FABMs: Early Diagnostic Tools in Endometriosis

ENDOMETRIOSIS Awareness Month

During National Endometriosis Awareness Month, we have published the story of two patients for whom charting the female cycle and using fertility awareness based methods (FABMs) expedited the treatment of endometriosis. Although this week’s interview with a patient begins with a common story of a frustrating search for answers, the promising outcome is becoming more frequent. It also highlights an exciting discovery: FABMS and charting may serve as early diagnostic tools in the often-long road to answers and effective treatment for women with endometriosis.

A third-year medical student conducted this interview while on a two-week online elective with Dr. Marguerite Duane, executive director and co-founder of FACTS. He plans to specialize in obstetrics and gynecology (Ob-Gyn) and participated in the FACTS medical student elective to learn more about FABMs and their important role in women’s health. 

Introduction
As part of the FACTS elective, I had the opportunity to speak with Mrs. L, who has been using the Creighton Model for six years. Like many women, Mrs. L turned to natural family planning (NFP)/FABMs after experiencing frustration with the women’s health care she received. Once she started charting and gaining insight into her reproductive health, Mrs. L felt much more empowered. Using FABMs also opened a door to a world of medical professionals trained in NaProTechnology who seemed to value taking time to understand her symptoms and make an accurate diagnosis. I am pleased to share her story and the lessons it taught me about improving women’s health through FABMs.

The Search for Answers
For a number of years, Mrs. L struggled with painful cycles and heavy bleeding, common problems for which many women seek the advice and care of women’s health professionals. When she shared her symptoms with her obstetrician-gynecologist, the physician was adamant she should initiate hormonal contraception with medroxyprogesterone injections. As a nurse, Mrs. L was hesitant about using birth control and concerned about the potential adverse effects. She also felt the doctor didn’t devote enough time to understand the root cause of her symptoms, preferring to treat her complaints empirically with hormones.

Mrs. L felt particularly distressed that her reservations about the injections and her desire for a diagnosis prior to initiating treatment were dismissed. As a nurse, she emphasized her esteem for doctors and other medical professionals, but felt disappointed by her physician’s flippant attitude. She wanted answers and hoped for more comprehensive care.

An Empowering New Approach
A while after this difficult experience, Mrs. L learned about the Creighton Model from some friends who had been using it. After contacting a Creighton Model trainer who lived locally, she started learning the method and began to chart her cycles and associated symptoms. Mrs. L found the Creighton Model relatively easy to learn and appreciated the regular contact with her trainer. More important, she related feeling empowered by becoming attuned to her cycles. As a nurse, she said she had a basic understanding of the reproductive system and its hormones, and using the Creighton Model to chart her cycle allowed her to apply her knowledge to gain an understanding of her body.

After charting for a few months, Mrs. L visited a new Ob-Gyn physician. While he expressed concerns that she may have a “hormonal imbalance,” he had never seen such charting before and explained he would not be able to look at her chart for clues about what might be wrong. Like her first doctor, he ultimately decided hormones were the best and only course of action for her, and prescribed progesterone cream.

A Crisis Uncovers Answers
While continuing to struggle with difficult cycles and troublesome bleeding, Mrs. L went to the hospital one day with abdominal pain. At the hospital, they diagnosed a large dermoid cyst and sent her for surgery—a left oophorectomy (removal of the left ovary). The surgery took significantly longer than expected, and the surgeon reported finding numerous adhesions in her abdomen and pelvis. At the time, her physicians did not make a connection between her chronic issues and the surgical findings. However, an Ob-Gyn physician friend suggested to her—after years of dealing with pain and bleeding—that she may have endometriosis.

Definitive Treatment through NaProTechnology
Around the time when her physician friend suggested a diagnosis of endometriosis, she met another physician trained in the Creighton Model who was able to analyze her Creighton charts. Thanks to the detailed information about her periods—and inferred hormonal patterns—this physician strongly suspected endometriosis. Thereafter, Mrs. L received care from a NaProTechnology-trained Ob-Gyn physician and eventually had surgery to address her condition.

Mrs. L continues to use the Creighton Model and receives care from a NaProTechnology-trained physician in a different state and an NFP-trained physician assistant with the hope of conceiving. Using the Creighton Model opened the door to understanding her cycle and enabled her to work with knowledgeable medical professionals trained in FABMs and NaProTechnology. She has experienced a great deal of relief from the dysmenorrhea and menorrhagia caused by endometriosis. Furthermore, she feels empowered by the insight into and understanding of her reproductive health that using FABMs provides.

Reflections from a Future Physician
Speaking with Mrs. L gave me a tremendous appreciation for NFP/FABMs as more than a family planning tool, but a key to improving women’s health. FABMs not only give women information that helps them avoid or achieve conception, but they also allow women to be active in monitoring and guiding their reproductive health, something that is extraordinarily empowering for patients. As a medical student, I also see the incredible capacity of FABMs to empower physicians and all women’s health practitioners, by giving us a powerful tool with which to understand women’s reproductive function better and a valuable vehicle to engage patients in dialogue about their health.