Queen of Hearts NaPro Technology- Natural Treatments for Women

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Queen of Hearts NaPro Technology- Natural Treatments for Women

Queen of Hearts NaPro Technology- Natural Treatments for WomenQueen of Hearts NaPro Technology- Natural Treatments for WomenQueen of Hearts NaPro Technology- Natural Treatments for Women
Home
Infertility
PCOS
endo
PMS
menopause
Patient Handouts
NaPro Symposiums
Education
Progesterone & Pregnancy
FHA
Abnormal Uterine Bleeding
Chronic Pelvic Pain
Thyroid Problems
Vitamin D
Mental Health
Osteoporosis
Glucose-Insulin Testing
Semen Analysis
Laparoscopy
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FCP webpage
Nutritionists
My favorite Prayers
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Polycystic Ovarian Syndrome

NaProTECHNOLOGY & Polycystic Ovarian Syndrome (PCOS)

What is PCOS?

PCOS is the most common hormonal problem in women of reproductive age, affecting approximately 9% -13% of women (some experts think as much as 21%). Although PCOS is most commonly seen in younger women, it can also present for the first time in women who are in their 40s and 50s. We also know this condition runs in families. There is a 20-40% chance of a PCOS-patient having a mother or sister who is also affected. 

What causes PCOS?

The cause of PCOS remains unclear, but experts do agree that Polycystic Ovarian Syndrome is a very complex condition which is most likely caused by both genetics and environmental factors. 

What are the symptoms of PCOS?

Many women will have no symptoms at all or very mild symptoms. However, some more common symptoms are: 


  • Irregular menstrual cycles and/or long cycles: abnormally long cycles can increase your risk of endometrial hyperplasia (thickened inner lining of the uterus) and endometrial cancer. 
  • Acne: more severe than typical, may be on face, back, upper chest. 
  • Hirsutism: hair growth on upper lip, chin, nipples/chest or abdomen. 
  • Alopecia: hair loss, oftentimes at the hairline and/or at the part line. 
  • High insulin levels: most often go undetected. High insulin levels put you at high risk of developing diabetes. 
  • Infertility: PCOS accounts for ~ 27% of infertility cases.
  • Miscarriage & Recurrent Pregnancy Loss (RPL): women with PCOS have a 20-40% higher risk of having a miscarriage as compared to women without PCOS, and some experience multiple miscarriages, ie: Recurrent Pregnancy Loss (RPL).  
  • Pregnancy problems: higher risk of ectopic pregnancies, gestational diabetes, pre-eclampsia and premature birth. 
  • High cholesterol: puts you at risk of heart attack and stroke. 
  • Sleep apnea: puts you at risk of heart attack, stroke, and sudden death. 
  • Psychological problems: depression, anxiety, eating disorders and/or disordered eating are all more prevalent in PCOS pts. 


For more information on PCOS and Infertility & RPL scroll to the bottom of this page where I have posted some recent research articles on treatments. For more in-depth information on Infertility and RPL see my webpage here. 

How is PCOS Diagnosed?

Most providers will make a diagnosis of PCOS by using the Rotterdam Criteria. 

A women must have only 2 of the 3 criteria mentioned below: 


1. Oligoovulation OR anovulation

  • 1-3 yrs after first period: menstrual cycles < 21 days or > 45 days apart. 
  • > 3 yrs after first period: menstrual cycles < 21 days or > 35 days apart OR you are having less than 8 cycles per year.
  • > 1 yr after first period: menstrual cycles > 90 days apart. 


2. Clinical and/or Biochemical Hyperandrogenism (affects 60-90% of pts) 

  • A diagnosis of "clinical hyperandrogenism" will be made if you have:  significant acne, alopecia (hair loss) and/or hirsutism (hair growth). 
  • A diagnosis of "biochemical hyperandrogenism" will made if you have high androgens in your blood when we receive your laboratory results. 


3. Polycystic Ovaries (diagnosed by ultrasound on Cycle day 5 if you meet one of the following criteria: 

  • You have at least one ovary with a total volume equal to or greater than 10 mls (hint: L x W x D = sum x 0.52 = total volume.  Ovarian total volume is reported in either mls or cc's. However, there cannot be a  dominant follicle nor a cyst present in the ovary making it larger. 
  • You have a total follicle count of > 20 in one ovary. Only follicles that are greater 2 mm and less than 9 mm in size in counted to meet this criteria. 


You may view or download the American Society of Reproductive Medicine (ASRM) 2023 International Guidelines for diagnosing and managing PCOS by clicking the button below. 


Special Note: 

The Rotterdam Criteria recommends AGAINST doing an ultrasound to diagnoses PCOS in women until they are 8 yrs past their first period. However, many providers choose to do an ultrasound, which I will also want to do for you. 


The reason is because your HPO-axis has not yet had time to fully mature, and oftentimes there will be many follicles present in one or both ovaries. Younger women are also more likely to have large ovaries and irregular menstrual cycles. Thus, most experts agree to give a diagnosis of "LIKELY PCOS" until the pt is beyond 8 years past her first period, and monitor her over time. 

The ARSM 2023 International Evidenced Based Guidelines for the Assessment and Management of PCOS

PCOS Lecture for Medical Providers

Sharon presented a lecture on PCOS via a MyCatholicDoctor LIVE Webinar on September 22, 2022. The aim of this lecture was to compare current mainstream medical literature and the 2018 International Guidelines for Diagnosis and Management of  PCOS to NaPro Technology protocols. Over 40 publications were cited during this talk. 


You are welcome to watch the PCOS lecture for medical professionals here.  

Click image to view lecture on YouTube. 

What will a NaPro appointment with Sharon Best be like?

Your appointments at MyCatholicDoctor with me will be one FULL HOUR in length. Generally speaking, NaPro appts will follow a typical protocol as outlined below. However, every individual is different and your situation may warrant a more expeditious process. Please know, the Creighton Model Charting is very important. Your CrMS chart will help direct me to what diagnostic tests and imaging tests should be done and what treatment plan would be most appropriate. 


First Appt: I will take a comprehensive medical history and provide you with education about normal healthy reproduction and oftentimes about a condition I suspect you may have after we have talked a while.
I will order a pelvic ultrasound which I will ask you to schedule on day 5 of your next menstrual cycle. I will order a series of laboratory tests. Click the "laboratory tests" button below to learn more.
You will be asked to begin charting your menstrual cycles using the Creighton Model System (CrMS). Please choose a Fertility Care Practitioner (FCP)  by clicking the "Fertility Care Practitioners webpage" button below to learn more about scheduling an Introductory Session to get started. 


Note: An exception is made for patients with a pre-existing diagnosis of PCOS and who are not having periods or who are having only 1-2 periods a year. In such a situation, I will offer a "progesterone challenge".  You will be given 200 mg of bioidentical progesterone to take for 10 days at bedtime. A "withdrawal bleed" should ensue approximately 3-6 days after  the progesterone is stopped. If a bleed does not occur, we may try another challenge with 400 mg of progesterone for another 10 days.  


Please consider joining me as I pray for you here.

Fertility Care Practitioner Webpage

Second Appt:  You will be asked to return to the office in 2 mos for a follow-up appointment to review the results of your imaging and laboratory tests. Together we will also review your Creighton Model System (CrMS ) chart to look for specific biomarkers which will help me make a diagnosis. 


Please upload an image of your CrMS chart two days prior to all follow up visits and send to me via the portal. 


Please add the length of your post-peak phase and your mucus cycle score (MCS) to the R-hand margin of the chart. Your Fertility Care Practitioner (FCP) will calculate your MCS for you. 


During this appointment, you may be asked to begin some supplements and/or medications. We will also discuss drawing a full set of hormone panels. We will make a decision if you should have a peri-ovulatory estradiol panel, a post-Peak estradiol & progesterone panel, or both panels. 


 Hormone Panels: 

  • Peri ovulatory estradiol panel: start on CD8, go to the lab EOD for an estradiol draw, until you have one draw post-peak. 
  • post-Peak estradiol and progesterone panel: P+3, 5, 7, 9, and 11. See Handout #3 on the the Patient Handout webpage.  
  • Hormone panels require 2 mos of CrMS charting AND the patient must be able to confidently identify her Peak day.


Many patients will be asked to consider working with a dietitian or a nutritionist to help optimize your reproductive health. Oftentimes I may also recommend a mental health appointment to help with anxiety, depression and/or disordered eating habits. 

recommended Dietitians and Nutritionists
primary care- Mental Health Appointments

Third Appt: You will return to the office in 2 mos to review the results of your hormone panels as well as the biomarkers on your CrMS chart. Most often at this time I will have made one or more more diagnoses to identify the root cause of your symptoms. Together we will discuss a treatment plan, which will be implemented. 

Follow Up Appts: You will return to the office every 2 months. During this time, I will conduct a comprehensive medical interview to ensure your symptoms have resolved, and to ensure you are responding well and not having any negative responses to the management plan. Depending on the individual patient and your individual diagnosis, I may need to monitor your progress with serial laboratory tests and/or serial imaging. 

After 6-9 months: If medical management has not been successful AND we have not identified yet any other root cause for your problem, you may wish to move forward with a diagnostic laparoscopy. However, this would be your personal decision after we discussed benefits vs risks for your individual case. All surgeries present risks, which can sometimes be serious.  Oftentimes, we will have identified additional medical conditions which are treatable with supplements and/or medications. On occasion, I may come to know a surgical evaluation will be of benefit to you earlier on in this process, and an expedited surgical referral will have been recommended. NaPro surgeons typically book out 5 mos to 18 mos. At any time, if you feel you would like an expedited surgical referral, please feel free to discuss this with me. 


Please review my laparoscopy page. You will notice NaPro surgeries are done very differently as compared to laparoscopies done by mainstream medicine surgeons. We use a near contact approach and a near adhesion-free technique", which has been described as pelvic surgery of the pelvis.  

At any point in time, if a diagnosis has been made, treatment initiated, and/or you are satisfied with the medical management we have implemented, you can schedule annual or biannual visits, per your choice. 

PCOS, Infertility, Recurrent Pregnancy Loss & METFORMIN

As mentioned above, women with PCOS have a higher rate of  rate of miscarriage and RPL, with the rate of miscarriage is about 20-40% higher. (1)


Below are a few clinical trials, published between 2001 and 2002, which indicate women with high insulin levels and PCOS may derive a benefit from taking a medication called metformin, in that the incidence of miscarriage was significantly reduced. (1, 2, 3)


The studies indicated that about 62 to 73 % of woman with PCOS experienced a miscarriage when not taking metformin. Whereas, only 9 to 36 % of women who were taking metformin experienced a miscarriage. We also have very good data over the years that indicates metformin is safe, it reduces blood glucose and insulin levels, and it can help to reduce androgen levels in women with PCOS. 


There are some more recent studies that indicate taking myoinositol can be almost as effective in reducing glucose, insulin, and androgen levels as compared to metformin (4, 5, 6). However, most research done over the years indicates myoinositol is bit less effective. Myoinositol has also been shown to improve ovulation rate and "clinical pregnancy" (beta HCG blood levels rise, but these trials did not report on the outcome of live birth rates. (4, 5, 6). The research I am citing can be found by scrolling towards the bottom of this page. 


Thus, if you have PCOS and we find high glucose, high insulin and/or high androgen levels in you blood, we will discuss treatment with either myoinositol or metformin (please click the "pharmacological treatment" button below for more information). Also, if you are currently tying to achieve a pregnancy, metformin may be a good choice. 


For more information on Infertility and Recurrent Pregnancy loss see my webpage here. 

PCOS, Pregnancy & Managing your Acne

As mentioned, acne is often experienced by women with PCOS, so you may be wondering if your acne medications are safe for your baby. Well, it is likely you may wish to change your current regimen when you are pregnant, or better yet,  prior to your pregnancy when you trying to achieve a pregnancy. 


Isotretinoin is the most concerning of all acne medications. Even one single dose can cause serious birth defects, to include but not be limited to malformations in your baby's facial bones, heart, and neurological system. Isotretinoin is sold under many brand names, eg: Absorica, Accutane, Amnesteem, Claravis, Myorisan and Zenatane. 


Topical retinoids are another type of commonly used acne medication, which is found in many different gels, creams, washes, and lotions. Topical formulations are those that are applied to the skin surface. Some retinoid products require a prescription. Whereas, others can be purchased over-the-counter. However, they are all not recommended for pregnant women. Some examples of retinoid products are: adapalene (Differin), tazarotene (Tazorac) and tretinon (Retin-A) 


Oral antibiotics are also sometimes prescribed to treat acne. Common antibiotics used are: clindamycin, doxycycline and minocycline. Again, none are recommended for pregnant women. 

ACNE MEDICATIONS (RECOMMENDED FOR ALL) & SAFE FOR YOU IN PREGNANCY: 


There are some topical antibiotic creams, lotions and washes that are safe for you to use during pregnancy. Here is some advice from Dr. Andrea Pearson, MD a dermatologist, friend, and colleague from MyCatholicDoctor: 


  • Erythromycin 2% ointment twice daily.
  • Clindamycin 1% lotion twice daily. 
  • Azelaic acid 15 or 20% cream, foam or gel twice daily (2nd and 3rd trimester only) 


Dr. Pearson also offers the non-pharmacological tips to help with acne: 


  • Gentle skin cleansing with Cetaphil or Vanicream cleanser. 
  • Vitamin C serum, which can help reduce both inflammation and hyperpigmentation (darkening of the skin), which can be associated with acne. 
  • Vitamin B3, in the form of niacinamide  is found in many over-the counter acne products. Niacinamide products also often help to mitigate both inflammation and hyperpigmentation. 
  • Avoid excess dairy (especially skim or low fat milk products) and whey protein, which are both pro-inflammatory and can exacerbate acne. 
  • Limit processed foods and excess carbohydrates. 
  • Lastly, the Mediterranean diet has been found to be one of the most effective diets for acne. 

BLEEDING KEY: How do I Measure Period Flow on my CrMS Chart?

I will be asking you to tell me very specifically how much you are bleeding. An example of a "detailed flow" is: M, M, H, L, L, VL/B


TAMPON or PADS: 

  • Very Heavy (VH): changing a full pad/tampon every 1-2 hours
  • Heavy (H): changing a full pad/tampon every 3-4 hours 
  • Moderate (M): changing a full pad/tampon every 5-7 hours
  • Light (L): changing a full pad/tampon every  8-12 hours
  • Very Light (VL): changing pad/tampon less than every 12 hours.


MENSTRUAL CUP MEASUREMENTS

  • Very Heavy (VH): 60 cc in a 24 hours
  • Heavy (H): 40 cc in 24 hours
  • Moderate (M): 20 cc in 24 hours
  • Light (L): 10 cc in 24 hours
  • Very Light (VL):  5 cc in 24 hours


**The Diva Cup comes in 20, 30 and 32 ml cups 32 being the largest but other cups may vary. 1 ml = roughly 1 cc 


Other important information about your flow: 

  • Tail End Brown Bleeding (TEBB): brown bleeding at tail end of period. 
  • Premenstrual bleeding: pink spotting or brown spotting at the prior to a full period starting. 
  • Intermenstrual bleeding: bleeding between periods. 

What type of laboratory tests may be done?

P+3 Progesterone to confirm ovulation (No LH monitor)

P+3 Progesterone to confirm ovulation (No LH monitor)

laboratory tests

P+3 Progesterone to confirm ovulation (No LH monitor)

P+3 Progesterone to confirm ovulation (No LH monitor)

P+3 Progesterone to confirm ovulation (No LH monitor)

P+3 progesterone vs LH monitor

What type of imaging tests may be done?

P+3 Progesterone to confirm ovulation (No LH monitor)

What type of imaging tests may be done?

Imaging Tests

Pharmacological treatments for PCOS

Pharmacological treatments for PCOS

What type of imaging tests may be done?

Pharmacological Treatments

Napro Wedge Resection Surgery

Pharmacological treatments for PCOS

Napro Wedge Resection Surgery

Wedge resection

Copyright © 2025 Queen of Hearts Fertility Care  & Napro Technology - All Rights Reserved---Ocean Video image courtesy of Sitthijate Poonboon. 

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