Dr. Jessica Shepherd On Conventional & Holistic Approaches To Women’s Health – Exclusive Interview

Part of your specialty is in gynecological conditions like endometriosis, adenomyosis, PCOS (polycystic ovarian syndrome). One of the things that we commonly see in the health care space is that women don’t get diagnosed with those diseases for several years, because they don’t even recognize that their periods are abnormal. So can you tell us a little bit about what’s normal and what’s not normal for a menstrual cycle?

There are some people from the time that they’ve started to have periods that may have some irregularities to it and so that’s always good to note. In your report to your physician, say, “This is my normal” and it may be slightly irregular. But when we think of, like, a true regular cycle, you want it to be every 28 to 30 days, plus or minus a day. And it should last anywhere from five to seven days. But you may have some that are plus or minus one from that four to eight, or even four to nine days. And then when we think of the flow, you would think that the flow would usually start heavier in your first through third day, and then start to taper off.

Now the big feature of a period that I think is where we’re starting to see some of these diagnoses being missed is pain. So during your cycle, it is an inflammatory phase. That’s part of the normal physiology of a period. And your body releases prostaglandins in order for this pathway to do what it’s doing. And that’s the beautiful part. I always try to maximize the beautiful part of what a body can do. Now, what we will see is there will be some discomfort for some during a cycle. And that, again, is due to the physiologic aspect of what’s going on. 

Now, where we start to see kind of mismanagement or misdiagnosis, or time duration of other conditions such as, say, endometriosis – and this is endometriosis awareness month — is that … pain is subjective. I can’t experience how you’re experiencing pain and vice versa. And so because it’s subjective, that’s where sometimes the mark is missed because someone’s saying “I’m in severe pain” and us not being able to really grade that or really know what severe means is sometimes we miss the mark on what “severe” is. And so I think — and ultimately physicians really are here to help women, or anyone, people in general — what we try to do is make sure that we’re not giving everyone the top-notch pain medication. 

So we do use a step approach to … try and address your pain. I think we need to do better in our conversation with patients on monitoring that pain and figuring out what that person’s pain scale is so we can really identify what severe means for that particular person. These are some of the things that we’re starting to see in management of endometriosis, painful periods, and pelvic pain, which we’ve come a long way.

Even from when I started my career, ’til now, I’ve seen changes in how we actually approach pain, and how we actually address it with women in a way that they feel heard. And then going from there to make sure, yes, your pain is being addressed in a way that either needs to be looked at differently or that we’re hitting the mark and we’re getting your pain addressed in a way that is good for both parties. And the last thing I would say is society, society for so long has really pushed off pain from a pelvic perspective because it’s a women’s health issue. And anything below the belt was so taboo that for so long women would have pain and then not say anything about it. So I think we’re moving too, in a way, that women will feel open to staying, “I feel pain. And it’s severe. And I need help,” and not feeling shame or embarrassment about disclosing that information.