The Truth About Natural Killer Cells & Miscarriage

On a daily basis we get people, who are having failed IVF cycles, calling my clinic looking for some miracle pill, to supposedly eradicate the body of natural killers cell and wipe them off the face of the planet in some war like rage, all because they have been told this will bring an end to their fertility woes.

I wish it was that easy and when my staff go on to explain that treating natural killers cells (uterine killer cells), and especially looking at the cause of natural killer cells (uterine killer cells), is complex, there is no one miracle cure, nor some magic pill, people get annoyed and hang up the phone in a huff ,without listening to the reasons why.

One of the things I always say, when people ask me about regulating natural killer cells for fertility purposes, is “How long is a piece of string?”

This is because this subject is very complex and there are many reasons why natural killer cells may be impacting implantation. So, hence the response is always going to be “How long is a piece of string?”

While Natural killer (NK) cells have an important role in the early responses to viral infections, they have also been linked with failure of pregnancy.

Increasingly, clinics are offering blood tests, at an increased cost to the patient, to measure the number and activity of circulating NK cells. As a result of these investigations, many women are offered treatments such as steroids, intravenous immunoglobulins, and tumour necrosis factor blocking agents. The scientific rationale for these tests and treatments, however, is not always supported by our current knowledge of the function of uterine NK cells.

So, I thought it was about time I set the records straight on the BS information, that seems to being handed around as gospel, by money hungry fertility clinics run by big health conglomerates, and by the rotten Dr Google, about natural killer cells (uterine killer cells) and these supposed miracle pills, that will miraculously fix someone’s fertility issues.

Let’s Look at the Facts about Natural Killer Cells Relating to Miscarriage

  1. There is no miracle pill, or one supposed miracle treatment, or a one pill solution to treat, or get rid of natural killer cells. You do not want to get rid of NK Cells.
  2. Natural Killer Cells are a natural part of the immune system designed to target inflammation, kill of cancer cells, kill off bacteria and protect the body from harmful invasion of foreign organism
  3. There is huge difference between natural killer cells that are circulating in the blood stream, compared to uterine killer cells
  4. Uterine Killer Cells are in large numbers during a pregnancy to protect the embryo
  5. Natural Killer Cells are only in large number and are only being sent out by the immune system because there is some inflammatory process going on in the pelvis, or the rest of the body
  6. You cannot regulate Natural Killer Cells numbers unless you first address the inflammatory process that is causing them to be in high numbers in the first place (Eg- Inflammatory gynaecological conditions such as PID, Endometriosis, PCOS, Adenomyosis, Adhesions, STI’s, CIN, HPV, Herpes etc)
  7. Many people have not had the proper initial fertility investigations and testing needed to actually fall pregnant in the first place and looking at Natural Killer Cells, before all that proper testing etc is done, is actually not assessing the patient properly.
  8. If you do not treat the cause of the Natural Killer Cells being in high numbers, you will not be able to reduce the numbers of Natural Killer Cells that are actually doing the job they are meant to do, which is …. Protect the Body.
  9. Many of the so called treatments for Natural Killer Cells, regarding fertility, have never been approved for such treatment and research on it is still inconclusive.
  10. Some of the treatments being proclaimed as miracle cures (Intralipids etc) are purely money making exercises that are preying on the vulnerability of people who have been told wrong information and have this perception of some killer being inside their body attacking their embryos.
  11. Intralipids have never been proven to treat Natural Killer Cells and are derived from highly inflammatory soy based compounds, which then in turn can cause more inflammation.
  12. The drugs used in the treatment of Natural Killer Cells are steroidal based and carry many side effects and are for more harmful to the body that any natural killer cell will ever be. The steroids are also a category C drug that has been shown to have an effect on the neonate
  13. Steroids, such as Prednisone, do work on regulating NK cells, but they do so by suppressing the immune system, thus compromising a person’s immunity. There are also risk to peoples minerals by using these long term and there are also other side effects to the body.
  14. Natural Killer Cells are there to protect the body, not hurt it.
  15. Natural Killer Cells are only attacking embryos because they are seen as foreign body as well and when they are there trying to kill of the diseases and issues causing inflammation in the body, they just happen to kill of any other foreign organism and inflammatory processes at the same time
  16. Again, to address natural Killer Cells, you need to address the inflammatory process as to why they are in high numbers in the first place
  17. The perception around Natural Killer Cells being this “thing” killing off embryos in the body is misguided and is actually not a true representation of what Natural Killer Cells actually do. It is purely often used to tug on the heartstrings of unsuspecting patients, who are highly emotive and clinics use these emotions to get them to pay for treatments that have never been fully proven to work.
  18. The name “Killer Cell” is too often exploited in the wrong context by many in the fertility world
  19. Blood tests cannot measure the number of Natural Killer Cells in the Uterus, Only a biopsy can do this.
  20. A Natural Killer Cell (uterine killer cells) Biopsy has to be done between the 24th and 28th day of your menstrual cycle to give the best results.
  21. Blood tests can only measure the circulating NK cells in the body and not the uterine killer cell activity, which can be the cause of recurrent miscarriage. So, if you have had a blood test, it is not measuring what is needed. Everyone will have circulating NK cells in their blood stream.
  22. The percentage of CD56+ NK cells in peripheral blood in normal healthy individuals varies from 5% to 29% (2)Despite this, more than 12% NK cells in women with infertility or miscarriage has been arbitrarily defined as abnormally raised and used as an indication for treatment (4)
  23. The percentage of NK cells in blood can be affected by many factors including sex, ethnicity, stress, and age too.

Natural Killer cells (Uterine killer cells and other NK cells) are the main immune cell-type found in the uterus. Their numbers increase through the menstrual cycle to peak at the time of implantation. If an embryo does implant, NK cell numbers increase further to 70% of all cells.

Uterine NK numbers start to decrease at around the 20 week mark of pregnancy and are all but absent at the end of pregnancy.

Natural killer cells acquired their name as a result of the initial test used to identify them in vitro. Unlike T lymphocytes, NK cells are able to spontaneously kill cells in a non-MHC restricted manner.

Regrettably, this is a misleading name in reproduction, and the powerful image of maternal cells attacking the fetus is emotive and easily exploited. None the less, these NK cells can kill off the embryo at early stages of pregnancy, but there is nearly always a reason why. That reason is inflammation in the pelvic cavity and uterus. This needs to be addressed to regulate the number of NK cells, not some notion of killing off the “Killer Cells”.

Types of Inflammation causing high Natural Killer Cells (Uterine Killer Cells)

  • Endometriosis & Adenomyosis
  • PCOS/PCO
  • Fibroids, Myomas
  • Vaginal Infections & Bacteria
  • STI’s
  • Cancer, Trauma, Localised Lesions & Others
  • Stress

Yes, stress can lead to a compromised immune system, which then leads to high TNF (Tumor Necrosing Factor) and increase Natural Killer Cells, which then leads to prolonged increase activated T Cells, and this then causes reduced implantation of embryos.

This is also a reason why any inflammation in the uterus or pelvic cavity needs to be addressed to help fix this issue and one of the reasons why any woman having fertility issues needs to be investigated and treated properly. This needs to involve proper differential diagnosis, proper pathology testing, genetic testing and surgical investigations such as laparoscopy prior to any further fertility treatment. A laparoscopy is the gold standard for addressing and treatment of issues in the uterine and pelvic cavity.

Natural Killer Cells (Uterine Killer Cells) can be a part of recurrent miscarriage, but we need to stop the misinformation and perception of them being some killer organism that isn’t meant to be in the body. They are meant to be in the body and the name is all too often exploited by many to offer unproven treatments and medications by clinics trying to increase profits.

If you want to regulate and treat natural killer cells (relating to recurrent miscarriage) properly, you need to find out what is causing them to be there in the first place. There is no magic pill to get rid of Natural Killer Cells. You cannot rid the body of Natural Killer Cells anyway. They are meant to be there. You can only regulate the amount of killer cells doing their job and you need to find out why they are in higher numbers in the first place. This is usually because there is some sort of inflammation, infection, bacteria, or malignancy going on in the body that has not been investigated properly in the first place. Let’s not forget that stress, yes stress, increases the amount of Natural Killer Cells in the body too.

At my clinic, I have a proper Natural Killer Cell protocol and treatment plan that is individually tailored and looks at the “cause” of high number of Natural Killer Cells and makes sure that proper investigations, testing and treatment are administered to treat the person properly. This can also be done alongside current medical protocols such as the Bondi protocol, or California protocol.

Regards

Dr Andrew Orr

(Reproductive Medicine & Women’s Health Medicine Specialist)

-The International Baby Maker

-No Stone Left Unturned

References

  1. Moffett-King A. Natural killer cells and pregnancy. Nat Rev Immuol 2002;2: 656-63.[CrossRef][Web of Science][Medline]
  2. Pijnenborg R, Vercruysse L, Hanssens M, Van Assche A. Incomplete trophoblast invasion: the evidence. In: Critchley H, MacLean A, Poston L, Walker J, eds. Pre-eclampsia. London: RCOG Press, 2003: 15-2615. Parham P. NK cells and trophoblasts: partners in pregnancy. J Exp Med 2004;200: 951-5.[Abstract/Free Full Text]
  3. Hiby SE, Walker JJ, O’Shaughnessy KM, Redman CWG, Carrington M, Trowsdale J, et al. Combinations of maternal and paternal innate immune genes influence the risk of pre-eclampsia. J Exp Med 2004;200: 957-65.[Abstract/Free Full Text]
  4. Aoki K, Kajiura S, Matsumoto Y, Ogasawara M, Okada S, Yagami Y, et al. Preconceptional natural-killer-cell activity as a predictor of miscarriage. Lancet 1995;345: 1340-2.[CrossRef][Web of Science][Medline]
  5. Ntrivalas EI, Kwak-Kim JY, Gilman-Sacchs A, Chung-Bang H, Ng SC, Beaman KD, et al. Status of peripheral blood natural killer cells in women with recurrent spontaneous abortions and infertility of unknown aetiology. Hum Reprod 2001;16: 855-61.[Abstract/Free Full Text]
  6. Bisset LR, Lung TL, Kaelin M, Ludwig E, Dubs RW. Reference values for peripheral blood lymphocyte phenotypes applicable to the healthy adult population in Switzerland. Eur J Haematol 2004;72: 203-12.[CrossRef][Web of Science][Medline]
  7. Kwak JY, Kwak FM, Gilman-Sachs A, Beaman KD, Cho DD, Beer AE, et al. Immunoglobulin G infusion treatment for women with recurrent spontaneous abortions and elevated CD56+ natural killer cells. Early Preg 2000;4: 154-64.
  8. RCOG Scientific Advisory Committee. Immunological testing and interventions for reproductive failure. London: RCOG, 2003. (Opinion paper 5.)
  9. Scott JR. Immunotherapy for recurrent miscarriage. Cochrane Database Syst Rev 2003;(1): CD000112.
  10. Daya S, Gunby J, Clark DA. Intravenous immunoglobulin therapy for recurrent spontaneous abortion: a meta-analysis. Am J Reprod Immunol 1998;39: 69-76.

 

 

Do you suffer pain with sex? (dyspareunia)

Do you suffer Dyspareunia?

Pain with sex, Intercourse pain, or dyspareunia, can cause problems in a womans life and it can be a cause of problems in couple’s sexual relationship. In addition to the physically painful sex, there is also the possibility of negative emotional effects. Then even when a woman may feel aroused and wanting sex, the fear of the pain can cause the whole process of wanting sex to stop.

How many people get Pain with Sex

It is estimated that about 20%-25% of women suffer vaginal pain with foreplay or intercourse. Pain can be acute, intermittent or chronic and can stem from a wide variety of causes that will be covered shortly. Unfortunately when women complaining of pain during sex, they are often dismissed as being inhibited, having psychiatric issues, or merely just making it up to get out of having sex. Many men would like to boast that it is them being well endowed that is causing the problem (they wish) but in fact if your partner is in pain, then you need to actually stop and listen to the reasons why. The fact is most of the time, their symptoms are related to legitimate medical issues that need to be investigated and treated accordingly. So guys, get your hand of it and start listening to your partner if she says she is getting pain.

What causes pain with Sex (Dyspareunia)?

In many cases, a woman can experience painful sex if there is not sufficient vaginal lubrication. There could be many reasons for this and one that is commonly seen in menopause. When this occurs, the pain can be resolved if the female becomes more relaxed, if the amount of foreplay is increased, or if the couple uses a sexual lubricant. Issues like this can easily be overcome, but there are some medical and gynaecological issues that could be causing the pain and being very much overlooked.

So what are the other causes of Pain with Sex

Endometriosis – This is a condition in which the endometrial like tissue (lesions) that lines the uterus grows outside the uterus. It can cause all sort of pain in the pelvis, bowel and rest of the body, but it can cause pain with sex. It is one of the leading conditions that does cause pain with sex. Many women with endometriosis may not have symptoms of it, or may only have one symptoms like pain with sex. Symptoms do not correlate to the extent of the disease either. Some people with small amounts get lots of pain, while others can have lots of it and have no pain. Endometriosis can only be properly diagnosed via surgery (laparoscopy)

Adenomyosis – is a condition which is very similar to endometriosis. It is a conditions in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). Adenomyosis can cause menstrual cramps, lower abdominal pressure etc, before the menses and can result in heavy periods.  It can also cause pain with sex. The condition can be located throughout the entire uterus, or localized in one spot

Vaginismus-  This is a common condition. It involves an involuntary spasm in the vaginal muscles, which closes up the vagina and prevents penetration from happens. It is sometimes caused by fear of being hurt.

Vaginal Infections-  These conditions are common and include yeast infections such as thrush and candida and these can cause inflammation to the vagina and cause pain with sex and also localized bleeding.

Vaginal skin conditions– Dermatitis around the vulva and also a condition called Lichen Sclerosis can all cause pain with sex due to the inflammation of the skin.

Problems with the cervix (opening to the uterus). In this case, the penis can reach the cervix at maximum penetration. So problems with the cervix (such as infections) can cause pain during deep penetration.

Problems with the uterus. These problems may include polyps, cysts, fibroids etc that can cause deep intercourse pain.

Problems with the ovaries – Problems might include cysts on the ovaries, or tubal disease.

Pelvic Inflammatory Disease (PID) – Often referred to as penis injected disease. With PID, the tissues deep inside become badly inflamed and the pressure of intercourse causes deep pain.

Ectopic Pregnancy – This is a pregnancy in which a fertilized egg develops outside the uterus, or into the tubes. It can cause immense pain and even death if not death with properly.

Menopause- With menopause, the vaginal lining can lose its normal moisture and tone and become dry. The vagina, uterus and surrounding organs can all suffer atrophy, which can cause bleeding and pain. It can also cause prolapse.

Intercourse too soon after childbirth, or surgery – Trying to have sex too soon after childbirth, or a surgery,  can cause pain during sex.

Sexually Transmitted Infections (STI’s) – These may include chlamydia, genital warts (HPV), genital herpes, or other STI’s.

Injury to the vulva or vagina- These injuries may include a tear from childbirth or from a cut (episiotomy) made in the area of skin between the vagina and anus during labor.

How Can Painful Sex In Women Be Treated?

Some treatments for painful sex in women do not require medical treatment. For example, painful sex after pregnancy can be addressed by waiting at least six weeks after childbirth before having intercourse, or when a women feels she is ready again. Make sure to practice gentleness and patience. In cases in which there is vaginal dryness,  or a lack of lubrication,water-based lubricants will help. In the cases of some conditions such as menopause, topical estrogen creams may be needed to bring tone back into the vaginal wall, along with lubricants during sex.

Some of the conditions such as endometriosis, PID, fibroids, or trauma to the vagina and will require surgery and adjunct therapies such as hormones and other medications.

Other issues such as vaginal infections, bacterial infections, skin conditions, STI’s etc may just need medications such as antibiotics, antifungals, steroids and other medications for their treatment

Some conditions like vaginismus, or psychological traumas (sexual abuse), may require a person to see a counselor, psychologist, psychiatrist, or sex therapist.

There are also natural medicines such as Acupuncture, Chinese Herbal medicine, naturopathy, herbal supplement etc than can help with pain, either on their own, or in combination with medical treatments and talk therapy

If you do have pain with sex, you need to go and speak to your healthcare provider, or seek the help of a gynaecologist, or women’s health specialist.

Pain with sex is not normal, and you need to find out the cause of these issues and not put it off. At my clinic, I can help you if you are having pain with sex.

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned

Could your health issues be coming from your Thyroid?

E5PRGR Doctor examining the thyroid gland of a patient.

Thyroid issues are common, especially in women and especially if there is a family history of thyroid disorders in your family. When your thyroid goes out of balance, it can cause all sorts of symptoms and issues in your body. You need to know what to look for.

When Your Thyroid Goes Awry

Does fatigue drag you down day after day?

Do you have brain fog, weight gain, chills, or hair loss?

Or is the opposite true for you: Are you often revved up, sweaty, or anxious?

Your thyroid gland could be to blame. This great regulator of body and mind sometimes goes haywire, particularly in women. Pregnancy and postpartum is when it can also go haywire too. Getting the right treatment is critical to feel your best and avoid serious health problems.

What Is the Thyroid Gland?

The thyroid is a butterfly-shaped gland in the front of the neck. It produces hormones that control the speed of your metabolism — the system that helps the body use energy. Thyroid disorders can slow down or rev up metabolism by disrupting the production of thyroid hormones. When hormone levels become too low or too high, you may experience a wide range of symptoms.

Symptom: Weight Gain or Loss

An unexplained change in weight is one of the most common signs of a thyroid disorder. Weight gain may signal low levels of thyroid hormones, a condition called hypothyroidism. In contrast, if the thyroid produces more hormones than the body needs, you may lose weight unexpectedly. This is known as hyperthyroidism. Hypothyroidism is far more common.

Symptom: Swelling in the Neck

A swelling or enlargement in the neck is a visible clue that something may be wrong with the thyroid. A goiter may occur with either hypothyroidism or hyperthyroidism. Sometimes swelling in the neck can result from thyroid cancer or nodules, lumps that grow inside the thyroid. It can also be due to a cause unrelated to the thyroid.

Symptom: Changes in Heart Rate

Thyroid hormones affect nearly every organ in the body and can influence how quickly the heart beats. People with hypothyroidism may notice their heart rate is slower than usual. Hyperthyroidism may cause the heart to speed up. It can also trigger increased blood pressure and the sensation of a pounding heart, or other types of heart palpitations.

Symptom: Changes in Energy or Mood

Thyroid disorders can have a noticeable impact on your energy level and mood. Hypothyroidism tends to make people feel tired, sluggish, and depressed. Hyperthyroidism can cause anxiety, problems sleeping, restlessness, and irritability.

Symptom: Hair Loss

Hair loss is another sign that thyroid hormones may be out of balance. Both hypothyroidism and hyperthyroidism can cause hair to fall out. In most cases, the hair will grow back once the thyroid disorder is treated.

Symptom: Feeling Too Cold or Hot

Thyroid disorders can disrupt the ability to regulate body temperature. People with hypothyroidism may feel cold more often than usual. Hyperthyroidism tends to have the opposite effect, causing excessive sweating and an aversion to heat.

Other Symptoms of Hypothyroidism

Hypothyroidism can cause many other symptoms, including:

  • Dry skin and brittle nails
  • Numbness or tingling in the hands
  • Constipation
  • Abnormal menstrual periods

Other Symptoms of Hyperthyroidism

Hyperthyroidism can also cause additional symptoms, such as:

  • Muscle weakness or trembling hands
  • Vision problems
  • Diarrhea
  • Irregular menstrual periods

Thyroid Disorder or Menopause?

Because thyroid disorders can cause changes in menstrual cycle and mood, the symptoms are sometimes mistaken for menopause. If a thyroid problem is suspected, a simple blood test can determine whether the true culprit is menopause or a thyroid disorder — or a combination of the two.

Who Should Be Tested?

If you think you have symptoms of a thyroid problem, ask your doctor if you should be tested. People with symptoms or risk factors may need tests more often. Hypothyroidism more frequently affects women over age 60. Hyperthyroidism is also more common in women. A family history raises your risk of either disorder.

Thyroid Neck Check

A careful look in the mirror may help you spot an enlarged thyroid that needs a doctor’s attention. Tip your head back, take a drink of water, and as you swallow, examine your neck below the Adam’s apple and above the collarbone. Look for bulges or protrusions, then repeat the process a few times. See a doctor promptly if you see a bulge or lump.

Diagnosing Thyroid Disorders

If your doctor suspects a thyroid disorder, a blood test can help provide an answer. This test measures the level of thyroid stimulating hormone (TSH), a kind of master hormone that regulates the work of the thyroid gland. If TSH is high, it typically means that your thyroid function is too low (hypothyroid). If TSH is low, then it generally means the thyroid is overactive (hyperthyroid.) But just measuring TSH levels is not enough. People with thyroid disorders can have normal TSH levels and the other thyroid hormone levels and this is why thyroid antibody testing is probably the most important testing to be done. High thyroid antibodies mean you have a thyroid condition and your thyroid gland is under attack. Hopefully doctor will want to check all the other thyroid hormones in your blood. If he/she doesn’t, make sure they do. They should always check TSH, Free T3, Free T4, Reverse T3 and Thyroid antibodies. In some cases, imaging studies are used and biopsies are taken to evaluate a thyroid abnormality.

Hashimoto’s Disease

The most common cause of hypothyroidism is Hashimoto’s disease. This is an autoimmune disorder in which the body attacks the thyroid gland. The result is damage to the thyroid, preventing it from producing enough hormones. Hashimoto’s disease tends to run in families. This is why thyroid antibodies needs to be checked because people with Hashimotos disease can actually have normal TSH levels and normal Free T3, Free T4 and reverse T3 levels.

Other Causes of Hypothyroidism

In some cases, hypothyroidism results from a problem with the pituitary gland, which is at the base of the brain. This gland produces thyroid-stimulating hormone (TSH), which tells the thyroid to do its job. If your pituitary gland does not produce enough TSH, levels of thyroid hormones will fall. Other causes of hypothyroidism include temporary inflammation of the thyroid or medications that affect thyroid function.

Graves’ Disease

The most common cause of hyperthyroidism is Graves’ disease. This is an autoimmune disorder that attacks the thyroid gland and triggers the release of high levels of thyroid hormones. One of the hallmarks of Graves’ disease is a visible and uncomfortable swelling behind the eyes. Again this is why testing thyroid antibodies is so important.

Other Causes of Hyperthyroidism

Hyperthyroidism can also result from thyroid nodules. These are lumps that develop inside the thyroid and sometimes begin producing thyroid hormones. Large lumps may create a noticeable goiter. Smaller lumps can be detected with ultrasound. A thyroid uptake and scan can tell if the lump is producing too much thyroid hormone.

Thyroid Disorder Complications

When left untreated, hypothyroidism can raise cholesterol levels and make you more likely to have a stroke or heart attack. In severe cases, very low levels of thyroid hormones can trigger a loss of consciousness and life-threatening drop in body temperature. Untreated hyperthyroidism can cause serious heart problems and brittle bones.

Treating Hypothyroidism

If you are diagnosed with hypothyroidism, your doctor will most likely prescribe thyroid hormones in the form of a pill. This usually leads to noticeable improvements within a couple of weeks. Long-term treatment can result in more energy, lower cholesterol levels, and gradual weight loss. Most people with hypothyroidism will need to take thyroid hormones for the rest of their lives.

Treating Hyperthyroidism

The most common treatment for hyperthyroidism is antithyroid medication, which aims to lower the amount of hormones produced by the thyroid. The condition may eventually go away, but many people need to remain on medication for the long term. Other drugs may be given to reduce symptoms such as rapid pulse and tremors. Another option is radioactive iodine, which destroys the thyroid gland over the course of 6 to 18 weeks. Once the gland is destroyed, or removed by surgery, most patients must begin taking thyroid hormones in pill form.

Surgery for Thyroid Disorders

Removing the thyroid gland can cure hyperthyroidism, but the procedure is only recommended if antithyroid drugs don’t work, or if there is a large goiter. Surgery may also be recommended for patients with thyroid nodules. Once the thyroid is removed, most patients require daily supplements of thyroid hormones to avoid developing hypothyroidism.

What About Thyroid Cancer?

Thyroid cancer is uncommon and is among the least deadly. The good thing with thyroid cancer is that it is encapsulated, so it won’t spread. Once the thyroid gland is removed, the cancer is removed also. The main symptom is a lump or swelling in the neck, and only about 5% of thyroid nodules turn out to be cancerous. When thyroid cancer is diagnosed, it is most often treated with surgery followed by radioactive iodine therapy or, in some cases, external radiation therapy

Complementary Medicine For Thyroid Issues

There are many complementary medicines that can assist thyroid issues and Acupuncture and Chinese Herbal medicine has successfully treated thyroid disorders for centuries.

There are also supplements and other herbal medicine to assist thyroid function, or balancing the thyroid hormones. Diet and lifestyle changes are also very important for thyroid health, as is working on the gut to reduce inflammation in the body and assist the immune system as well. There are also compounded natural thyroid medications we can discuss with you also

At my clinic,  I can help with all hormone issues and can help you with thyroid testing, blood tests etc and thyroid management.

Regards

Dr Andrew Orr

Reproductive Medicine and Women’s Health Medicine Specialist

-Women’s and Men’s Health Advocate

-No Stone Left Unturned

What Is Lichen Sclerosus?

Lichen sclerosus is a long-term problem of the skin. It mostly affects the genital and anal areas. Sometimes, lichen sclerosus appears on the upper body, breasts, and upper arms. For this article I am just going to talk about Lichen Sclerosus of the genital region (Vulva) and more around how this affects women and how it can be treated and managed. Lichen sclerosus can cause itching, pain and scarring of the affected areas, but there are treatments available that can relieve symptoms and prevent and treat scarring.

Who Does Lichen Sclerosis Affect?

While anyone can get lichen sclerosus at any age, women after the menopause have the highest risk. In fact, it is about 10 times more common in women than in men. It is possible, but rare, for children to be affected.

What Are the Symptoms?

Early in the disease, small white spots appear on the skin. The spots are usually shiny and smooth. Later, the spots grow into bigger patches. The skin on the patches becomes thin and crinkled. The skin may also be inflamed and red or ulcerated from scratching.

Skin affected by lichen sclerosus can tear easily, and there may be tiny fissures (cracks in the skin). When severe, there may be bleeding and blistering.Sometimes, the skin becomes scarred. If the disease is a mild case, there may be no symptoms. 
Other symptoms are:

  • Itching (very common)
  • Discomfort or pain
  • Bleeding

Genital lichen sclerosus

Lichen sclerosus that affects the vulva usually feels intensely itchy. There may also be pain, stinging, burning or discomfort, especially during sex or when urinating.

Lichen sclerosus is a chronic, or ongoing, condition, and over time it can lead to scarring. If this affects the vulva, it may narrow the entrance to the vagina, interfering with sexual intercourse.

Women with severe lichen sclerosus in the genitals may not be able to have sex. The disease can cause scars that narrow the vagina. Also, sex can hurt and cause the patches to bleed. However, treatment with creams or ointments can help. Women with severe scarring in the vagina may need surgery, but only after lichen sclerosus is controlled with medication. When the skin around the anus is affected, pain when emptying the bowels can lead to constipation.

What Causes Lichen Sclerosus?

Doctors don’t know the exact cause of lichen sclerosus. Some doctors think a too active immune system and hormone problems may play a role. In women, lichen sclerosus also seems to be associated with autoimmune diseases (conditions where the immune system attacks the body), such as lupus , alopecia and thyroid disease. It is also thought that people inherit the likelihood of getting the disease. There may also be a hormonal involvement as It is also more common after menopause, when there is less oestrogen in the body.

Lichen sclerosus is more likely to appear on skin that has been damaged or scarred from some other previous injury. Importantly, lichen sclerosus is not infectious and your partner cannot catch it during sex.

How Is It Diagnosed?

Lichen sclerosus can often be diagnosed from the appearance of the affected skin. It is important that your GP refer you to a pelvic floor/urodynamic specialist, reproductive medicine specialist or women’s healthy specialist that specialises in conditions affecting the female reproductive organs. Sometimes a referral to a dermatologist may also be needed also.

Besides visual diagnosis, a biopsy may be recommended to confirm the diagnosis. This involves taking a small sample of affected tissue for a pathologist to examine under a microscope. This allows specialists to make sure that it is not a different disease.

Treatment of lichen sclerosus

Treatment of lichen sclerosus is aimed at:

  • Relieving symptoms of itch and discomfort;
  • Healing the lesions (returning the affected skin to its normal colour and texture);
  • Preventing the development of scar tissue; and
  • Treating any scar tissue that has developed.

Medical Treatments for Lichen Sclerosus

Lichen sclerosus is usually treated by applying a strong steriod cream, or ointment to the affected area. This is usually applied daily for several weeks, or months, and then less frequently (once or twice per week) long-term to prevent a recurrence.

Corticosteroid ointment or cream should be applied only to the white patches and gently rubbed in. Try to avoid applying steroid to the normal surrounding skin to help prevent side effects.

Symptoms such as itch may improve within a couple of days of starting corticosteroid treatment. Healing of lesions generally takes longer.

Women with Lichen Sclerosis will need regular follow up consultations and management with their specialist while using these creams and ointments for a long time because they can cause the following

  • Thinning and redness of the skin
  • Stretch marks where the cream is applied
  • Genital yeast infections.

Sometimes, women just do not get better using this medication and there could be other things that could be stopping symptoms from clearing up. This could be from the following:

  • Low estrogen levels
  • Infection
  • Allergy to the medication.

Other treatments

If topical steroid treatment is not effective, your specialist may recommend other medications and treatments that target the immune system and help control inflammation.

  • Sometimes other medications such as Retinoids, or vitamin A-like drugs are used and your specialist may also recommend laser treatment.
  • If scarring has occurred, this does not usually improve with steroid treatment. Scarring in females that is affecting sexual intercourse or urination may be helped by surgery
  • There are also some new medical treatments that are presently being researched and providing some amazing results options and I will discuss at a later date. They are actually natural medicines that are being used as a medical treatments. All I can say is that I have seen the results of this new treatment option and I think it is going to help many people. At present on of my colleagues, Dr Philip Hall, is using this treatment to help women as part of a research project. I will update people when I am allowed to say more about this new treatment.

Natural Medicine Treatments

  • There are natural medicine treatments that have been shown to help Lichen Sclerosus
  • Traditional Chinese Medicine
  • Acupuncture
  • Homeopathy
  • Herbal Medicine
  • Nutritional Supplements
  • Diet and nutritional changes ( to help reduce inflammation)
  • Counselling ( to help with dealing with the long term affects of dealing with this disease)

Self-care measures for genital lichen sclerosus

The following self-care measures may help in the treatment of lichen sclerosus that affects the genital area.

  • Gently wash the area daily with warm water and pH neutral soap cleanser.
  • Try not to rub or scratch the area. This can sometimes be really hard when it is itchy and inflamed
  • Avoid tight clothing and any activities that may aggravate itching and discomfort, such as bike riding.
  • Your specialist may recommend you apply cream to gently moisturise and protect the area.
  • Women should use a mirror to become familiar with the location and appearance of their genital lesions, and to apply cream or ointment to the affected area of the vulva.

Complications and follow-up

If you have been diagnosed with lichen sclerosus then it is advisable to have regular follow-up appointments with your specialist every 6 to 12 months. In addition, genital lichen sclerosus is associated with a small, but important, increase in the risk of cancer developing at the affected site. Frequent check-ups are important to detect any cancers early on, when they can be more easily treated.

I have treated many women with Lichen Sclerosus in my years in practice and I do find that a multimodality approach is the best way to treat and manage this disease effectively. Sometimes you need to have a team to help treat this, just like many other diseases women endure.So many women are are at their wits end with this disease and all sorts of treatments that have not worked. I can say this if this disease is treated and manage properly, it can give women their quality of life back.

Take care

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

Women’s & Men’s Health Crusader

-“No Stone Left Unturned”

 

 

 

 

Could you need an Iron Infusion?

Iron infusion: Uses, benefits, and what to expect

As a reproductive medicine and women’s health specialist I am used to seeing women with really low iron, due to various gynaecological conditions.

Many women do not even know they are low in iron until they get bloods tests to show that they are. Being low in iron can be very dangerous for a woman on so many levels.

Many women who are suffering from fatigue are actually low in iron.

Symptoms of low iron can include

Fatigue

Dizziness

Fainting, or feeling of feeling faint

Pale skin

Breathless

Frequent headaches

Palpitations, or racing heart

Easily irritated

Difficulty in concentrating

Cracked, or reddened tongue

Loss of appetite

Strange food cravings

Risk Factors For Low Iron

Heavy menstrual bleeds

Endometriosis

Adenomyosis

Fibroids

Coeliac disease

Inflammatory Bowel Disease

Pregnant and Breast Feeding Women

Certain Cancers

Vegetarians and Vegans

Girls going through puberty

Certain illnesses

Sometimes when Iron gets too low, supplements just will not be enough to get iron levels up to where they should be quick enough. This is where iron infusions can be very effective.

So what is an Iron Infusion?

An Iron infusion is when iron is delivered via an intravenous line into a person’s body.

Increasing the amount of iron a person has in their blood can cure anaemia, or increase a low red blood cell count.

The body uses iron to make hemoglobin. Hemoglobin is an important part of red blood cells and helps carry oxygen around the body.

If a person does not have enough hemoglobin, they can feel tired, or have symptoms mentioned previously. An iron infusion may be used for someone with an iron deficiency when supplements do not work.

As discussed before, there are a variety of medical reasons can cause low iron levels, so your doctor, or healthcare specialist will order iron studies and other tests to see what may be causing someone to be deficient in iron.

An iron infusion may be given if a person’s blood counts are so low that taking iron supplements or increasing their daily intake of iron-containing foods would be ineffective or too slow in increasing their iron levels.

What to expect

A person will go to a doctor’s office, hospital, or another healthcare facility to have an iron infusion. This is done intravenously and the infusion will take between 15-30 minutes if it is given in amounts of 200-300 milligrams (mg). In days gone by iron infusions would take hours to do and would have to be done in a hospital setting.

The new rapid iron infusions allow iron into the body much quicker and have little to no side effects compared to the older solutions that took hours to administer and were not as good as the new versions used now.

What happens after an iron infusion?

An individual can experience some mild side effects after an iron infusion. The symptoms are usually mild side effects such as headaches, metallic taste in the mouth, or some mild joint pain. Some people can feel faint and nauseas after an infusion but this is usually people who do not tolerate having blood taken, or having needles given. Reactions to infusion are rare, but your healthcare provider will explain all this too you. There are some people who may be allergic to iron, just like people can be allergic to certain foods.

Most people will only need one infusion done, but sometimes people with very low iron may need multiple infusions done. This will be after careful monitoring and testing to see where your iron levels are.

Usually iron levels will return to normal and symptoms of iron deficiency will decrease several weeks after the infusion. A doctor will regularly check the person’s iron levels and blood counts to ensure the iron infusion is working.

Iron infusion vs. injection

Doctors can administer iron to someone via an injection or an infusion.

Iron injections are given intramuscularly, but while iron injections may be faster than iron infusions to administer, they can have some unpleasant side effects. Some of the side effects can be pain at the site of the injection, bleeding into the muscle, and permanent discoloration at the injection site. This is why more doctors are now recommending iron infusions over the injections

Before and after the Infusion

Most people do not need to fast or stop taking their medications beforehand, and can also resume their everyday activities after an iron infusion.

If a person is taking regular iron supplements, however, a doctor will usually tell them to stop taking these about a week before the procedure. This is because the supplements may prevent the body from absorbing the iron from the infusion efficiently.

A person will need to resume iron supplements at some stage after the receiving iron infusions, t ensure levels stay where they should be. Your healthcare provider will tell you when to do this.

People who have a genetic issue called haemochromatosis should not ever have an iron infusion.

Iron infusions are now being used more and more, when iron levels are low and people are not responding to supplementation and adjustments to their diet. I recommend them to many of my patient who have low iron due to many varying reasons. Like I said said before, many of my gynaecology patients, fertility patients and pregnancy patients have very low iron levels and will actually need an infusion to get their levels up quickly.

If you are feeling tired, lethargic and may be at risk of low iron, have a talk to your healthcare provider about finding out if you are low in iron and also discuss having an iron infusion if your levels are really low. Your healthcare practitioner may not know about the new iron infusions and that they are now a great option to use and have very little side effects compared to the older methods and solutions. Some GP clinics now specialise in administering iron infusions too.

Regards

Dr Andrew Orr

Reproductive Medicine and Women’s Health Specialist

-The International Baby Maker

-No Stone Left Unturned

 

Women’s Health Consultations

Women’s Health Consultations

*Are you sick of Painful Periods?
*Are you getting pain with sex?
*Is your period irregular and messing with your life?
*Are you getting bad acne?
*Are you getting increased bladder frequency?
*Are you getting some incontinence with exercise?
*Are you sick of having to put up with mood swings and hormone imbalance?
*Sick of healthcare professionals and friends telling you that your symptoms are normal?
 
Many of these issues are not normal, but more importantly many of these issues can easily be treated quite easily with the proper investigations, treatments and proper management. 
 
Everyday I see women who are sick of being ‘missed’ and ‘dismissed’ by everyone they see and they just want to get some sort of normal life back. This is where as a Reproductive Medicine and Women’s Health Specialist, with over 20 years experience with fertility, pregnancy and women’s health, I can really help. My motto is “No Stone Left Unturned” and I apply this to every person I have helped.
 
I am proud to announce that I now have a better way of being able to doing consultations for anyone needing help with gynaecology, fertility and other health issues. It doesn’t matter where you live, now I can help more people from around the globe and get them the answers they should be getting. 
 
Before we only had skype, which had limitations of not being able to screen share the important information that I need to share in a consultation with patients
 
Well, now I can do consultations through Zoom and these are nearly the same as if you were with me in person and share the same information, just the same as if you were in person.
 
Reports and Treatment medicinals and supplements are then mailed to you.
 
This is for patients who live out of the Brisbane area, or are interstate and overseas and it gives so much more scope to help everyone who wants my help.
 
If you want to get the best advice, best care and see someone with over 20 years experience in helping people, who is a Reproductive Medicine and Women’s Health Specialist (medical) as well as having qualifications in complementary medicine, then you need to see book in with me.
 
My multi-modality approach has helped over 12,500 plus babies into the world and helped tens of thousands of women with women’s health issues and gynaecological conditions such as Endometriosis, Adenomyosis, PCOS, Fibroids, Bladder & Bowel Issues, Pelvic floor stability, Thrush, Migraines, Hormone Imbalance and so much more. I can help with all Women’s Health and Reproductive issues.
 
As a Baby Maker and Women’s Health expert my motto is “No Stone Left Unturned” and I apply that to every person I help. It is because I care and want to help care for you as well.
 
If you would like to organise an online, or in-person consultation with me, please give my staff a call on +61 7 32795697, or email info@shentherapies.com.au. You can also submit an online enquiry through my website www.drandreworr.com.au too.
 
I hope to be able to help you and care for you all soon
 
Regards
Dr Andrew Orr
Reproductive Medicine & Women’s Health Specialist
-No Stone Left Unturned
“The International Baby Maker & Women’s and Men’s Health Advocate”

Exciting New Online Consultations

Exciting New Online Consultations

*Are you sick of Painful Periods?
*Are you getting pain with sex?
*Is your period irregular and messing with your life?
*Are you getting bad acne?
*Are you getting increased bladder frequency?
*Are you getting some incontinence with exercise?
*Are you sick of having to put up with mood swings and hormone imbalance?
*Sick of healthcare professionals and friends telling you that your symptoms are normal?
 
Many of these issues are not normal, but more importantly many of these issues can easily be treated quite easily with the proper investigations, treatments and proper management. 
 
Everyday I see women who are sick of being ‘missed’ and ‘dismissed’ by everyone they see and they just want to get some sort of normal life back. This is where as a Reproductive Medicine and Women’s Health Specialist, with over 20 years experience with fertility, pregnancy and women’s health, I can really help. My motto is “No Stone Left Unturned” and I apply this to every person I have helped.
 
I am proud to announce that I now have a better way of being able to doing consultations for anyone needing help with gynaecology, fertility and other health issues. It doesn’t matter where you live, now I can help more people from around the globe and get them the answers they should be getting. 
 
Before we only had skype, which had limitations of not being able to screen share the important information that I need to share in a consultation with patients
 
Well, now I can do consultations through Zoom and these are nearly the same as if you were with me in person and share the same information, just the same as if you were in person.
 
Reports and Treatment medicinals and supplements are then mailed to you.
 
This is for patients who live out of the Brisbane area, or are interstate and overseas and it gives so much more scope to help everyone who wants my help.
 
If you want to get the best advice, best care and see someone with over 20 years experience in helping people, who is a Reproductive Medicine and Women’s Health Specialist (medical) as well as having qualifications in complementary medicine, then you need to see book in with me.
 
My multi-modality approach has helped over 12,500 plus babies into the world and helped tens of thousands of women with women’s health issues and gynaecological conditions such as Endometriosis, Adenomyosis, PCOS, Fibroids, Bladder & Bowel Issues, Pelvic floor stability, Thrush, Migraines, Hormone Imbalance and so much more. I can help with all Women’s Health and Reproductive issues.
 
As a Baby Maker and Women’s Health expert my motto is “No Stone Left Unturned” and I apply that to every person I help. It is because I care and want to help care for you as well.
 
If you would like to organise an online, or in-person consultation with me, please give my staff a call on +61 7 32795697, or email info@shentherapies.com.au. You can also submit an online enquiry through my website www.drandreworr.com.au too.
 
I hope to be able to help you and care for you all soon
 
Regards
Dr Andrew Orr
Reproductive Medicine & Women’s Health Specialist
-No Stone Left Unturned
“The International Baby Maker & Women’s and Men’s Health Advocate”

What Affects a Menstrual Cycle – Part 2 (Common Gynaecological Factors)

There are many things that can cause disturbances to a woman’s menstrual cycle and on my previous post I discussed how Non-Gynaecological factors, such as diet, lifestyle etc, can be contributing. In this post I will discuss some of the common gynaecological conditions that can cause problems with women’s menstrual cycles.

The sad thing is that many of these are often overlooked and often masked by putting women on the contraception pill. The other issue is that many are led to believe that the pill is the answer to their issues, when sadly it isn’t.

Many of these common gynaecological conditions continue to become worse while having their symptoms masked and exacerbated by these hormones. Even more disturbing is that many women are not heard when speaking about menstrual issues, menstrual pain and other factors that do in fact interfere with their daily life on both a physical and emotional level.

Lets look at the common gynaecological factors that can affect a woman’s cycle.

  1. Endometriosis– is one of the most common causes of period pain and it caused by abnormal growth of endometrial cells both inside the uterus and outside the uterine lining. The exact cause is not known. While period pain, clotting, ovulation pain, pain with sex, pain on bowel movement, IBS like symptoms etc are commonly talked about, many women with endometriosis are asymptomatic and would not even know they had it. It is commonly missed, misdiagnosed and overlooked by healthcare practitioners and is why it often takes up to 10 years for the definitive diagnosis to be made. There is no cure and now it is thought that genetic factors and parental mode of inheritance is a predominant part of this disease. We do know that estrogens make it worse also. Endometriosis can only be diagnosed by surgical intervention. For more information please read my posts on endometriosis and also visit the Endometriosis Australia website.
  2. PCO/PCOS – Polycystic Ovaries/Polycystic Ovarian Syndrome is one of the most common caused of menstrual cycle irregularities, or ceasing of the menstrual cycle. It is mainly caused by insulin resistance and it also runs in families. There are two types of presentation with this condition. One is just having the cysts on the ovaries and the other is just the syndrome without the cysts. These days it is common lobbed under the one condition called PCOS. Along with menstrual cycle disturbances, it can also cause mood swings, hair growth/hair loss, acne, ovulation pain, infertility, anovulation, weight gain/weight loss, pot belly, fluid retention and much more. Diet and lifestyle changes are the number one treatment for this condition. Scans can pick this condition up, but can also miss it too. It can be diagnosed via surgical intervention and sometimes-extreme forms of this do need surgical intervention known as “Ovarian Drilling”
  3. Fibroids – Also known as myomas are benign growths that can occur inside and outside the uterus. Up to 40% of women over 40 years old have fibroids. They can cause problems with irregular uterine bleeding, heavy long bleeding, bleeding in between cycles, anaemia, pain with sex, problems with urinating and back pain. They can also cause infertility and miscarriage. There are 3 types of fibroids (intramural, submucosal & subserosal). They are thought to be caused by excess estrogens and problems in hormone metabolism. They can be removed surgically and some small ones embolised.
  4. Polyps – Are benign overgrowths, or bulges, of the normal tissue lining the uterus into the uterine cavity. They can cause irregular bleeding, heavy bleeding, bleeding after intercourse and infertility. Some women have not symptoms at all. Polyps may also be found in the uterine cervix. Polyps are usually attached to the underlying tissue by a base or stalk, and they vary in size. They can basically act like an IUD and stop implantation and therefore need to be removed in order for a woman to fall pregnant. Polyps only rarely contain cancerous cells
  5. Adenomyosis– Is very similar to endometriosis by the fact that it causes pain, irregular bleeding, heavy bleeding, bloating, lower abdomen pain and can affect the day to day functioning of woman all over this world. Adenomyosis growth penetrates deeply into the uterine lining and also inflames the nerves inside the lining. It cannot be seen visually and some special high contrast scans and MRI can pick it up, but not always. Usually a biopsy is needed to diagnose it. Medically the only way to properly get rid of Adenomyosis is via a hysterectomy. In the meantime, mostly anti-inflammatories, some hormones and other forms of pain management are given to provide symptomatic relief.
  6. Thrush– Vaginal thrush is a common infection caused by an overgrowth of Candida albicans yeast. This yeast lives naturally in the bowel and in small numbers in the vagina. It is mostly harmless, but symptoms can develop if yeast numbers increase. Symptoms you may experience if you develop vaginal thrush include vaginal discomfort – itching or burning, a thick, white discharge with a ‘cottage cheese’ appearance and yeasty smell, redness or swelling of the vagina or vulva, stinging or burning while urinating or during sex, splits in the genital skin that can cause bleeding and irritation. The condition is mainly treated with antifungal creams, pessaries and probiotics.
  7. Cancers – In 2008, a total of 4,534 new gynaecological cancers were diagnosed in Australia; this equates to an average of 12 females being diagnosed with this disease every day. On average 4 females in Australia die each day from a gynaecological cancer each day. The most commonly diagnosed gynaecological cancers are uterine cancer, ovarian cancer, cervical cancer, vulval cancer, cancers of other female organ and placenta and vaginal cancer. All can cause irregular bleeding, but some may not present with any symptoms at all. Proper diagnosis and early intervention is the key to any gynaecological cancers. For more information on diagnosis, symptoms and treatment please refer to the cancer council website.

There are other conditions that I haven’t discussed because of focusing on the main gynaecological conditions that can affect a woman’s cycle. I haven’t gone into the treatments of these disease states and will go into this at a later date. What I will say it that early intervention is the key to any disease state in the body and seeing the right people is paramount too. Please know that many of these disease states will require a multimodality approach and please remember that there is always help out there. Never put up with period pain, or menstrual irregularities, or be told the symptoms many women face daily are normal. The value of a second, or third, or tenth opinion is crucial for some people to get help and to find the right person to help.

Please remember that period pain IS NOT normal and neither are many of the menstrual irregularities that many of you face daily. There are always treatments and help out there too. I help so many women daily, with most of these sorts of conditions, and with the right treatments, diagnosis and investigations, you can be helped too.

Take care

Regards

Dr Andrew Orr

-Leaving No Stone Left Unturned

“The International Baby Maker” and “Women’s and Men’s Health Crusader”