Acne Can Be a Major Sign That You Have Polycystic Ovarian Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is the most common reproductive/endocrine disorder — and most common cause of infertility — affecting 9 -18% of women around the world. One of the major signs that you may have PCOS is acne on the face, or other parts of your body. Many women will have this one symptom overlooked and then have a major reproductive/endocrine disorder overlooked as well.

Despite the prevalence of this chronic condition, one-third of women diagnosed with PCOS saw at least three health professionals over the course of two years before receiving a diagnosis, according to a study from the University of Pennsylvania.

Polycystic Ovaries (PCO) is a characterised by multiple cystic growths on the ovaries. In large it is an endocrine and hormonal disorder, but it has potential to cause gynaecological and reproductive issues and these issues can be varied. Women with PCOS may not have cystic formation and just have symptoms that are part of the syndrome only (eg-acne, irregular cycle).  PCO and PCOS really are two different conditions, but now they are both put under the one title of PCOS and this actually isn’t correct. Some women only have the cysts (PCO), while others have no cysts but have the syndrome (PCOS). Some have both. The one thing that they all have in common is that they all have insulin resistance. The other thing we know is that there is usually a family member with the same condition whom has passed the condition on genetically. Often the family member passing on the genetic traits, doesn’t even know that have the condition in the first place.

Recent studies have shown that there are “major gaps” in education and support for women with these conditions (PCO and PCOS). We see the same thing with other gynaecological conditions such as endometriosis and Adenomyosis and why these conditions can take up to a decade to be diagnosed properly

As a Reproductive Medicine and Women’s Health Specialist I see these same issues with so many women waiting years to get a proper diagnosis and they have seen multiple healthcare professionals in both the medical and complementary medicine profession. It also creates confusion and anxiety for women who just want an answer to their condition and are not being diagnosed properly and also getting conflicting advice and treatment in the interim.

The signs and symptoms of PCOS are very clear and easily diagnosed, but many healthcare professionals end up focussing on one symptom, while overlooking the bigger picture and then these poor women get their condition missed.

Acne is one of the major signs of having PCOS and many women have his overlooked, or unaware that they may have a condition that could affect their fertility later on. If a women presents with Acne, irregular periods etc, I know there is a very good chance that she could have, or actually has PCOS. The problem for these women, as explained before is that healthcare providers and placing too much emphasis on only one of these symptoms, which is usually the Acne, or just that the cycle is irregular. Then women are then put on the Pill and these symptoms are masked for years, until they try and have a child and have difficulty doing so. The other issue is that the acne is often the focus, due to vanity reasons, and this is also why the many of the treatments for the acne are not working, because they are failing to treat the root cause of the issue. It just becomes one big vicious circle that goes round and round until someone finally diagnoses the actual cause properly.

Women with PCOS also have an increased risk of type 2 diabetes, gestational diabetes, metabolic syndrome and anxiety and depression, and studies have shown that the longer it takes for the condition to be diagnosed, the longer the patients condition begins to affect both their physical, emotional and reproductive health

The most common signs of PCOS are:

  • Absent, Irregular and Inconsistent menstrual periods,
  • Acne
  • Excess hair growth (some women can have hair loss too)
  • Central obesity

But many women with PCOS are of normal body weight and can actually be underweight too. It can affect women of any shape, weight or size. Some women with PCOS have regular menstrual cycles and can be fairly asymptomatic (meaning no symptoms) too

Just like endometriosis, women with PCOS are often missed and dismissed and the impact this has can be significant psychologically and also significant on their future fertility. There needs to be better health professional resources and international dissemination to improve diagnosis, education, management and reproductive and health outcomes.

I am always saying to healthcare professionals (medical and complementary medicine) that if you don’t know how to do your job properly, you don’t know how to diagnose conditions like PCOS or Endometriosis properly, or it is out of your scope of practice, get out of the way and refer these women onto people who are trained to diagnose and manage these conditions properly.

Lets, help put and end to PCOS and also put an end to Endometriosis and other inflammatory gynaecological conditions as well. Let’s break the silence and help women get the diagnosis and care they need. Early intervention and treatment is crucial for any disease state and let’s help women get this care sooner.

Take care

Regards

Dr Andrew Orr

-The Brisbane Baby Maker

-Women’s and Men’s Health Advocate

 

-“Period Pain IS NOT normal”

-“Leaving no Stone Left Unturned”

 

Knowing All Too Well What It Is Like To Live With Pain

I often get asked how I know so much about pain and living with disease state and pain on a day to day basis. While I am a man and cannot truly understand what it is like to have a gynaecological condition and the associated symptoms, I can understand how pain can affect ones daily life and how hard it is to manage a chronic disease state.

You see, I too have a chronic disease state that was missed and dismissed for many years. It causes me pain when the disease grows back and the inflammation gets bad. It has required me to have multiple surgeries, because it was missed for so long. Even though surgery helps, it isn’t a cure and the disease can grow back and then start causing pain and associated symptoms again. Sounds a lot like endometriosis doesn’t it?

While I don’t have endometriosis, I do have a disease that is very much like endometriosis and just this week I have had my 7th surgery for this disease.

My disease state grows in my sinus cavities and it can cause such excruciating pain in my head and make me feel really unwell. It’s really hard to use your brain to shut off pain, when the actual pain is in your head and it feels like my head is going to explode. If the disease gets out of control too much, it could cause extreme pressure and actually cave the bones around the sinuses inwards, so it can be dangerous.  I wish someone had listened to me and helped me earlier on so that I wouldn’t have to have been going through the surgery again.

But, I have learned to find the right team to help me. I have learned to manage pain levels using a multimodality treatment approach. I have learned that diet and lifestyle choices can help me manage my disease state. This is why when I talk to all of you, I understand what you all go through and why I am so passionate about telling you all the facts and helping you get the right help and intervention. They always say that to truly understand pain, you have to experience it yourself. Unfortunately I know all to well how pain can affect the whole body, not just where the pain is orginating from.

While I know first hand how bad pain can affect ones life, I have also learnt that the disease does not define me. I am not the disease and I have made a conscious decision to be proactive with my health and not live and breath the disease.

While it is good to be educated and proactive about your health, it isn’t good to live in your disease and let it overcome you and rule your life either. It is about getting up each day, making healthy choices, pushing yourself to move forward and remember that it is all about small steps forward, not matter what is going on.

I found the more I focussed on my disease, the worse things became and I got caught up in the pain cycle and the disease took over and it just made things too hard on both a physical and emotional level. Sure, there are days when you will have a bad day and that is ok. I know I had days where I had to take painkillers and just get on with it and nobody would ever have known how much pain I was in. Sure, there are going to be days when it doesn’t seem fair and that nobody can truly understand what it is like for you. The main thing is to not live in the ‘poor me’ syndrome and not let the disease define you. It is about overcoming the disease and being you again. It is about finding your team to help you. It is about finding that support you need and not buying into the diagnosis and living in the disease.

The more positive you are, the happier you are, the quicker you will heal and the treatments will work better too. Whatever you need to do, you just need to go and do it. If that means seeing a counsellor, seeing a pain specialist, seeing a gynaecologist, seeing a nutritionist, getting some acupuncture, seeing a physiotherapist, seeing a chiropractor/osteopath, taking pain killers, taking herbal medicines, or whomever and what you need that can help you, then you need to do it.

I also know all too well how hard it can be to get started, but when you get started and you keep going and you find the right team of people to help you, that is when you get the results. Never underestimate the power of positivity and never think that all is lost and get lost in your disease state and symptoms. Even if you make two steps forward and then one step back, you are still moving forward. Try and do something you love each day and try and find joy and positivity in your day. It is so important.

Lastly, never ever just take one opinion and always get multiple opinions about what you are experiencing. This is why I offer a multimodality approach for people and offer a multitude of services like a one stop shop. It is why my motto is “No Stone Left Unturned” because I dont want to see anyone be missed and dismissed. The reason I do a multimodality approach and use and integrative medicine approach, is so I can help people as much as possible on my own and then only have to refer for things like surgery and some other specialty areas that I do not do.

Please remember that pain, no matter where it presents in the body, is a sign of inflammation and a sign that something isn’t right. It is a sign that something needs to be investigated and managed and is you are being missed and dismissed constantly, then you need to find another healthcare practitioner, or a team of healthcare people that can help you moving forward and get some sort of normalcy back in your life. If you can’t find the right person, or team, then book in and see me instead. I’ll make sure “No Stone is Left Unturned” and I also understand what it is like to live with pain. You wont be missed and dismissed at my clinic. Don’t forget that I can do online consultations for people that live interstate, aren’t local, or live overseas. I can be your eyes and ears and be your guide and coordinator too. I understand pain.

Take care

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

Women’s and Mens Health Advocate

-No Stone Left Unturned

-Period Pain IS NOT Normal

 

 

Early Intervention & Early Management Is Vital For Gynaecological Conditions & Menstrual Issues

By now many of you would know my stance on Period Pain not being normal and that the sooner you get the cause treated and managed the better one is going to be in their day to day life.

Unfortunately not everyone knows that Period Pain is not normal and neither are some of the other symptoms women get each month with the onset of their menstrual cycle. Having heavy bleeding, bleeding in between cycles, menstrual cramps, severe pain, irritable bowel like symptoms, dark clotting, ovulation pain, bowel and bladder pain and urgency etc, are all not normal symptoms that a woman should endure with her cycle. Getting these symptoms at any time of your cycle is not normal either.

Early intervention and early management is the key to any disease state in the body and this definitely applies to menstrual issues and gynaecological disorders. Once a disease is expressed into the body, it can be very hard to treat, especially if it is left a long time and then inflammation spreads to other parts of the body, or in close proximity to where the initial disease was first expressed.

One of the reasons that prompted me to do this post was after a young woman, now in her 30’s, had contacted me and thanked me for helping her back when she was in high school. Since then I have known all of her family well and helped with maintaining their health. At the time she was about 14 years old and showed all the signs and symptoms of endometriosis. She was in so much pain each month, when her cycle came, and she was often curled up on the floor with nausea and vomiting from the pain. Everyone, including GP’s etc, had told her this is normal and that she needed to get used to it. They also told her that she is too young to have endometriosis, or any major gynaecological condition.

That is so bad. Please, please know that period pain IS NOT normal and that teenagers are not too young to have endometriosis. To be honest, they are now finding endometriosis in young girls under 10 years old. Many gynaecological issues can start very early on in a woman’s life, especially if there are hereditary factors involved.  Gynaecological and menstrual issues can be passed from generation to generation, so if mum, or your grandmother, or someone in your family tree had menstrual issues, or a gynaecological condition, there is a good chance that you may inherit this as well.

The long and short of it all was that her mother was also getting frustrated at everyone not helping and somehow ended up finding out about me and ended up in my clinic. From there I got her into one of the advanced trained laparoscopic surgeons I work closely with as soon as possible and this is where stage 4 endometriosis was found and excised properly.  Without coming to see me, this poor girl would never have found the cause of her menstrual pain and associated symptoms. I then did all her management of her disease moving forward. The main thing that this young girl and her mother were worried about was how this was affecting her education and daily life, but how this could also affect her future fertility.

The one thing I know is that the sooner there is intervention and treatment, the better the prognosis for a woman’s future fertility is. The one thing I do know is that endometriosis doesn’t always cause infertility, but it can make it harder to fall pregnant, if it isn’t managed early enough. The longer you leave a disease in the body untreated, the worse it gets, and then the symptoms get worse and the worse the future outcomes may be.

Lucky for this young lady is that she did have early intervention and management and she has proudly messaged me to tell me that she has had her 3rd child and that she puts it all down to me helping her when she was younger. I have many women message me and tell me much the same thing. It is so important not to leave these things just because you are being told it is normal. What the hell is normal about being in so much pain that you feel like you could die?

All too often I see women having gynaecological conditions, like endometriosis, missed and dismissed and that the longer that the disease has been dismissed, the harder it is going to be to treat. That is a sad fact for many women and some will have to endure repeated surgeries due to being missed and dismissed and have a life of issues, if their issue isn’t managed properly either. Many have not seen the right healthcare professionals, or the right surgeon either.

I have discussed in many of my previous posts.  Please have a read of my previous posts about this subject and the seeing the right team of people. This is why it is so important to have early intervention and also see a proper advanced trained laparoscopic surgeon who specialises in the excision of disease states like endometriosis. Then there needs to be proper management and treatments and lifestyle changes administered to help with suppression of the disease state, helping with inflammation and improving quality of day to day life.

There needs to be a multimodality/team like approach to the management of women with gynaecological issues, as there is no one single fixes all approach, with any medicine. While surgery may be a necessary part of the overall management of disease states such as endometriosis, it isn’t the saviour that many perceive it to be. Surgery does not sure endometriosis and there is no cure for the disease at present time. Once you have it, it is there for good.

Surgery is a necessary but small part of the overall picture that needs to combine many other treatments and modalities to give the best outcome for a woman overall. Once the surgery is done you need to look at managing and suppressing the disease and this is done by lifestyle changes, dietary changes, acupuncture, physio, herbal medicines, hormone therapies, pilates, yoga, pelvic floor and core exercises and many other modalities depending on one’s individual symptoms.

When I treat women with gynaecological conditions, or menstrual issues, I make sure they all get an individualised, person centred, caring approach tailored to how they are presenting rather than a one treatment for all approach that many seem to get. You won’t get the results you need that way because we are all individuals with different needs and different symptoms overall.

Lastly, please remember that period pain and menstrual irregularities are not normal and that the earlier you get onto it and get it treated and managed, the better your future outcomes will be.

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned

-Period Pain IS NOT Normal

Stop Telling Women That Period Pain is Normal

After seeing my 10th case of misdiagnosed Endometriosis this week, and goodness knows what else, I can say that I am well and truly over it and about to scream.

I am about to scream if I hear that one more woman, young or old, is told by their healthcare professional, GP, specialist, best friend, mother, facebook buddy etc, that period pain is normal.

Period pain IS NOT normal. It is far from normal and we all need to stop telling our daughters, sisters and women of this world that it is.

I think that anyone that says that need to come and work with me for a day and see the ramifications of women believing that period pain is normal, just because their doctor, healthcare professional, friend, or mother told them that it is.

I think I should post up some rather gruesome pics of women’s reproductive organs stuck together, their insides bleeding, and their pelvis completely obliterated. Yes, obliterated. That was the words that one of the surgeons used today to explain the insides of a woman that had been told that there is nothing wrong, just suck it up, scans havent found anything and just go on the pill and btw, period pain is normal

No it F#%$ing isnt (sorry for swearing but time for diplomacy is over). Women need a voice and need to be heard. Some of these poor women may not be able to have children, or have a healthy sex life, or be able to feel the pleasure of wonderful sex without pain, or ever hold their own baby, because they have been told to suck it up and be told that period pain is normal.

Period pain IS NOT normal and the sooner we get everyone to know this important fact the better. Sure, a little bit of discomfort can be normal. By that I mean just a tiny bit of pressure and basically knowing your period is about to come. But pain…. That is not normal. If you, your friend, your daughter, your sister, your wife, or any other woman you know, has to have days off work, days of school, is laying on the floor in pain, taking pain killers to get through the day, or beginning of their period, then that IS NOT normal.

Please get them to get a referral and see a good specialist who will listen to them and not dismiss them and may miss a gynaecological issue that could affect them for the rest of their lives. No… scans and blood test etc, do not always find the cause of period pain. Have a read on my other posts about this.

If you cant find someone that will listen and help, then book in a consult with me and I will help you get you properly investigated and properly managed moving forward

My motto is “No Stone Left Unturned”and my other motto is “Period pain IS NOT normal”. If you are in pain with your menses, or even any any other time during your cycle, or having pain with sex, or pain with ovulation, pain with bowel movements, pain for no known reason at all, then you need to get something done about it.

I think if I hear one more poor woman get told that Period Pain is normal, I am going to start sending those people gruesome pics of all the insides of women who have been told that period pain is normal, only to find out that it isnt and all the reasons why.

Sorry for the rant, but our daughters, our sisters, our wives, our female partners and women all over this world deserve better.

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned

-Period Pain IS NOT Normal

Ultrasounds and blood tests have limited value for diagnosing some causes of period pain and menstrual irregularities

I know I have said this often, but it seems that every day I get another email saying that “I have period pain and I have been to the GP and done scans and bloods tests and he/she says that there is nothing wrong”

The problem is that there is something wrong and the first thing wrong is that someone was told that there is nothing wrong, when they have only had very basic testing done

The second thing wrong is that most of these women are not being referred onto an appropriate specialist, which is what good sound ethical practice is. This is why some conditions like PCOS are taking up to 3 years to be properly diagnosed and conditions such as endometriosis are taking up to a decade to be properly diagnosed. It just should not happen

I can’t begin to tell you how many women I have seen over my years in practice, that have been told that there is nothing wrong with them, or that the practitioner hasn’t found anything, when really all they have done is a basic scan and a few random blood tests. Then when these women are properly investigated we end up finding all manner of issues. Yet, these women were told that there is nothing wrong

All I can keep telling people is that while ultrasounds can find some causes of gynaecological issues, there are many issues they cannot find. It also depends on the technician, or person scanning you too.

Gynaecological issues such as endometriosis, cannot be diagnosed by ultrasound and can only be diagnosed by surgical intervention, in the form of a laparoscopy. Then, as I have said many times too, it all depends on the surgeon you have seen. If your surgeon isn’t an advanced trained laparoscopic surgeon there is a very good chance you may not have been investigated properly. I have mentioned this in one of my previous posts.

Even some cysts,PCOS, polyps and other masses can be missed on scans and let’s not even talk about blood tests. Sure, some hormones levels can be a pointer to a certain issue, but they are not an accurate diagnostic. To be completely honest, many women with serious gynaecological issues will have normal hormonal levels and have completely normal blood results. This can even happen in certain cancers and why some of the cancer markers are now not being used as definitive diagnosis.

I can tell everyone that I have seen many gynaecological issues being missed, and women being dismissed over the years, and it still happens on a daily basis. If you have menstrual issues, or are in pain daily, or just with your menstrual cycle, and you are being told everything is fine, then you need to get a second opinion and a referral to a specialist.

Better still, come and book in a consultation with me and I will help you get you sorted and managed properly.

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned

 

Can we always blame hormones being out of balance, for women’s health issues?

Often I see people posting that the source of all women’s issues is their hormones being out of balance. While sometimes this may be true, saying that the source of all women’s health issues is hormones being out of whack is not completely true. Sure, hormones may have a bit to do with it, but is it all erratic hormones?

Hey, it is good to blame something, but is it really fair to keep saying that women are all just an imbalance of hormones, when they are just having a bad day, or just don’t know why they are feeling the way they do?

The fact is that when I consult with women and they tell me that they, or their partner, or family etc, think they are a hormonal mess, I always have to tell them that this may not necessarily be so. More often than not, when I do my work ups on women, their hormones are actually normal and not out of balance at all.

So why would a woman be feeling like she is out of balance if her hormones are all in normal range?

Well, the answer to that is…. “How long is a piece of string?”

Yes, this is one of my favourite saying because, with any health issue, or imbalance in the body, you need to look at the individual and what the individual has been doing.

When I consult with women about these issues I will always go through a thorough history and testing with them and find out the following

  1. Are they stressed?
  2. Are they sleeping?
  3. Have they had a major upset in their immediate environment?
  4. Are they eating well?
  5. Are they drinking too much alcohol?
  6. Are you taking medications, or recreational drugs?
  7. Are they having too much sugar?
  8. Are they exercising?
  9. Are they taking time out for self?
  10. Is their partner the source of their moods and ill health?
  11. Do they have a gynaecological condition that has, or hasn’t been diagnosed?
  12. Have you had a health condition, or virus, or some other long standing health issue?

There are so many things that can affect a woman’s moods and wellbeing. Stress is probably the biggest factor, followed by lack of sleep and poor diet. High sugar intake also causes inflammation and can affect hormones, but it can just affect your moods. Poor diet and high sugars can also affect gynaecological conditions and affect an upcoming menstrual cycle too. Having a big drinking session on the weekend, or just a few drinks during the week can seriously affect your health, moods and motivations. Try not drinking for a month and see just how much better you will feel and how much better you wake up in the morning. A big binge drinking session on the weekend can affect you for a week afterwards

Lack of exercise can be another big factor in feeling tired. It is a catch 22 situation. When you are tired you don’t feel like exercising, but sometimes you are tired because you aren’t exercising. Exercise keeps the body feeling fit and moods better and your menstrual cycle better too. Not getting enough sleep can seriously affect your body on all levels.

Lack of sleep will not only make you feel tired, grumpy and teary, but it affects everything. Lack of sleep and too many bright lights in your room can affect your melatonin levels too. Melatonin is also responsible for conversion to serotonin, which is what helps moods as well

Too much stress and running on adrenalin does not help the body either. The body goes into this hyper-activated state and that can cause low grade anxiety and also affect the moods and the body’s energy levels. We also need to check if a woman is suffering depression and this is the cause of her health issues, or why she may seem out of sorts.

Then, you could have a gynaecological issue that is causing inflammation in the body and then being exacerbated by things you are doing in your life too. Some gynaecological issues are asymptomatic, but can cause issues with your health, your moods, your energy and yes, your hormones. But, many women with gynaecological issues actually have normal hormone levels, so it isn’t always hormones causing gynaecological conditions either.

At certain times of the year, we are more prone to colds and flu’s and viruses and these can affect our health, our energy, our moods and our systems as a whole. Some post viral symptoms are worse than the actual virus and can last long after the virus symptoms have subsided.

Chronic pain can also throw the body into a state of shock and affect both the moods and the bodies ability to function. Inflammation can play real havoc with a woman’s body and her health.

There are so many things that can affect a woman’s body and it as we can see, it can’t always be blamed on hormones. There are so many other factors to consider, which can affect a woman’s energy, her moods, her concentration and her daily life. So next time you are feeling a bit off, or a bit moody, or teary, or tired, don’t be so quick to dismiss it as just being hormonal. It may have nothing to do with hormones at all. If someone else tries to dismiss you as being hormonal, maybe it is time to be hormonal like and tell them where to go. Politely, but firmly of course.

If you are feeling like there is something wrong with your body, or you feel out of balance, it is a good idea to see your healthcare provider and get some basic testing done and delve a little deeper into why your body isn’t feeling the best it could be. I always make sure I get a thorough history off women and listen to all of their concerns so that they aren’t just dismissed as just having their hormones out of whack. They may be, but it is best to check first and that isn’t hard to do. I think too many women are just dismissed as being hormonal, or that it is hormones out of balance. Nine times out of ten, it is often something else. Let’s not forget that as we get older, we do start to slow down more too. But, let’s not talk about that one as that could be a whole post on its own.

Take care

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned

 

Asking the Right Questions about Period Pain & Gynaecological Issues.

I didn’t know how I was going to start this post, or begin to talk about what I am about to talk about, other than I got some inspiration after a text message, and a phone call later on,  from my eldest daughter yesterday. I will talk about that soon. But let’s talk about some of the phone calls and messages I get from people every day and how some of these messages gives me a heads up into what may be going on for these people and then getting them in for a proper consult and the right help.

Every day I get phone calls, emails, Facebook messages etc, from women (young and older) who are experiencing period pain, menstrual issues, and other related symptoms and nearly all of them have the same story. I have been to the GP and I have had blood tests and scans and they say that there is nothing wrong. It happens so often and it is like there is a script written for these poor women who just want to get out of pain and get some sort of normal life back. I get so annoyed when I hear this repetitious line. Not at the people telling me, but knowing that these poor women really haven’t been investigated properly at all and probably won’t be unless they come and see me.

Yesterday I got a text that I really wasn’t expecting, as it was from my eldest daughter.

It read “Hey Dad, is endometriosis hereditary?”

To which I replied “Yes it can be, why?”

I anxiously awaited the next reply and thankfully she was asking on behalf of a friend. But this poor friend had been experiencing really bad period pain and had basically had blood tests and scans and been told that everything was normal. Apparently one of the scans showed some fluid in the Pouch of Douglas (POD), which can actually be a sign of endometriosis and inflammation. Worse still, this poor girl’s mother actually has endometriosis and nobody is putting two and two together and asking the question “I wonder if the daughter may have it too?”

Well, there is more than a good chance that she does have it and thank goodness my daughter actually knows the signs and knows that scans and bloods tests cannot diagnose many gynaecological issues, especially endometriosis. Lucky my daughter also knows that you need to see an advanced trained laparoscopic surgeon who specialises in the excision of endometriosis and has done years of extra surgical training to specialise in these disease states. The good thing is that she knows that you cannot just see a regular gynaecologist to get this done.

But, not everyone is as fortunate as my daughter to know this and help her friend to come and see me to help her see my surgeon and then I can help her with management of the disease, if found (which is highly likely) after the surgery. The other good thing is that my daughter knows there is no cure for endometriosis and that surgery isn’t going to fix the problem either. She knows it will help, and is needed, but after the surgery, the management post surgery is the most important, for disease states like endometriosis. Unfortunately not many people know this and don’t have the disease managed properly post surgery. Women with endometriosis and some other inflammatory gynaecological issues will need a team approach, or a multimodality approach  post surgery, because even with the best medical intervention, it really isn’t enough and why so many women have the disease and symptoms return, or may still be in pain and have other recurring symptoms. There is never a one treatment, one pill, fix all approach to disease states such and endometriosis. This is where so many go wrong.

One of the main issues for women can be that they really have not seen the right healthcare professions, especially the right surgeon and unfortunately this is many of the women that have had surgical intervention. This one is so important.

Whenever I get messages from women in pain, or I consult with women who have period pain and all the other associated symptoms, there are some standard questions I ask, to know if they have been given the right information, been diagnosed properly, or seen the right surgeon.

  1. I always ask “what tests have you had done?” – I know that if they have only had blood tests and some scans, then these women have not been investigated, or diagnosed properly.
  2. Then I usually ask “Have you just seen your GP, or have you seen a specialist?”– Most of the time many women have not been referred onto a specialist and have only just been seen to by a GP. This is one of the biggest issues women face when it comes to gynaecological conditions. GP’s are just general practitioners. They are not gynaecologists and definitely not advanced trained laparoscopic surgeons. The best thing any woman can do is ask for a referral to a specialist and a good GP should know to do this anyway. This is one of the biggest reasons that women from all over the world take up to a decade to be diagnosed with disease states such as endometriosis. On a daily basis women are missed and dismissed and told there is nothing wrong, go on the pill, or that they have some inflammatory bowel condition, when in fact they have endometriosis, or adenomyosis, or some inflammatory gynaecological issue. Btw, this isn’t to put GP’s down, unfortunately this is what happens to so many women and why it often takes up to a decade for women to be diagnosed with diseases such as endometriosis. This is an unfortunate fact and it needs to change.
  3. Then I ask “Have you had a laparoscopy?”– One of the most common responses is “What is a laparoscopy?” and that way I know they haven’t had one done. A laparoscopy is the gold standard investigation of the pelvis and the only way to properly diagnose disease states and causes of period pain, such as endometriosis.
  4. If the woman has had surgery I then ask “was the surgery done publically, or privately?” – This will tell me a few things. It will let me know if it was just done be a public surgeon, who probably isn’t an advanced trained laparoscopic surgeon. The issue is that there really aren’t that many advanced trained laparoscopic surgeons that do public work, and even if you strike the jackpot and do happen to get one, there is a good chance they are only in a teaching role to instruct a trainee surgeon to do the surgery anyway. But mostly women do not get an advanced trained laparoscopic surgeon in the public system. It is sad, but true unfortunately. Many times the first surgery in the public sector is purely investigative too and no excision (disease removal) is performed. This means that the woman has to come back for further surgery, or surgeries.
  5. If they the woman has had surgery done previously by a private specialist then I usually ask “Who was the surgeon that did your investigation and surgical procedure?” – Sometimes I can ask if the surgeon was an advanced trained laparoscopic surgeon and the patient usually will respond to not knowing, or even know what I was talking about. That usually gives me a clue that it most probably wasn’t, but then I can go and check the specialists qualifications online and see if they are, or most probably aren’t, an advanced trained laparoscopic surgeon who has done years of extra specialised surgical training.

All those 5 questions can tell me much about what some of these poor women have had done, or haven’t had done, and then I can formulate an appropriate treatment plan and management for these women moving forward. It is always hard explaining to the ones that have had surgery before that they haven’t seen the right surgeon and that they are going to need further surgery. The hardest thing for me is seeing women on support pages about to have their first surgery and I always worry that they aren’t seeing the right surgeon and if they don’t, there is a good chance that they are still going to be going through the same issues, over and over again, until they find the right person to help them. If only I could see all these women before they did anything, so that they can be given the right information and the facts and be managed properly.

The good thing is that when I do get to see women who chose to see me, I can explain to them the  facts and the right information and then why and how with a proper surgeon, that it can make a huge difference to how they are feeling and their recovery and management post surgery. I can also explain how surgery really is necessary, but is only a small part of their overall treatment and management of their disease moving forward. I can also explain the facts around their disease moving forward too and make sure that women under my care are given the right information, the right investigations and right management going forward.

This is why my initial consultations take about an hour and a half and we go over everything from their health history, medical history, hereditary issues, diet, lifestyle, surgical intervention, medications, natural medicines, blood tests, scans, investigations, sleep, sexual health, libido and everything that a woman needs to know about her particular issues. It is also about listening to a woman’s concerns and complaints and really hearing what she has to say and is experiencing. Then I formulate a treatment plan and management and 20 page report of findings for them for what we are going to be doing to help them moving forward. I also give them a step by step treatment plan of treatments and medicines etc they will need too. That is why my motto is “No Stone Left Unturned”, because there is no stone left unturned and I also make sure they see the right people (surgeons and anyone else that they may need to see). If there are things that I can’t do (surgery etc), I make sure that my patients only see the best people and then I can help manage the rest of their disease state for them.

I wish I could see every woman before that went for any investigation, or surgery, so I can point them in the right direction and help them manage their gynaecological condition properly. This is why I am so passionate about doing my posts on social media, or giving time for charity events to talk about women’s health issues and gynaecological issues such as endometriosis, adenomyosis and PCOS. It is why I do healthcare practitioner education and seminars to help educate them better too, so that they can help their patients better and not miss and dismiss them.

I just hope that I can help those who have not been heard and that have been missed and dismissed. I also hope we can get people to listen to the things I have presented above and also help women get a voice, be heard and get government listening and get more education to younger women too.

Lastly, I cannot say it often enough….. Period Pain “IS NOT” normal and if you, or your daughter, or your sister, or your mother, or cousin, your best friend, or anyone you know has period pain, especially bad period pain and other symptoms, please, please, do not tell them that this is normal. It is not normal and they need to come and see me, or another healthcare professional who specialises in women’s health and gynaecological conditions, so that they can be investigated properly and have their issues managed properly too.

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned

 

 

 

No Bad Carbs + Increased Protein = Increased Fertility & Increased Pregnancy rates

I know I talk about it all the time, but a good diet, and I mean a good diet (not half hearted, I am trying to do it diet), can actually increase your fertility and pregnancy rates

Every day I get people ask me “What can I do to increase my fertility and my chances of pregnancy?”

Well, I always say “How long is a piece of string?”, but while there are many things that people can do to increase their fertility, one being start of my fertility program, the other important one is starting with a good diet. That is one thing “You” are solely responsible for and something “You” can do for yourself. This is for the couple too. Not just the woman.

Healthy couples produce healthy babies. That means health men produce healthy sperm and healthy women produce healthy eggs and the combination creates healthy embryos that go on to become healthy babies. It really is a fact. Even for same sex couples, a partner should be supporting their other half in the journey and at the end of the day a healthy diet is going to help everyone live longer to enjoy their children later on, and hopefully grandchildren too.

Obviously there is a lot more to it, and why in my fertility program I cover “everything” for the couple,  but this is one way to ensure your body is ready to have a baby. This is also part of my PACE (Primal, Ancestral, Clean Eating) diet that I have formulated.

Recent studies have shown that when the bad carbohydrates are removed and the protein increased, that the clinic pregnancy rates shot up by 80%. Yes… a massive 80%

The other thing that is important is that eating this way also improved the embryo quality. Blastocyst development was higher in the high-protein group than in the low-protein group (64% vs 33.8%), as were clinical pregnancy rates (66.6% vs 31.9%) and live birth rates (58.3% vs 11.3%).

Reducing carbohydrates and boosting protein intake can significantly improve a woman’s and couples chance of conception and birth according to the research presented at the American Society of Reproductive Medicine (ASRM) several years ago.

The effect is “at the egg level,” said lead investigator. He presented the findings here at American Congress of Obstetricians and Gynecologists 61st Annual Clinical Meeting.

Carbohydrate-loaded diets create a hostile egg and embryo environment even before conception or implantation, he explained.

“Eggs and embryos are not going to do well in a high-glucose environment.” By lowering carbs and increasing protein, “you’re bathing your egg in good, healthy, nutritious supplements,” he said.

These studies demonstrate how little many in the reproductive medicine and fertility profession know about the effect of micronutrients in our diets on various aspects of reproduction.

These studies demonstrate a field wide open for future research and shows how bad carbohydrates (refined grains, refined sugars etc) have an inflammatory effect that affects fertility and pregnancy outcomes and also detrimental to IVF outcomes.

This is why I always promote a grain free, primal based diet (PACE Diet) to all of my patients, especially my fertility and gynaecology patients. It is an essential part of my overall success rate and why I have been able to help over 12,500 babies into the world and help many with gynaecological issues as well.

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-The International Baby Maker

-No Stone Left Unturned

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.

 

 

Alcohol Decreases Fertility & Makes Gynaecological Conditions Worse

In today’s modern society, alcohol has become the cornerstone for social engagements, business dinners and after work relaxation. It is important to realise however, that alcohol can directly impact the fertility of both males and females. In males it can decrease sperm quality, reduce testicular size, decrease libido and cause impotence, all of which can impair fertility. In females it has a more systemic response, affecting the reproductive hormones, leading to abnormalities in the menstrual cycle and an increased risk of miscarriage.

Many men and women these days are actually consuming copious amounts of alcohol and may think that their drinking habits are normal, when compared to others around them. When people do things on a regular basis, it becomes their normal. But truth be told, many people’s drinking habits, both men and women, are actually in the realms of alcoholism. The impacts of that are far reaching and fertility and gynaecological conditions are definitely impacted by alcohol consumption.

Effect of Alcohol on Conception for Men

Fecundability refers to the probability of conception during a particular menstrual cycle. It is dependent on the reproductive potential of both partners. Alcohol decreases fecundability by its effect on sperm quality and quantity. Men who continue to consume alcohol on a regular basis, can decrease their sperm motility, morphology and their DNA in the sperm. All of which are important factors in achieving fertility. While outwardly a man’s sperm may look OK, many forget that inwardly, the sperm DNA could be highly fragmented and unless this is tested every ejaculation, you will have no idea how bad the sperm actually is. A one off DNA fragmentation analysis does not mean the sperm each time is OK. It only measures the sperm from the ejaculate that was tested and sperm quality can change by as much as 20% each ejaculation.

Testicular size is also affected by alcohol intake; and can also affect sperm production. Alcohol is a depressant of the central nervous system (CNS), and can disrupt the autonomic system of the CNS. These effects are temporary and short lived. Abnormal sperm production is also temporary and also can resume after abstaining from alcohol.

One study, this one looking at couples going through IVF treatment, found that for every additional drink a man consumed per day, the risk of conception not leading to a live birth increased by 2 to 8 times. This was especially true if the drinking occurred within a month of the IVF treatment.

Effect of Alcohol on Conception for Women

In women, alcohol affects fecundability, by disrupting the delicate balance of the menstrual cycle. Clinical research data published in the “British Medical Journal” suggests that women, who drank socially, 1-5 drinks per week, were at a greater risk of decreased fecundability when compared to women who remained abstinent. These findings underscore the importance of remaining abstinent while attempting to conceive.

Alcohol disrupts the hormonal imbalance of the female reproductive system, leading to menstrual irregularities, and even Anovulatory cycles, (menstrual cycles where ovulation fails to occur). Menstrual pain can directly be linked to the amount of alcohol consumed in the lead up to the menses and consumptions of alcohol, even small amounts, exacerbates most gynaecological conditions. These changes can drastically decrease a woman’s chance of becoming pregnant and thus affect fertility.

Alcohol effects fertility in both partners, and can do so in so many ways. For couples who desire to have a baby, it is best to stay away from drinking completely. Presently there is no safe limit of alcohol intake; even socially acceptable amounts of alcohol can affect fertility potential and outcomes. Moderate drinking (1-2 drinks in one sitting) is probably okay, especially if you reserve those drinks to a few times a week, instead of daily. However, if you’re going through IVF treatment, or trying to conceive naturally, you might consider cutting out alcohol for the time being. A woman that is trying to concieve, or trying to improve a gynaecological issues, or menstrual issues, should not be consuming more than 4 standard drinks per week. A male who is trying to conceive, or have sperm quality issues, should have no more than 2 standard drinks in one sitting and be having at least 2 alcohol free days per week. These are all part of the healthy drinking set out in health department and government safe drinking guidelines.

Trying to conceive is a special time in a couple’s life, it should be filled with love, devotion and safe health practices, which means a healthy diet and lifestyle and having a healthy mind too. It also means having healthy drinking habits as well.

Decreasing alcohol, having bete foods and looking at a healthy detoxification program is also a great idea for those trying to increase their fertility and get their reproductive systems working better. Healthy eggs and health sperm make healthy babies. Healthy reproductive systems also mean better menstrual cycles and better testicular health too.

Safe drinking everyone

Regards

Dr Andrew Orr

(Reproductive Medicine & Women’s Health Specialist)

– The International Baby Maker

-Women’s and Men’s Health Advocate

– No Stone Left Unturned