Rebuilding Women’s Reproductive Health.
The Problem Isn’t Technological: Rebuilding Women’s Reproductive Health.
We have the scientific data we need to understand the relationship that a woman’s ovulation has to her overall health, and that healthy ovulatory patterns are a prerequisite to being fertile. We also have the data to teach women to observe their biomarkers, to check whether they ovulate in any given cycle, and to teach doctors to diagnose and treat the underlying abnormalities these observations reveal. So why don’t we?
Women are being disserved by the medical community because of ideological and technological commitments among medical professionals. Instead of looking at what actually constitutes a healthy, well-functioning female reproductive system, many professionals seek to “manage” women’s health and fertility through technology. This ideological commitment has led to a blindness even when facing large-scale data that demonstrate the urgent need to re-evaluate and restructure the framework within which diagnosis and treatment of female hormonal abnormalities is made.
These data propose the immediate possibility of drawing on a clear and nuanced understanding of the endocrine foundations for a woman’s reproductive health, and thus the creation and reliance of concrete tools that aid an integral medical project. To continue to prefer the human person, and in this case the woman and her integration in medicine done on the ground, a greater movement on behalf of the community to prefer these research advances—and a move toward developing tools drawing on this research—is key.
Endocrine Foundations for Women’s Reproductive Healthcare.
For decades, the medical community has had access to research that demonstrates that a woman can observe interior hormonal activity through concrete external physiological signs or “biomarkers,” such as patterns of her bleeding and changes in mucus production.
These biomarkers—including the specific pattern within which they are produced—lay the physiological foundation for a woman’s ovulation, health, and fertility. Since the endocrine system is designed in a particular way, if a woman is healthy, her biomarkers will be produced in an objectively healthy pattern. Where there is a lack of health, biomarker production may cease entirely—or be produced in an objectively unhealthy cycle pattern.
In healthy women, ovulation and a certain mucus pattern will be necessarily connected, as the estrogen level required for the first immediately produces the second. Additionally, certain forms of mucus permit sperm transmission to a woman’s fallopian tubes, whereas other forms create active antimicrobial barriers at the cervical level to block both bacteria and sperm from the uterine canal.
Over decades, these biomarkers have been systematized in such a way that, if taught well and internalized by the woman who learns them, she can read the “systematization” of her own body without relying on external products or procedures. In addition to the potential for an education in the reality of her body, the patterns that can be read over time through the concrete biomarkers tracked daily can reveal the degree to which a woman’s individual body maps onto the greater objectivity built into her endocrine system—to determine, ultimately, whether she is healthy; whether she is fertile.
The biggest question today, however, lies not in the concrete data of the biomarkers themselves but in the meta framework within which they ought to be read. Research advances continue to highlight ever-greater complexities of endocrine activity. These should condition our nuanced understanding of what constitutes health in a woman of reproductive age, especially in the context of the physiological effects of a healthy ovulatory pattern, both on her endocrine system and on her entire body. Sadly, medical professionals and popular culture dismiss an array of manifestations of hormonal abnormalities in women as “normal,” failing to diagnose or treat the underlying problems.
Each Woman’s Body Is an Integrated Whole.
In this respect, today’s reproductive healthcare education and medical management options are deeply deficient. They fail to look at each concrete data point—each biomarker—as a manifestation of a larger, unified system, and as an indication of whether or not that system is functioning in a healthy way. Even more so, the diagnostic and treatment weight of these biomarkers is never considered in most contemporary nursing and medical schools, and medical professionals are therefore actively conditioned not to pay attention to the underlying objectivity of the endocrine system and the personalization demanded to understand a disruption in any single woman’s body.
By contrast, an important 2017 article in the Linacre Quarterly titled “Ovulation, a sign of health” summarizes recent research and emphasizes that “understanding and promoting the knowledge and use of biomarkers of ovulation in women is a key aspect to consider when evaluating their health status.” As the authors note, the female body is ordered to an ever-deepening and emerging unity of the endocrine system. All the physiological components of the system (the ovaries, the fallopian tubes, the pituitary gland, and more) cooperate with each other. In other words, without the existence and unity of certain physiological and systemic components, health and fertility are impossible.
Beyond its unity, however, this system tends toward a certain integrity, understood as an operation of these pieces proportionate to their own structure. For example, levels of estrogen, progesterone, the luteinizing hormone (LH), and the follicle-stimulating hormone (FSH) do not change or increase in a general or relativistic sense. Instead, they must hit supremely concrete levels, under concrete timing, for ovulation and the key cycle events demanded for a fully healthy cycle to occur.
In a generally healthy cycle, the brain will launch the FSH, which will then prompt the growth of a follicle under the production of estrogen within it. As estrogen levels increase, a woman experiences the production of a more moist and fertile mucus, and when these levels peak, the LH is released from the brain to rupture a follicle in ovulation. Following ovulation, the empty follicle—now called the corpus luteum—produces progesterone, which maps onto the production of a dry mucus as well as the thickening of the uterine lining, to help maintain and stabilize pregnancy, were pregnancy to occur.
These hormonal changes must occur to their requisite proportion for ovulation, the follicular phase (the phase of follicular development, from the cycle’s beginning through follicular rupture in ovulation), and the luteal phase (the phase of progesterone production in the corpus luteum, the follicle empty of an egg post-ovulation) to coordinate in the creation of a fully healthy cycle. As one example, FEMM, a non-profit providing endocrinological education and medical care, defines a healthy cycle as one lasting twenty-four to thirty-six days total, with a clear pattern of ovulatory mucus and a luteal phase lasting between nine and eighteen days. A woman who sees two consecutive abnormal cycles—cycles that are outside this range and without these characteristics—or three abnormal cycles over the course of a year, manifests an abnormality that demonstrates a disjunction from the pattern objectively intended for her by the structure of her system.
To identify the state of her health and fertility, the degree to which a woman’s endocrine system stands in unity and integrity can be measured over the space of a physiological continuum—from puberty through menopause, a woman’s biological “phase of maturity.” Of course, these characteristics do not apply in the same way to the reproductive stages before or after that phase.
What’s Wrong with the Status Quo.
Today, there is widespread ignorance about the nature of the female reproductive system and the mechanisms underlying a woman’s health and fertility. More developed analytical frameworks for patient diagnosis among medical professionals committed to an integrated diagnosis make it evident that significant populations of women experience severe abnormalities. In other words, significant numbers of women live in a status quo of a lack of objective health based on the demands of their systems. Abnormal patterns have been normalized, and the development and codification of different technologies has become a deeply ideological diagnostic and treatment norm.
This disjunction between a clear objective framework in the realm of contemporary reproductive endocrinology and singular manifestations of clinical abnormalities is historical. It is rooted in a system that has preferred in its diagnostic and treatment methodology different forms of “technology.”
The first form of preferred technology is the oral contraceptive pill (OCP). The OCP enabled the suppression of hormonal activity without any regard for its relationship to a woman’s objective endocrine system and health—long before researchers asked the question of what constitutes objective health essentially. Decades after its introduction, statistics are clear on the consistency and severity of difficulties experienced by women who take it (see research published on hormonal contraceptives by the Centers for Disease Control & Prevention [CDC]). Still, these symptoms are read without a clear framework for what, wholly, constitutes objective health and healthy (a)symptomatic patterns for women.
The second form of technology lies in different forms of reproductive technology, most especially in vitro fertilization (IVF), which enabled the reverse over-stimulation of hormonal activity—also without any understanding of the relationship to a woman’s system. According to the CDC, IVF is successful 20- to 30-some percent of the time, and over-stimulation of the ovaries often results in severe symptoms. Beyond any immediate ethical judgments, in the cases of infertility that give rise to the pursuit of IVF, little to no effort is made for a systematic diagnosis of the underlying endocrine activity and the reasons for its disjunction from the objective structure that would give rise to healthy, fertile ovulation and maintain a healthy pregnancy.
The lack of a clear systemic framework prevents large-scale, institutional judgments of any given physiological experience as abnormal. Unfortunately, that also means that these problems are not identified as treatable, because a clearly understood framework is necessary for diagnostic methods and treatment mechanisms that can re-integrate the body.
What Does This Mean for the Person?
Without a clear framework of what constitutes female reproductive health, larger human and personal causes and repercussions of endocrine abnormalities go entirely unconsidered.
For example, a woman with very low progesterone levels—a hormone necessary to maintain pregnancy—may experience them due to abnormally high cortisol. High cortisol levels do not manifest in a vacuum. Before treating either the low progesterone or the high cortisol, a medical provider should make the effort to understand whether the abnormalities are purely physiological, or whether they relate to other experiences of the patient in question (i.e., an array of triggers that can cause acute or chronic stress), with causes that are not necessarily quantitative in nature. Valid treatment should not simply seek to alleviate an existing symptom pattern—in this case, the low progesterone. Instead, it should integrate everything about the endocrine structure that would cause this external hormonal effect, beginning with the high cortisol and anything else that might have caused the systemic disruption.
The ideology at work within the field of reproductive endocrinology—and, even more so, within the fields to which the research is applied, including family medicine and OB/GYN practices—is such that a lived preference for the personalization of care is surrendered for the sake of expediency, technology, and external “results,” like the creation of a child. Instead, we should focus on providing an understanding of the many hormonal layers within the endocrine system, re-integrating them with time and diagnosis targeted with great precision.
To change the tide, researchers and medical practitioners must commit themselves to integrity in research and its applications in diagnosis and treatment. In particular, there is an urgent need for the widespread development and implementation of practical tools. These tools—and the ways they necessarily alter the care for individual women, woman-by-woman—propose and give preference for the unity and integrity of the body. We need a practical, grassroots move to create new data points—women who have been healed in accord with the endocrinological framework known and acknowledged—that, over time, will verify the legitimacy and necessity of the principles of a sound framework for understanding women’s endocrinological health… (By Weronika Janczuk).
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