Mary G Bruno

Based on my own personal experience and other important information I’ve learned

If you’ve hung around the world of fertility awareness long enough and have encountered someone who has experienced moderate to severe pain and/or infertility, or a range of other symptoms, you are probably familiar with this common question:

“Have you tried NaProTechnology?”

When used within the right context and being respectful of boundaries, it’s not a bad question to ask. But many wonder – what is the difference between your average OB/GYN and a NaProTechnology (also referred to as “NaPro”) surgeon?

I might be the perfect patient to answer that question.

After suffering from severe period cramps and heavy bleeding for 12 years and hopping between 4 mainstream doctors, I was finally diagnosed with endometriosis by a local well-known mainstream gynecologist who performed my first laparoscopic surgery.

Seven months later, I had my first of several NaPro surgeries. I’ve been treated surgically by a total of 3 different NaPro-trained surgeons (plus 3 different Napro fellows-in-training) and by 3 different NaPro-trained primary care physicians. I have learned quite a bit of difference between the two approaches to surgery and medical management.

Naturally, each individual person, physician, and the relationship between the two are unique. Although NaProTechnology is a standardized system, not all doctors will provide the same exact experience as a whole. Also, there are other good surgeons that specialize in the removal of endometriosis and do not prescribe birth control outside of NaProTechnology. This is a practice referred to as “restorative reproductive medicine.” I will only speak about NaPro surgeons here because that is what I am most familiar with. The information I will share is based on my own personal experience, as well as other important things I have picked up along the way.

My experience with and knowledge of these two different approaches to surgery and medical management will be broken down with consideration of:

• Extent of surgical training
• Use of birth control
• Use of charting
• Attitude towards fertility
• Time spent
• Adhesion prevention
• Additional Support

I will conclude with a short recap at the end if you prefer not to read all the details.

1. Extent of Surgical Training

Mainstream

One must be a college graduate to attend medical school. Once he or she graduates from medical school as a doctor, a residency is selected within a specific discipline. For many doctors, this is the final step of training before they begin their practice.

This is where you’ll find your mainstream gynecologist. It is where women typically go to get a pap smear, birth control, have a baby, or to get some relief from their women’s health related symptoms.

I’m not a physician, but I have had enough of my own doctor appointments, spoken to enough women, and heard enough doctors speak candidly about it to learn that the way medical school trains their students to handle an array of symptoms from acne to bad cramps is to prescribe birth control. In a recent Hormone Genius Podcast episode, Dr. Sheryl Hansel, M.D., explained that “…in this [doctor] community…we are not taught enough about [fertility awareness] in school. It is just drilled into us as to how the pill…is the fix for everything…”

Whether hormonal birth control or the copper IUD is used, it will take longer to diagnose and treat diseases like PCOS and endometriosis because hormonal contraception’s purpose is to simply turn the system off in hopes of improving symptoms, rather than fixing the problem(s) itself.

PCOS is a multifaceted condition that requires individualized assessment and treatment while the system is still running. When it comes to endometriosis, there is no research to indicate that shutting off the system decreases its growth.

According to this research by Patrick Yeung Jr., M.D., Shweta Gupta, and Sam Gieg, “Surgical management (especially by an expert surgeon) has been shown to be beneficial in reducing pain, improving infertility, and preventing progression or recurrence of disease. Postoperative hormonal suppression helps reduce pain symptoms and recurrence of endometriomas, but it does not seem to prevent disease recurrence or progression of peritoneal endometriosis, and has not been shown to improve future fertility…” 

Endometriosis is a surgical disease. Mainstream OB/GYNs do get trained to surgically remove endometriosis, but it is not extensive. The focus remains on symptom suppression via birth control before and after surgery.

“One area that I didn’t get a lot of experience in residency was a really good diagnostic laparoscopy…so using the scope to look around the pelvis thoroughly; adequately; methodically for endometriosis or other abnormalities…we weren’t taught that at all in residency…and learning how to properly treat endometriosis using a laser…”

Jillian Stalling, MD, OB/GYN, “Voices in the Desert” Video, The Story of the Pope Paul VI Institute

This doesn’t mean that there aren’t many good mainstream doctors who care deeply about women and sincerely want to see their fertility improved and symptoms relieved. The doctor who performed my first surgery and finally diagnosed me was one of them. But it is important to fully understand what we are getting when we select our physician, and especially when we sign up for surgery.

NaPro

According to Dr. Casey McGraw, M.D., a fellowship-trained urologic surgeon, “Others [doctors] elect to complete an additional fellowship following residency, with the goal of sub-specializing and mastering a specific area of medicine… ‘Fellowship-trained” simply means that a physician has shown the highest level of dedication to their chosen field and has achieved the highest level of training possible.‘ “

In order to become a NaProTechnology-trained surgeon, one must complete the St. Paul the Great Fellowship.

“The Saint Paul VI Institute for the Study of Human Reproduction under the direction of Thomas W. Hilgers, MD, has established a one-year fellowship training program in Medical and Surgical NaProTECHNOLOGY. It has been named after Pope Saint John Paul II who was very supportive of the education and research efforts at the Saint Paul VI Institute. On February 17, 2004, the textbook on NaProTECHNOLOGY was officially presented to him.

The purposes of this fellowship are the following:

1. To provide an opportunity for obstetrician-gynecologists who have completed their residency to acquire additional skills in approaches to the treatment of women’s health problems which are designed to cooperate with the menstrual and fertility cycle.
2. This would include advanced study in reproductive endocrinology and its application to such conditions as infertility, repetitive miscarriage, premenstrual syndrome, postpartum depression, recurrent ovarian cysts, etc.
3. This fellowship would also expose the individual to the surgical procedures and specialized techniques which are specifically designed both endoscopically and via open laparotomy approaches to be “near adhesion free” procedures.
4. The individual physician would have the potential to become eligible for certification through the American Academy of Fertility Care Professionals as a FertilityCare Medical Consultant…”

See a recent Instagram post from NaProTechnology-trained surgeon, Dr. Naomi Whitakker, M.D., OB/GYN, that further illustrates this unique style of treatment.

NaProTechnology surgeons are also some of the few who will perform an ovarian wedge resection, which is the closest one can get to healing PCOS. Read more about the NaPro approach to PCOS management here.

Helpful Hint: Surgery is the gold standard for endometriosis diagnosis. Excision, which is a technique used to cut the disease out at the root versus being burned off at the surface, is the gold standard of surgical endometriosis removal.

According to comments given by Dr. Gavin Putoff, M.D., during a lecture, when endometriosis is excised by a mainstream or NaPro doctor, 80-90% of patients will have a significant improvement in pain level. He also added that the recurrence rate when using excision is 18-20% and rises up to 80% when burning is used. So no matter who your doctor is, ask whether or not they plan on using excision to remove the disease.

2. Use of Birth Control

Mainstream

Three other mainstream physicians prescribed the pill for me without digging into the root cause of my pain, ultimately leaving me with a disease undiagnosed and, therefore, untreated. The first was most notable because it was during my first OB/GYN appointment right after I got my first pap smear. I was eager to engage in some dialogue about what seemed to me to be very painful and heavy periods by age 19, but she wasn’t interested. She just asked me “What kind of birth control do you want?“

About 5 or 6 years later, the doctor (mainstream) who diagnosed me was the first physician to truly listen to me. I will never forget the ironic wave of relief I felt when she told me “You’re not crazy. Your symptoms are real and likely being caused by a disease called endometriosis.”

She had just personally watched my ultrasound take place and that’s when she found what was eventually confirmed to be an endometrioma, scheduled surgery, and then became the fourth mainstream doc to talk to me about birth control. She instructed me to begin taking it immediately and to continue taking it after the procedure. I considered it, but ultimately declined.

It should be noted that birth control typically carries its own array of unwanted side effects and potentially serious health risks, but does tend to be a relatively easy means of decreasing or eliminating symptoms of women’s health dysfunction. When it improves symptoms, it is possible for them to return even while hormonal suppression is continued (remember, endometriosis can continue to grow).

Napro

According to the FertilityCare Centers of America website:

“Based on over thirty years of research and practical application, NaProTECHNOLOGY (Natural Procreative Technology) is a women’s health science which has, as its main principle, the ability to work cooperatively with the woman’s menstrual and fertility cycle.”

In other words, NaProTechnology physicians do not prescribe birth control.

Dr. Margot Anderson, M.D., told me that in order to attend the training to become a NaPro Medical Consultant, she had to sign a form stating that she will not prescribe birth control. Certified NaProTechnology Medical Consultants are bound by this as a part of their ethics.

Helpful Hint: Some doctors will attend the training, but not all will become certified or maintain their certification. So, there are some doctors who have received the NaPro training, but have “gone rogue,” so to speak, and may or may not choose to follow all of the protocols and may be open to prescribing birth control. If having a certified NaPro doctor is important to you, find one at fertilitycare.org.

It is true that there are some situations where women experience such severe symptoms, that it could be considered impractical for her to not be on birth control, at least temporarily. I was one of those women and although I still chose not to be on birth control, I completely understand why some women do choose it and that decision needs to be respected. Surgery is not always an option for everyone.

I only needed to tolerate my most severe pain for several months until I could get to my 11th surgery where my adenomyosis was finally diagnosed and removed, which ended up giving me great relief. In the meantime, I used narcotics temporarily, in addition to strong anti-inflammatories, heating pads and hot baths, supplements, made diet changes, and required a few Toradol (strongest anti-inflammatory) injections and three ER visits for morphine.

If you do choose to use birth control, please be aware that sex on fertile days can result in a pregnancy that will likely be terminated if breakthrough ovulation occurs. Consider charting while using hormonal birth control so that sex can be avoided if a fertile window is identified.

Helpful Hint: Many women engage in a stressful search for a gynecologist who will respect their decision to not use birth control, no matter the reason, and to use fertility awareness/NFP instead. For the first several years of my young adult life, I thought I needed a gynecologist for my annuals and to manage symptoms – but not everyone does.

After hopping from mainstream gyno to gyno, I realized that I could use my local NaPro medical consultant (regardless of the FA/NFP method used) for medical visits and consult my long-distance OBGYN surgeon when necessary. My local NaPro doctor is also my primary care physician who can do pelvic exams and give pap smears. She is not considered a specialist, so my insurance covers more of the financial cost. I haven’t seen a local OB/GYN since 2015.

You will need an OB/GYN, midwife, or doula if you get pregnant, eventually. The NaPro medical consultant can monitor and manage progesterone levels (if needed) until it’s time to see the person who will deliver your baby. NaPro Medical Consultants also offer highly effective treatment for postpartum depression whether or not Creighton is being used for charting.

3. Use of Charting

Mainstream

Mainstream doctors do not receive education in regards to any natural charting system. Dr. Margot Anderson, M.D., explained to me that the efficacy of fertility awareness based methods (FABM) are not acknowledged by most doctors or medical school faculty. And even if they were, there would not be enough space in the curriculum to fit it in.

Helpful Hint: FACTS is an excellent organization that focuses specifically on educating medical professionals and students about how FABMs work and how they benefit patients.

None of my mainstream physicians have attempted to gather any information in regards to biomarkers of my menstrual cycle to inform their diagnostic or treatment plan.

NaPro

The FertilityCare Centers of America website continues:

“NaProTECHNOLOGY relies on the CREIGHTON MODEL FertilityCare System (CrMS) biomarkers to monitor easily and objectively the occurrence of various hormonal events during the menstrual cycle. CrMS provides valid information that can be interpreted by a woman and by physicians who are specifically trained in this system.

NaProTECHNOLOGY is the first women’s health science to network family planning with reproductive health monitoring and gynecologic health maintenance unlike common artificial and suppressive approaches. This is a fertility-care based medical approach rather than a fertility-control approach that provides medical and surgical treatments.

NaProTECHNOLOGY identifies the problems and cooperates with the menstrual and fertility cycles that correct the condition, maintain the human ecology, and sustain the procreative potential…”

It took me roughly 12 years to be diagnosed with endometriosis within the mainstream gynecology machine. After I began with the Creighton Model System, I sent a copy of 2.5 cycles charted to the surgeon who created NaProTechnology, and without stepping one foot into his office, he was able to tell me:

“In reviewing the Creighton Model chart, the following observations are made: It reveals intermediate-limited mucus cycles and tail-end brown bleeding. These findings are often associated with hormonal dysfunction, ovulation defects, endometriosis, chronic low-grade endometrial infection, chronic inflammation of the cervix, pelvic adhesions, and/or blockage of the fallopian tubes.”

He recommended “a thorough hormone evaluation of [my] menstrual cycle (without medications), a thyroid system dysfunction panel, and a diagnostic laparoscopy, hysteroscopy, and selective hysterosalpingogram with endometrial cultures.”

He added that “I do realize that you have had a laparoscopy in the past [mainstream; took place only one month prior to the charting he is referring to]; however, the endometriosis was treated in such a way that it has a high recurrence rate and scar tissue formation…it is imperative that a gynecologic surgeon use meticulous antiadhesion techniques in order to preserve your fertility.”

It should be noted that a lot of time, effort, patience, and commitment are required to gather the important information that charting provides. It is, by its nature, very different than birth control and calls for quite the lifestyle change.

4. Attitude towards fertility

Mainstream

“Well it seems like in medical school and even in my residency training, there’s this philosophical undertone in the training that pregnancy…is a preventable disease. So it is with that kind of underlying attitude, there is not a lot of respect for the woman’s fertility. It is sort of something that can be…tossed aside.”

David Parker, MD, JP II Fellow, “Voices in the Desert” Video, The Story of the Pope Paul VI Institute

Although I quickly learned that we disagreed on quite a few things, I really liked the mainstream OB/GYN that performed my first surgery. Despite our differences, I did get a sense that she truly wanted me to find physical healing and preserve my fertility.

However, despite her heart being in the right place, I noticed a fundamental difference between her attitude towards a woman’s fertility and Dr. Hilgers’. I stuck with her through my first few post-op appointments even after I flew to Omaha two separate times to have my first and second NaPro surgeries, and even though I cancelled my second local surgery that was scheduled with her. She must have thought I was crazy. But over time, we ended up engaging in a good bit of dialogue.

She made it clear that her game plan for preserving my fertility after surgery would be use of birth control – the shutting down of fertility – until I was ready to get pregnant. (Refer back to this research for one reason why that was unlikely to be effective if appropriate surgical technique was not used.) I was not comfortable with this over-simplified plan of action – or lack of action?

During my pre-op, she explained that she would do everything she can to preserve my fertility, but if she would find the damage to be too severe, she wanted my permission to remove one or both ovaries and/or my uterus during surgery while I was under anesthesia – then handed me a pen to sign on the dotted line, which I did because I didn’t know any better at the time.

Thankfully, I kept all my reproductive organs. But because I never went on birth control, I was aware that my symptoms never actually improved. Three months later, I learned that I now had 2 endometriomas and she scheduled a second surgery – again explaining that she’d do her best to keep all my organs intact, but this time promising to be more aggressive.

NaPro

The first time I ever heard of Dr. Hilgers, M.D., the creator of NaProTechnology, was when he was being interviewed on the radio. He caught my attention when he said he never prescribes birth control – a physician who doesn’t prescribe birth control? Does that exist?

Still shocked, I picked myself up off the floor as he continued. He described his attitude towards a woman’s fertility with such reverence that it took me by surprise because I hadn’t heard very many people speak like that outside of well known authors and speakers – much less a male OB/GYN. He explained that a woman’s fertility is an integral part of her whole person, and that she and her fertility should be dually respected and cherished. And this was part of what inspired the development of NaProTechnology.

I live in the South and he practiced in the middle of the U.S. I had never been on an airplane and already had my second surgery scheduled locally with my mainstream doctor. The moment that interview ended was the moment I decided to cancel my local surgery and fly to Omaha, NE instead. My fertility was too important to be put into the hands of someone who, despite her very best intentions, didn’t understand how to truly appreciate it. I needed someone I could trust wholeheartedly, whether I was engaging in dialogue or unconscious on an operating table.

I have never been asked to sign a paper giving permission to any of my NaPro doctors to remove any reproductive organs in 10 surgeries because that was never an option. There was one exception – after several surgeries, I requested that the doctor remove a problematic ovary so that I could ovulate out of the good one every cycle. He agreed.

5. Time Spent

In one of her blog posts titled “Direct Primary Care – a contract between you and me,” NaProTechnology Medical Consultant, Dr. Margot Anderson, M.D., explains how mainstream medicine tends to work:

“Doctors are increasingly losing their autonomy and find themselves working under the constraints of a hospital administrator or an insurance company. They are incentivized to see as many patients as possible in a limited block of time because each patient visit means another bill sent to insurance…

When I started to look at job opportunities, I found out how the majority of primary care physicians are paid. The hospital systems I talked to said, “you’ll have a set salary for the first year and then you will switch to a production basis.” …[meaning] I would be incentivized to see as many patients as I could possibly fit in one day because each patient visit equaled a bill to the insurance company and thus earnings for the clinic…”

Mainstream

Time spent in individual doctor appointments with all 4 of my mainstream doctors were minimal, lasting 15-20 minutes max. This leaves about enough time for a little conversation, a pap smear and/or pelvic exam, and a birth control prescription.

My surgery lasted 1.5 hours.

NaPro

NaPro treatment can be divided into two parts: surgical and medical management. The surgeons complete the fellowship and the medical consultants receive other additional training in regards to medical management.

Not everyone needs a surgeon, but some women do. Depending on the situation and accessibility, the surgeon will operate and then he or she will often refer to a NaPro Medical Consultant (typically a primary care physician, family medicine doctor, or nurse practitioner) to take over the medical management. Both use the Creighton Model chart to direct assessment and treatment.

Because the chart is being used in this way, the NaPro physician, by nature, tends to spend much more time with each individual patient – which is often to the detriment of their own income. Each doctor’s office may operate a little differently, but because the foundation of this style of treatment is individualized and applies to the whole woman, it requires more in-depth dialogue, medical history review, and other information to be gathered during appointments.

The model of direct primary care that Dr. Anderson (referenced above) uses for her practice is unique and gives her even more flexibility, allowing her to devote more time to her patients. Direct primary care is not as common, but it is a model that can be utilized by both mainstream doctors and NaPro physicians.

Although my situation was unique and not all surgeries take quite so long, my NaPro surgeries ranged from 6.5 to 8.5 hours. I believe this speaks again to the appreciation given for my fertility. Our reproductive organs are precious and delicate, and there is a lot of area to cover. It takes time to operate carefully and thoroughly.

6. Adhesion Prevention

Adhesions are also referred to as scar tissue. All surgeries, regardless of the area of the body they are performed on, produce scar tissue. The amount of scar tissue produced is dependent on each individual person’s body. Some people produce more than others and there is no way of telling the degree to which it will form prior to surgery.

Scar tissue by itself can cause pain, infertility, and other problems. This is one reason why many physicians are hesitant to perform surgery in the first place.

Mainstream

I’m not aware of any additional training given to prevention of adhesions, or scar-tissue, during or after surgery for mainstream gynecologists.

NaPro

Dr. Hilgers, the creator of NaProTechnology, has devoted over 23 years of research to decreasing adhesions associated with surgery. He was able to decrease adhesion scores from 33.2 to 2.5! All surgeons who complete his fellowship receive this training.

If you’re a nerd like me, you’ll want to read the whole research paper because it’s fascinating. But here is an abstract if you don’t have so much time on your hands: Near Adhesion-Free Reconstructive Pelvic Surgery: Three Distinct Phases of Progress Over 23 Years | Journal of Gynecologic Surgery (liebertpub.com)

7. Additional Support

Our women’s health needs are individual and vast. Regardless of their approach to treatment, each doctor is unique and some will have more knowledge and willingness than others to try new things and provide an array of treatment options and/or supplement recommendations.

Mainstream

The extent of my personal options for treatment were surgery (after roughly 12 years of pain) and birth control. I was given 3 diagnostic ultrasounds ordered by 2 different doctors.

NaPro

Once again, the Creighton Model Charting System is the foundation of NaProTechnology. Users are taught to chart by a Practitioner, who is trained to identify (not diagnose) a multitude of risk factors that can show up in the chart. If any are present, he or she will refer the user to a NaPro physician who uses that information to direct their assessment(s) and treatment. As a result of years of research and the standardization of the Creighton charting system, many different protocols have been developed to serve a variety of different women, situations, and reproductive categories.

One of my diagnoses, endometriosis, is often associated with limited cervical mucus (as determined by the Creighton-specific mucus cycle score) and low progesterone, two things that can be easily visible on a Creighton chart. Subjective pain levels are also evaluated by Creighton Practitioners as a part of the structured follow ups.

Here is some of the additional support I have received over the years in addition to surgery:

-multiple targeted (appropriately timed within the menstrual cycle) hormone levels drawn to assess my estrogen and progesterone levels

-bio-identical (chemically identical to what the body produces; not synthetic) progesterone and estrogen to supplement what was low (charting is needed to take these hormones at the right time within each cycle).

Each woman absorbs medication differently, so many NaPro doctors will give progesterone, for example, orally, vaginally, via intramuscular injection, OR through subcutaneous HCG injections (to help the woman make her own progesterone) to ensure they are able to find which avenue for supplementation is most effective.

-various supplements to improve my cervical mucus production, which is vital to achieving pregnancy

-labs to evaluate vitamins and minerals followed by appropriate supplementation

-various thyroid assessments followed by appropriate supplementation

-at one point, it was determined that my unusual bleeding was due to an endometrial infection, so my husband and I were both given an antibiotic to take for a certain period of time.

-3 of my NaPro doctors have recommended several supplements to improve ovarian support, promote regression of endometriosis, and decrease inflammation

-an anti-inflammatory diet has been recommended by all of my NaPro doctors

-Many diagnostic ultrasounds (also important to be targeted to the right time of the menstrual cycle depending on what the doctor is looking for) and 3 MRIs.

Conclusion

As you can see, there is quite a bit of difference not only between the two styles of medical and surgical practice, but between the philosophies that drive each person. It is important to understand how your doctor practices so you can make the best decisions for yourself and your future.

Let’s recap:

• NaPro-trained surgeons complete one extra year of surgical training (fellowship).
• NaPro Medical Consultants receive extra training in regards to medical management.
• The foundation of mainstream gynecology seems to be birth control, essentially shutting the fertile system down.
• Birth control adds side effects and risks and doesn’t address underlying issue(s), but does tend to be a relatively easy way to improve symptoms. These can return long-term even while BC is continued.
• NaPro doctors do not prescribe birth control. The foundation of NaProTechnology is the information gathered from the woman’s body via the Creighton Model Charting system, which directs treatment.
• Charting requires a lot of effort to gather the info it provides. It is very different from birth control and calls for quite the lifestyle change.
• NaProTechnology is driven by the goal of identifying and treating underlying problem(s).
• You may be asked to sign permission for a mainstream surgeon to remove reproductive organs during surgery if they deem necessary. It is unlikely that a NaPro doctor will ask you to sign such a form.
• It is more likely that a NaPro physician will spend more time with his or her patients due to the nature of treatment.
• NaPro surgeons receive additional training in adhesion prevention.
• NaPro physicians offer additional support via protocols.
• There are excellent physicians who practice restorative reproductive medicine outside of NaPro, too.
• Surgery is the gold standard for endometriosis diagnosis. Excision is the gold standard for surgical treatment.

It’s pretty simple to find a mainstream gynecologist. There are much fewer NaProTechnology-trained surgeons, but another reason I like to recommend them is because out of the physicians who practice restorative reproductive medicine, NaProTechnology has a vast searchable network both nationally and internationally.

Browse here for the U.S. Browse here for Europe. Browse here for Australia. There are physicians who practice in Latin America, but I am unaware of a searchable database for that location at this time.

Search here for a network of FEMM doctors who provide restorative reproductive medicine outside of surgery. These doctors can use FEMM or Billings charts to direct treatment.

Final Thoughts

For me, the biggest difference between mainstream and NaPro is in the opposing philosophies and approaches to fertility and treatment as a whole. If a physician is willing to prescribe birth control and/or refer for artificial reproductive technologies, it tells me a lot about his or her perception of women, relationships, and the integration of her fertility with her whole person.

Even at their best, no doctor or treatment plan is perfect. Both NaPro and mainstream doctors can make mistakes and poor decisions. I have had large improvements in pain and some improvement in hormonal management but have never been pregnant. NaPro is not a fool-proof miracle cure that will make everyone’s problems go away and it shouldn’t be pushed as such.

No doctor, diet, method, or speaker can promise a pregnancy or 100% pain relief. But we can expect to be heard and for our underlying issues to be sought and addressed. All women deserve that. I want to see a doctor whose core mission is to treat each woman cooperatively; to listen to what her body is communicating and respond holistically. Not everybody wants that and that’s okay, but I hope this information helps you to make decisions that are informed.