These are some of the main Facts about PCOS
Dr Andrew Orr
-No Stone Left Unturned
-Women and Men’s Health Advocate
These are some of the main Facts about PCOS
Dr Andrew Orr
-No Stone Left Unturned
-Women and Men’s Health Advocate
Many gynaecological issues such as endometriosis and PCOS often take years to be definitively diagnosed and women have to suffer the consequences of their disease state through being missed and dismissed along the way. Then after many years of suffering, they finally get the diagnosis they have been looking for, but then many are not told what to do next, to manage their disease state moving forward. From a state of relief then comes a state of despair as the diagnosis is made and realisation that disease state you are living with isn’t really being helped as well as it could be. So now what?
As someone who has had to live with a chronic disease state daily and spent many years trying to find the right help and be diagnosed properly, I know all too well what many face daily. Many days it just feels like you are knocking your head against a brick wall and nobody wants to help, or listen to what you are telling them. This is why it is important to take things into your own hands and keep searching until you find the right help. That is why I know do what I do and my motto is “No Stone Left Unturned”.
The sad but real truth is that we do know that despite the best medical interventions and treatments that many women will continue to suffer the consequences of their disease state. We know that disease states like endometriosis have no cure and despite surgical intervention, hormonal therapies, pain medications etc, that the disease state can continue to grow and cause debilitating symptoms, both physically and emotionally.
While surgical interventions, hormone therapies and pain medications can offer women some reprieve in their disease state, are they enough?
Sadly the answer is “no!” and this is where many get caught in the vicious cycle of further surgical intervention, the need for new hormonal therapies and a dependency on pain medications. There are also the side effects of some of the medications and treatments and also the effects on future fertility. Treatments also tend to be about treating the masses, rather than the individual. We know that while women may suffer the same disease state and similar symptoms, all will have differing symptoms as individuals as well.
The trouble with the current treatments for many gynaecological issues such as endometriosis and PCOS, is that they are suppressive rather than being curative. These treatments also tend to mask the disease and also only provide temporary relief of symptoms during the period of treatment. On discontinuation of treatment the reoccurrence of symptoms is generally to be expected. For example, after medical treatment and surgical intervention, the reoccurrence rate of endometriosis is said to be around 25% after 2 years and around 50% or more at 5 years.
So what is the answer?
For any disease state to be treated and managed properly it needs to follow these treatment principles.
Do treatments like this exist?
Well, the answer is ‘yes!’… and ‘no!’
There is no curative medical treatment for endometriosis, but there are treatments that can assist in helping women with their disease state and to become symptom free, or at least live a fairly normal life.
There are treatments that can assist PCOS and actually assist in the reversal of some of the symptoms that are associated with the disease.
The one thing I explain to my patients is that they need to be real about their disease state and they also need to look at their expectations versus reality. The longer one has had a disease state for, or health issue for, the longer it is going to take to manage. Then I always talk about the magic pill. I think many people are waiting for “the magic pill”, which does not exist, and then get caught up in the vicious cycle of “Nothing works” and then spiral over and over again. I wish there was a magic pill to take to solve everyone’s disease state, but there isn’t and this is something that all concerned need to come to terms with. I know I have been there, so I understand where people minds go to. When you are in pain, or living with disease state, it is all too easy to blame everything and become very cynical and negative, which in turn does not help the disease state either. This is why when it comes to dealing with any disease state, we need to help the individual emotionally as well, so that they can learn to be focussed, be clear and also learn to cope with their symptoms better.
The problem is that many just get caught up in the one dimensional medical treatments of surgery and taking a pill approach, when in fact they need so much more. Again, this is not discrediting that surgery and medications are a much needed part of treatment for many, especially those with endometriosis, or severe PCOS etc. Many will not be able to function daily without surgical intervention, or pain killers, etc. But, as mentioned before, while they are necessary, they are not enough and women need to be looking outside the box and looking for a more individualised, multi-modality, team like approach, if they truly want to get the help they are needing and to be clinically managed properly.
So where do you find these treatments and people who can help?
Well, that is the million dollar question that everyone is looking for and probably the hardest thing to answer. In every profession and every industry there is good and bad and not everyone specialises in the disease state you are wanting help with. This is the biggest hurdle many will face. The sad but honest truth is that many people are seeing someone that doesn’t have the skills to deal with their disease state and is actually a big part of them not being able to move forward with proper treatment. This isn’t just related to the medical profession either. It is the same in allied health, complementary medicine and other areas of health. This is why it is so important to find the right person, or the right team to help you. People that have the right skills, the years of experience, the specialisation in the area you are needing help with and also willing to work in with others to help you be managed and treated properly. If the healthcare practitioner you are seeing isn’t helping you, then you need to change. Don’t just sit there complaining about it. Don’t go back to them and go and find someone who will help you. It might just change your life. Remember that if you do not change anything, nothing changes.
Having to live with a chronic disease state daily, I know the issues people face, on both a physical and emotional level. I know how hard it is to find the right people and get the right help and having to sift through the BS people tell you, when in fact many of these really have no idea. I really get how hard it is and I also hear how people are being missed and dismissed daily and it annoys the hell out of me.
This is why as a healthcare practitioner, I use a multi-modality approach to healthcare. I help people with as much of my own skills and multimodality treatments and then I am also their guide, their coach and their voice, if they need to be referred to others. I always work within my close network of healthcare professionals and only refer to those whom I can trust and whom I know have the skills to help me and to help my patients. I always joke with my patients that I am here to keep the others honest and also be their guide every step of the way.
For those that are living in chronic disease state, I do feel for you, as I know how hard it is when you have to deal with a chronic disease daily. The one thing I did learn though is that you have to fight and you need to take your health into your own hands. If you aren’t strong enough to do it on your own, find someone who will be your voice for you. I know this is what I do for my patients.
If something isn’t working for you, or your symptoms aren’t getting better, then this means you need to change something. Don’t just keep doing what you have been doing and expect it to change. Don’t get caught up in the blame game, or get caught up in the label, as this doesn’t help you either. It just creates more stress and negativity. The best way to help your condition is to help yourself and get your mind and body strong again. You also need to realise that nothing is going to fix overnight and there is no such thing as a magic pill. You need to take one day at a time and do things one step at a time, no matter how hard things seem. You need to put one foot in front of the other and just keep doing that. Yes, you will have bad days, but as long as you are progressive and being monitored and managed properly and you are progressing forward, no matter how slow you may think you are going, then this is a good thing.
I often say that when one is faced with the challenges of having to deal with a chronic disease, or chronic health issue, that it is like running a marathon. You can’t not put in the training and all of a sudden wake up one day, without any training, and expect to run a marathon and complete it.
To run a marathon you need to put in the work. You need to train. You need a coach to motivate you and help you with your training. You need to put good food in. You need to put supplements and additional nutrients in. You need to get your mind right and be motivated. To do that you need a mind coach, or a psychologist, or counsellor, or mindfulness coach. What will get you over the line in the end is “You” and the work “You” have done and the advice “You” have followed and the lifestyle and dietary changes and the body conditioning. It is about everything “You” have done in combination coming together to help you overcome the marathon of your disease state. Nobody is going to do this for you and this is probably one of the hardest things I had to learn on my own health journey. You can either stay where you are, and live in the state you are living in, or you can get up and take control of your own health. It isn’t going to be easy, but it can be done. I help people do this everyday. I see people do this everyday. It is also about finding the right people to help you and support you along the way. This is what I now do for my own patients and if you so need help, I can always assist you in the marathon of your own disease as well.
Dr Andrew Orr
-No Stone Left Unturned
-Women’s and Men’s Health Advocate
The word “Barren” comes originates from the French word ‘Brehaigne’, which means not producing, incapable of producing offspring, infertility, infertile; sterile.
Sounds terrible doesn’t it?
Fortunately very few women are ‘sterile’ and the word “infertility” is often misused in our modern society. Nobody is truly infertile, unless they actually have reproductive organs missing, or have genetic abnormalities that will actually prevent conception from happening etc. When a couple is having trouble conceiving, we should really use the word “sub-fertility” instead of “infertility”
The problem with talking fertility, sub-fertility, or infertility is that we often reference, target, or even blame the woman. Yes, women are often the blame of not being able to conceive a child and therefore the myth of the barren woman still runs deep and is very much in existence and kept alive by all concerned today in our modern world.
But is conception and the ability to conceive a child inherently the fault, or responsibility of the woman?
The answer to that is “No!”, but there is still this expectation, or focus, that not being able to conceive all falls back on a woman. Sometimes women actually wrongly blame themselves, or wrongly take on that responsibility too. Some women will even take on that burden, to protect a partner, who may actually be the main issue. Then we now have an area of medicine that has its focus as being the woman, because women are the primary driving force for wanting to have a child. Hence the vicious cycle continues in this terrible loop and then many, practitioners included, buy into the myth of the barren woman and so the cycle continues over and over again.
Well, I am here to tell you that women are not the only part of having a child and that men play just as big a part when it comes to fertility issues and not being able to conceive.
No matter what you get sold, or what BS (bullshit) you are sold, while pulling on your ‘I need a baby heartstrings’, to make you part with your hard earned money, the fact remains, and will always remain, that it takes a sperm and an egg to make a baby. That is basic biology 101 and no matter what someone tries to tell you, sperm quality is just as important as egg quality in this equation.
Every day I see practitioners, both medical and in complementary medicine, focussing in on women as the primary focus of fertility and actually feeding the myth of the barren women by their very actions. Many times the men are overlooked, or ignored, or completely disregarded in the fertility equation. Not only is this unethical, to just treat and focus on the women when it comes to fertility treatment, but it is highly negligent as well. Men are not born with an inherent right to automatically be able to conceive and worse still, the male sperm levels have fallen by as much as 60% in the last 70 years, with sperm quality levels said to be dropping at an alarming rate.
So why is the focus, the burden, the guilt and the whole emotional baby roller coaster left solely to women?
Well, I have explained that practitioners are to blame, the fertility profession is to blame, society is to blame, guilt is to blame and last of all men are a big part of the issue too.
Men are often to reluctant passengers in the fertility journey and are often very happy to bury their heads in the sand and pass the responsibility of not being able to conceive onto a woman. Then many men are told their sperm is fine, when in fact it is far from being fine.
Over 50% of fertility issues are related to male factors and up to 85% of miscarriage issues may be related to male chromosomal, or DNA issues related to sperm. As I said before, research has now shown that the male sperm quality has fallen by up to 60% over the last 70 years and is actually on the decline. Men are often the bigger part of the fertility picture and it isn’t just the woman at all.
Semen analysis parameters are based on what is needed for Assisted Reproduction (IVF, IUI, ICSI) , not based on what is needed for natural conception and this is where some of the biggest issues lay. Misinterpretation of semen analysis and misinterpretation of parameters have many men believing they have OK sperm, when in fact it is far from being OK. With modern procedures such as ICSI, we only need a few single sperm to be able to fertilise eggs and this can still be considered ok, because at least there was some sperm to fertilise the egg in the first place. A few single sperm, or a few hundred sperm, or even a few thousand sperm is not OK when it comes to natural conception. We actually need a few hundred million sperm for it to be OK and even then they need to be motile and they need to be swimming properly (rapid progressive) and actually be of good shape (morphology)
While a semen analysis is often the first part of male fertility evaluation, it is also very limited. While we can look at morphology, motility, concentration, count etc, it does not tell us about the actual quality of the sperm inside. Many sperm may look ‘OK’ via a semen analysis, but inside their DNA integrity is poor and there are high amounts of DNA fragmentation and this can only be measured by a DNA fragmentation analysis. Even then, each time a man ejaculates, the quality of the sperm will be different and can differ by up to 20% in each ejaculate.
We also know that what a man eats, drinks and even his physical and emotional health will affect his sperm quality and that a man’s physical, dietary and emotional health can be passed onto his offspring through the sperm. This is why it is important for a man to get his physical and dietary and emotional health in check way before he tries to conceive a child with his partner.
We always say that the healthier a man is, the healthier his sperm is and the healthier the woman is, the healthier her eggs will be also. A healthy man and a health woman produce healthy babies.
I have been assisting couples with fertility and pregnancy for over 20 plus years now, and helped over 12,500 plus babies into the world, and I can tell you that conception is not just about the woman. It gets back to basic biology 101 that it takes a sperm and an egg to have a baby. Even when couples are having issues trying to conceive, or doing IVF, or however they are trying to conceive, there will be some issue on the man’s side and the woman’s side. Unless there is absolute infertility on one side, or the other, there will always be a bit of both the man and woman to work on to assist in being able to conceive.
While the myth of the barren woman runs deep in society, fertility clinics and through the guilt handed down from their fellow sisters and mothers, fertility issues and the right to be able to conceive ‘does not’ fall solely into the hands of a woman, far from it. Men are an equal part in the fertility equation and men need be held just as accountable when it comes to trying to have a baby, or if there are difficulties in conceiving. No matter what anyone tells you, a man needs to be part of treatment, management and support of the journey to have a baby. This is a big part in my multi-modality fertility program being so successful in assisting over 12,500 babies into the world. Fertility isn’t just the responsibility of the woman, it is the responsibility of the man as well and I make sure both the man and the woman are properly investigated, clinically managed and helped with treatments as well.
Dr Andrew Orr
-No Stone Left Unturned
-The Brisbane Baby Maker
Men, it is time to eat more nuts, to help your…. ummm… NUTS!
But this isn’t just about your family jewels, this is about helping with what they produce and helping you carry on your family tree. A diet rich in nuts has been shown to improve sperm count, motility, morphology and sperm DNA.
Recent research published in the European Society of Human Reproduction and Embryology (July 4th 2018) has shown the men that regularly eat nuts have improved sperm quality and function and less DNA fragmentation in their sperm.
In many forms of traditional medicines, foods and the shapes of foods, often correlate to an organ in the human body. To give you an example, walnuts look like a lung and they also look like a brain. There are now research papers to show that walnuts may assist with brain function and help with lung function as well.
Many of the foods we eat may also assist fertility. Many of these foods may look like a reproductive organ, or contain seeds in them. Fruits such as dragon fruit and kiwi fruit look like the shape of a testicle, or an ovary and have seed in them, which traditional medicines often say are good for the seed (meaning eggs and sperm on a fertility level)
Hence it is no surprise that nuts, can help with… ummm… well…. a man’s nuts (reproductive organs)
This new research showed that the inclusion of mixed nuts (almonds, hazelnuts and walnuts) in a regular diet significantly improves the quality and function of human sperm, according to results of a randomized trial which measured conventional semen parameters and molecular changes over a 14-week study period. The findings, say the investigators, ‘support a beneficial role for chronic nut consumption in sperm quality’ and reflect a research need for further male-specific dietary recommendations.
Results firstly found significantly higher levels of sperm count, vitality, motility and morphology in the men randomised to the 60 g/day nut diet than in those following their usual diets free of nuts. Moreover, the subjects in the nut group also showed a significant reduction in their levels of sperm DNA fragmentation, a parameter closely associated with male infertility. Indeed, it was this change in the level of DNA fragmentation in the sperm cells by which the investigators explained, at least in part, the improvement in sperm count, motility and morphology.
Nuts are dense foods containing many antioxidants, omega 3 oils, amino acids and folate. This may explain why nuts are so beneficial to improving sperm quality overall. Antioxidants help with oxidative stress, which can be a big factor in DNA damage to sperm and poor sperm quality. Antioxidants and amino acids help with proper formation of sperm at the cellular stage and help prevent damage to sperm cells and help with repair and formation of the DNA of sperm as well.
There is much more growing evidence through research literature that healthy lifestyle changes such as following a healthy dietary pattern can assist conception. Healthy parents make healthy babies. It takes a sperm and an egg to make a baby and healthy men produce healthy sperm. This is why it is important for not only the woman to be healthy prior to conception, but for the man to be healthy as well. The health of the father is passed onto the child and there is growing evidence to support this now.
When it comes to fertility and trying to have a baby, males need to be an equal part of the equation. Fertility isn’t just a woman’s responsibility and fertility issues are not just related to women.
Dr Andrew Orr
-No Stone Left Unturned
European Society of Human Reproduction and Embryology. “A diet rich in nuts improves sperm count and motility: Improvements associated with better male fertility and explained by a reduction in sperm DNA fragmentation.”
Many years ago I was asking this same question, “But what do I do?” and “Who is going to help me?”
Like so many others, I know all too well about having a chronic health condition and living with that daily. Yes, I too have a chronic disease state and I also know what it is like to live in that chronic disease state. That is why I understand what many of you go through daily. I may not know what it is like to live with your disease state, but I know what it feels like to live in chronic disease state and have to live with the consequences of that disease. I also know what it is like sitting there thinking that nobody seems to be able to help me and one seems to be getting nowhere with this. Then the vicious cycle of then doing nothing, because one believes that nothing works and nobody can help, and then nothing gets done and the symptoms continue and then you get even more and more frustrated. Yes, I have been there too. This is why I do what I do now and why I want to help others get out of their rut, and help them overcome their disease and learn to manage their disease better to then have a better life.
But unlike many others, I do know the power of positivity and know that once I put my mind to something and commit to it, then I’ll do as best I can and it also helps get the process going. I also know that in order for something to change, that I also had to be proactive and make things change. It is that old saying “If you don’t change anything, then nothing changes”
So one day I sat down and said “Right, let’s just forget about whom I have been seeing, forget the blame game etc and let’s just really look at this objectively. What do (I) need to do to create a change?” and “Can I do all these changes on my own?”
Sometimes asking these sorts of questions about yourself can be quite confronting and when you do, you also need to be completely honest with yourself and have those around you be honest with you also. Then you have to take that advice, listen to what people are saying and then go about finding someone to help you and then actually make the necessary changes that are needed. But, finding someone to help can be really hard too. Like every other profession, or industry, or workplace etc, there are good and bad people in what they do. Unfortunately finding the good people to help can often be hard, but it doesn’t mean they are not out there. There are good people out there, and people who are excellent at what they do, but it also means not being sceptical and also having an open mind, otherwise you will just give up and not do anything again. Then you end up being in the vicious ‘poor me’ cycle again and that isn’t going to help anyone. This is where a good counsellor or psychologist can help and be impartial and be objective in what you need to do to move forward.
Then I also learnt that I had to stop the blame game and had to learn to stop making excuses. I know all too well that it was much as it is easy to blame others and blame things for not working, but at the end of the day we are all in charge of our own health, our own lives and what happens to our body too. Well, to a point anyway. I do know that sometimes you just can’t help genetics and hereditary disease, but at the same time, these disease states can be managed “If” you get proper care.
I remember a good friend sitting me down and talking to me about what I should do and also some of the questions this friend asked me. Some of the things he said to me and insights he shared with me were things like these.
This friend of mine said to sit there for a minute or so and really reflect on what he was asking and be completely honest with myself.
He said to me “You know how some people come to see you and then they go away and then don’t take on any of the recommended changes and don’t do the treatments and then expect for things to miraculously changes and you to somehow just fix them without them having to do anything….. are you one of those people too?”
Not something I wanted to hear, but I did appreciate the honesty. I could relate to what he was saying because if one doesn’t do the necessary recommendation, or do the treatment, then one isn’t going to get better and then you can’t blame the person you are seeing if it all goes pear shaped.
Then he said to me “You can’t keep doing the same thing over and over again. If it isn’t working, you can’t then expect a different outcome each time, or just hope that all of a sudden it works.” He then went on to say “I’ll put it to you this way. If you keep running into a brick wall and then it hurts and you fall over and then get back up again and try to do it again thinking it might not hurt this time, and expect a different outcome, when you know it is going to hurt, then you need to start asking yourself some serious questions”
Then he said to me “Let’s really look at expectation versus reality. You have had this disease state for a really long time, but in your own mind you want it fixed straight away, or after a few days, or after a few weeks. The thing is… it isn’t going to happen.” He then continued “You know all too well that if you have had a disease state for years it isn’t going to fix overnight and that it is going to take months, or may even take a year or more to fully get on top of it, depending on the severity and what is going on”
This friend also said to me “Sometimes pain levels and symptom and all a matter of expectation versus reality too. Sometimes you think you aren’t getting better, when in fact you actually are. If someone where monitoring you properly you may have started out at 10/10 pain and may now be 5/10, which is an improvement. But, because you are still in pain, you won’t see it as such until someone points out the difference. It is all relative to what you believe versus what is actually happening ”
Lastly he then put it rather bluntly to me “Who the bloody hell have you been seeing and are they any good?” then he added “Because we all know there are people out there you wouldn’t send your dog to and the good ones are few and far between. Btw, who sent you there in the first place?”
He then added one more thing in “You can’t try and do this yourself, or try and treat yourself because that isn’t going to work and this is not your area of expertise. Go and see someone for advice and help and don’t be like many others and try and (Dr Google), or try and self-manage your own disease. That will end in tears”
So, after my brutally honest, but helpful, conversation with my friend, I did have a big conversation with myself and realised some things. These same things I now share with my own patients.
Having lived with a chronic disease state for most of my life, I do know how challenging it can be for people and to find that strength and courage to actually get up and do something about your health. It can also be disheartening when the people you have seen have missed and dismissed your disease too. It all just compounds and adds to the daily burden of what you are going through. But, never let those things stop you from finding someone who can help, or finding the strength to get up and make the necessary changes you need to make a better life for you. I think that having a disease is sometimes like learning to ride a horse. You may fall off many times, but you need to just get straight back on again until you master the art of staying on and being a good rider and being in control. But even the best rider is going to fall of every now and again, and that is ok too.
Just remember that there is always help out there and there are people who will listen and who do specialise in the area you need help with. Lastly, for you to get better, it also needs for you to be a big part of the driving force behind that and actually do the work needed. Don’t just sit there in ‘poor me’ mode. Get up and get yourself out there and do what you need to do for you. If something isn’t working then change it. Just remember that in order for a change to take place, something has to change. Something that means you changing your belief and your thinking too. It might also mean changing the healthcare provider you are seeing too.
As someone who has been there, I hope this helps you all get the help you so desperately deserve. Just remember that if you don’t know what to do, or where to get help, please know I am here to help you as well. You can always book in a consult (in person, or via online) and I can help assist you with your health, and also point you in the right direction too.
Dr Andrew Orr
-No Stone Left Unturned
Vaginal bleeding between periods can be common and is not generally a cause for concern. Most of the time women will get just very light pink coloured watery flow, or just some spotting. There can be many reasons why a woman would be getting bleeding between periods, which includes hormonal changes, injury, or an underlying gynaecological, or health condition.
While bleeding between your periods may not be cause for concern, on one level, the ideal situation is to not have any form of bleeding at all and if you do get bleeding between your cycle, it is a good idea to have this investigated, just to be on the safe side.
What a proper menstrual cycle should be like
I have done quite a few posts on what a proper menstrual cycle should be like, but I will go over this again just briefly
A proper menstrual cycle should be between 26-32 days in length and really only have about 3-5 days flow. Any longer than this can be too long and put a woman at risk of being low in iron, especially if this happens all the time.
The blood flow should be a nice red consistency, no clots, with no stopping and starting, and women shouldn’t have too many digestive disruptions, and really, a woman should not be getting pain with her cycle. A little bit of distention and knowing the period is coming is fine, but there should not be pain at all. If you have to reach for the pain killers and the heat pack, or are doubled up in pain, this is not normal and you need to get this checked out.
As mentioned before, there can be a variety of reasons for breakthrough bleeding, some of which are no cause for concern at all. Some however do need to be investigated.
Below are some of reasons for bleeding between periods:
When an egg is released from the ovary, it does create a tiny wound, through which the egg will then travel through the tubes and prepare to make its way to be fertilised, or then shed with the menstrual flow. At ovulation, this tiny wound can also create a tiny amount of bleeding, which can be seen as spotting during the ovulatory phase of a woman’s cycle.
When an embryo implants into the uterine lining and begins to grow, many women experience spotting around this time. This is called implantation bleeding. They may also experience some slight cramping at the same time and all of this is quite normal. Some women may then experience some lighter bleeding as the embryo grows further. They usually get some light spotting, which can be a light pink, or a brown colour. Sometimes it can be more like fresh blood. While this is normal, it is a good idea to get this checked out just to be on the safe side and to also put the pregnant mothers mind as ease too.
Bleeding between menstrual periods can be an early sign of a miscarriage. Many women may not even know they are pregnant and may be completely unaware they are having a miscarriage. While it is generally thought that once a woman reaches twelve weeks gestation everything is generally going to be ok, miscarriages can occur at any time during pregnancy.
After having a termination women can bleed for some time after the procedure, or taking the medication to start the abortion process. If bleeding continues and is very heavy, women need to seek medical advice.
Polyps are small growths that can develop in the uterus or on the cervix. They are often a cause for unexplained bleeding between the cycles. Polyps do need to be removed as they can prevent implantation happening and they can also turn cancerous if left behind. Polyps are a very common cause of bleeding between periods.
Fibroids, or myomas (also known as leiomyomas, or fibromyomas) are growths, or benign (non-cancerous) tumours that form in the muscle of the uterus. Up to 40% of women over the age of 40 years have fibroids and as many as 3 out of 4 women develop fibroids in their lifetime.
Fibroids can cause heavy bleeding, extended bleed and painful periods. They can also cause infertility, miscarriage and premature labour. In many women, they will not cause any problems at all. Fibroids are a very common cause of bleeding between the cycles.
Polycystic Ovarian syndrome (PCOS)
Polycystic Ovarian Syndrome (PCOS) is a very common condition that can cause irregular periods, absent periods, and can also cause bleeding between periods. PCOS can also cause other issues such as acne, weight gain, infertility and hormonal and emotional disturbances.
Endometriosis or Adenomyosis
One in ten women are diagnosed with endometriosis and many more do not even know that they have it. Endometriosis and Adenomyosis are very closely related, with endometriosis usually being more superficial disease and not confined to the uterus, and adenomyosis being deep within the uterine tissue. Chronic conditions such as endometriosis and adenomyosis, can cause bleeding or spotting between periods. These conditions may also cause heavy or painful menstrual periods and cramps between periods. Adenomyosis will usually cause more bleeding symptoms along with pain etc.
Sexually transmitted infections (STIs)
Some sexually transmitted infections (STIs) can cause pain, vaginal bleeding and spotting. If you do suspect you may have a STI, you need to see your doctor for investigation and treatment.
Injury to the vaginal wall
During sexual intercourse the tissue of the vagina can be damaged and this can then cause bleeding. If the vagina is too dry, lack of arousal, and not lubricated enough this is more likely to happen. It can also happen if there is atrophy in the vaginal tissue as well. This is called atrophic vaginitis. This is more likely to be seen when a woman is going into menopause, or undergoing cancer treatments, or has diabetes.
Menopause or perimenopause
The menopausal stage of life and especially the perimenopause stage, can be a cause of irregular menses and irregular bleeding. It can also cause spotting, or heavy bleeding too. Perimenopause is the period leading up to menopause. This stage of a woman’s life can last for up to 10 years as hormone levels in the body change and can be unstable.
Hormonal contraceptives are a common cause of bleeding between periods. They can also cause irregular bleeding and this can be quite usual in the first 3 months of using the contraceptive. If a woman misses takin her oral contraceptive, it can also cause irregular bleeding, or a withdrawal bleed. Intrauterine Devices (IUD’s) like the Mirena, will often cause irregular periods and irregular bleeding in the first 3 months after it have been inserted. If bleeding lasts for longer than 3 months on any contraceptive, it is a good idea to seek medical advice and get investigated and managed properly.
The morning after pill, or emergency contraceptives, may also cause bleeding. If bleeding persists, you should seek medical advice.
Vaginal bleeding between periods can also be a sign of gynaecological cancers in women. Most bleeding that women get is not serious, but it still needs to be checked. Cervical cancer can affect women of any age. Bleeding between the cycle, or after intercourse, and pain after intercourse, or unpleasant smelling discharge can be symptoms of cervical cancer and these all need to be checked by your doctor, or gynaecologist.
Uterine cancer tends to occur in women over 50 year of age. One of the early symptoms of uterine cancer can be vaginal bleeding. Uterine cancer mostly affects women are in the menopause and no longer have periods, so this is why any bleeding after menopause needs to be investigate and seen as not being normal.
Yes, stress can cause abnormal bleeding and also interfere with a woman’s cycle. Increased levels of stress can interfere with hormones and this can lead to bleeding, irregular cycles, or pain with cycles too.
When to see a doctor
If vaginal bleeding between periods is heavy, persistent, or unusual then a woman should go and see a specialist, or a gynaecologist, who is a specialist in this area of medicine. As mentioned previously, while some causes of bleeding are not serious, some are and need to be properly investigated and properly managed medically.
Treatment and prevention
All women should keep a record of their menstrual cycle and when the period starts and how long it lasts for. Any abnormal bleeding should be recorded so that you can show your healthcare specialist if need be. Any abnormal bleeding should be investigated and the treatment will depend on what the underlying cause is.
Women should try and see their healthcare specialist for regular pap smears and regular check-ups for gynaecological health.
If women are getting small tears and bleeding caused from dryness in the vagina, then there are water based lubricants that can be used to help with lubrication and to moisturise the surrounding tissue.
There is no cure for gynaecological and reproductive issues such PCOS and Endometriosis, but these disease states can be treated and managed to give women a normal life. Proper treatment of these issues needs a “Team”, or multimodality approach using medical options, surgical interventions, pelvic floor specialists, acupuncture, herbal medicines, hormone therapies, and diet and lifestyle changes. It is about using what works for the individual and not a blanket one treatment fits all approach.
Last but not least, all women should know that period pain is not normal and that irregular bleeding really isn’t normal either. While most causes of bleeding are not life threatening, they still need to be investigated and checked out properly. Never ever put off seeing a specialist if you have abnormal bleeding.
Dr Andrew Orr
-No Stone Left Unturned
The average Australian woman reaches menopause at 51 years of age- with a normal range from 40-55. Contrary to the popular concept, the female body does not become depleted of eggs at this time, but the remaining follicles become less and less responsive to hormonal stimulation.
Premature menopause is defined as cessation of ovarian function prior to 40 years of age. About 1% of women will experience menopause before 40.
The approach of menopause is signalled by rising LH and FSH levels as the pituitary attempts to prompt a response by the ovaries.
The menopause signals the permanent end of most ovarian function and hence the menstrual cycle in a woman’s life. Sex hormones don’t only influence reproductive tissues but also have a multitude of other functions including effects on bone and mineral metabolism, cardiovascular function, memory and cognition, effects on the breast and genitourinary system as well as nutrient absorption.
There are a variety of symptoms which are believed to be due to reduced oestrogen levels and approximately 85% of women will experience some of these symptoms to a greater or lesser degree. These symptoms can be summarised as:
Vasomotor symptoms– (these tend to be early onset):-Hot flushes ( or “flashes” as they are called in USA literature), Night sweats, Formication ( a particularly unpleasant sensation likened to ants crawling under the skin – “formica” is latin for ant)
Urogenital Symptoms– (tend to occur about 3-4 years after menopause):-Dry Vagina, Change in vaginal pH, Atrophic vaginitis/altered vaginal discharge, Dyspareunia, Urinary frequency/dysuria/aggravation of stress incontinence
Associated physical changes-these are partly the result of the normal ageing process, but may be accelerated by declining oestrogen levels. These may include decreased fitness and flexibility, changes in distribution of body fat, changes in sleep patterns
Loss of elasticity of skin and support tissues (may result in):- Worsening of uterine prolapsed, Loss of glandular breast tissue ( breast size and texture changes), Skin changes and wrinkling, Less nipple sensitivity and erectile potential, Joint and muscle pain, Skin dryness
Emotional and psychological changes– it is sometimes difficult to separate the hormonal from the personality-driven and situational as the cause for these symptoms, but women at the menopause may complain of such symptoms as:- Anxiety and/or depression, Insomnia, Lack of concentration and poor memory
Effects on Bone– (these effects may not become apparent until some years after menopause) :- Osteopenia/osteoporosis, Fracture and bone pain
There are other symptoms which have been ascribed to declining androgen levels, though the evidence is less clear-cut. These may include such symptoms as:
Change of body shape – increasing fat deposition around abdomen, less at buttocks and thighs
Loss of libido :- Many libido issues are caused by emotional issues and changes to lifestyle rather than being a hormonal issue
Change in body hair distribution– Pubic hair thins, hair on the head may thin or if woman carries the gene for male-pattern baldness may recede at temples and crown. Facial hair may increase.
The main cause of people seeking treatment for the menopause is for relief from vasomotor symptoms, the main one being hot flushes or night sweats.
There is a lot of misinformation about the peri-menopause and menopause stage of a woman’s life. Some of the peri-menopause (meaning before the menopause) symptoms can start up to 8 years before a woman actually goes into menopause (meaning the menses stop). Then some of the actual menopausal symptoms can last many years after the menses has stopped and this is something that is not discussed enough and often poorly understood by many, including many healthcare practitioners.
Some women with menopausal symptoms do not choose to pursue any medical treatment when they experience it. However, some women have severe symptoms that affect their quality of life, and may need to have medical treatment in the form of hormone replacement. One of the biggest fears around hormone replacement therapy is the increased risk of breast cancer. You can talk to your specialist, or doctor about these risks before you start any form of treatment. There are now compounded bio-identical hormones to assist menopausal symptoms and these may not have the breast cancer risk factors of conventional hormone replacement medications.
Examples of some medical treatments available for menopause include:
Traditional medical HRT can also help with bone strength and reduce the risk factors for heart disease.
The Women’s Health Initiative of 2002, issued a warning against the long-term use of traditional hormone therapy (HT) because of the increased risk of breast cancer, but this study was poorly explained and created lots of panic for both practitioner and patient alike. Since then alternative methods, such as bioidentical hormone therapy, have been developed.
Bioidentical hormones are chemically the same as those that the body produces naturally. As a result, the body should is not able to tell the difference between the hormones it produces and the bioidentical ones. Bioidentical hormones can be made from a variety of sources that span plant and animal products and are said to have less side effects than traditional hormone replacement medications. Many women get great relief from Bio-identical Hormones, but it is important to speak to your healthcare provider about these and if they are suited for you
Women may also consider trying herbal medicines or other dietary supplements as a means to reduce the incidence of menopause symptoms. There are now many menopausal formulations on the market and anyone wishing to use complementary medicines should speak to a qualified complementary medicine practitioner about what is suitable for them. Never self prescribe natural medicines with consultation from a qualified healthcare practitioner.
Chinese medicine has been treating and assisting symptoms menopause for thousands of years very effectively. The key to Chinese medicine treatment is that a practitioner will assess and treat each person individually, not with the one treatment fix all plan. We aren’t all the same so why should we all be given the same treatment.
It must be noted that up until recent times the Chinese did not have a word for Menopause and that very few women experienced any of the symptoms of menopause. The only ones that did seem to were the rich and those of noble heritage, who ate very rich and luxurious diets. This does show that diet and lifestyle factors do affect menopausal symptoms. Many used to believe that the Chinese didn’t get menopause because of their higher consumption of phytoestrogens such as soy. This has now been proven not the case, as soy products “do not” have any benefit to menopausal symptoms, but adherence to proper diet and lifestyle improvements does.
There is also some really good evidence to show that acupuncture can assist with hot flushes and also assist with the symptoms of menopause.
In addition to medical and complementary medicine treatments, there are many at-home treatments that a woman can do to reduce menopausal symptoms. These include:
It must be noted that menopause is a normal part of a woman’s life and menopause is not a medical condition. The main reason that women seek help in menopause for is the menopausal symptoms such as hot flushes, dryness and loss of libido etc. At my clinic I use a multi-modality and individualized approach to treating and assisting the symptoms of menopause, using a combination of Medical science, Integrative Medicine treatments, Chinese herbs, Diet, Nutritional supplements and Lifestyle changes and find this gives the best results in assisting my patients.
Dr Andrew Orr
-No Stone Left Unturned
Interstitial cystitis (IC) is a chronic inflammatory bladder condition in which there is persisting chronic pelvic pain, urinary frequency and urgency, bladder pain or pressure, and it can also resemble the symptoms of a urinary tract infection, but there will be no infection present. The pain can range from being mild to severe.
Worldwide Interstitial Cystitis affects up to 100 million people and it can affect both men and women, regardless of age. IC is also known as painful bladder syndrome (PBS), bladder pain syndrome (BPS) and chronic pelvic pain (CPP)
Women with interstitial cystitis may experience many of the same symptoms as those with endometriosis. Women can have both Interstitial Cystitis and endometriosis at the same time. Some people with IC may also have irritable bowel syndrome (IBS), Fibromyalgia and other pain syndromes
People with IC have chronic symptoms in the urinary tract that last more than 6 weeks in duration. Infection has not been identified as a cause of IC. Physical and emotional stress can worsen the symptoms of IC.
Interstitial Cystitis can cause the following symptoms:
The pain may be experienced as discomfort or tenderness or irritation or burning sensation in the bladder, in the form of spasms in or around the bladder, or stabbing or burning vaginal pain or simply a feeling of pressure on or in the bladder or a feeling of fullness even when there is only a little urine in the bladder.
In many people, the pain is relieved temporarily by urination, while other people may also feel strong pain following urination.
The pain or discomfort may be constant or intermittent. It may also be felt throughout the pelvic floor, including the lower bowel system and rectum. In some patients the pain may be very severe and debilitating.
Other people, particularly in the early stages, may have milder frequency with/without urgency and without a true sensation of pain. What they may experience, however, is a feeling of heaviness, fullness, discomfort or pressure.
During the evaluation of potential IC, several tests may be completed to make a diagnosis. These tests may include taking a full medical history, completing a bladder diary, pelvic examination, including a neurological exam and urinalysis to rule out or diagnose an infection
Other diagnostic tests that can be carried out include:
Cystoscopy: This is performed inserting a tube, with a camera attached, into the bladder to evaluate the lining and to look for inflammation and signs of disease. A specialist may also evaluate the bladder capacity with a cystoscopy.
Urodynamics: The bladder is filled to test its capacity by measuring the pressure during filling and voiding. These tests evaluate the function of the bladder, urethra, and sphincter muscles.
Biopsy: During a cystoscopy, a biopsy may or may not be taken to rules out cancer or other inflammatory bladder conditions that can cause pain similar to IC.
Potassium sensitivity test: This is a test in which potassium and water are instilled into the bladder. In healthy bladders, pain is not felt with either solution. In cases of IC, however, pain is typically experienced when the potassium is instilled.
People with IC may be sensitive to certain foods and beverages. There is a range of items a person may need to excluded from their diet after receiving an IC diagnosis. This will be different for each individual but there are certain foods and drinks that an individual with IC should be aware of potentially needing to avoid. There are food and drinks such as:
Some people with IC may need to a food elimination diet over several weeks to see which specific foods and drinks may be exacerbating their symptoms. There are many foods that do not have an irritating effect on the bladder and contain vital nutrients to help fight disease. This is why elimination diets and specific dietary requirements need to be done under the guidance of a healthcare professional.
People with IC should also give up smoking if they are a smoker, as the chemicals can affect this condition too.
The treatment of interstitial cystitis is complex and needs a multimodality approach to treat it effectively. It may require treatments such as:
Your specialist or healthcare provider will discuss the best forms of treatment for your individual case. People with IC should also be referred to a Urodynamic and Pelvic Floor Specialist who specialises in this area.
Complications from IC can vary between individuals and why there is no one treatment fix all approach to this conditions. IC can affect a person life on so many levels. It can affect their bladder volume, their quality of life, their sex life, their libido and have an affect on sexual intimacy and it can also cause them emotional distress. It is a complex condition that can affect every aspect of a person’s life both physically and mentally and why a multimodality treatment approach is needed.
The exact cause of IC is not known, but there are several theories as to what triggers the condition. Some possible causes include:
IC is a chronic inflammatory condition that affects many people world wide. It cannot be fully cured and requires close clinical management and care. A multimodality treatment approach needs to be adopted that is suited to the individual. When this is done properly, people with IC can still have a good quality of life.
Recommended treatment usually involves diet and lifestyle changes, stopping smoking, drinking less before bedtime, and scheduling planned toilet breaks to ensure the bladder does not get too full.
Dr Andrew Orr
-No Stone Left Unturned
April 3, 2018 Researchers in the United Arab Emirates (UEA) have found that women who have Polycystic Ovaries Syndrome have an increased risk of uterine cancer, reducing their chances of fertility.
The researchers have also found that women, who are overweight, or obese, are also at increased risk of uterine cancer. Being overweight and obese also increases a woman’s chances of PCOS too, but not all women with PCOS are overweight.
A study published in the Journal of the National Cancer Institute last year has shown that endometrial cancer diagnoses have increased in 26 of 43 countries, mainly due to increasing obesity cases which themselves have tripled in the last 40 years, according to World Health Organisation.
The experts believe that obese women are 10 times more likely to suffer from uterine cancer. Being overweight, or obese also puts women at risk of other diseases such as heart disease and diabetes.
There are other factors involves such as an imbalance in the hormones with over-exposure to estrogens can lead to endometrial cancer. This could be due to endogenous causes such as Polycystic Ovaries Syndrome, or exogenous causes such as unopposed estrogens in menopausal hormone therapy if progesterone is not prescribed.
Some women may have genetic family syndromes that is predispose to uterine cancer along with breast, ovarian and other cancers. The causes of uterine cancer may be multifactorial, but this new research does help with screening of women who are suffering from PCOS, or who maybe overweight, or obese.
The researchers did find that regular exercise and healthy lifestyle choices can serve as a protection against uterine cancer, but can also help with PCOS and obesity.
The researchers did warn that women in reproductive years should not take symptoms of endometrial cancer lightly, since early diagnosis and treatment is an essential key to fertility preservation.
Once a condition that only affected women of advanced years, increasing clinical evidence now suggests that even women below 40 years of age can be diagnosed with uterine cancer.
The cancer cases are on the rise due to higher incidence of known co-morbidities such as obesity, diabetes mellitus and hypertension.
Symptoms of the endometrial cancer include:
Early screening is essential and women can safely consider fertility preservation provided that the cancer is diagnosed in early stages.
Fact around uterine cancer
Women who have PCOS, or who are overweight, should be seeking help with dietary and lifestyle management to help prevent them from other risk factors such as certain cancers. The number one treatment for PCOS is changing to a low GI diet and doing regular exercise. One of the major causes of PCOS is insulin resistance and this is a big factor in many who are overweight, or obese, or have type 2 diabetes. All of these issues can be controlled with the right management.
Dr Andrew Orr
-No Stone Left Unturned
A multi-modality approach was one of the best ways I found to help Headaches & Migraines
Many years ago I used to suffer lot of debilitating migraines and headaches. Actually if I did get a headache, I was thankful because that was never as bad as a migraine, that could make you bed ridden with a head feeling like ten hangovers accompanied with the vomiting and light sensitivity. Even when the migraine had subsided I still felt washed out and like a train had run over me. Thankfully I haven’t had a migraine for many years and all thanks to a combination of chiropractic, acupuncture and diet and lifestyle changes.
Like many migraine and headache sufferers, mine were most likely caused by a neck injury, or whip lash, along with blocked sinuses. Current research shows that most headaches and migraines have a neck injury or neck complaint as a predisposing factor. Some neck injuries could go back to childhood or even a traumatic birth and you might not even know about it.
While neck related issues seem to be a major cause, there are many other contributing factors such as poor diet and lifestyle habits. Too many high GI carbohydrate foods and highly refined foods that interfere with blood sugars, can also cause headaches and migraine. Certain chemicals and additives in foods can also exacerbate headaches and migraines too. Let’s not forget how alcohol can be a big factor in headaches and migraines too.
Lack of fluids and inadequate hydration can also be a big cause of headaches and migraines too. While water is important to hydrate us, water alone is not enough. We need to make sure we get electrolytes into us as well. These need to be proper electrolytes, not lolly water such as sports drinks such as gatorade and powerade.
An imbalance of hormones, or hormonal surges, can also cause headaches and migraines and can be a big problem for women around the time of their menstrual cycle.
One other area that is overlooked is that the sinuses are inflamed or blocked and the associated inflammation and blockage is causing pressure and pain and causing headaches and migraines. This is a big one for many people and sadly, all too often, it is overlooked. A simple CT scan of the paranasal sinuses can see if the sinus cavity is blocked. If the sinus cavity is blocked by polypoid disease, or obstruction, it may require surgical intervention.
Lastly the biggest headache producer of all….STRESS!
Stress will tighten up those shoulder and neck muscles and then constrict all the blood flow to the head and the next thing you know it is headache and migraine city.
Whichever way you look at it, headaches are caused from an imbalance in the body and need to be rectified. Unfortunately too many people use the band aid treatment of painkillers to try and deal with the mighty headache or migraine. Nobody can argue with the painkilling properties of a dose of panadeine forte or a pethidine injection. I’d had many a trip to the doctor to get a shot in the behind. It was either that, or my head felt like it was about to explode. Worse still the pain often gets that bad that dying would be a relief. Well, that’s how it seemed anyway. I’m sure anyone who has suffered a really bad migraine wouldn’t have minded ending it all to get out of pain.
The only problem with painkillers, is they really don’t look at fixing the cause of the problem. Not only that, all painkillers have long term side effects that can be very bad for your health and some medication can be very addictive.
Like any health problem you have to look at treating the cause and not just the symptoms. A headache or migraine is actually the symptom of a much bigger cause. The problem for most people is that they only treat this problem symptomatically or seek help when they get a migraine or headache. It is the good old band aid approach to health care.
So how do you treat headaches and migraines and try and prevent them from coming back?
The answer as I’ve said is using a multimodality approach use the ancient wonders of Acupuncture, the more modern practices of Chiropractic and addressing dietary and lifestyle changes. Of course any other medically related issues need to be ruled out too. Like any health related condition, the management of headaches and migraines require a series of treatments to fix this problem, not a one off when you are experiencing a headache or migraine. Unfortunately I used to be one of those people who only do something about my headaches and migraines when I was suffering one. This was until I learnt that if I had regular treatments while I didn’t have a headache, then the practitioners could get to the bottom of the cause of my problems and prevent a migraine from happening. I wish I’d learnt that lesson sooner.
You will also need to address any dietary, hormonal and lifestyle issues that may be also exacerbating, or causing your headaches and migraines too. You also need to rule out any medically related issues as well and this can be done alongside other treatment modalities at the same time. This is how I now treat people and why I use a multimodality approach to assist people and give them the best results.
Just like many people have a misconception about getting Acupuncture, because they have a fear of needles or it may hurt, many people have misconception of Chiropractic. For one, just like acupuncture, it doesn’t hurt. and two, it isn’t about cracking bones. No bones are cracked, only gently realigned by expertly trained doctors whom have spent 5 years at university to do so. Before your first treatment, a good practitioner will usually take a series of x-rays to evaluate what needs to be done before ever adjusting the body. This way the practitioner can accurately and precisely pin point the exact cause of your particular problem. Just like with any healthcare professional, a series of questions is asked to get precise evaluation of the overall cause of your particular issue and then only after a treatment plan formulated, is the patient actually treated. Just like Chinese medicine, chiropractic looks at he cause of the problem to treat the symptoms. This is why they go so well together.
When I finally did get my headaches and migraines sorted, I found that it was a combination of acupuncture, chiropractic, diet and lifestyle changes that gave me the best results. This is why to this day that I firmly believe that with any health condition, headaches and migraines included, that a multimodality treatment approach is the only way to go. All of this can be done alongside medical treatment options as well. Of course the cause of migraines and headaches are different for each individual and this is why individual assessment and management protocols are needed for each person. This is why people need to see an appropriate healthcare professional and not try to manage headaches and migraines on their own.
If you need help with Headaches and Migraines, give our clinic a call and let’s assist you with getting the help that you so desperately need.
Dr Andrew Orr
(Reproductive Medicine & Women’s Health Specialist)
-Women’s & Men’s Health Advocate
-No Stone Left Unturned