Why we should stop treating painful periods and endometriosis with the birth control pill and what we should do instead.
By Shirelle Edghill, Creighton Model FertilityCare Practitioner
Last week I wrote about common medical reasons that doctors prescribe the birth control pill, and why I think there is a better way to approach treatment for things like painful periods. If you haven’t read part I, I recommend that you catch up here.
Today I’m going to address one of the common reasons that women start using hormonal contraception: painful periods and endometriosis. Pain is always something that is hard to quantify, but I’d like to talk about what we would consider “normal” as far as period cramps. Mild or moderate cramping that can be helped by a heating pad or an anti-inflammatory like ibuprofen, is normal. Being curled up in the fetal position in bed unable to go to work or school, vomiting due to pain, having diarrhea during your period, passing out due to pain—all of these things would be abnormal.
In order to bring you real patient experiences with the NaPro approach to treating painful periods, I reached out to four different women who sought treatment for their painful periods, first with a non-NaPro trained physician, and later with a NaPro trained physician. I wanted to really get a feel for how NaPro is so different from the mainstream approach by talking to real women.
The NaPro Technology trained doctors first had each woman chart her cycles with the standardized Creighton Model FertilityCare System charting method. Creighton practitioners teach women how to chart in a way that will allow the doctor to fully understand exactly what she is seeing as far as how many days of bleeding she has, what other discharges she has, how long her overall cycles are, and how long her pre-ovulatory and post-ovulatory phases are. All of this information is invaluable to the doctor to help him/her begin investigating what might be wrong, and to properly time tests and procedures to the correct phase of the cycle. As a practitioner, I often will see clues on the chart that can indicate what the problems may be.
In the group of women who shared their stories with me, three of the women had struggled with painful periods since puberty. All three eventually also struggled with infertility. I also spoke with one younger, single woman who turned to NaPro Technology for painful periods. Each woman who shared her story with me said that the only treatments she had ever been offered by her mainstream OB/Gyn was the birth control pill, getting pregnant, or hysterectomy. Prior to turning to NaPro, only one of these women had been diagnosed with anything that might be causing her pain.
Each woman was from different areas of the United States and worked with four different NaPro trained physicians. Each described the lengthy amount of time that the NaPro doctor took with her during her first appointment, reviewing her Creighton Model FertilityCare chart, and discussing her health history at length.
Today, I will give an overview of some of the different approaches the doctors used to diagnose and treat these women. It would be impossible to tell you the exact treatment for “painful periods,” because painful periods are just a symptom of some underlying disease or dysfunction. In the cases of the women I spoke with, every one was diagnosed with endometriosis, but some had other underlying issues as well, including hormone problems, cysts, uterine infections, and pelvic adhesions.
I’m going to put on my teacher hat for a moment (did I tell you I used to teach third grade?), so bear with me. Endometriosis is a condition in which some of the lining cells that should be inside the uterus, migrate outside the uterus and implant in different areas of the pelvic cavity. These cells are reactive to the normal hormones from the menstrual cycle. They can attach to the walls of the pelvic cavity, the ovaries, the bladder, and the bowel. This is likely why some women who are eventually diagnosed with endometriosis also have gastrointestinal issues. Scientists really aren’t sure what causes endometriosis. Endometriosis affects approximately 1 in 10 women. There are theories that it is caused by the period “backing up” into the fallopian tubes, or that it’s really an inflammatory condition caused by an immune response. It can cause painful periods, very heavy periods, painful sex, pain with urination, diarrhea, nausea and vomiting, and infertility. Endometriosis is difficult to diagnose. It can only be definitively diagnosed through a small surgical procedure called a laparoscopy. Only large areas of endometriosis, or endometriosis in certain areas can be diagnosed through a pelvic exam or an ultrasound. Endometriosis also sometimes happens without noticeable symptoms of pain. I have worked with women who’s only symptom of endometriosis was infertility.
Okay, back to my ladies. For diagnosis, what each woman described to me was a bit different depending on her circumstances and causes of the pain. But each one received extensive bloodwork, including testing for things like thyroid dysfunction and monitoring the function of the ovarian hormones. Each woman had ultrasounds and pelvic exams to see if the causes of the pain could be determined. The hysteroscopy procedure was also often used to put a scope inside the uterus and see if diagnosis could be obtained this way. Several of the women were advised to change their diets to remove processed foods and foods that might cause more of an inflammatory response. Weight loss recommendation and support was another treatment that one woman found helpful. In the case of moderate pain, a medication that can be helpful is one known as Ponstel, which has been shown to decrease menstrual pain as well as excessive bleeding during the menstrual period. Eventually, each woman in my group felt that she wanted a definitive diagnosis, for which laparoscopic surgery was performed. You can read and learn more about this technique here.
So, why are many OB/Gyns opposed to any kind of surgical techniques to diagnose and treat gynecological problems that can ONLY be diagnosed or treated by surgical interventions? This is really important to understand, because when you go to your neighborhood OB/Gyn, they will likely look at you like you're crazy if you ask about surgical options. Pelvic surgeries to treat pain and infertility were much more commonly used before the advent of the birth control pill, drugs like Clomid, and the IVF procedure. The procedure fell out of favor with the medical community because the original versions of this procedure often caused more damage than the problem itself. When you operate on the pelvis, there is a risk of what are known as “pelvic adhesions.” They’ve been described as looking like slime and cobwebs in the pelvic cavity, basically scar tissue that can create a lot of issues. They can cause pain and problems like infertility. For good reasons, this method of diagnosis and treatment was questioned as whether or not it was worth the risk to get definitive answers if we created more problems in the process. But the creator of NaPro Technology, Dr. Thomas Hilgers, has addressed this problem by developing and teaching other physicians an adhesion-free protocol for performing gynecological surgeries like diagnostic laparoscopies. Now we have the benefit of this extremely useful procedure for diagnosis and treatment, with significantly less risk. Most non-NaPro trained doctors are not familiar with these techniques, having not been taught them in medical school, and will still have the problem of creating pelvic adhesions if they do attempt to operate on a woman’s pelvis, causing more damage. One of the ladies who shared her story with me, had experienced this situation of pelvic adhesions from a previous pelvic surgery with a non-NaPro trained physician. When a NaPro surgeon went back in later, he found that her endometriosis had returned and she also had pelvic adhesions which were causing her further pain. The NaPro doctor surgically removed the pelvic adhesions caused by the first surgery, as well as the endometriosis and she is now feeling much better.
For the treatment of endometriosis, the technique that best prevents the endometriosis from recurring is known as excision-literally, the “cutting out,” of the endometriosis. Other techniques that some doctors use usually result in the endometriosis returning. The birth control pill does nothing to remove these areas of endometriosis. The birth control pill turns off the normally functioning ovarian hormones which can stimulate the areas. For some women, this can temporarily decrease their pain. There is a myth that hysterectomy can cure endometriosis, and that childbirth can cure it. In fact, some doctors tell women to try to get pregnant in order to cure the problem, which is what my friend Nicole Havrilla experienced and talks about in her blog about endometriosis.
The great thing is that the NaPro Technology trained physician would be able to use this surgical technique to diagnose and also perform the needed treatment at the same time, removing the need for two surgical procedures. The procedure is done with a very small incision, often using a da Vinci robot. During this diagnostic procedure, other abnormalities can also be corrected, specifically those having to do with PCOS or removal of pelvic adhesions from prior surgeries. Several corrections can be done all at once, and there are often several problems happening all at once.
After surgery, each woman I talked with, described having the first normal menstrual periods they’ve ever had in their lives. In the interest of full disclosure, one woman was still having pain after the surgery. Her NaPro doctor continued trying to correct this for her, and decided to have her try pelvic floor therapy. After receiving this therapy, she described the difference as “amazing.” For one woman, she was finally able to conceive children naturally. All were very pleased with the care they received with their NaPro Technology trained physicians, and described it as a significantly different approach to the care they had previously received.
Through this post, what I hope you’ll realize is that there are other options other than the birth control pill to treat painful periods and endometriosis. I hope that women will realize that both medical and surgical options have a place in women’s healthcare, just like they do when we treat any other area of the body. By way of analogy, I’ll share that I’ve had back problems for years. Two years ago, I decided I really needed a proper diagnosis in order to figure out what my next course of action should be. My doctor was able to diagnose my lower back pain as being related to my L5 disc, and she felt that physical therapy would be my best remedy. But, she did bring up surgery as an option to permanently correct it. She gave me the OPTION and I was the one that could decide if the benefits and risks were worth it. I am arguing that women need to be given all of their options when it comes to gynecological health problems. Not just the option that the doctor has already decided will be best for her.
I would love to connect with you! I can be reached at ShirelleEdghill@gmail.com . I’m also on Facebook @ShirelleEdghillFCP