Cervical Health Awareness Month

NaProTechnology Benefits and Applications for Modern Women​

By: Paul Seraly, MD

Director’s Note: This week, we conclude our ‘Cervical Health Awareness Month’ series with this summary of an article published in 2011 titled, “The New Women’s Health Science of NaProTechnology.” [1]  In his paper, Dr. Thomas Hilgers discusses the strengths and applications of natural procreative technology (NaProTechnology or NaPro) in the medical and surgical treatment of various gynecological conditions. An Ob-Gyn physician, researcher, and author of multiple textbooks, Dr. Hilgers co-developed the Creighton Model FertilityCare System, a fertility appreciation-based method (FABM) that teaches charting of cervical mucus. Through further research into the Creighton Model, he later developed the groundbreaking science of NaProTechnology. Dr. Paul Seraly, a former FACTS elective participant, summarized Dr. Hilgers’ article, noting the lack of awareness that remains in the general public as well as the medical community about this modern, innovative, effective, and evidence-based approach to women’s healthcare.

Introduction

The development of the birth control pill in 1960 brought about a new wave in women’s reproductive care. While designed to avoid conception, it quickly gained traction for the symptomatic treatment of many gynecologic concerns. Yet, the “treating,” which was more of a “masking” of symptoms, led to a subordination of the actual “addressing” of the root causes of disease. In his 2011 review article, “The New Women’s Health Science of NaProTechnology,” Dr. Thomas Hilgers describes natural procreative technology (NaPro) as a way to return to the practice of addressing reproductive and gynecologic concerns while avoiding methods that intentionally suppress natural function. [1]  NaPro can be used to treat a wide variety of conditions, including infertility, polycystic ovary syndrome (PCOS), endometriosis, and premenstrual syndrome (PMS). The use of biomarkers also allows for effective natural family planning (NFP). A full description of the NaPro framework can be found in Hilgers’ medical textbook, “The Medical & Surgical Practice of NaProTechnology.” His article serves as a useful overview to understand the basis as well as many applications of NaProTechnology.

“In his 2011 review article, “The New Women’s Health Science of NaProTechnology,” Dr. Thomas Hilgers describes natural procreative technology (NaPro) as a way to return to the practice of addressing reproductive and gynecologic concerns while avoiding methods that intentionally suppress natural function.”

 Creighton Model FertilityCare as the Backbone of Physiologic Monitoring

Research on cervical mucus that began in 1976 at the St. Louis University Natural Family Planning Center can be seen as the nidus of NaProTechnology. At that time, changes in cervical mucus were found to be strongly correlated with underlying shifts of estrogen and progesterone throughout a woman’s menstrual cycle. These cervical mucus changes were analyzed and later described in a standardized way. This made possible the development of the Creighton Model FertilityCare System (the Creighton Model), which uses vulvar discharge to delineate — objectively and prospectively — where a woman is in her cycle day to day. An important feature of this natural method is the ability to locate the “peak day.” The peak day is the last day of estrogen-driven, fertile-type mucus (described as clear, stretchy, lubricative) and a reliable indicator of ovulation. A study [2] referenced by Hilgers found ovulation to be +/- 3 days of peak day in 100% of cycles analyzed.

“The Creighton Model FertilityCare System … uses vulvar discharge to delineate — objectively and prospectively — where a woman is in her cycle day to day.”

Medical and Surgical Applications of NaProTechnology

• The accuracy of Creighton Model charting enables a woman to know exactly where she is in her cycle and time intercourse accordingly based on the desire to avoid or achieve pregnancy. A meta-analysis of the Creighton Model found a 99.5% correct use effectiveness when used to avoid pregnancy. [3]
• By accurately locating the peak day, physicians can perform targeted hormonal assessments of the pre- and peri-ovulatory periods as well as the luteal phase. One scenario in which this information is valuable is when assessing for inadequate luteal function. The traditional day 21 progesterone test may not accurately capture the luteal phase in women who have not yet ovulated, which can lead to faulty results and misdiagnosis. Using cervical mucus changes leads to a much more accurate assessment of each phase of the menstrual cycle.
• Transabdominal/transvaginal ultrasound is used in conjunction with cervical mucus to identify disorders of ovulation. This approach is guided by the evaluation of 3,000 cycles of spontaneous ovulation.
• Research on premenstrual syndrome (PMS) and postpartum depression (PPD) led to the use of isomolecular progesterone to restore natural hormonal function while also greatly decreasing symptom burden.
• The Creighton Model can be used to detect unusual bleeding patterns such as premenstrual spotting, intermenstrual bleeding, and tail-end brown bleeding. Hormonal assessment and hysteroscopy can then be used to target management.
• Infertility is a major health concern for couples that often leads to emotional and financial burdens when turning to in-vitro fertilization (IVF), which often does not address the underlying issue. NaPro utilizes hormonal assessment, ovarian ultrasound, hysteroscopy, and routine laparoscopy to pinpoint an organic cause of infertility. Hilgers’ article cites two studies that point to the greater efficacy of NaPro when assessing pregnancy and family building rates compared to IVF in patients with endometriosis and polycystic ovaries. [4][5]
• NaPro’s surgical advancements have led to a reduction in scar tissue and adhesion formation when surgically treating endometriosis, PCOS, and pelvic adhesions.

Reflection and Implications

“The benefits and applications of NaProTechnology are not widely known and often not taught in the traditional medical school curriculum. As a result, access to this restorative approach to reproductive healthcare may be significantly limited for many women and couples.”

Studies of NaProTechnology demonstrate its high efficacy in planning pregnancy, addressing infertility, and identifying the root cause of various gynecologic conditions. Undeniably, NaPro’s greatest strength is its ability to work with the natural function of a woman’s body rather than suppressing it. Hilgers effectively articulated the framework of NaPro in this 2011 article. Since then, NaProTechnology has continued to advance, and more research is available. Its greatest challenge appears to be the lack of awareness in the general public and within the medical field about its evidence-based merits. The benefits and applications of NaProTechnology are not widely known and often not taught in the traditional medical school curriculum. As a result, access to this restorative approach to reproductive healthcare may be significantly limited for many women and couples.

References

[1] Hilgers, T.W. (2011) The new women’s health science of NaPro Technology. Archives of Perinatal Medicine 17 (4), 191-198.
[2] Hilgers, T.W., Abraham G.E., Cavanagh D. (1978) Natural Family Planning -1. The peak symptom and estimated time of ovulation. Obstet. Gynecol. 52: 575-582.
[3] Hilgers, T.W., Stanford J.B. (1998). The use effectiveness to avoid pregnancy of the Creighton Model NaPro Education Technology: A meta-analysis of prospective trials. J. Repro. Med. 43: 495-502.
[4] Rock J.A., Guzicek D.S., Sengos C. et al. (1981) The conservative surgical treatment of endometriosis: Evaluation of pregnancy success with respect to the extent of disease as categorized using the temporary classification systems. Fertil. Steril. 35: 131-137.
[5] Adashi E.Y., Rock J.A., Guzicek D.S, et al. (1981) Fertility following bilateral ovarian wedge resection: A critical analysis of 90 conservative cases of the polycystic ovarian syndrome. Fertil. Dteril. 36: 320-325.

ABOUT THE AUTHOR

Paul Seraly, MD

Paul Seraly, MD is a first-year family medicine resident at Via Christi in Wichita, KS. He completed his undergraduate and medical education at the University of Pittsburgh, PA. Dr. Seraly enrolled in the FACTS elective as a fourth-year medical student to gain a greater understanding of the physiologic basis of fertility and to learn skills to serve patients interested in fertility awareness-based methods of family planning. After residency, he plans to pursue further training to specialize in palliative care and Hospice.