Causes of bleeding in between cycles

Why am I getting bleeding between my periods?

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.

What are the causes of bleeding between periods?

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:

Ovulation

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.

Implantation bleeding

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.

Miscarriage

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.

Termination

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 

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

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

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.

Emergency contraception

The morning after pill, or emergency contraceptives, may also cause bleeding. If bleeding persists, you should seek medical advice.

Certain cancers

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.

Stress

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.

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned

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Menopause

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.

Treating symptoms of Menopause

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:

  • Hormone replacement therapy, such as taking estrogen therapy at the lowest, most effective dose.
  • Vaginal estrogen, which is applied directly to the vaginal tissues to aid with elasticity and assisting with vaginal atrophy
  • Antidepressants (SSRI’s), have been shown to reduce the incidence of hot flashes in some postmenopausal women.

Traditional medical HRT can also help with bone strength and reduce the risk factors for heart disease.

Bioidentical Hormones

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

Complementary Medicines

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 and Acupuncture

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.

Things to do at home

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:

  • Avoiding triggers that are know to make hot flushes worse. Examples can eating spicy foods, drinking hot beverages, acidic foods,  being in hot weather, or being in hot rooms.
  • Using water-based vaginal lubricants during sexual activity to reduce discomfort due to dryness and thinning tissues. Vaginal estrogen creams may be needed as well
  • Reduce Stress & Practicing stress-relieving techniques. Examples can include mindfulness, Tai Chi, Qi Gong, meditation, yoga,  journaling, massage, counselling and other forms of relaxation therapy
  • Do not smoke. Smoking can increase the risk of hot flushes and contributes to many other health issues such as certain cancers.
  • Do Weight Baring Exercise. Weight baring exercise is needed to keep strong and health bones and it also has other health benefits. You can also look into doing yoga and pilates to help with core strength and to help with pelvic floor strength and tone. Exercising can also help to relieve stress.
  • Pelvic Floor Exercises. Kegels exercises or use of Jade eggs (known as yoni eggs), or Ba Wen Balls, can help with pelvic floor muscles and increase blood flow into the vagina and pelvic floor area and also help with bladder control

Summary

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.

Regards
Dr Andrew Orr

(Reproductive Medicine and Women’s Health Medicine Specialist)

-No Stone Left Unturned

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Could You Be Suffering With Interstitial Cystitis?

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:

  • Chronic pelvic pain that lasts 6 months or more
  • Symptoms affected by the menstrual cycle
  • Pain, pressure, discomfort or unpleasant sensation that may worsen as the bladder fills
  • Urinating often alleviates the pain and may give a temporary sense of relief;
  • Suprapubic pain or discomfort
  • Pelvic pain (lower abdominal pain), sometimes extending to the lower part of the back, the groin and thighs
  • In women there may be pain in the vagina and vulva
  • In men, pain in the penis, testicles, scrotum and perineum
  • Both men and women may have pain in the urethra and rectum
  • Pain with sexual intercourse in both men and women (dyspareunia)
  • Pain on ejaculation in men
  • Pain may worsen with specific foods or drinks
  • A frequent need to urinate (frequency), including at night (night-time frequency or nocturia)
  • An often urgent or compelling need to urinate (urgency)

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.

Diagnosis

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.

Diet

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:

  • tea and coffee
  • Soft drinks and soda (including diet drinks)
  • alcohol
  • citrus, citrus drinks and cranberry
  • artificial sweeteners
  • spicy food

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.

Treatment

The treatment of interstitial cystitis is complex and needs a multimodality approach to treat it effectively. It may require treatments such as:

  • Urodynamic Therapies
  • Physiotherapy with a specialised pelvic floor physiotherapist
  • Pelvic Floor Therapy (Kegels, Yoni eggs, Ba Wen Balls, internal TENS)
  • Surgery, including laser surgery
  • Neuromodulators, such as electrical nerve stimulators
  • Injections, such as Nerves blocks, Antispasmodics and Botox therapy
  • Pain medications- including narcotics, NSAIDS, Anti-inflammatories,
  • Hormone therapy, both oral and intravaginal
  • Antidepressants
  • Acupuncture
  • Pilates and Yoga
  • Exercise
  • Herbal Medicines, including Chinese Herbal Medicines
  • Amino acids, vitamins and antioxidants
  • Sex Therapy and counselling
  • Mindfulness
  • Adopting health sleeping habits

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

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.

Causes

The exact cause of IC is not known, but there are several theories as to what triggers the condition. Some possible causes include:

  • Damage due to previous surgery
  • Defects in the lining of the urinary bladder that cause irritation
  • Overstretching of the bladder due to trauma
  • Pelvic floor muscle dysfunction
  • Autoimmune disorders
  • Spinal cord trauma
  • Genetics
  • Allergy

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.

Regards

Dr Andrew Orr

Reproductive Medicine and Women’s Health Medicine Specialist

-No Stone Left Unturned

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Women with PCOS May Be at More Risk of Uterine Cancer

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:

  • vaginal bleeding between periods
  • bleeding after menopause
  • an abnormal, watery or blood-tinged discharge from vagina
  • constant back and pelvic pain
  • unintended weight loss
  • fatigue and nausea

Early screening is essential and women can safely consider fertility preservation provided that the cancer is diagnosed in early stages.

Fact around uterine cancer

  • Early diagnosis of uterine cancer can save women from fertility loss
  • World over, an increasing number of women in reproductive years falling prey to the disease
  • Obese women are 10 times more likely to suffer from endometrial/uterine cancer, other causes include hypertension and diabetes
  • PCOS may now be a risk factor for 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.

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned

Dr Andrew Orr Logo Normal 20 07 2016

 

Banishing Headaches and Migraines

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.

Regards

Dr Andrew Orr

(Reproductive Medicine & Women’s Health Specialist)

-Women’s & Men’s Health Advocate

-No Stone Left Unturned

 

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The Silent Face of Endometriosis

She closes the door and enters the day, with the face that she wants the world to see. She is beautiful, she is vibrant, she is smiling, and she is ready to face what ever the day may bring.

She is immaculately dressed, her hair brushed so neatly and even though she doesn’t need it, she has her make up on, her lipstick applied so neatly and she is every bit the goddess that the world will see today and every other day as well. All this makes her feel good and helps her to go about her day. She is a daughter too some, a sister to others and a partner to her beloved. She is grace and elegance and she is every bit a woman and she it about to embrace her day.

But, while she is every bit the goddess, and a warrior, and her beauty knows no bounds, underneath her catwalk like composure, is another story that the world around her may never really know, or ever come to understand. It is something that they just cannot even see.

Today is like any other day for her, but today is the day that her hidden disease has decided to raise its ugly head. Unlike the beauty that we see before us, this inner demon has taken hold of her and nobody will know the torment that goes on beneath her skin and deep into every organ in her precious body. Today would buckle many and have many lose their way, but not her, she is a warrior and she will not give in.

While the constant anxiety and pain and mixed emotions scatters every cell in her brain, she remains composed and ever focussed and this is all that she will let the outer world see. Very few will know that today is not a good day, but even then those that know, will know that this will not stop her from going about her day.

There are days though, that none shall see her and these are the days that no matter how hard she tries to embrace the day, the disease within has its tight grasp around her and she just need to hide away and deal with the pain. On these days it is just all too much to bear and though she will not give in, todays battle is best not fought, and she just wisely knows today is the day to rest, heal and repair. She knows that sometimes to win a battle, it is best to not fight at all.

Today the flare of the disease within has sent aches to her muscles, sensitivity to her skin, aches to her head, cloudiness to her brain, deep pain to her bones and spine and pulsating pain to her womb. Her belly is swollen, like she is about to give birth and the intestines feel like that are being twisted and ripped apart. She feels nauseas, her head pounds like the worst every hangover and she feels like she is about to pass out. Even the most important bodily functions are just too hard and just too sore today. The disease tries to contort her, to stop her, but she remains upright and continues her day. She does not let the disease win and she will never buy into the label and let it confine her.

Some days are even more stressful, because her monthly cycle has appeared and has come with full vengeance and feels like flood waters through the place that a woman gives birth. On those days, she may even feel like she has given birth and what is bought forth, only few will ever hear about. Not even her partner may see what these flood waters bring and what she just felt like she birthed. That is secret women’s business and only talked about in private, or to the healthcare provider that may assist her from time to time.

She is loving, she is vulnerable, she is caring, she is giving, she is strong, she is fierce when needed and she is every bit the woman that the world knows a woman to be. Even at times of intimacy, she will still give her all and love with such passion and tenderness, but all the while her partner will never know that the pain that may be within. Some days are good, some days are bad, but that doesn’t stop her expressing her passion, her love and her womanly desires and love for her partner. Her heart is pure love and a good man will know how to love her and support her and care for her on the days where she needs gentle, loving, tender care.

Today may not be a good day, but she will brave the day just like any other and hide the disease crippling her within. She will not cry out in the open, she will not even make a fuss. Not many will know today is a bad day, because her courage and strength will get her through the day, just as it has every other day. You will only see what she wants you to see and that is a smiling, strong, vibrant woman about to go and conquer her day.

This is what I see through my eyes, of the strong, vibrant goddess that we all shall see. Because I know the war she is fighting, I see what many do not see. I see what she goes through and why she sometimes has to hide away. I see her wipe away the tears she sheds in silence. I see how restless she is when she tries to sleep. I see the mixed day of pain and emotions and how she tries to regain composure to overcome her day.

Through my eyes I don’t see weakness and someone who is fragile, or someone who gives in. I see a goddess, a mighty warrior, someone who can overcome and conquer all before her. Not by brute force, but by love, by compassion, by listening, by understanding and by knowing how to do what is needed and when it is needed. That is true strength, she is a true warrior and she shows what is it is to be a strong capable super woman. She will not let her kryptonite conquer her and she will overcome it and conquer it instead.

Through my eyes I will never really be able to know, or understand what she really goes through. I can never know what she endures each day. I can only but imagine what it is like to be in her shoes and walk the path that she walks most days. But I know that on days that she isn’t feeling her best, she will let the world see the best that she can be. She won’t fuss, she won’t cry, she won’t show any pain. She is a true warrior and she just puts on her makeup, puts on her lipstick, brushes her hair nicely, dresses eloquently and gets on with her day. Those are the days that we can support her and love her and help her get through her day.

This is the face of endometriosis and only those that suffer from this horrible disease will know what it is like to live in silence while the rest of the world is completely unaware.

Let’s end the silence for the strong warrior endo sisters and the next time someone tells you that they have endometriosis, remember that just because they look fine, they look vibrant, they look strong, they look like a beautiful goddess etc……

Just remember that they may be fighting the fight within and today may not be a good day.

This is for my loved ones with the disease and every one of the “endo sisters”

March is Endometriosis Awareness month, so please take the time to acknowledge those with the disease and let’s help end the silence and please remember my most important motto…. “Period Pain IS NOT Normal”

Take care

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-Endometriosis Crusader

-No Stone Left Unturned

-Period Pain IS NOT Normal

 

Red wine protects your teeth and gums and helps your gut health as well

Researchers have now identified yet another reason why you should keep enjoying a glass of red wine. While Red wine stains the teeth, a new study says that it might protect your oral health at the same time. The findings were published in the journal of Agricultural and Food Chemistry

The research was led by M. Victoria Moreno-Arribas and colleagues from Instituto de Investigación en Ciencias de la Alimentación in Madrid, and the Department of Health and Genomics at the Center for Advanced Research in Public Health in Valencia.

Polyphenols to the rescue

We already know plenty of reasons to have a nice glass or red and how good it can be for our health. A recent study said that it could help to keep the brain young, and previous research has tied it to hormonal health as well as heart disease prevention. Studies have also shown that drinking a glass of vino each day may help us to live longer as well. But as we always say, alcohol is good for us in moderation, not in excess and should be consumed with food and not on an empty stomach.

While know that red wine has many health benefits, new research from Instituto de Investigación en Ciencias de la Alimentación in Madrid, and the Department of Health and Genomics at the Center for Advanced Research in Public Health in Valencia have revealed red wine may protect against the formation of cavities and against gum disease.

Many of the health benefits of red wine come from its content of polyphenols, which are a series of micronutrients with antioxidant properties. We know that some of these antioxidants, such as resveratrol, can protect against action of free radicals, which play a key role in the cellular aging process.

But polyphenols are also super nutrients which help our microbiome and help with our good gut bacteria. Some polyphenols can be absorbed into the small intestine and there they interact with the gut microbiota and fend off bad gut bacteria that might threaten our health. The research team found that polyphenols found in red wine and grapes could have a similar, protective effect in the mouth, fending off harmful oral bacteria that cause cavities and gum disease.

What the researchers found was that the two red wine polyphenols caffeic acid and p-coumaric acid were most effective at repelling the harmful oral bacteria and preventing them from attaching to healthy tissue. They also found that phenolic metabolites, which are substances formed as the polyphenols start transforming in the mouth, suggested that these small products may in fact be the “active ingredient” associated with the polyphenols’ protective effect.

This is great news for those that like to have a nice glass of red and this research also adds to more health benefits of drinking red wine. But as said before, red wine is an alcoholic beverage and as such it is important not to overdo it either. What is your friend, in moderation, can also be your enemy in excess. The good thing is now you can enjoy a nice glass of red in moderation and know you are getting many health benefits from it, and also know that your teeth and gut health (microbiome), are being looked after as well.

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned

What Are The Signs & Symptoms of Iodine Deficiency?

Why does the body need Iodine?

Iodine is a water soluble mineral that is needed in our diet to ensure that the thyroid works properly.The thyroid gland uses iodine to make thyroid hormones.

Thyroid hormones play an important role in a wide range of bodily functions, including metabolism, bone growth, immune response, and development of brain and the central nervous system (CNS).

Iodine helps convert thyroid stimulating hormone (TSH) to triiodothyronine (T3) and thyroxine (T4). This conversion is important for the thyroid to function properly.

Iodine is essential for brain development, bone health, healing, immune response, energy, metabolism and the development of the central nervous system. We also now know that we need iodine to help with pregnancy and fertility. Iodine deficiency during pregnancy and early childhood can also lead to developmental problems.

An iodine imbalance can lead to an overactive, or under-active thyroid.

Being deficient in iodine limits the ability of the thyroid gland to make hormones, causing hypothyroidism. Hypothyroidism happens when a person’s thyroid does not produce enough thyroid hormones. Hypothyroidism can cause symptoms of fatigue, depression, forgetfulness, hair weakness, hair loss, dry skin, weight gain, cold intolerance and constipation.

Signs of iodine deficiency

According to new research published last year, it was estimated that about a third of people are deficient in iodine. Here are some of the common signs that could suggest that a person may have an iodine deficiency.

1.Weight gain

One of the most noticeable signs of an iodine deficiency is unexpected weight gain.

When a person has a healthy metabolism, they burn calories to give them their energy. Hypothyroidism, or a lack of thyroid hormones, can slow down a person’s metabolism and this can then lead to weight gain. It is important to remember that weight gain is not always a sign of an iodine deficiency. It may only be a symptom when weight gain cannot otherwise be explained. Eating foods that are highly refined and high in sugars are probably the most common form of increase weight.

2.Feeling weak & lethargic

When a person has an iodine deficiency, they may feel weak and lethargic. Hypothyroidism can slow down a person’s metabolic rate and then they burn fewer calories for energy. When they have less energy, the muscles do not work as efficiently and then the person would feel weak. But, feeling weak may also be from other factors such as lack of sleep, lack of essential nutrients, lack of food intake and nutrient deficiencies. This may also be a sign of other health issues and needs to be investigated if it goes on too long.

3.Feeling tired

Unexplained tiredness may be a symptom of iodine deficiency. When a person is iodine deficient their metabolic rate may drop and this could cause them to feel tired. But, feeling tired does not always mean a person is iodine deficient. As mentioned before, if a person is not getting enough rest, it is natural for them to feel tired. Feeling tried could also be a sign of iron deficiency, or other health issues, but, if tiredness is unexplained, it may be a symptom of an iodine deficiency.

4.Hair Loss

Hair loss is another possible sign that a person might have an iodine deficiency.

Thyroid hormones support the renewal of hair follicles and when someone has hypothyroidism, a shortage of thyroid hormones means the hair follicles stop being renewed. It is natural for hair to fall out, but it is normally renewed. But, while hair loss can be a sign of iodine deficiency, it can also be caused by other hormonal issues as well as stress. Stress is one of the most common causes of hair loss.

5.Drying skin

Having dry, flaky skin could be a sign of hypothyroidism, and can be the result of iodine deficiency. Thyroid hormones help with the renewal of new skin cells. A lack of these hormones and a deficiency of iodine, may cause dead skin cells to build up, sometimes resulting in dry, flaky skin. While dry skin can be caused by iodine deficiency, it can also be caused from other factors such as lack of hydration, lack of essential oils and other health conditions

6.Feeling cold

Iodine deficiency causes a lack of thyroid hormones, which can then affect a person’s metabolic rate to slow down. As their metabolism slows down, a person produces less energy to give the body warmth. A lack of energy and lack of body heat will mean a person is more likely to feel the cold. But, feeling cold isn’t always a sign of iodine deficiency and can be a sign of lack of circulation and other health issues.

7.Having a slow heart rate

Having an iodine deficiency may make a person’s heart beat more slowly.

When a person’s heart rate slows down, they may feel a bit dizzy, nauseas, or sick. It may also make them feel a bit faint. But feeling this way may also be a sign of other health issues, or it could also be a sign of a virus, or issue with someone’s cardiovascular system and needs to be checked out.

8.Learning or memory problems

Thyroid hormones are important for brain development and Iodine deficiency may cause a lack of these hormones, resulting in problems with memory and learning. Studies have shown that people, who are deficient in iodine and have lower level of thyroid hormone, may have parts of their brain being smaller and this then affects their memory. But while this may be the case, learning and memory problems could be caused from other health issues and need to be checked out properly

9.Pregnancy complications

Iodine deficiency may cause issues during pregnancy for the developing baby and it can be harder to get enough iodine during pregnancy. Not only does a women need iodine for herself, but she needs it for the growing baby inside of her as well.

Thyroid hormones are necessary for the healthy development of a baby before it is born. A lack of iodine and thyroid hormones may prevent the baby’s brain developing properly. It may also affect their immune system and affect their growth. If a pregnant woman’s body is too low in iodine it could cause her baby to be stillborn.

10.Heavy or irregular periods

Deficiency in iodine can lead to low thyroid hormone levels, which can then affect the levels of hormones that regulate a woman’s periods. Iodine deficiency can lead to periods that are heavier than usual, or the periods that are more or less often than usual. While, iodine deficient could cause abnormal abnormalities in a woman’s menstrual cycle, irregular or heavy periods are usually a sign of gynaecological conditions that needs to be evaluated by a specialist.

11.Swollen neck and goitres

If a person is deficient in iodine, the thyroid gland can become enlarged and this can then make the neck become swollen. This can lead to a condition called goitre. Abnormalities with the thyroid gland and hormones can also cause growths called nodules.

When the thyroid does not have enough iodine, it will try to absorb more from the blood and this then causes the thyroid to become enlarged, making the neck appear swollen.

Complications and diagnosis.

An iodine deficiency may happen when a person does not consume enough foods that are rich in iodine, or have adequate supplementation. This deficiency is more likely to affect pregnant women who need a higher intake of iodine.

Pregnant women and their babies experience the most serious complications of iodine deficiency. In the worst cases, it can lead to babies being stillborn or born with mental issues due to stunted brain development.

If you think you may be deficient in iodine you can go to your doctor and they can organise proper testing for you. The most effective way to diagnose iodine deficiency is via a urine test.

If you have a family history of thyroid issue, or are to conceive, or are pregnant, you should be supplementing with iodine based multivitamins or individual supplements. A person needs to consume 150 micrograms (mcg) of iodine each day to maintain a healthy level for their body. You should also be looking at eating iodine rich foods daily as well.

The following are good sources of iodine:

  • Seaweed
  • Cod, tuna, salmon and white fish
  • Plain Yogurt, Cheese and Milk
  • Iodized salt
  • Shell fish and oysters
  • Eggs
  • Dried prunes

Regard

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned

 

 

Alternative Ways to Assist Pain and Help with Pain Management

After my recent posts of the management of pain, pain medications and how pain affects so many people lives daily, it is pretty clear that there are lots of people out there in pain. Worst still it highlights what I have known for many years, is that many people who are in pain, or have inflammatory pain conditions, are not being managed really well. Unfortunately many are also trying to manage their own pain conditions and may even be dependent on pain medications. Some of these medications taken long term may in fact be exacerbating their current symptoms, or actually making their pain and inflammation worse. Some of the medications may in fact by shutting off the body’s ability to know that it isn’t actually in pain anymore, but the body actually thinks it is. It is such vicious never ending cycle for many people and there seems to be no long-term, or short term, solutions for many who have to endure the physical and emotional consequences of all these things combined.

The one thing for sure, is that pain often isn’t managed well and there need to be more done to help those in pain. But, it also requires those in pain to seek proper help too. Again it is a bit of complex issue and many in pain often get dismissed initially as well, or are looked at as people who are dependent on pain medications just seeking more pain meds.

Pain does need proper management and if pain is not managed properly, it can do more damage than the medications health professionals, and the person in pain, are worrying about. But sometimes the blanket pain medication treatments don’t work, or they just aren’t enough, and this is why when it comes to pain, it need to be managed with a multi-modality approach. It really cannot just be all about taking medication, or telling people to just go and learn to live with their pain and all will be OK. It won’t be OK and we need to start to educate all concerned that there other options that may assist the current medical treatments and management strategies.

Let’s look at some of the alternatives to pain medications and how these things can help assist those in pain and can be used alongside medications to give better control of pain and also help in reducing dependency of pain medications.

1.Watch your diet

Eating the right foods may provide some protection from the symptoms of pain and the disease state that you may have. The role of diet in inflammatory conditions has been investigated in recent years due to the influence of diet on some of the processes linked to certain disease states that are causing pain and inflammation on a daily basis. Many of the so called anti-inflammatory diets out there are now outdated and have outdated nutritional and dietary advice that don’t really help much at all.

People in pain need to adopt an anti-inflammatory (grain free, primal, ketogenic style diet) to assist with settling any inflammation in the body and also helping the immune system.  This also needs to include prebiotic and probiotic bacteria to help with digestive function, immunity and gut health.  Regulation and restoration of gut function and the microbiome is so important and assisting with pain and inflammatory conditions.

Excess bad carbohydrates increase insulin response and this then causes the body to store fats and stops the burning of fat. This also leads to inflammatory conditions and more inflammation in the body. Excess body fat, now known as obestrogens (because it is estrogenic) needs to be controlled and managed through diet and exercise too. Excess fat and excess weight all lead to inflammation and stress on the body and this can also exacerbate pain and pain pathway.

Certain environmental estrogens, known as endocrine disruptors,  such as preservatives, plastics, pesticides and insecticides that can be ingested through certain nutrients have been suggested as risk factors for exacerbating pain and creating inflammation in the body too

2.Try complementary medicine and complementary therapies

Many people with pain and inflammatory disease states find symptom relief from using a range of different complementary and alternative medicines. There is some good solid research to show that certain natural medicines may help with the management of pain and inflammatory disease states and the associated symptoms. There is now some good research to support many natural medicines treatments such as Acupuncture, Chinese herbal medicine, vitamins, omega 3 oils, probiotics, chiropractic/osteopathy, Yoga, Pilates and more.

Out of all the natural medicine therapies, Acupuncture and Chinese medicines has been one of the most researched and have shown to be the most beneficial and to assist those suffering pain and chronic inflammatory disease and their associated symptoms. Acupuncture has been widely researched to assist with many pain conditions and is now even used in some emergency departments around the world, for acute and chronic pain. Chinese herbal medicines have been used for centuries for pain and inflammatory disease and modern research has shown that certain Chinese herbs and herbal medicine formulas may assist with pain and painful conditions.

Certain strains of prebiotics and probiotics have also been shown to help with the immune system, microbiome, bowel, and digestive associated symptoms of some pain conditions. Probiotics have also been shown to not only help with digestive and immune function, but also with the psychological function as well. It does need to be specific strains of probiotics though. Correction of the microbiome, but using pre and probiotics may assist in reduction of inflammation in the body and thus assist with pain and painful disease states.

There are also western herbal medicines and naturopathic herbal formulations that can assist with pain and assist with pain management. There are also certain amino acids and nutritional medicine supplements that have been shown to assist with managing pain and inflammatory conditions. Like any conditions, management need to be done on an individualised approach and what works for one person, may not work for another.

Chiropractic and Osteopathy have been used for centuries to assist with pain and pain conditions. By correction of the sublaxations and correction of posture, this can assist in better nerve functioning, better blood flow to muscles and also help with pain reduction and reducing inflammation.

Just like with medical treatments, when it comes to complementary medicines, it is important to find someone who is a qualified practitioner and who specialises in pain management. Just like in the medical model, this can also be hard to find. Please find someone who is a registered healthcare practitioner, or part of an association for qualified healthcare practitioners.

3.Boost intake of omega-3 fatty acids

The is lots of research on the health benefits of taking Omega 3 fatty acids and a diet high in these healthy fats. Omega 3 fatty acids may assist many inflammatory conditions such as depression, cardiovascular disease, arthritic conditions and many conditions where inflammatory processes are then leading to pain.

Researchers have also found that the type of fat included in your diet makes a difference in your risk factors for inflammation and pain conditions. Studies have shown that people whose diets were heavily laden with trans fats increased their risk of the expression of inflammatory disease by 48 % when compared with individuals who ate the least of these. By comparison, women whose diets were rich in omega-3 oils lowered their risk of inflammatory conditions by 22 % compared with those who consumed the least amount.

Eating foods high in omega-3 fatty acids, such as salmon, flaxseeds, almonds, and walnuts, may be helpful for pain and inflammatory conditions. Another way to get Omega 3 fatty acids is through supplementation, but please make sure you are using a practitioner only grade omega 3 supplement to ensure higher potency and better quality control.  Just remember, it is all about reducing inflammation.

4.Exercise

Often, people who experience pain fear exercising, in case it causes more problems for them. But over time, regular physical activity may decrease the pain and discomfort that you feel. High-intensity exercise and resistance training may assist in helping to reduce the reducing the symptoms of pain and reducing inflammation in the body.

While resistance training and high intensity interval training may assist in pain management and reducing inflammation in the body, some of the more gentle forms of exercise, such as Yoga and Pilates, may also assist in reducing pain and inflammatory response in the body too. Yoga and Pilates can stretch and strengthen your muscles, help with core strength, help with circulation, which all may be beneficial for pelvic pain management and stress reduction.There has been lots of research into the benefits of Yoga and Pilates and how it can assist pain and inflammation.

No matter what exercise, you choose, exercise may help those with pain and inflammation in many ways, including:

  • encouraging the circulation of blood to your organs
  • maintaining nutrients and oxygen flow to all your body systems
  • assist with decreasing pain and inflammatory response
  • assist with reducing stress
  • releasing endorphins in the brain, which are pain-relieving, “feel good” chemicals

Research has shown that those who engage in some sort of regular exercise have fewer symptoms of pain and less inflammation that those people who do not participate in regular exercise.

5.Managing Stress Levels

Stress and emotional factors are probably one of the most under rated causes of pain and inflammatory response. Stress and emotional factors are big factors in any disease and can make any disease worse. Not only can stress and emotional disorders be exacerbated by pain and inflammation, but so can pain and inflammatory symptoms be exacerbated by stress and emotional disorders, in a never-ending cycle. Pain and inflammation could contribute to making your stress levels, or emotion issues worse, due to the impact that the associated symptoms have on all aspects of your life, including family and personal relationships and work.

Stress management, Counselling, Mindfulness and Relaxation techniques may all assist in reducing stress and emotional disturbances that exacerbates inflammation and pain pathways and painful conditions.

People with pain and chronic pain and inflammation need to manage stress by using mindfulness and relaxation techniques. These can help you to increase your awareness of your body, refocus on something calming, and reduce the activity of stress hormones and inflammation in the body. It is all about learning coping mechanisms and what works best for you, not what works best for others.

6.TENS and Neuromodulators

Transcutaneous electrical nerve stimulation (TENS) is an inexpensive nonpharmacological intervention used in the treatment of acute and chronic pain conditions. These small battery-powered devices deliver alternating current via cutaneous electrodes positioned near the painful area. The parameters of pulse frequency, and pulse intensity are adjustable and linked to TENS efficacy. TENS activates a complex neuronal network to result in a reduction in pain

Neuromodulation is the process by which nervous activity is regulated by way of controlling the physiological levels of several classes of neurotransmitters. Many pain management specialist now use a common form of neuromodulation involves using a device to deliver electrical current in therapeutic doses to the spinal cord to disrupt pain signals from the spinal cord to the brain, converting them to a more pleasant tingling sensation. This has been proven a safe and effective therapeutic approach for managing chronic pain of the arms and legs, neck and back often after spine surgery, or for other neuropathic conditions.

In Summary

It is important to know that people with pain and disease states that are causing chronic pain, will need a multi-modality, or team approach to deal with this disease. The team you need and modalities that you will need will be dependent on your individual symptoms. This will mean finding practitioners who will listen to you and also be open to trying some of the alternatives to some of the pain medications and opiates alongside pharmaceutical medications. As I said before, these alternatives may assist in treating your pain and managing your pain long term and also help with reducing some of the pain medications you may have been dependent on. Try and find healthcare professionals that can offer you a multi-modality approach for ongoing care and support and who also have a team of other people who specialise in the disease you are suffering from too. Again, the approach that you and your pain management specialist, or healthcare provider, choose to take will vary depending on your signs and symptoms.

Before starting any pain management, or new treatment, it is important to know all of your options and the potential outcomes of all of them and to know that the people that you are seeing are specialists in your condition and know how to manage the disease properly. That can often be the hardest thing to find and why you need to do your homework and see people who are specialists in this area of medicine. Too many people are missed and dismissed purely because they are just seeing the wrong people in the first place.

Lastly, if you are in pain and have a pain condition, please do not try and keep managing it yourself, or try to self-medicate. You need to be managed properly and should be getting the advice of a professional, not your friends, family or social media buddies. Pain needs to be managed and it needs to be managed properly and this also goes for pain medications as well. If you are still in pain and pain symptoms are getting worse, this means that you need to get something done about it because your disease may in fact be getting worse, or your body may not be responding to medication any longer.

Take care

Regards

Dr Andrew Orr

Reproductive Medicine and Women’s Health Medicine Specialist

-No Stone Left Unturned

 

Lets Talk About Pain, Pain Medication, Dependency, Detox & Withdrawal Symptoms

Recently I did a post on over the counter pain medicines and how that as of February 2018, that some of these codeine based pain medicines, will now no longer be available over the counter in Australia. I know that in other parts of the world, these medications are not available over the counter anyway and in some countries even paracetamol is not available as readily as it is here in Australia.

The post surely did get people talking and it surely highlighted some very important points. It also highlighted how many people are in pain daily and something that I have known for a long time. I actually know that pain and people with pain conditions, aren’t managed very well. It also highlighted that many people are self managing pain conditions and that many do not realise that they in fact dependent on medications, alcohol and other drugs. Many also do not realise that the pain and symptoms they are experiencing daily, may in fact be withdrawal and dependence symptoms from their medications and substances they are using, including alcohol, and may have nothing to do with their condition at all. It is a very complex issue and there needs to be more education around this very sensitive issue.

Now, before we get started and before anyone tries to bring the personal/emotional side of things into this, I need to be very clear on this and set some boundaries up front. I need everyone to listen to this, so it is clear and that what I am about to say is coming from personal experience, clinical experience and someone who cares and is just trying to help with the right advice and right education around this issues.

So before we start I need to get a few things straight

  1. I have lived with a painful condition and have used pain medication and been dependent on pain medications. I have also withdrawn off pain medications
  2. I have loved ones who have pain conditions, who suffer daily and have also used pain medications to get through their day. Also know many of these have learned to manage and overcome their disease and pain too.
  3. People in pain, need help to get out of pain and pain medications are one way of doing this
  4. Many people who are in pain are actually dependent on pain medications and are completely unaware that they are dependent
  5. It is completely OK to take pain medication when someone is in pain. It just needs to be monitored a little better than it has been in the past.
  6. Please take the personal out of this and just sit back and listen
  7. I am not here to judge, or attack anyone
  8. This post is purely from heart, from caring and also about helping people with education so that they can get help if they need to
  9. The first part of any change and getting help is admitting you have an issue, or a problem, in the first place.
  10. The is no guilt, shame, or anything wrong with admitting you have a problem, or a dependency
  11. For the sake of this post I am going to used the word “Dependency”, rather than the words “Abuse” or “Addict”
  12. Perception is reality and sometimes ones perception is not reality, or based on all the facts
  13. Not all pain is from the withdrawal of medications either, but some of it could be.
  14. We are here to support people and care for people, not attack them. Anyone found attacking another on any posts surrounding this subject, will be deleted.
  15. Lastly, to get help, you need to see a qualified healthcare practitioner and you should only ever rely on information from a qualified health expert, not from your friends, your support groups, or anyone without a proper qualification in things to do with medical, medicines, or health conditions.

Right, now we have set the boundaries and we are clear, we can move forward and I can start explaining about pain, pain medications, pain pathways and also withdrawal symptoms

Before I start, I need everyone to open, his or her, minds a bit and think of how you feel when you have had some alcohol. Let’s not forget that alcohol is a drug and it can make you feel good initially and then not so good if you have a few glasses, or more. You can also become dependent on it too, and yes, it can be abused.

So, say you have a few glasses of alcohol, how do you feel while you are consuming it and shortly after?

This is for the average person, but most people would feel a little warm and tingling and feel quite good wouldn’t they?

But, even with a few glasses, would you necessarily wake up OK the next morning?

Some people might wake up semi OK, some might feel a little less than OK?

For some, a few are nothing because they are used to having way more. Some of these people may in fact be dependent and actually have an alcohol dependency.

So, say you have more than a few glasses of alcohol, how might you feel the next morning?

More than likely you may feel a little dusty, or for some, you may in fact have what we all know to be a hangover… is that correct?

You might feel really tired, irritable, nauseas, sore, have a headache, or a really bad head that feels like it might explode, and all the senses are just a little on hyper-drive and you would feel a little off??

Now that we are clear that alcohol can give you a hangover and make you a bit sick and that alcohol is in fact a drug, let me ask you this?

If alcohol is a drug and it can give you a hangover, even after one night of taking it, and taking just a few glasses of it, then why would not a medication, that can produce all the initial effects of alcohol, then not cause you a “Hangover Effect” the next day as well????

Just have a think about that for one second and let it really sink in.

Hmmmm, what are you thinking now?

Well, I am sure this is where we get some people going “But, but, but!”

Well there are no “But’s”. This is the hard but honest truth. Any drug, being prescription, over the counter, off the street and illegal, can cause you a withdrawal and hangover effect. Also, the longer you take those drugs, the more you take them etc, the more you need to take and the more dependent you become on them. This doesn’t mean I don’t get why people take these medications. I do get it and I get all the reasons behind it too. This is just to explain everything logically and properly to people so that they also get that they may not be managed properly and that they may also be dependent on medications, which are actually in the long term, making all their symptoms worse, or actually causing the ones they have now.

Just so people don’t forget, please go back to points 1 and point 2 in the ground rules I set before. I have lived with pain and I have loved ones who are in pain and yes, I have taken pain medications and so have my loved ones.

Ok, so we are now all on the same page and are clear here, yes, many of the medications that people are taking daily, or periodically, or once off, or chugging down by the packet load, or are actually causing them rebound symptoms and withdrawal symptoms, when those drugs wear off.

We also need to recognise that some people are only taking medications every so often, when they need them too and this is more for people who are medication daily, or frequently. But even still, people do need to be away of rebound symptoms from taking medications, even periodically.

When we talk about “withdrawal” and “rebound symptoms”, let’s all go back to the alcohol story. We know that the hangover symptoms occur because of a rebound and withdrawal affect from the alcohol messing with the symptom, causing dehydration, causing inflammation and then causing all manner of symptoms from nausea, headaches, tiredness and even muscle and joint pain. The same goes for when you take any pain medications, especially those that are opiates, or contain codeine, or convert to morphine in the body.

Are we all getting this yet??

Right, then lets move on.

Now, the longer you take a medication the more your body gets used to it and the more that you may have to take to get that same therapeutic affect on the body and the pain that you are trying to manage. But, the more you have to take, the more dependent you become on that medication and the more worse you are going to feel when the medication wears off and tries to leave the body. Then it is going to take longer to ween off the medication, when you finally realise that you are dependent and that you need to so something about it. That is if you have that realisation, or finally admit there may be an issue.

One of the things that I have mentioned many times before, is that sometimes the body has been in pain that long, that the body doesn’t realise that it isn’t in pain any longer, that you also need to turn that response off, because it has actually become a habit, rather than the body actually still being in pain. The other issue is that the pain medications may in fact now be what are causing the pain, through rebound symptoms and withdrawal.  This one is a bit tricky to explain to people, but in essence what we need to do is actually tell the body it isn’t in pain any longer, so that it switches off that response in the brain. To do that we need to detox an individual and then see what pain really does exist still and then manage those remaining symptoms. I will talk about proper medical detox further in the post.

Now let’s look at how pain medications, opiates and some elicit drugs work

Pain medications, Opiates and other pain relieving drugs, all change the way the brain responds to pain and they can also produce a “high” feeling by disrupting the reward and pleasure centres in the brain. This is why they can make you feel a bit stoned, or a bit light headed and why you should not drive, or operate machinery etc, while you are taking them. They can dehydrate and constipate you too, so this is why you should only take as directed and also make sure you drink enough water, take some electrolytes and take it easy too. Let’s not forget the serious side effects of medications that can put overload on your liver and other vital organs and actually shut them down, if taken for long enough, or in a super high dose.

The central nervous system, which includes the brain, cardiovascular and respiratory systems, has opioid and pain medication receptors that receive opiate drugs and other pain medications, and these drugs bring a variety of physical and emotional effects. Your heart rate, respiration, blood pressure, and body temperature are usually all lowered while pleasant feelings are increased. It can cause the opposite effect too, where some people get hyper-activated responses too.

Repeated use, or abuse, of pain medications, or an opioid drug, can actually change the way an individual’s brain chemistry works and then lead to physical and psychological dependence. The body may not feel “normal” anymore without the drug’s interaction, and withdrawal symptoms may start in between doses or when an individual stops taking the pain medication, or drug they are on.

What Are Pain Medication, Drugs and Opiate Withdrawal Symptoms?

Certain over the counter medications (such as codeine based meds), prescription painkillers, Opiates and heroin, can produce withdrawal symptoms just hours after the last dose, and the symptoms can last for a week or more. Sometimes these symptoms can be minor, but many times they can cause all manner of symptoms, which I will list below in detail. Some symptoms can be major and unassisted withdrawal may, or may not be life-threatening. When someone doesn’t withdraw properly it can also lead to relapse and further dependence on a medication, or drug. Medications and therapy, accessed in medical detox, may make relapse less likely. I’ll talk about why it is necessary to do a proper medical detox first, before seeing practitioners outside the medical detox model.

What Are Pain Medication ad Drug Dependency Symptoms?

Pain medication and drug withdrawal symptoms can last about a week, or even longer for some, and may include:

  • Irritability
  • Agitation
  • Depression
  • Muscles aches
  • Insomnia
  • Thoughts of suicide
  • Anxiety
  • Inability to concentrate
  • Diarrhea
  • Bowel Pain and Rectal Pressure
  • Severe bloating
  • Fluid Retention
  • Sweating
  • Body aches
  • Runny nose
  • Headaches
  • High blood pressure
  • Irregular heartbeat
  • Many other symptoms not mentioned here

Detox and Withdrawal Duration

Withdrawal is the collection of side effects that occur when a drug is removed from the brain and body of someone who is dependent on it, while detox is the actual removal of the drug itself.

Withdrawal symptoms can last anywhere from a couple of days to up to a week or longer. For most pain medications and prescription opiates, withdrawal symptoms take shape 8-12 hours after the last dose and it peaks in the first 72 hours. The time within the withdrawal period depends on the medication, or drug taken. This is where rebound symptoms can occur.

The first week of withdrawal is typically the worst, but some symptoms may actually last longer. Symptoms typically last up to one month, but can linger for several months. Some effects can be permanent if there is a genuine abuse of a medication. Symptoms that can last longer than one week include tiredness, muscles aches and tiredness, depression, anxiety, and trouble with sleeping.

This diagram shows the withdrawal of these medications and time frames of side effects from withdrawal after the last dose is taken.

Medical Detox

Detox may begin before withdrawal symptoms start and while the drug is still active in the body. This way the drug can be safely removed. During medical detox, individuals are monitored around the clock for 5-7 days, vital signs are continually checked, and medications may be used to control more difficult withdrawal symptoms. If an individual is heavily dependent on pain medications, opiates, or took large amounts of the drug for a long time, or has a family or personal history of addiction, medical detox may last up to 10 days. Medical detox ensures that an individual is stable before moving on with a comprehensive substance dependence treatment and management program.

Relapse after a proper detox can increase the risk for a potentially life-threatening overdose since the brain and body may not be used to the same amount of drugs that was used before. Each year around 30,000 people worldwide die each year as the result of a prescription pain reliever overdose. Each year around 500,000 people worldwide seek emergency department treatment for a reaction to the abuse, or dependency of pain medications or drugs to help with pain. By decreasing pain medication side effects and dependency on these medications as drugs, an individual may be less prone to seek out these same pain medications and drugs again after detox. Medical detox can help sustain abstinence and potentially prevent a tragic, relapse-related consequence.

While there are non-medical forms of detox, I wouldn’t recommend someone doing these until a proper medical detox is done. Proper support and around the clock care is needed in the initial stages of a proper detox and this really cannot be provided out in private practice, or by complementary medicine practitioners during this initial stage. I am all for people seeing natural medicine practitioners and using natural medicines but this needs to be done after the initial medical detox. That first phase needs 24-hour care, medicines, psychological care and so many things that would be really hard to find out in a non-medical environment. There are some specialised centres that use a multimodality approach, using medical science and complementary medicines, but these are few and not always cheap to access either.

Sure, after the initial medical side of things, go your hardest and you should be seeking natural alternatives to pain medications and looking and diet and lifestyle choices to help deal with pain. You should also be seeking alternatives to pain medications and seeking therapies that can help manage your pain, such as acupuncture, herbal medicines, pilates, yoga, counselling etc. All these things are important for ongoing care and helping deal with disease states and ongoing pain. But if you have reached the point where you are dependent on a medication, or drug, you are going to need lots of help and you will need help with proper detox first. Please, do not think that those packet over the counter detoxes from a chemist etc, are a proper detox. They are just a herbal laxative that cleans out your bowel. Always speak to a qualified professional to get proper advice about detox and microbiome restore.

Having lived with pain and having actually properly detoxed off meds years ago, it wasn’t until I was off all meds and things managed properly while detoxing, that I realised that some of my daily pain, was actually withdrawal effect of my pain meds. I don’t think many people realise that this happens and all the nausea and migraines and headaches and increased pain, is actually withdrawal. Only once pain is managed well, a proper medical detox done and then a plan put in place, do people realise how much the meds were actually part of their daily struggle and it was all withdrawal. Then you can use proper pain management strategies and alternatives for pain and also preventative strategies too.

I hope this has given you all a better insight into pain, pain medications and withdrawal symptoms and if you aren’t being managed properly for your pain and pain condition, then you need to talk to your healthcare professional about this. Everyone’s pain and pain symptoms are going to be different, even if they have the same disease state, or inflammatory condition. This is why individual treatment plans are much more effective than a treating the masses approach.

I’ll do a separate post of some alternative to pain medications and drugs shortly, as it is whole post in itself. I will be collaborating with integrative medicine practitioner and mindfulness expert Rosa Bunn on this topic. 

In the meantime have a read of my post about me knowing what it is like to live with pain

https://drandreworr.com.au/knowing-all-too-well-what-it-is-like-to-live-with-pain/

I have written quite a few articles on pain and pain management and I urge you all to have a read of them all, so that it gives you some understanding of where I am coming from and also some helpful pain management strategies

  1. https://drandreworr.com.au/getting-a-handle-on-pain-with-proper-pain-management/
  2. https://drandreworr.com.au/stop-telling-women-that-period-pain-is-normal/
  3. https://drandreworr.com.au/early-intervention-early-management-is-vital-for-gynaecological-conditions-menstrual-issues/
  4. https://drandreworr.com.au/period-pain-is-not-normal-and-doctors-in-australia-and-the-rest-of-the-world-need-to-start-listening/
  5. https://drandreworr.com.au/asking-the-right-questions-about-period-pain-gynaecological-issues/
  6. https://www.sciencedaily.com/releases/2017/06/170618103517.htm
  7. https://www.medicalnewstoday.com/articles/318532.php

Take care and if you do need help with pain and pain management and getting of pain medications, you can always come and see me and book in a proper consultation and I can help you and point you in the right direction too. Sometimes we all need a little help in the right direction and sometimes the first step is admitting you have a problem in the first place. Oh, yes, I also get that many of you have been missed and dismissed also and this is why you are where you are now.

Telling it how it is and keeping it real. I get it and I understand.

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned