Imagine having access to a pill that could solve every problem that is burdening you at this moment. As unrealistic as it sounds, that is exactly what mainstream medicine claims to possess when a girl or woman of reproductive age walks through the door with any complaint. From acne to depression to cramps, birth control is a one-size-fits-all approach to all of women’s problems. However, as many of us have learned by trying on “one size fits all” articles of clothing, what is advertised does not always hold true. Each woman is uniquely made, and to assume that there is one product of any sort that can fit all of our beautiful differences is comical, to say the least.
While it would be a relief for doctors and patients alike if there were an easy fix to stubborn reproductive health disorders, the complexity of these disorders requires a more intensive approach.
Endometriosis and polycystic ovarian syndrome (PCOS) are two of the most common reproductive disorders that plague women today. In fact, both disorders are known to affect at least 10 percent of women of reproductive age and are leading causes of infertility. Despite the number of us who are suffering with these disorders, for decades, mainstream medicine has been satisfied with prescribing synthetic hormones to mask symptoms, rather than attempting to identify and resolve the root of the problem. But I speak from personal experience when I say it can be detrimental to the health of women when we attempt to quiet our bodies as they scream for help. Further, the birth-control approach too often results in a significant delay in diagnosis and a possible worsening of the disease.
What is endometriosis?
Endometriosis is a disease in which tissue that is similar to the lining of the uterus grows in areas outside of the uterus. This abnormal tissue growth can lead to cysts, scar tissue, and adhesions, and inflammation within the body. While this disease has been known to occasionally show no symptoms at all, a common symptom of endometriosis is pain throughout the menstrual cycle. This pain is commonly reported during menses (periods), ovulation, sex, urination, or bowel movements. Other symptoms may include heavy periods, irregular spotting, bloating, and nausea.
For some women, the common denominator of endometriosis symptoms is that they tend to be cyclical (occurring around the same time every menstrual cycle). It is important to note that this is not an exhaustive list of symptoms and that the intensity and prevalence of symptoms does not necessarily correlate with the progression of the disease.
What is PCOS?
Polycystic ovarian syndrome, known as PCOS, is a disorder in which unreleased eggs within the ovaries cause multiple cysts to form on the ovaries. PCOS often results in an imbalance of hormones; women with PCOS typically have elevated levels of the androgens testosterone and androstenedione. Some of the symptoms of PCOS include irregular cycles, insulin resistance, increased hair growth, acne, weight gain, fatigue, and depression and anxiety.
How are these reproductive disorders typically diagnosed?
The symptoms of both endometriosis and PCOS mimic many other disorders and diseases, and the ambiguity of these symptoms makes diagnosing a difficult task for many physicians. Further, neither disorder is diagnosable through a simple test.
PCOS is often only able to be diagnosed after ruling out a number of other possible diagnoses. Endometriosis is only able to be diagnosed through surgery by a highly skilled gynecologist who can recognize the disease in all of its forms.
Unfortunately, there is often a significant gap between the onset of symptoms and the time it takes to receive a diagnosis of endometriosis or PCOS. For those with endometriosis, a study revealed the median time from first symptoms to diagnosis is 9 years. For those with PCOS, it often takes more than two years and multiple doctors to diagnose. While diagnosis for PCOS may seem to be happening at a better rate, studies show that 50 to 75 percent of women with PCOS remain undiagnosed.
How are PCOS and endometriosis typically treated?
The exact causes of these devastating diseases are still unknown, and a cure for either disorder has yet to be found. Fortunately, there are treatments available both to alleviate symptoms as well as to treat the underlying source of symptoms. Because of the ambiguous nature of the disorders and the invasive nature of surgical treatments, many physicians opt for the former of the two options.
For some women, symptoms of PCOS and endometriosis are able to be treated using diet changes partnered with moderate exercise and sufficient sleep. Physicians are also able to recommend certain vitamins and supplements that have been shown to reduce symptoms. Therapy and other mindfulness exercises may be helpful in attending to symptoms of anxiety and depression that may result from these disorders.
To treat PCOS and endometriosis, in addition to painkillers, the most prescribed treatment is some form of artificial hormones in the form of hormonal birth control. A handful of women will notice a reduction—and occasionally an elimination—of their symptoms from using artificial hormones. Nonetheless, synthetic forms of hormones frequently bring with them a plethora of their own problematic side effects. In addition, while synthetic hormones in contraceptives may occasionally suppress the progression of the disease, they have not been shown to have any impact in reversing damage already done.
Doctors weigh in: are forms of birth control effective treatments?
While it is very common for gynecologists to prescribe birth control, this is not a cure and does not eliminate endometriosis lesions. Dr. Robert Albee, the founder of the Center for Endometriosis Care says, “Drug therapy that can destroy endometriosis has yet to be discovered.” He goes on to explain that if the disease is not fully removed, patients may still have to face symptoms from the disease that is still present in the woman’s body.
Dr. Ken Sinervo, current director of the Center for Endometriosis Care, agrees, stating, “Counseling patients to undergo a lengthy protocol of suppression serves only to further delay the diagnosis and definitive treatment.” Further, he says, “Data indicate that little difference exists in effectiveness of the various analogs, all of which last only while the patient is undergoing treatment and most of which have negative side effects.” That is to say that the prescribing of birth control to treat endometriosis only delays the inevitable need for further treatment once a woman stops taking the drug.
In regard to PCOS, Dr. Jolene Brighten, an expert on post-birth control syndrome, has similar views. In fact, she argues that not taking into account the role that insulin resistance plays in PCOS makes “a quick fix with birth control without regard for the root cause of the condition downright dangerous.” She also alludes to the fact that, although those with PCOS are often prescribed birth control to regulate their cycles, they are at higher risk of their periods not returning once they stop taking the pill. "In my clinical practice," Dr. Brighten writes, "I've helped many women who have reported regular periods before going on the pill, only to find irregular or absent periods once they discontinue it."
Overall, there is still much research that needs to be done on these disorders. Unfortunately, because mainstream medicine is settling for birth control as an optimal treatment, it is often assumed that there is no urgency in the need for research. As a result, little funding is provided for this research to be done. Dr. Jeff Arrington, an OB-GYN specializing in Minimally Invasive Gynecologic Surgery (MIGS) expresses his frustration with this fact: “More time and money is spent on researching hormones and medications that may help control only the symptoms than there is on understanding the actual disease and looking at tools for better surgical identification of margins, or even medications or therapies that may actually one day help the body truly get rid of endometriosis.” As a result, Dr. Arrington explains, “delay of diagnosis with prolonged suffering and progression of destructive disease is far too rampant” due to the focus on hormonal suppression.
Is there a better way to treat endometriosis and PCOS?
The current standard of treatment for endometriosis, and the only way to diagnose and treat the root of the disease, is by having surgery. Laparoscopic excision surgery to remove all endometriosis lesions in their entirety results in a significantly reduced risk of disease recurrence and an increased likelihood of reduced symptoms. Unfortunately, it is common for surgeons who have not been properly trained to attempt to treat the endometriosis with laparoscopic ablation surgery. During this procedure, the physician burns off the top layer of the disease, leaving a majority of the disease behind. This has been shown to result in an increased likelihood of “recurrence” (although it is not truly recurring, it is ongoing, since the disease was never fully removed) as well as an increased likelihood of scar tissue formation. This scar tissue can be both painful and harmful to a woman’s fertility.
Dr. Monique Ruberu, a board-certified OB-GYN who stopped prescribing birth control and became certified in Natural Procreative Technology (NaProTechnology), shared in a Natural Womanhood interview that the doctor you choose for treatment can make a big difference in your endometriosis healing. For surgery, Dr. Ruberu says, “you want to go with a NaPro-trained surgeon, because that individual will go in and actually look for the endometriosis and remove it, not just burn it. Because when you burn it, it will come back; but if you remove it, then you have a much better chance of resolution.”
For PCOS, physicians often recommend diet and exercise changes as well as progesterone-identical supplements as a first line of defense. For some, by supplementing bioidentical progesterone (not artificial synthetic progestin) during certain phases of the cycle, women are able to begin ovulating and experience a reduction in symptoms. When these treatments do not work, it is sometimes recommended that a laparoscopic ovarian wedge resection be performed. This surgery removes a portion of the ovary in order to establish normal hormone levels and allow for ovulation to occur. For such a surgery, the importance of a highly trained surgeon, such as one trained in NaProTechnology, cannot be overstated. Just as is the case with endometriosis surgery, scar tissue formation has the potential to cause more problems if not properly prevented. Another procedure, called laparoscopic ovarian drilling, occurs when a surgeon creates holes throughout the ovary in an attempt to get the same results as an ovarian wedge resection. Some think this procedure is less effective than an ovarian wedge resection due to a higher likelihood of scar tissue/adhesion formation.
How Fertility Awareness Methods can help with PCOS and endometriosis
Fertility Awareness-Based Methods (FABM) teach a way of charting a woman’s menstrual cycle by monitoring certain biological signs that can provide more information about that woman’s health. These methods see the menstrual cycle as a “fifth vital sign” because of the amount of information that it provides about a woman’s health.
There are a number of different modern and evidence-based methods that follow this model, and each is unique in the signs that they choose to focus on. Cervical mucus, basal body temperature, and hormone levels are examples of biological signs measured in these methods. Choosing a method can be overwhelming for some, but there are resources available to make this process easier. Ultimately, the method that you will best use is the best method for you. What’s more, every method includes their own set of educators who will be able to support you as you learn the language of your body. Charting your cycle with these methods allows you to have a better understanding of the correlation between certain symptoms and different phases of your cycle. This knowledge is incredibly empowering and gives you the tools needed to better advocate for yourself to your doctors.
How do I find the right doctor to treat endometriosis and PCOS?
Restorative Reproductive Medicine (RRM) is a new approach to women’s health that focuses on monitoring and supporting a woman’s reproductive and gynecological health. Physicians who follow this model are continually working to better understand women’s bodies and find the root of problematic symptoms in order to treat them and allow the body to function at a more optimal level.
In relation to endometriosis and PCOS, RRM doctors have an advantage when it comes to treatment options. The reason for this is that they are trained to understand Fertility Awareness-Based Methods of charting and to use a woman’s chart to inform their treatment plan. For example, physicians may have women test their hormones during certain phases of the cycle in order to more effectively evaluate hormone production. In response to this, hormone supplements that are identical to those naturally produced in the body can be prescribed at the exact time of the cycle that they are needed.
NaProTechnology (Natural Procreative Technology) is a women’s health science that is a form of restorative reproductive medicine. NaPro trained physicians are taught specific surgical techniques that are effective in preventing scar tissue and adhesions, which is a particularly important skill to have when it comes to surgery for endometriosis and PCOS. For those having difficulty managing their disorder with lifestyle changes (and even for those who are having success), considering surgery or other natural treatments from a NaPro-trained physician could be particularly beneficial.
How do I advocate for my health?
So, now that you have all of this information, what’s next? As you can probably tell, there is still much work that needs to be done when it comes to recognizing, diagnosing, and treating stubborn reproductive health disorders. The need for more research is huge and essential to having a better understanding of these disorders and working towards a cure. It is time we stop settling for band-aid treatment options, and demand the care that we deserve.
This process starts with open and honest conversations about our bodies. From a young age, many girls are taught to be ashamed of their periods. Most don’t know anything about their menstrual cycle outside of the monthly bleeding and its accompanying symptoms. Let’s all vow to work toward normalizing these conversations so that girls and women are not left believing that their suffering is normal or “just part of being a woman.” Also, by encouraging girls to begin charting with their first period, we will equip them with the tools they need to advocate for their health should any reproductive issues or abnormalities arise throughout their lives.
Once we have a better understanding of our body’s language and what it is trying to tell us, we will have more control over our treatment. Whether you decide to find a doctor who is well versed in FABM or not, it is important that you are able to play an active role in your care. It is never acceptable for a physician to belittle you, and if you believe that you are experiencing medical gaslighting, you should find a different doctor. Don’t be afraid to ask your physician questions. It can be especially helpful to ask about certain connections you have made between symptoms and your cycle. Your FABM educator can be a great resource for helping you to prepare for your doctor’s appointments, and if you don’t have a Restorative Reproductive Medicine doctor near you, many RRM and NaPro-trained doctors will give consultation advice for you to know what labs, tests, and treatments to request of your local doctor to help you get the answers and care you need.
While the work required to educate and advocate for yourself may seem overwhelming, you are not alone. There is a team of people who are able and willing to help you every step of the way. The fight for better care for women is one that is worth it, and we all have the ability to take a step in the direction of positive change.