Crohn’s and Colitis Awareness Week

Identifying the Signs: What’s “Normal?”

By: Alicia Khan, MD

Director’s Note: To mark Crohn’s and Colitis Awareness Week, we are featuring an enlightening interview with Sara,* a NICU nurse who found her way to fertility awareness-based methods (FABMs) years after graduating from nursing school. Growing up, she witnessed her mother suffering from painful menstrual cramps, heavy bleeding, and ulcerative colitis. Thus, she didn’t question her own painful cycles until her mother’s diagnosis of endometriosis. Dr. Alicia Khan, a former FACTS elective participant, interviewed Sara about the utility of tracking her cycle with Creighton to learn more about her reproductive health and identifying and treating the underlying causes of her painful cycles.

Sara* is a long-time nurse in the neonatal intensive care unit (NICU), so her only exposure to women’s health was through the general education she received in nursing school and the deliveries she attended on her unit. She knew very little about the female reproductive cycle and the importance of reproductive health until her mom received a hysterectomy 15 years ago. At that time, Sara learned her mother had an advanced case of endometriosis, but her mom had suffered through her condition for years without realizing it. Looking back, Sara says her mom checked all the boxes: she had a history of severe menstrual cramps, a heavy flow, and had even developed ulcerative colitis, all classic signs of endometriosis. Sara was shocked to learn her mom had lived her entire life with this condition and never received appropriate care to relieve her symptoms.

“Her mom checked all the boxes: she had a history of severe menstrual cramps, a heavy flow, and had even developed ulcerative colitis, all classic signs of endometriosis.”

Sara and her two sisters struggled with the same issues throughout their adolescence. She shared that all three of them had experienced debilitating cramps since the age of 13. However, Sara never realized her situation was abnormal, especially because her mom and sisters suffered from the same symptoms. It wasn’t until all three sisters began to experience infertility — each struggling to conceive for 3 to 5 years — that Sara realized something was very wrong.

Upon reflection, she is saddened by the fact that she has had these symptoms since the age of 13 and lived until the age of 36 thinking her debilitating menstrual cramps were normal. She wishes she had learned about fertility awareness-based methods (FABMs) earlier so she could take charge of her reproductive health much sooner and receive the appropriate care.

“She wishes she had learned about fertility awareness-based methods (FABMs) earlier so she could take charge of her reproductive health much sooner and receive the appropriate care.”

 Before learning about FABMs, Sara pursued several routes to manage her painful menstrual cycles. She was first put on oral contraceptives in college, which did help improve her cramps and lighten her flow. She never had short-term adverse effects from the medication but was concerned about other long-term issues associated with taking birth control to manage her periods. The deeper root problem became apparent when Sara and her husband decided to start a family. She could no longer take the birth control pill and her periods began interfering with her quality of life.

With the guidance of one of her sisters, Sara began seeking out help for her infertility issues. She saw an OBGYN who started tracking her progesterone on day 18 of her cycle using the Standard Days Method. She was placed on a progesterone suppository, which lengthened her cycles and improved her sleep, but she still was unable to conceive. Next, Sara visited a reproductive endocrinologist where she attempted ovulation induction with letrozole. Her husband also received a full workup for causes of infertility but received a clean bill of health. After many cycles of induction, Sara was still not able to get pregnant.

Sara was disappointed and exhausted with all the appointments and failed attempts. Her physicians recommended in-vitro fertilization as the next step, but she did not want to have a procedure that did not align with her faith. Worst of all, she felt all these methods were merely putting a bandaid on the issue rather than fixing the source of the problem. Furthermore, her period-related symptoms had not subsided: she was still dealing with excessive bleeding, intense cramps, and pain with sex.

Desperate for solutions, a light bulb went off where she least expected it. She was speaking with a friend at church who brought up NaProTECHNOLOGY (Natural Procreative Technology). Sara was intrigued by the option to learn more about her reproductive health and cycle in a natural, noninvasive way. Her friend connected her to a Creighton-trained NaPro clinician the “rest was history.” 

Sara has now been tracking her cycle using Creighton for five months. I was fascinated to hear how Sara’s charting empowered her to take control of her own health and determine the source of her problem. Through charting, she observed she had brown spotting at the start and end of her menstrual cycle as well as around the time of ovulation. These were classic signs of endometriosis, so her NaPro clinician arranged for her to have exploratory surgery to confirm the diagnosis and excise any signs of endometriosis. Sara spoke excitedly about her belief that this approach would not only help with infertility but also with her difficult menstrual cycles. She is very hopeful this procedure will help improve both her fertility and quality of life.

“Through charting, she observed she had brown spotting at the start and end of her menstrual cycle as well as around the time of ovulation. These were classic signs of endometriosis.”

For Sara, another great takeaway from charting with the Creighton Model was learning more about her body and understanding why other methods may not have worked well for her in the past. Sara noted she had constant cervical mucus, which made it hard to identify her peak day and optimal time for fertility attempts. By charting with Creighton, she also learned her ovulation did not usually occur by day 18, which may explain why the progesterone had been ineffective in the past. She also recalled that after the letrozole induction her cervical mucus production completely stopped. Had she been charting with Creighton, this may have been an indicator that the induction would not be successful.

Sara appreciates the many benefits of charting her menstrual cycle and using NaPro Technology to help her grow her family. She particularly appreciates that her husband is also able to be a part of family planning through charting and learning more about her reproductive physiology. Sara hopes that in the future it will be common to introduce FABMs to women at an early age, whether through school or in the doctor’s office, to equip women to become actively involved in maintaining and improving their own reproductive health and overall quality of life.

*Names have been changed to respect the privacy of the interviewee. All information is shared with permission.

Alicia Khan, MD

Alicia Khan, MD is a second-year psychiatry resident at Medstar Georgetown University Hospital in Washington D.C who plans to pursue reproductive psychiatry. In medical school, Alicia was the co-founder of the Women in Medicine Section of the Medical Society of DC, an organization dedicated to promoting professional development and mentorship opportunities for female physicians. Alicia was also the president of the Georgetown AMA chapter and championed a policy resolution advocating for the standardization of intimate partner violence screening, which was adopted as policy by the Emergency Medicine Residency Association. She is excited to use FABMs to help women navigate the complex physical changes and manage the psychological impacts of their ever-changing reproductive cycle over their lifetime.