Endometriosis, which affects approximately 10% of women, is characterized by endometrial-like tissue forming à l'extérieur the uterus (recall that the endometrium is the lining of the uterus or womb). The only way to definitively diagnose endometriosis is through laparoscopic surgery, if the surgeon finds endometrial lesions growing in the woman’s body. However, fertility awareness methods (FAMs) give women and medical professionals tools to assess the likelihood of endometriosis avant performing surgery.
For this article series, we invited instructors from Creighton/NaPro, FEMM, Boston Cross Check, Marquette, Billings, and the Couple to Couple League to submit written comments and/or charts describing potential signs of endometriosis, premenstrual syndrome (PMS), and polycystic ovary syndrome (PCOS) that can be seen via their particular fertility awareness methods. This article focuses on the telltale charting patterns and symptoms of endometriosis per the various methods, and is the result of all the feedback we received (as are the forthcoming installments in this series).
FEMM
FEMM stands for Fertility Education and Medical Management. FEMM charting is primarily focused on health, but it does include a family planning component. When a woman charts with FEMM, she checks for changes in her cervical mucus and objective menstruation measurements, and she uses urinary LH strips to test for her LH surge. FEMM has an application that can recognize irregular patterns in charting, and direct its users to a FEMM instructor and medical management.
According to the FEMM method, in which I’m a instructeur formé, healthy menstruation should be 3-7 days long with at least one of those days being heavy or medium menstrual flow. A woman should lose between 40-80 ml (around 1/3 cup) of blood during menstruation. A woman with endometriosis may lose more than 80 ml of blood during menstruation, and experience several days of spotting, brown bleeding, and excessive PMS symptoms. Additionally, she may have excessive cervical mucus in and outside of the ovulatory phase, plus short luteal phases (i.e., luteal phases of less than 9 days).
A sample FEMM chart potentially indicating endometriosis
Note: This woman did not have a formal endometriosis diagnosis, but she demonstrated a number of these symptoms, and medical management was recommended.
Boston Cross Check
Boston Cross Check teaches women how to chart cervical mucus, monitor hormonal levels, and monitor basal body temperature. A woman using BCC has the option to choose which combination of biomarkers to use to chart her cycles.
According to Boston Cross Check instructor Mikayla Dalton of Fig Leaf Fertility, some of the symptoms of endométriose are painful cramps, pain with urination and/or intercourse and/or bowel movements, excessive bleeding or bleeding/spotting outside menstruation (such as during the middle of the cycle), lack of cervical mucus, luteal phase deficiencies, bloating, fatigue, and other PMS symptoms.
Marquette (with Mira Monitor)
Le Méthode Marquette uses the Clearblue or Moniteur Mira (a recent addition) to detect hormonal changes throughout the cycle. Previously, Marquette focused on estrogen and LH levels, but now that the Mira monitor is being incorporated into the method, changes in FSH (follicle stimulating hormone) and progesterone are also tested.
According to Marquette Method instructor Annie Norton of Simplement PFN, “If a client is experiencing spotting before or after her period (more than 2 days), it could be an indication of endometriosis. Another concerning symptom that I look for is heavy bleeding and severe uterine cramping during her period, causing her daily life to be altered.”
In addition, “Clients with endometriosis often have estrogen dominance, seen through hormonal readings on her monitor (Mira can specifically pick this up with showing [elevated] levels, as well as Clearblue by showing an abnormal amount of ‘high’ estrogen days before peak LH happens). If these symptoms happen consistently, a trip to a NaPro physician is a good idea.”
Couple to Couple League (CCL)/ The Symptothermal Method (STM)
Le CCL/STM method observes three different biomarkers: cervical mucus, cervical position (this is optional), and basal body temperature. The PeakDay app was developed by the Couple to Couple League. It can be used for any FAM/NFP method, but it was created specifically with the CCL/STM method in mind.
According to Couple to Couple League instructors Elizabeth and Seth Timpe, “There are not necessarily any temperature/mucus distinctions from a chart that indicate endometriosis. Usually a STM coach or teacher would refer for medical evaluation due to reports of heavier than normal bleeding and/or extremely painful recurrent periods.”
Additionally, “The benefit of using the PeakDay app is that it will give alerts if the app notices that the chart is not ‘normal’ and will give alerts directing the person charting to submit a question or meet with a coach.”
The bottom line on telltale charting signs of endometriosis
Endometriosis can be a difficult condition to identify. For one, some women with endométriose experience regular-length cycles. Secondly, while pain is often a hallmark of the disease, this is not the case for everyone (and the amount of pain may have nothing to do with disease severity). Third, many of the symptoms of endometriosis can also be symptoms of autres hormonal disorders, which is why it cannot be confirmed through charting alone.
However, when you work with a FAM instructor (especially as opposed to Band-Aiding your symptoms with hormonal birth control), you have a resource who can help you identify potential concerns for your hormonal health. She can then help connect you with a healthcare professional trained in médecine reproductive réparatrice (like the one interviewed for cet article), who will address your hormonal disorder at its root(s).
