In standard reproductive health care, a woman with cycle irregularity or painful bleeding is often trialed on different oral contraceptive pills to ‘regulate’ her period and lessen the pain, despite limited evidence to support this approach 1. This approach is suppressive, in that it turns off the normal hormonal cycle and with that provides a ‘regular’ bleed that is chemically induced 2. It doesn’t address or correct the underlying issues such as abnormal ovulation or endometriosis. Those problems often return when the patient stops the pill or wants to try and become pregnant.
In RRM, patients are taught how to chart their cycle, using one of several methods that are based on published science 3 This would help the medical provider identify the pattern of the bleeding and determine what the most appropriate cooperative (timed to the body’s cycle) tests to do are. It will help the physician know if the patient is likely ovulating normally or not. For instance, a woman with a 34 day cycle who bleeds for 5 days, followed by brown bleeding for 5 days, with a normal mucus pattern (this is the cervical fluid that indicates the time around ovulation) and a short time after ovulation to their period may have low progesterone and sub-optimal ovulation. Ovulation induction medication and luteal phase (after ovulation) hormonal support can result in a perfectly normal cycle chart and normal hormones measured seven days after ovulation and normal function. Other treatments that work with the cycle may also be used once a diagnosis is made.
The physician may also see patterns that would make them concerned about endometriosis. Treatment can then be directed towards special surgical techniques that identify and remove most of the lesions. Medical therapy can work towards normalizing estrogen and progesterone levels and using other cooperative therapies to minimize recurrence and manage pain.