnancy rate of 0-2.2 pregnancies per hundred women years in initiates.

All three studies had impressive numbers of women included in their study, living in many parts of the world.

▪      The World Health Organization’s multi-center study took place from 1997 – 1981. The locations included Auckland, Dublin, San Miguel, Bangalore, and Manila. There were 869 women in the study, equaling 10,215 cycles of use.  There were 2.2 method-related pregnancies per hundred women years in initiates. (2.8 when the initial phase excluded)

Published: Fertility and Sterility 1981 Vol. 36, p. 152ff, 1981 Vol. 36, p. 591ff.

▪      Indian Council of Medical Research Task Force on NFP (1995) had the states of Uttar Pradesh, Bihar, Rajasthan, Karnataka, and Pondicherry.  They had 2,059 women with 32,957 women months of use. The study concluded there were 0.86 method-related pregnancies per hundred women years in initiates.

Published: Contraception 1996, Vol. 53 pp. 69-74.

▪      Jiangsu Family Health Institute, China (1997) Dr. QIAN Shao Zhen. This study had 1,235 women with 14,280 women months of use.  No method-related pregnancies in initiates. (5 user-related pregnancies)

Published: Chinese Medical Journal 1998.
​
Good to note: Evidence-based method-related Pearl Index for Billings Ovulation Method® is 0-2.2 per hundred women years in initiates. 

Q. You have such a fascinating history. Would you please take us back to where you lived as a child, including your Jewish roots and how you ended up becoming Catholic?

Life in Vienna was ordinary until March 10, 1938, when Hitler arrived to “take his homeland back into the Reich.” By Passover 1939, there had already been enough persecution of Jews that I was sure that it was time for the Messiah to come.

There was a tradition that a cup of wine at the Seder table would be drained mysteriously the year the Messiah was to come. I was bitterly disappointed that the cup was still full at the end of the Seder. In June that year I was sent to England in a children’s transport. 

The family who received me had already been in touch with my parents, so I was far better off than the many who just went into the unknown. My parents had sent me out as they did not know if or when they would get the visa for the United States that they had applied for, and they wanted to make sure I would be safe even if they did not make it out. My English family were members of Church of England, although Mrs. Dodd had recently become a Christian Scientist. In their wonderful reception of me I realized that the Messiah had already come.

In March 1940, my parents were able to sail for New York to try to begin to build a new existence. Their English was from what they had learned in school, but they applied themselves. Father became a cook in a camp in the Adirondacks. He had been a mess sergeant in the Austrian cavalry in World War I. The following September, my mother had collected enough money to pay for a ticket for me to join them in New York.

Crossing the Atlantic alone was an adventure in seasickness. The only place I was not nauseated was on deck, where I sat on a drum until I was asked to not sit on the depth charge! I did not see the Statue of Liberty when we entered the harbor, but was so pleased to see lights after living in the blackout, and the big Wrigley’s Chewing Gum sign.

My parents met me in New York and Mother’s scream when she saw me embarrassed me, as I had become very English. I learned later that three ships had left Scotland together, and no one knew who was on which one. One was bombed, one was torpedoed, and only ours, the Cameronia, got through. Once we got over the initial greetings, Mother immediately took me to a beauty shop for a haircut. My hair was too long! Then, we went to meet the great aunt and uncle who had provided the affidavit needed for my parents’ entry to the United States.

By then, my mother had a summer job as a domestic helper with a family in Elberon, NJ. I was allowed to stay with her. The family had advanced some of my fare. I was sent to Long Branch, New Jersey Junior High School where, at age 12, I was put in Grade 9 because of the long list of subjects on my report card from Dr. Williams’ School in Dolgelley, North Wales where we had spent the previous year because the war had begun in England. The list was impressive: arithmetic, geometry, and algebra. But they were so minimal that I never had a proper basis for math. When I decided on a medical specialty many years later, I immediately ruled out therapeutic radiology as I was sure I would never get the dosage properly calculated.

When the New Jersey job ended, Mother found another with a German immigrant family on Staten Island who had come a few years earlier. I attended Avery High School and even got placed in an English honors class, thanks to my British school year.

We met my second cousin, Marlene, who encouraged us to leave New York, which was becoming an enclave of refugees. So, we made a stop in New York in preparation for a
for a move to Louisville, KY. This was prolonged by my coming down with measles and pneumonia, causing me to miss a trimester of grade 9. But we did arrive in Louisville, and my parents set about building a new life for us.

The Jewish Refugee Service was immensely helpful by finding a couple of rooms for us when we arrived and later helping to find jobs for my parents and an apartment. It was all very basic, but we were so happy to be alive. I was sent to the YWCA camp for two weeks the next summer and heard a reading of 1 Corinthians 13. When I got back to Louisville, I bought a Bible at Woolworths for 25 cents and read the whole New Testament in three days. I had no doubt it was true.

Q. Where did medical school come into play? How did you decide to become an obstetrician/gynecologist?

I had seen the lecture hall at the University of Vienna Medical School on a newsreel when I was eight years old, and somehow knew that someday I would be hearing lectures there. Obviously, I did not get to study in Vienna, but the idea of becoming a doctor never left. I liked the idea that in obstetrics, medicine and society met. I was interested in both the scientific and the personal aspects of medicine.

What followed was too personal to write about, but suffice to say that we had a pre-med course at the University of Louisville entitled, “History and Philosophy of Science,” taught by the chairman of the biology department. He taught that there are three kinds of truths: social, scientific, and religious, which were in parallel and never intersected.

As a medical intern, I had a patient who had rheumatic heart disease and was three months pregnant. At that time, the treatment was therapeutic abortion. However, the chief resident in medicine, a convert to Catholicism, would not sign off on it. I was indignant that he was “imposing his religion on science,” but the woman did well with medical management.

We now know that therapeutic abortion is NOT the proper treatment for such situations, thanks to Dr. Samuel Cosgrove, a non-Catholic who was head of the Margaret Hague Maternity Hospital in Jersey City.

​In any event, that incident, and meeting a young man who was Catholic, introduced many other considerations. Internship was followed by residency in pathology in Massachusetts General Hospital in Boston. There were wonderful bookshops near the hospital. I picked up the Summa contra Gentiles and could not understand a word of it, so I enrolled in a night course in “Problems in Western Philosophy” at Harvard’s Lowell Institute for $5! I discovered that there were far more ways of looking at truth than my college course had mentioned, such as if truth subjective or objective, absolute or relative, etc.

I also enrolled at the Paulist Catholic Information Center and, after a rather intense year of study and prayer, concluded that the truth was both absolute personal and objective, proved by the One who said He was the truth and proved it with His Life, Death, and Resurrection.

This was the gift of faith, not a philosophical proof. I was received into the Catholic Church on May 8, 1952, in the Paulist chapel on Park Street in Boston. I received the grace to give my whole life to the Lord and, five years later, entered the Medical Mission Sisters. Although I was not drawn to the foreign missions particularly, I knew the Lord had children in need everywhere. Providentially, after pathology, I had trained in obstetrics and gynecology. This training was much needed in the five years I spent at Holy Family Hospital in Rawalpindi, Pakistan, followed by two years in Dhaka, East Pakistan, which is now Bangladesh.

When my mother became blind during my time in Dhaka, I asked to return home. In 1968, I joined the Medical Mission Sisters House of Studies in St. Louis. There I returned to Washington University where I had been a resident physician. When my old chief was replaced by an enthusiastic abortionist, I went across town to St. Louis University, a Jesuit school where I was teaching when Roe v. Wade was imposed.

Q. When did you first hear about the Billings Method™? And what was your initial reaction to it? 

Cardinal Carberry, archbishop of Washington, sent the first American edition of The Billings Method to all the Catholic doctors in St. Louis in 1972. It had been published by Msgr. Robert Deegan of the Department of Health and Hospitals for the Archdiocese of Los Angeles. It made more sense than the previous information on the cycle: calendar and temperature rhythm. The book was complicated, but I had just delivered the fifth child of a charismatic couple and they did not want to have any more children, at least not for a while. The couple and I prayed and cursed our way through the book together. In 1973, Roe v. Wade was decided.

My first reaction was to go to parishes to teach about embryonic and fetal development, but that made little impact. Therefore, it made sense to try to prevent abortion by preventing the crisis pregnancy. Obviously, contraception was not the full answer. Even today, 45% of undesired pregnancies are conceived during a cycle in which the women said they were using a contraceptive.

I met Larry Kane, the founder of the Human Life Foundation, when I had occasion to go to Washington. He suggested I meet Mercedes Wilson. The following June, Mercedes stopped in St. Louis and explained the Billings Method™. It was like turning on the light in a dark room. We no longer fell over the obstacles. She talked about the upcoming meeting in Sydney. I was teaching Ob/Gyn at St. Louis University Medical Center at the time, and a group of us had a chance to take over the space of a crisis pregnancy center that was moving from the basement of St. Joseph’s Catholic Church in Clayton, MO. That became the Aware Center. My department sent me to Sydney, Australia, where I met 200-300 Billings Ovulation Method® user couples who were walking statistics, testifying to the success of the method. There had not been much published effectiveness data up to then. The lectures were excellent on the biology of sperm, the hormones controlling ovulation, and the human reactions. On my return to St.  Louis, I found myself the local expert on the Billings Method™, except that Sydney was 8,000 miles away. This was before cheap long-distance calling and decades before the internet. One of our group of eight who began the Aware Center was a professional teacher who did the initial instructions. Others did the follow-up and support. The crisis center had maintained a roster for consultations 24/7. We began to do it that way, but discovered that there really was no such thing as an emergency coitus. When in doubt, don’t!

Q. Over the years you became friends with some of the great leaders in our field, including Drs. John and Lyn Billings, Dr. James Brown, and Dr. Kevin Hume, among many others. What are a couple of your most cherished memories of your time with them?

Kevin Hume met my flight when I first arrived in Sydney. He and Peggy were hospitable throughout my stay, even introducing me to Sydney rock oysters, which he assured me were the best in the world. After the meeting I flew to Melbourne and sat with Lyn as she taught beginners, and I sat with Kath Smyth as she did follow-up. After watching Kath for the morning, I said, “I think I can do that.” So, she let me take the lead in the afternoon. Heaven help us! But that’s how we started. Kath was doing the urine estrogen and progesterone assays for Jim Brown. Gradually, the correlations between cervical mucus patterns and the continuum of ovulation were elaborated. That was Jim Brown’s life’s work. The final version was published after Jim died, by Len Blackwell, his long-time collaborator in New Zealand.

Q. As the founder/developer of Teen STAR, please tell us how it came to be and what it is.

At the second international Billings Method™ meeting in Melbourne in 1978, Dr. John Billings asked me to have a look at the teens, as no one was doing anything with or for them. The beginnings were providential. During a meeting of the Human Life & Natural Family Planning Foundation board meeting, Kay Ek introduced me to her sister, Mary Thormann, Ph.D., a professor of child development at Marymount College in Fairfax, VA. We talked about the need, and somehow she managed not only to support our endeavor but introduced me to Eunice Kennedy Shriver, with whom she did Meals on Wheels at Our Lady of Victory Parish in Washington. Mrs. Shriver was the executive director of the Joseph P. Kennedy Jr. Foundation for the prevention of mental retardation. At a meeting which the Kennedy Foundation sponsored at the National  Institutes of Health, her husband, Sargent Shriver (founder of the Peace  Corps), laid out the case for prevention of teen pregnancy as a long-range prevention of mental retardation, as teen mothers often delivered prematurely and had more  mentally handicapped babies. On that basis, our research proposal for offering fertility awareness to teens was accepted. It was warmly advocated by Dr. Robert Cooke, scientific advisor to the Kennedy Foundation, who felt that it was dangerous to give contraceptive steroids to adolescents when no one knew their long-range effects. Bob Cooke was a Presbyterian and former chairman of pediatrics at Johns Hopkins. When we found that in our pilot group of 200 girls, the pregnancy rate was 0.44% compared with 12% in the population at that time, we felt that we could begin to train teachers. Teen STAR (Sexuality Teaching in the context of Adult Responsibility) evolved gradually. Mary Lou Bryant led one of the girls’ groups. Being an experienced teacher, she did not follow my medical outline but went into the class and asked, “Do you want to talk woman talk?” She recorded their questions, which became the basis of the content and sequence of the high school girls’ curriculum. We always met with parents before and midway into the program. Soon, the mothers were asking for a similar program for their sons. The current curriculum for young men was written by Fr. Don Heet, O.S.F.S., Ed.D. He wrote it after he had taught it for five years at Pope Paul VI High School in Fairfax, VA. Later, the grade school curriculum was added by Mary Lou. I added the holistic sexuality lecture/discussion sequence, and the postpartum sequence was done by Sr. Nora Dennehy, RGS, Ph.D., and the late Sr. Ursula Fagan, MMS, MSW.  We have always insisted on behavioral outcome evaluations and reported them in the scientific literature. All curricula include experiential learning of the woman’s fertility patterns. Boys record their emotions.

Word about Teen STAR spread. Canada was our first international site, then Chile, UK, and France. Many others have followed. We now have an International Teen STAR Federation. Dr. Pilar Vigil, M.D., Ph.D., is the current president. At least 15 countries have autonomous programs, meaning they can train their own teachers. Dr. Vigil reports that we have programs in 56 countries, including places where there is only one teacher.

Q. How long does a training take, and do you still help with trainings?

The initial training requires 35 hours. Part of that can be done online. That is followed by a year of practicum where the teacher is supported in their first-year experience. After two years of teaching, teachers become eligible to be trained as trainers of teachers.  Recertification is required every three years. Since last November, we have a new interim executive director, Deacon Santiago Molina (a trainer and supervisor of Billings teachers for BOMA-USA). He has assumed responsibility for the program.

Q. What do you see the future holding for us in the Natural Family Planning field?

As people become more aware of the harmful effects of contraceptive steroid hormones, many more are seeking natural methods. The use of natural methods requires couple communication. This in turn may help heal the culture, which is currently separating sex not only from procreation, but from relationship. It’s going to be a long haul.

Q. If you could give a piece of advice to Billings teachers, what would it be?

My own bias is to focus more on the time of puberty, when the hormonal changes demand so much from the teen, and teach fertility awareness then. Waiting to teach adults is too late, in view of the huge effort to insert LARCs, long-acting reversible contraceptives (IUDs and implants) into any teen who can be persuaded (or coerced). By then, brain maturation, which peaks between the ages of 10-15, may already have been damaged. Obviously, we should continue to teach anyone who desires to learn, but I think we need to focus on the teens.

​Although the basic science of NFP is already settled, more is constantly being added. It’s all God’s work. Hang on to Him. 

By Ann Marschel

Have you ever wondered or thought about how you could teach the Billings Ovulation Method full-time? Maybe you are currently teaching and unsure of the steps to continue to teach the Method and make a profit doing so.

Anna Saucier, one of our webinar speakers, gave great insight on how to start and grow a business. Setting goals, making a plan, and using strategies that have been outlined below can and will help you in getting your BOM business to grow.

First, you have to brainstorm some goals for your business. Then you have to figure out what challenges you’ll face. Finally, start a 90-day plan.

Here is an outline to follow:

1. Goals - What do you want out of this?
   1. To help, but what else do you want to get out of this?
   2. Boundaries - How often do you want to be working on this?
   3. What joy do you get from this work?
2. Challenges
   1. What is holding you back from reaching those goals?
   2. Whatever you believe is holding you back, is true. How can you overcome this?
3. 90-Day Plan
   1. Set aside time to brainstorm goals and challenges, and identify three things you can do to address those goals and challenges.
   2. 5-year and 1-year planning is too long, which is why the 90-day plan works.
   3. The goal needs to be done in three months, so no procrastinating!
   4. Choose 3 goals that are simple, targeted, and direct. Ask yourself, "What can I get done in 30 days to move me closer to my goals?"

Overall, when starting a business, there will be lots of learning involved.

Tools, Techniques, and Technology

Once you have completed the questions and planning above, the items below will help you to reduce feeling overwhelmed and stressed.

Organization

1. Document everything you do
   1. You have to know what you do on a day-to-day basis in order to know if you're doing the right thing.
      1. Create a bullet list of all the things you do
      2. Having an awareness of what you're doing on a daily basis is key.
2. Identify a place for everything
   1. Client files should always go back to where they belong (a file cabinet).
   2. Keep materials organized
3. Create processes
   1. Document the steps - First, Second...
   2. Think of this as something you could hand off to someone and they could complete the task.
4. Establish Habits
   1. Habits are powerful and effective.
   2. Follow these over and over again (every day).

Time Management

1. Stop fighting time
   1. It's important to recognize that we do, in fact, have time.
   2. What do we do with our time?
2. Time is an opportunity to create value, not just to get things done
3. Instead of looking at time to be productive and efficient--make it a goal to be EFFECTIVE!

Now take your 90-day plan and do this:

1. Plan your time
   1. Break it down to monthly goals.
   2. Stick to a schedule (say no to things that threaten it).
2. No multitasking
   1. Focus on one thing at a time.
   2. Focusing Question - What is the one thing you can do, so that everything else you do is effective? (Taken from Gary Keller's book, The One Thing)
      1. Think about the one thing. It may be for a client, your business, and/or what you want to give to this world. This guides your whole thinking.
      2. This focus is a daily, minute-by-minute concept.
      3. One thing at a time
      4. Ask yourself what is most important right now, and give it your full attention.

Marketing and Sales

1. Move past your own prejudices of sales and marketing.
2. Marketing is about serving people.
   1. Talk to people, interact with them, ask them what they need, even before they are your clients.
   2. Think about who is the ideal type of person in a situation or struggle that you want to serve?
3. Try selling through stories.
   1. Think about common objections you get when you are talking with someone.
   2. Overcome these objections by telling stories about previous clients who have had success with BOM.
   3. The story should relate to the client's same situation. You can share what happened and how that other person's life was transformed.

Essential Tools
 
In order to have a successful business, it’s important to have a scheduling system and some way to keep track of your finances. When it comes to a scheduling system, Anna spoke about a calendar, one that gives you automatic reminders once you have the information in it. Anna uses one called Acuity Scheduling. She also recommended having a bookkeeper. You can do this yourself as long as it’s consistent. She uses YNAB because it keeps everything in one place and organizes her finances for her once she inputs that data.
           
Being a BOM instructor and growing your business can be done. Helping clients and enabling others with the knowledge of how their body works in regards to fertility is life-changing. With the guidance from Anna, building your business hopefully is not as intimidating anymore. Instead, it can be looked at as a wonderful opportunity to help people while earning income to support yourself. 

By Mike Gaskins

When we think of Billings Ovulation Method and Natural Family Planning, we should never discount the importance of that word “natural,” especially when considered as an alternative to birth control. In business terms, it’s a selling point that can never be overstated. In social terms, it’s a tenet of the Method that’s easily underestimated.

It is the inherent un-naturalness of hormonal birth control and its subsequent complications that accentuate this important point. I’m grateful not only for what you offer as BOM instructors, but for what you may prevent.

Nelson Pill Hearings

Nearly 50 years ago, Senator Gaylord Nelson chaired congressional hearings that focused exclusively on hormonal birth control. His goal was to address two principle concerns:

1. Whether The Pill had been proven safe and
2. Whether women were being given sufficient information about the possible dangers.

Sen. Nelson opened the hearings with the stated objective: “to present for the general public’s benefit the best and most objective information available.” In the process, they covered a shockingly diverse list of side effects and complications that sent the nation into a panic. Women across the country began calling their doctors asking to be taken off The Pill.

When Pill proponents criticized Sen. Nelson for creating a panic, he shot back that if women had been warned about the dangers before being prescribed, they wouldn’t be alarmed hearing about them now.

As a result of the hearings, The Pill became the first drug in history required to contain a patient information booklet in the package. Otherwise, not a lot has changed since those days on Capitol Hill in 1970.

I cover the Nelson Pill Hearings in greater detail in my book In the Name of The Pill, but for the sake of brevity, I’d like to look at just four of the side effects discussed at the hearings and make a case for why I think it’s time to bring The Pill back to the Hill.

Blood Clots

Then - The hearings discussed a groundbreaking British study that uncovered a 7.5-fold increased risk of death from stroke.

Now - In 2012, the New England Journal of Medicine revealed that some current formulations of combination oral contraceptives can double a woman’s risk of having a heart attack or stroke               
[ http://www.nejm.org/doi/full/10.1056/NEJMoa1111840?query=featured_home]. It’s also worth noting that in 2016, Bayer, the maker of today’s most popular brands, Yaz/Yasmin, paid out $2.04 billion to settle over 10,000 blood clot-related lawsuits. [https://www.drugwatch.com/yaz/settlements/].

Breast Cancer

Then - The first major headlines of the hearings came when Dr. Roy Hertz proclaimed, “[Estrogens] are to breast cancer what fertilizer is to the wheat crop.”

Dr. Max Cutler testified that 1 out of every 20 women will develop breast cancer sometime during her life. Dr. Hugh Davis added, “Now, there are some 75 to 80,000 women in this country per year who are developing diagnosed carcinoma of the breast. If the chronic taking of steroid hormones eventually increased this by only 10 percent, we would have a very, very hazardous situation on our hands…”

Now - We have witnessed a 210% increase! 1 in every 8 women will develop breast cancer in her life.  Over 268,000 cases of breast cancer will be diagnosed this year [https://www.breastcancer.org/symptoms/understand_bc/statistics].

Lupus

Then - Dr. Giles Bole Jr. described a rare disease called lupus to the senators. He was beginning to see this older person’s disease among young women who recently started on birth control. Dr. Herbert Ratner later testified that an estimated 1 out of every 2,000 birth control users developed lupus.

Now - In 1999, Arthritis and Rheumatology published a report that concluded the incidence of lupus had tripled in the past 40 years, and 90% of the diagnoses are women [https://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-systemic-lupus-erythematosus].

A decade later, in 2009, scientists from McGill University in Montreal released the results of a massive population study. They collected data on 1.7 million women and found that women on oral contraceptives were 50% more likely to develop lupus [https://www.webmd.com/lupus/news/20090413/birth-control-pills-may-raise-lupus-risk#1].

Depression & Suicide

Then – Barbara Seaman warned that many doctors believed “that suicide, not blood clots, may, in fact, be the leading cause of Pill deaths.” Dr. Francis Kane testified at the hearings that 1 out of every 3 Pill users showed depressive personality changes, and a little more than 1 out of every 20 became suicidal. He added that women on birth control had “distinctly higher scores,” meaning not only were more of them getting depressed, but they were also experiencing greater depression.

Now - Fast forward to 2016, Danish researchers conducted a cohort study of 1 million young women, and discovered that women taking hormonal birth control were 70% more likely to develop depression. One year later, a continuation of the same study revealed that women on birth control more than tripled their risk of committing suicide [http://time.com/5030447/birth-control-side-effects-suicide/]!

Insufficient Follow-Up

Next year will mark the 50th anniversary of the Nelson Pill Hearings. These four side effects represent only a small sample of what was discussed at the hearings, but I think they alone should be sufficient for us to demand that they bring The Pill back to the Hill. It’s time for new hearings focused on answering the same two questions:

1. Whether The Pill has been proven safe and
2. Whether women are being given sufficient information about the possible dangers.

I’m sure many of you have already heard about the side effects of hormonal contraceptives from your patients, and here is something you can do now to make a difference. A group of physicians and women’s health advocates have petitioned the FDA to include new black box warnings on these contraceptives. This petition is open for public comment until November 2019. Please add your comment and encourage your patients who have had negative side effects to add theirs by clicking on this link: https://www.regulations.gov/document?D=FDA-2019-P-2289-0001&fbclid=IwAR3B0ox9-SOcOKbQASz2v4yB37HS7yvPJ04VBaVVrapffSxUCwSTwTUw9bQ


Mike works as a writer/producer in all forms of media. His recently published book, In the Name of The Pill, examines the powerful forces that gave us birth control before it was proven safe, exposes the deceptive tactics used to keep patients in the dark, and explores the numerous ways women’s health has been sacrificed in the name of The Pill.