Ask Dr. Bob: Know About Endometriosis as a Cause of Pelvic Pain

Dear Dr. Bob:
"I have had problems with severe menstrual cramps and pelvic pain since I was 13. At that time, my doctor told me that I likely had endometriosis. I was given Naproxen, which is an anti-inflammatory medication or NSAID, for pain and placed on the birth control pill - neither of which helped a whole lot. Now as a married adult I am having trouble getting pregnant. I consulted a fertility specialist and was told that my best option for having a baby was in vitro fertilization [IVF]. I am uncomfortable with this option because IVF results in "embryo wastage"- freezing or destruction of unused embryos, and I believe that human life begins at conception. I had heard about NaPro Technology from a friend who said this might be helpful to me. Can you explain?

Dr. Bob Responds: 
You have asked a pretty complex question here. I will try to address your question in the following sections:

First: What is endometriosis and who is affected?

Endometriosis is a common condition that can cause painful menstrual cramps [dysmenorrhea], pelvic pain, irregular cycles and/or infertility in adolescents and adults. It is frequently first noticed during the teenage years. According to a review in Up-to-Date, an online medical textbook, the disease has been reported in 25 to 38 percent of adolescents with chronic pelvic pain and 47 percent of those with chronic pelvic pain that undergo laparoscopy, a surgical procedure done through 1-4 "mini-incisions."[1] Among adolescents undergoing surgery for pelvic pain not controlled with oral contraceptive pills [OCs] and NSAIDS, endometriosis was found 50 to 70 percent of the time. So, it's not surprising that your symptoms were not completely relieved with the treatment you received. I am also hopeful that your doctor evaluated you for other causes of pelvic pain, which can include ovarian cysts, sexually transmitted infections and problems affecting other organs like your bladder or intestines.

Endometrial implants are pieces of endometrial tissue, similar to that found in the lining of your uterus, except that these implants live on other surfaces within the abdomen-outside of the uterus. Under the influence of your cyclic hormones endometrial implants swell and become inflamed. The inflammation causes pain and can also disrupt monthly hormone patterns, potentially contributing to infertility. Endometriosis can cause blockage of ovarian tubes and irritation of other pelvic organs and tissues. 

article continues at http://www.fertilitycarefriends.org 

Dr. Bob Motley is the 2013 Recipient of the Drs. Gino and Mary Papola Award for his outstanding contributions to Catholic Health Care in service to Christ and His Church.

Dr. Bob is an FFC Board Member and involved in its Mission.  He  was the previously the Director of the Philadelphia Catholic Medical Association Medical Student programs and is a guiding force in the education of medical professionals and couples in the use of Natural Family Planning.   

The Friends of FertilityCare Philadelphia are a group of health care professionals and members of our community who wish to promote effective, integrated health care for women and couples. To that end, the Friends of FertilityCare are dedicated to making Creighton Model FertilityCare services and NaProTechnology known, respected and applied throughout the Greater Philadelphia region. The primary intention of the Friends of FertilityCare is to educate all people in the "good news" of Creighton Model FertilityCare System and NaProTechnology.

A Step Further: An Interview with Abby Johnson

by Sylvia Dorham, FCP

Abby Brannam-Johnson, former Planned Parenthood worker, whose journey to a pro-life point of view is chronicled in her best-selling book, Unplanned, recently began her studies to become a Creighton Model FertilityCare Practitioner.

Although suffering from a debilitating pregnancy-related condition, she took time to answer some questions about how she came to Creighton when I caught up with her at her home on May 2, 2013.

You've told the story in other places about how you realized you needed to stop contracepting. Tell the story of how you were introduced to NFP.

 A couple of my "new" friends (since I had lost all of my friends at the clinic) were NFP users. I had always believed NFP was ineffective and always told myself that I would never be one of  those dupes that actually believed you could prevent pregnancy with a calendar. I really didn't know what NFP was and how it worked. I only knew what I had been told by Planned Parenthood...which was not accurate information. One of my friends was using it for PCOS and that really got me looking into it. I realized that it had to be more scientific than I originally thought.

What were your thoughts that led you to decide to teach it?

I really saw it as a way to minister to women and men. I am so committed to helping people understand the dangers of contraception, it just seemed like a natural next step. I love NFP and I really wanted others to see how wonderful it was.

How did you choose a model? 

The Creighton Model is very scientific and medical. It can help couples with infertility. It can help with diagnosed gynecological conditions. I knew that I would have a hard time getting pregnant after my Mirena IUD was removed, so I wanted to go with the model that would be most effective with infertility.

On your blog, www.abbyjohnson.org, you call yourself  'a fighter, a defender of women.' How does teaching NFP fit into this calling?

I feel like we are fighting against a contraceptive culture. Women are tricked into believing that birth control is the ONLY thing that can help them with their health and with their futures. My goal is to show them a better way and to defend them from this contraceptive mentality that runs rampant in our society.

How does NFP fit into being pro-life?

Well, if we believe as pro-lifers that life begins at conception, then we MUST be against hormonal birth control, as it can take the life of a newly-conceived child. It seems pretty simple to me. My goal is to help other people see that connection.

How can we do a better job of 'selling' NFP?

I think we just have to sell facts. Once people know the truth about NFP and how it really works, NFP sells itself.

Unity issues in the pro-life community are similar to unity issues in the greater NFP community. How do we create unity?

In any community there will always be a sort of competition. I don't think it is a problem unless it starts to damage our message. I support all of the NFP methods, but personally feel like the Creighton model is superior...simply because I have used it myself and I have seen it work for so many couples. But that doesn't mean the other methods aren't valuable. We all have to support what we believe is best. The overlying issue is whether we believe some type of NFP is suitable for all women...and I hope we do.

Will being an FCP be your primary focus, or do you plan to keep up your speaking schedule?

I will continue to do both. Eventually, I hope to move into being an FCP in a more full-time capacity. As I go around and speak, it is an opportunity to educate the public about NFP.

Your message focuses on loving the workers of the abortion movement and hating the sin of abortion. How can Jane Everyday do the most good for the unborn and their mothers?

We just all have to find our calling in the pro-life movement...and I do believe that everyone has one. With one in three women having abortions in just our country alone, it is no longer enough to just pray at home. We must be active and do everything we can to spread the pro-life message. It is time for us to step out of our comfort zones and get very uncomfortable. Lives depend on it.

Finally, you're addressing Creighton practitioners and NaPro Doctors - what would you like to tell them?

I would like to simply encourage them to keep on spreading the truth. We are going against the grain and are trying to create a paradigm shift. It is not an easy task, but we must be committed.  The more we talk about our work, the more we will encourage others to join us in this fight.  Visit abbyjohnson.org for more information about this courageous pro-life woman

Abby Johnson is an author and pro-life advocate. 

Sylvia Dorham, FCP is a Pro-life author, speaker and voice-over artist. She is also a Creighton Model FertilityCare Practitioner.

The Creighton Model FertilityCare Practitioner education program can be completed in as little as thirteen months. Graduates of the program are considered allied health professionals. The educational program beginning September 14, 2013 will be sponsored by the Marguerite d'Youville FertilityCare Center of Manchester, NH. More information at http://library.constantcontact.com 

Plans for New Philly Healthcare Option for Women - St. Gianna Center!

by Christine Rizzo

Philadelphia, PA - Interested Philadelphians met at St. Francis Xavier Church on May 11, 2013 to discuss the possibility of a NEW Philly healthcare option for women-The National Gianna Center for Women's Health and Fertility._TM Icon

The Gianna Center, now operating in New York and New Jersey, is a medical practice, which offers women both primary care and specialized OB/GYN care in the same office. The existing Centers offer Catholic women, as well as women of other faith traditions, a new alternative for comprehensive healthcare including primary care, obstetrics, natural family planning and treatment for infertility that honors their dignity and the sanctity of human life.  They are members of the St. Peter's Healthcare System, formed in 2007, that offers an expansive scope of health and wellness services we offer to local communities.

The first seeds planted for this meeting began in late March, when Cardinal Timothy M. Dolan, serving the Archdiocese of New York, wrote to his brother Bishops asking them to consider joining him in supporting a National Gianna Center in their diocese.  Ronald C. Rak, President and CEO of St. Peter's Healthcare System, at the invitation of the Archbishop of Philadelphia, Charles J. Chaput, spoke to the small group of interested Philadelphians, including doctors, nurses, business people, non-profit leaders and clergy,  asking them to consider "sharing resources in an effort to establish a Gianna Center in Philadelphia."   

With two centers up and running and four other dioceses requesting the same, St. Peter's has developed key collateral to share with communities that are ready to make a difference in women's healthcare.  Sharing resources like a national marketing team, grant and funding sources and universal quality standards, St. Peter's leadership team seems ready to partner with local communities.   "There's safety in numbers," one participant remarked. Most agreed there would be real power in a common name and identity if The Gianna Center seeks to grow nationwide.    

To Motherhood & Children

Excerpts from Dr. Kathleen Berchelmann 

As Mother's Day is nearing, children are always in the mix of the conversation . . .

And if you are a Mom of four children, like Dr. Kathleen Berchelmann, and happily announce the expected arrival of your fifth, be prepared to hear, exactly what she did:

"Do you hate money?"

"Are you done now?"

"Are you crazy?"

"Was this planned?"

"Don't you know there are things you can do to prevent this?"

"You must be Catholic or Mormon."

Critics of large families mention the burden that our children will be on society and the Earth.  Parents with large families hear about the health care costs that their children will generate and the size of their family carbon footprint.  Others express concern for the marriage, worried that the couple will be too tired, have financial stress, or not have enough time for each other.

Here's Dr. Kathleen Berchelmann's wonderful opinion on her and her husband's "problem":

Here's my question: why can't we look at children as future contributors to society, not burdens on society?  My children are the best gift I have for society.  Children bring hope for the future and model unconditional love.  Have we forgotten?  It is the sign of a dying society when we see our children as burdens rather than beacons of hope, future innovators. 

The National Center for Health Statistics says the over all birth rate in 2011 is the lowest in this country since 1920. As a college-educated Caucasian female, I am predicted to have 1.6 children per 2011 statistics.  America's overall fertility rate is 1.96, according to the latest fiqures from the Centers for Disease Control & Prevention, which is below the replacement rate of 2.1. The replacement rate refers to the number of children each woman needs to have to maintain current population levels, or zero population growth.

 We do not have an over-population problem in the United States, we have a low-birth-rate problem.  Experts predict that global population is also slowing.  This trend is likely to continue as contraception becomes increasing availability in the developing world.  When birth rates fall below replacement rates societies suffer.  The average age of the population increases, creating a top-heavy society with heavy heath-care and resources needed. But I'm not having kids to re-populate the earth, I'm having kids because I love them.  Yes, I will have a few more years of diapers and crying babies at night, but the rewards are many.  Here are my favorites:  

• Children keep me young and joyful.  I have to turn my anxiety off and play pretend with my 4-year-old, I rest every few hours and breastfeed my baby, and I share my six-year-old's delight in drawing a dream-house with fifteen stories.  They get me to eat home-made snow cones and play in the rain.  I play outside almost every day.  Do you?     

• Younger kids bring joy out of my older kids.

• No matter how grumpy they get.  My son can have a terrible attitude, but when his baby sister wants to play with him, he always smiles and obliges her.

• Life is never boring!  Our kids are each so unique, so different from the others.  And they keep growing and changing.  We never know what to expect.

• I don't sweat the small stuff anymore.  I used to clean and polish away every nick in my wooden furniture and keep my bathroom spotless.  These days I figure a few marks in my furniture adds to their antique value.  I find fingerprints on my bathroom mirror endearing.

• Parenthood makes me work hard. Without kids, I'm sure I'd watch more TV, drink more wine and become a more selfish individual.  With kids, I'm forced to think of others and avoid self-absorption.  Kids make me realize how ridiculous I can be.

• One of my kids complains about dinner almost every night.  It's really annoying.  Then I realize there are things that I complain about too much, too. There is nothing like parenthood to keep you humble.  Just when you think you have it all figured out, they throw you another curve ball.

• I want less stuff.  I keep thinking, if we had fewer kids and more disposable income, what would I do with it? Drive a fancier car, live in a bigger house?  I don't want a fancier care and certainly don't want to clean or care for a bigger house. 

Some people worry that we won't be able to give each of our kids the one-on-one attention that they need.  Because we home school, our kids get plenty of individual attention every day. A new baby is perhaps the best gift you can give to your other children.  A 14-year-old from a family of five told me, "I can't imagine not having siblings.  That would be my worst nightmare.  It would be lonely." 

Kathleen M. Berchelmann, M.D., is a pediatrician at St. Louis Children's Hospital and Washington University School of Medicine, director of the St. Louis Children's Hospital Social Media Team, and co-founder of the ChildrensMD hospital physician blog. Her work has been featured in print and online publications including the St. Louis Post-Dispatch, the Chicago Tribune, and TIME magazine. She is a frequent contributor to Fox2 News STL Moms. Kathleen and her husband are raising four children.

On Lent, Chocolate, and the Meaning of Love

By Damon Owens

February's calendar carries lessons in perfect love for all of us. The back-to-back celebrations of Ash Wednesday [February 13] and St. Valentine's Day [February 14] may give pause to those considering a Lenten chocolate fast, but the beautiful complementarity of placing our cultural ode to romantic love within the purifying frame of sacrifice, prayer and preparation for the Resurrection of Christ should not be missed.  

This is a bold symbol of perfect love in our Christian call to purify eros through agape!

The mystery and importance of human love in God's Divine plan has been a major emphasis of the Church for the last 50 years. It is no coincidence that Pope Benedict XVI's first encyclical God is Love explored the distinctions and complementarities of eros [passionate, seeking love] and agape [free gift of self] in our life, and in their profound connections to God Himself as Eros and Agape. Benedict launched - and firmly placed - his papacy in the "heart" of man and woman made in the image and likeness of God.     

True love is good. Love is of God. But not all love is the same. Passionate love without willful direction to the true good of the other quickly deforms into a using, self-seeking lust. Self-gift without an inner longing for the good of the other becomes cold, mechanical duty. Who wants to be used or merely someone else's duty?

This is a bold symbol of perfect love in our Christian call to purify eros through agape!

The mystery and importance of human love in God's Divine plan has been a major emphasis of the Church for the last 50 years. It is no coincidence that Pope Benedict XVI's first encyclical God is Love explored the distinctions and complementarities of eros [passionate, seeking love] and agape [free gift of self] in our life, and in their profound connections to God Himself as Eros and Agape. Benedict launched - and firmly placed - his papacy in the "heart" of man and woman made in the image and likeness of God.     

True love is good. Love is of God. But not all love is the same. Passionate love without willful direction to the true good of the other quickly deforms into a using, self-seeking lust. Self-gift without an inner longing for the good of the other becomes cold, mechanical duty. Who wants to be used or merely someone else's duty?

These are, of course, merely concepts to those first learning Natural Family Planning [NFP], and only "take on flesh" for the couples living their call to holiness in marriage with NFP. Daily observation and charting of their fertility - far from isolated - must be integrated with into the large and small realities of everyday life: work, finances, illness, kids, sexual desire, travel, etc.

Knowledge of the only times where intercourse can achieve pregnancy is a crucial contribution to a couple's self-knowledge, but it is only a crucial beginning. This knowledge must be ordered to their mutual love and sanctification through self-mastery. It is important for couples to see self-mastery as a self-possession that makes self-gift possible. We cannot give what we do not possess. This is a directing of our sexual power/gift/desire/drive, not a renunciation, denial or repression!

Eros will ebb and flow, but the marital pledge of agape is a self-gift that must always be in season. Whether a couple is using NFP to achieve or postpone pregnancy, success is rooted in the virtues "firm and habital dispositions to do the good" that enables a couple to give and receive themselves honestly in the sexual embrace. This is the real school of NFP where we "work out our salvation in fear and trembling." Will we allow eros as sexual desire to rule and direct itself [and us] or will we choose to direct it with

agape? Are we even capable of directing eros with agape? When we fail, do we despair or "begin and begin again?" 

This is why marriage is the school of love: it is where we learn to restore the great and complementary loves eros and agape. NFP is like that demanding teacher that draws out the best in us. Only years later do we look back in awe and gratitude at what that teacher drew out in us. 

Perhaps during this time of year, we can focus on our call to perfect eros through agape. Instead of or in addition to some renunciation, we can focus on one small, simple, concrete act of self-mastery to make a more sincere self-gift.

The calendar gives us something to meditate with Lent and Love in the Divine Plan  . . . and don't forget the Chocolate! 

Damon Owens serves as the Executive Director of the Theology of the Body  Institute and lectures around the world on Theology of the Body, NFP and the good news of sexuality and marriage. He appears regularly on television and radio and has produced several series available from EWTN including NFP:  Embracing the Marital Gift.