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

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

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

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

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

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

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

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

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

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

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned

 

Asking the Right Questions about Period Pain & Gynaecological Issues.

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

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

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

It read “Hey Dad, is endometriosis hereditary?”

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

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

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

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

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

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

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

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

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

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

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

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

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

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned

 

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-The International Baby Maker

-No Stone Left Unturned

Sex Around The Time of Embryo Transfer Increases The Likelihood of Successful Early Embryo Implantation and Development.

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One of the things that I  promote is that regular sex is so important for our fertility patients, on so many levels. Sometimes the obvious eludes some people though

One of the things I see quite regularly is that couples doing Assisted Reproduction (ART) are abstaining from sex fearing it will affect their chances of conceiving. Actually the opposite is true. By not having sex during ART cycles (IUI, IVF etc) you are affecting your chances of conception.

I have often spoken about the importance of sex and orgasm assisting implantation in other posts and there is so much medical research to back this up

Let me ask the question “If you were trying naturally, would you stop having sex for fear that conception has taken place?”

Then why would you stop having sex around an ART cycle?

Let’s face the facts, implantation takes place in the uterus, and not the vagina, and no man is that well endowed to even penetrate the cervix, so…. Let’s get a grip here

The question to ask is “What does an embryo feed off and need to successfully implant?”

The answer is blood!

Think of a tick borrowing into skin to feed off its host.

How do you get blood flow into the uterine lining?

The answer is that sex and climax stimulate blood flow to the lining to assist implantation and also prepare the lining for implantation!

Nature has given us all the tools for healthy conception to take place, and yet many of us just aren’t using them.

This article shows that sperm are also beneficial in assisting implantation and exposure to semen around the time of embryo transfer increases the likelihood of successful early embryo implantation and development.

http://humrep.oxfordjournals.org/content/15/12/2653.full

Don’t forget that regular sex during this time not only helps assist implantation, but it also helps with the bonding process and physical connection process during this stressful time. Many couples split up because of losing this connection during the ART process and sex is a way of keeping that physical and emotional connection. Sex also tells your body you are also preparing to conceive on another level too.

For those doing IVF etc, next time you are doing an ART cycle maybe it is time to start doing things the way nature intended to give you that boost you so desperately are needing. Time to go and get busy people.

Regards

Dr Andrew Orr

Reproductive Medicine and Women’s Health Medicine Specialist

-The International Baby Maker

– No Stone Left Unturned

Seminal fluid improves fertility women and improves IVF pregnancy rates

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Seminal fluid is often viewed as simply a vehicle to carry sperm to fertilize the female egg, but a more complex function in influencing female reproductive physiology is now evident
Remarkably, seminal fluid contains special signaling agents that interact with the female reproductive tract to prime the immune response, with consequences for fertility and pregnancy outcome. This research isn’t new and we have spoken about this in previous posts. But we now know a bit more about how sperm may assist in implantation for, especially for IVF.

See my other post http://drandreworr.com.au/sex-around-the-time-of-embryo-transfer-increases-the-likelihood-of-successful-early-embryo-implantation-and-development/

Recent studies demonstrate a key role for seminal fluid in enabling  embryo implantation and optimal placental development. In particular, seminal fluid promotes health immune responses which facilitate embryo implantation by suppressing inflammation, assisting uterine circulation and blood supply and also protecting the embryo.

There is emerging evidence  where seminal fluid provokes an adaptive immune response in the cervical tissues after contact at intercourse, and spermatozoa accessing the higher tract potentially affect the endometrium directly. Research has now shown that sperm and seminal fluid actually help with endometrial receptivity, which is needed to create the right environment for a healthy embryo to implant.

These biological responses may have clinical significance, explaining why

[1] intercourse in IVF ET cycles improves the likelihood of pregnancy

[2] inflammatory disorders of gestation are more common in women who conceive after limited exposure to seminal fluid of the prospective father

[3] preeclampsia incidence is elevated after use of donor oocytes or donor sperm where prior contact with conceptusalloantigens has not occurred.

Research like this is important to define the mechanisms through which seminal fluid interacts with female reproductive tissues, to provide knowledge that may assist in preconception planning and infertility treatment. It also bring attention to the fact that couples still need to be engaging in regular intercourse during IVF cycles to help not only with implantation, but to increase pregnancy rates through optimization on the endometrial lining through contact with seminal fluid. Regular intercourse also promotes connection and bonding for the couple as well and this is something that is very much overlooked.

My clinic offers a comprehensive Fertility Program where couples are educated on important factors such as this… and more

If you would like to find out how you could improve your chances of having a baby, please give my clinic a call and ask about my highly successful fertility program that has helped over 12,500 babies (and counting) into the world and can increase a couples chances of conception by 96.1% *

For more information on my highly success fertility program, see also http://drandreworr.com.au/fertility/fertility-program/

Regards

Dr Andrew Orr

Reproductive Medicine and Women’s Health Medicine Specialist

-The International Baby Maker

-No Stone Left Unturned

Facts about sperm health and their lifespan

Typically, millions of sperm cells are produced in the testicles every day. During this time, many things can affect their formation and interfere with their quality and maturity.

From a tiny sperm cell it can take between 90-120 days before a sperm is fully mature. The sperm eventually develops a head and tail, so that its cells start to resemble the shape of a tadpole. The head contains all of the DNA, or genetic material, and the sperm uses the tail to help it move. A sperm doesn’t reach full motility until it actually reaches the egg, where when touching the egg it creates a reactions that causes “super motility” to give it the final power to push inside the egg. This is called the acrosome reaction.

There has been lots of debate about the actual time it takes for a sperm to mature and become fully motile, but general consensus is that it will take somewhere between 90-120 days. This is why it is important that men look after their health long prior to conception, because the sperm they ejaculate today was created around 90-120 days ago and what they did to their bodies at that time, will influence how healthy those sperm are. So if a man had a poor diet, was drinking, smoking, had heaps of stress and goodness knows what, this can all have an impact of the maturing sperm and this can result in poor sperm quality and damage to the DNA of the sperm, which will then be carried onto his offspring, should the sperm be successful in fertilising an egg. This is why the couple need to be healthy prior to conception, not just the female.

Biology 101 tells us it take a sperm and an egg to make a baby, not just an egg. Sperm quality issues make up a big part of fertility issues and they can also be a big part of miscarriage issues too. I have spoken about this many times in previous posts. Up to 85% of miscarriage issues can be related to chromosomal and DNA factors related to poor quality sperm and this is often very much overlooked.

What factors impact on sperm health?

There are always many factors that can affect the sperm formation process and interfere with sperm quality and the DNA of the sperm.

Health and lifestyle factors

  • Recreations drugs, medications or alcohol use
  • job, or occupation
  • tobacco use, or smoking in general (including recreational drugs)
  • stress
  • overheating the testicles (spas, saunas, bike riding)
  • excess weight gain and excess body fat
  • Trauma
  • Bike riding (due to heat and trauma through the seat of the bike)
  • Poor diet and nutrition
  • Excess sugars and additives
  • Preservatives and artificial colours and artificial sweeteners

Environmental causes

  • exposure to industrial chemicals
  • heavy metals
  • radiation or X-rays

Medical reasons

  • infection of the testicles
  • cancer of the testicles
  • swelling of the veins (varicoceles etc) that drain blood from the testicle
  • hormone imbalances
  • physical problems in the tubes that carry sperm through the reproductive system
  • chromosomal or genetic disorders (such as Kleinfelters syndrome)
  • certain medications
  • surgery involving the pelvis, abdomen, or reproductive organs

How long do sperm live inside the female body?

There is always a huge misperception about how long sperm can survive outside the man’s body and when they enter into the female reproductive tract. Many women are told all manner of untruths of sperm lasting for weeks at a time. The truth is that sperm cannot survive for long once they are exposed to the air outside of the body.

Precisely how long they can survive depends on the environment that they are released into and how quickly the fluid surrounding the sperm cells dries up.

Sperm lifespan inside the female body

After ejaculation, sperm may be able live inside the female body for several days, but that is dependent on many varying factors once they enter a woman’s body.  The fluid in a woman’s reproductive tract, especially the fallopian tubes, has all of the nutrients that sperm need for their survival during that time. But while the woman’s body can help sperm on their way to meet the egg, it can also hinder it their survival as well. But even so, sperm really only have about 24 hours to fertilise an egg once it is released. After 24 hours, if the egg isn’t fertilised it will die, so really, it doesn’t matter how long the sperm can survive for if the egg has already died.

Poor sperm have to contend with many things when they enter a woman’s body. A woman’s vagina is coated in acids, to protect her from infections and bacteria, but it is also lethal to sperm. This is why within minutes and hours, most of the 300-500 million sperm that set off in search of the egg will be dead. Only a few million will survive to swim through cervix.

A woman’s body can help to get the sperm going up into to the cervix though. Through climax (orgasm) contractions are created that can help pull sperm up and into the uterus. Through these contractions the cervix is dipped time and time again into a pool of waiting sperm and this then helps carry the sperm up into the second stage of their journey through the uterus and then up into the tubes.

Once inside the female reproductive tract, the sperm cells must swim through the cervix and into the uterus to reach the fallopian tubes and then on to find the female egg. It is a very long journey for sperm to make and very few survive. Many get lost inside the uterus and some are attacked by the woman’s immune system along the way. By the time the survivors make it to the fallopian tubes to have a rest, there will only be less than 20 or more left to make the final journey.

After the sperm have a rest in the tubes and actually feed off some of the nutrients in the tubes many more will die, or be lost inside the tubes and by the time the final sperm reach the egg, there will be less than 10 single sperm left. Only one may then go on to fertilise the egg and an embryo is then started to be created.

This is why all men need to have their sperm quality checked by a proper andrology lab and some men will need further testing of the DNA (DNA fragmentation analysis) and further genetic testing if the semen results are poor. This should all be done prior to trying to conceive, as 50% of fertility issues are related to men. If a man has any of these risk factors, he should try to change them at least 3-4 months before trying to conceive, since that is how long it takes for sperm to fully mature. Some men may need longer than this, depending on what is causing their sperm to be of poor quality.

I will discuss some more myths and facts around sperm and what the most important parameters are to look at with sperm, in some later posts.

Regards

Dr Andrew Orr

(Reproductive Medicine and Women’s Health Medicine Specialist)

-Women’s and Men’s Health Advocate

-No Stone Left Unturned

 

 

 

Period Pain “IS NOT” Normal and Doctors in Australia and The Rest of The World Need to Start Listening

Millions of women around the world are told that period pain is normal and then go on to endure years of suffering and even infertility because it. Some women have endured so much pain and been “missed” and “dismissed” by so many healthcare professionals so many times that they have taken their own life because of it. It just should not happen and it needs to stop.

One of the major causes of period pain is Endometriosis, or its sister disease Adenomyosis. This crippling disease can cause period pain, pelvic pain, joint pain, pain with bowel movement, irriatbel bowel syndrome, pain with ovulation, swollen painful belly (known as endo belly), chronic fatigue, anaemia, heavy painful menstrual flow and can lead to infertility. Some women will quite literally not even be able to work due to debilitating symptoms of this disease.

It is estimated to affect 176 million worldwide and affect one in ten women, but that is only the ones diagnosed, so those figures are grossly understated. The facts around the disease are also grossly understated and poorly understood by many and why so many women are “missed” and “dismissed” by all the so called healthcare professionals they have seen. The other issue for a significant portion of women with the disease, is that they are asymptomatic (meaning no symptoms) and do not even know that have it. Many of them may never be diagnosed unless they are having problems falling pregnant, and even then many of them are not investigated properly to see if endometriosis is the cause of their long-term struggle to have a baby. It really is disgusting on so many levels. There is no other way to put it.

Of those one in ten women actually diagnosed many of them have taken up to ten years, or more, to be diagnosed and have their disease “missed” and been “dismissed” by multiple healthcare professional during their debilitating journey to find an answer for their sufferings. It is a nightmare of epic proportion for women world wide and the nightmare needs to end and healthcare professionals and everyone else needs to become educated and start listening to women and getting the message out there that “Period Pain IS NOT normal”.

So many women worldwide are suffering from period pain, pelvic pain, pain during sex, or infertility and endometriosis is the first thing that needs to be ruled out. Young women in particular have trouble convincing people they are having more than just bad period pain. So many young women (and older ones) are told just to “Suck it Up”, or “Deal with it”. Many mothers will even tell their daughters “This is just normal”, or “This is just what happens”, or “I have to put up with this, so you need to as well”, when in fact nothing could be further from the truth. Teenagers are not too young to have the disease and have it diagnosed and investigated either. Early intervention, diagnosis and management is crucial when it comes to endometriosis. The longer the disease is left, the harder it is to treat and manage, and left untreated can cause a woman years of debilitation and misery in every aspect of her life, years of surgery, years of pain killers and opiates, even after the best medical treatment. Healthcare providers and women around the world need to know that the longer it takes to diagnose, the longer the disease is there and the more damage it can do inside the body. Some women will have their lives crippled by not having early intervention. Some women have got to the point that they can no longer put up with the disease and being dismissed and have either attempted taking thier own life, or have succeeded in doing so. It is just so wrong that women get to this point.

The other issue that women face, once they are diagnosed, is that many of them end up seeing the wrong specialist to do their surgery. While most gynaecologists can do investigative surgery, many of them are ill-equipped to surgically remove the disease and actually do not specialise in the disease, or the excision of the disease properly. So many women have not seen the right specialist, who has not investigated and managed the disease properly and then left women to deal with the consequences of this inadequacy in their scope of practice. Women and healthcare providers need to be educated that women who potentially have endometriosis, or have a high likelihood of the disease, need to see an Advanced Trained Laparoscopic Surgeon, who has had extra specialised training in the excision of the disease and who has had extra specialised training in the management and treatment of the disease as well. Just because someone is a gynaecologist, or specialist, does not mean they are a specialist in the disease. This is also a huge misunderstanding when women require diagnosis and management of the disease and why so many are still left with crippling pain and symptoms, even after medical intervention. Quite simply, they have just seen the wrong person for the job and this also needs to be addressed in education and training around this disease.

This week the National Institute for Health and Care Excellence (NICE) in England has released the first ever guidance on managing this horrible disease that affects millions of women worldwide. They are hoping it will not only help GP’s and healthcare providers in the UK, but also GP’s and healthcare providers here and around the rest of the world too. NICE is calling for GP’s in Australia and the rest of the world to stop overlooking symptoms of this disease, such as bad period pain, so that women are not “missed” and “dismissed” for up to a decade or more. NICE are asking for endometriosis to be taken more seriously than it presently is and while that is starting happen here in Australia and the rest of the world, the changes have still been too slow. It really is just not good enough given that so many women are suffering from this debilitating disease worldwide.

One of my mottos is that “Period Pain IS NOT Normal” and I will continue to say this forever and a day and it is great to see national health care bodies like NICE actually backing that up and trying to get healthcare providers to do the same. While others are slow on the uptake, I will never stop in my quest to get women the help they need for this disease and will do my best to stop women being “missed” and “dismissed” and get them the help, care and attention they need and hopefully be a part of one day bringing an end to this debilitating disease.

Next week I will be in Sydney at a National Endometriosis Symposium shouting my message to healthcare practitioners as well. Let’s hope they finally start listening to the facts about endometriosis too. Let’s end the silence and get this information out there to everyone. If you do want to find out more about the facts about period pain and this disease, you can visit my webpage, or you can also visit Endometriosis Australia at www.endometriosisaustralia.org. I specialise in the treatment and management of this disease and want every woman on the planet to know that Period IS NOT Normal and that there is help out there.

 

Take care

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-“No Stone Left Unturned”

-“Period Pain IS NOT Normal”

 

 

Women with PCOS Have Four Times Higher Risk of Developing Type 2 Diabetes

One of the hardest things I find that is hard to get through to women with PCOS, is their risk factors for type 2 diabetes, gestational diabetes and their increased risk of cardiovascular disease. It has long been known that the major driving factor behind PCOS is insulin resistance and this also increases the risk factor of developing diabetes for those with this endocrine/reproductive disorder.

Polycystic ovary syndrome is an endocrine/reproductive disorder that affects millions of women of reproductive age worldwide, and a new study has shown that it also put these women at a significant risk of developing type 2 diabetes.

PCOS is also the leading cause of female infertility and many women with this condition are often misdiagnosed, or do not know that they have it. PCOS is also a risk factor for miscarriage too. Please see my other posts about signs and symptoms of PCOS.  (Click Here)

All women with PCOS will have insulin resistance, either hereditary insulin resistance, or purely caused by diet and lifestyle choices. Insulin resistance is a condition wherein the muscles, fat, and liver do not respond properly to the hormone, so the body keeps producing more of it. Excessive insulin production is a risk factor for type 2 diabetes and gestational diabetes. This is why it is so important for women with PCOS to follow a modified Ketogenic/low GI style diet and that the number one treatment for PCOS (as recommended by the World Health Organisation) will always be diet and lifestyle changes.

Young women with PCOS at risk

This new study investigated 54,680 women in total and found that younger women with PCOS are now more at risk of developing diabetes than older women with the disease. The study found that the risk factor for developing diabetes is four times greater for younger women. This is probably due to poor diet and lifestyle choices that many young women are choosing these days.

The increased risk of developing type 2 diabetes is an important finding and this is something that women with this disease should know, especially those who are obese and have PCOS as well. But it is important for women that are of normal weight, or even underweight to know that they are also at an increased risk as well. Just because you are underweight, or of normal weight, doesn’t mean you cannot have PCOS, or be at risk of diabetes.

This new research was carried out by Denmark-based scientists and the findings were published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

Women’s and Men’s Health Crusader

-“The International Baby Maker”

-“No Stone Left Unturned”

What is Implantation Bleeding?


Implantation bleeding: Causes and symptoms

Implantation bleeding occurs when a fertilized egg attaches to the lining of a woman’s uterus to start the growth process of pregnancy. Some women’s lining can be more affected and be more prone to bleeding during a pregnancy. It is a normal occurrence in pregnant women, yet many women are completely unaware of what it is. Obviously it can be a bit worrying for anyone when they are bleeding during a pregnancy and I will discuss this later.

Some women may confuse the bleeding with spotting from menstruation, as the two can appear similar. What women also need to know is that getting a menstrual cycle, or the appearance of what looks like a menstrual bleed, does not mean you aren’t pregnant. You can have a bleed and still be pregnant.

Usually when it is implantation bleeding. The bleeding is very light and will usually require no medical attention. In some cases, however, implantation bleeding may require a visit to your specialist, midwife, or healthcare provider

What is implantation bleeding?

Implantation bleeding can just before the expected menstrual cycle, or around the early stages of pregnancy. It can also happen again when the embryos is growing and impacting on the lining of the uterus.  Again this is a normal part of pregnancy for many women. Some women may not get any bleeding, or signs of implantation either.

The process of implantation starts  shortly are fertilization. Once a sperm has fertilized an egg, it is called an embryo. The embryo travels through the fallopian tube towards the uterus. During this time, the embryo multiplies, becoming a blastocyst, which usually takes about 5-6 days to reach this stage. About 1-2 days after an embryo reaches blastocyst stage, it will then attach itself in the wall of the uterus and this is called implantation. During this implantation stage, the embryo can cause disruption the uterine wall and this then cause what we know as implantation bleeding. As the embryo grows even bigger, it can then cause further bleeding later on in the first trimester as well. While this is considered normal, it can cause distress for women and any bleeding should be checked by your healthcare provider.

Signs and symptoms

Implantation bleeding is one of the earliest easily identifiable signs of pregnancy. It is also a normal part of pregnancy and all women should be aware of this. As explained before, women can still have a normal menstrual bleed and still be pregnant. It is usually a lighter bleed, but some women can actually have quite heavy bleeds and still maintain a pregnancy. About 1 in 4 women actually have a bleed during their pregnancy.

Despite all that, there are some distinct signs and symptoms to help women identify implantation bleeding:

  • Early bleeding: Implantation bleeding will often occur a few days before the expected menstruation cycle. This is not always the case, however, and many women confuse the two. As discussed, it is not uncommon for women to actually get their normal menstrual bleed and still be pregnant. Never think that just because you get a period, that you cannot be pregnant.
  • Unusual coloured bleeding, or discharge: Implantation bleeding produces an unusual discharge that varies in colour from pinkish to very dark brown or black.
  • Very light bleeding: Bleeding and discharge caused by implantation will usually not last no more than about 24 hours. It can last a bit longer for some women though. Many women experience just a few hours of spotting or one spot or streak of discharge. Obviously any bleeding should still be checked by your healthcare provider.
  • Cramping: Implantation can also cause mild and temporary cramps. Some women who are doing IVF may also be on progesterone gels that can also cause bleeding and cramping too. Cramping and bleeding does not always mean a miscarriage. If you do experience this and are worried, please always consult with your healthcare provider.

Other signs

As implantation is an early sign of pregnancy, a woman may also experience other pregnancy-related symptoms. Early signs of pregnancy can vary from woman to woman and may include:

  • Mood swings
  • Fatigue and tiredness
  • Dizziness
  • Headaches and Migraine’s
  • Tender, swollen breasts
  • Nausea and vomiting
  • Changes to the bowels (constipation, or loose bowels)
  • Heightened sense of smell
  • Food cravings and aversions
  • Increased body temperature

Treating implantation bleeding

Implantation bleeding is a normal sign of pregnancy and is not usually dangerous. Because of this, there is no need for treatment. As I have stated before, if you are unsure, you should always consult with your healthcare provider.

Bleeding caused by implantation usually clears up within a couple of days with no treatment necessary. Abnormally heavy bleeding may be a sign of menstruation or a pregnancy complication. As I have previously shared, some women who are doing IVF, may be on progesterone gels and other medications, which may also cause some bleeding and cramping. Some women with signs of abnormal bleeding may need the same medications to help with hormonal levels. Some bleeding could be a sign of something more serious so please consult your healthcare provider. If you are experiencing heavy bleeding along with pain, please present to your nearest emergency centre as this may be signs of a miscarriage, or ectopic pregnancy.

Complications of implantation bleeding

Implantation bleeding is not usually a cause for concern most of the time. It is just a sign of embryo implanting into the lining of the uterus.

Women who are still uncertain about whether they have experienced implantation bleeding should consult their healthcare provider and take a blood test to see if they are pregnant, or not. Please do not rely on home pregnancy tests as these can be inaccurate in the early stages of pregnancy. The most accurate way to determine pregnancy is to do a blood test. This is very important for women undergoing IVF treatment too. Too often women will do a home pregnancy test and think they are not pregnant, when in fact they are. The issue is that the home pregnancy tests won’t pick up pregnancy hormone in the urine if it is too early. This can cause a woman much distress at the time and then when she finds out later on through the blood test, that she is actually pregnant. Please never rely on urine based home pregnancy tests.

Please note that if you experiencing heavy bleeding during any stage of pregnancy that this can be a sign of a complication and women should seek medical attention.

If you need help with irregular bleeding, miscarriage, fertility, pregnancy or any advice for Women’s health issues, please call my staff and they will be able to let you know what consultation, or program is best suited for you. Please call my clinic on +61 07 3832 8369

 

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Specialist

-The International Baby Maker

-Women’s and Men’s Health Crusader

“No Stone Left Unturned”

 

 

The Facts About Period Pain & Endometriosis- “What Women Need To Know”

The Facts About Period Pain & Endometriosis

-“Why some of the things I hear women get told gets me angry sometimes”

After my recent post on endometriosis and sharing what “Endo Belly” is,  I have to say that I think hearing your stories has got me even more fired up. Not because of your stories, these I like hearing ( if you know what I mean), but because so many of you have been ‘dismissed’ and had so much ‘missed’ over the years.

Many of you have also been told utter BS (bullshit… sorry for swearing) and it just gets me so upset to hear this BS continue in both the public arena, closed groups and by other healthcare professionals. When are women going to get the support they need and get the health system to start listening.

Today I was talking to a couple about this very topic and was explaining to the this young lady’s partner that if guys had pain in their testicles daily and couldn’t walk, were curled up on the bedroom floor, had vomiting from the pain, had to ingest copious amounts of pain killers etc to just function, then governments would rewrite the health system, laws would be made, research would be done and those testicles would endure pain no longer. Well.. that is what I think anyway.

The biggest problem for women is that many of you believe that period pain is normal, because that is what you have been led to believe. Then healthcare professionals reinforce it and you are basically made out to be neurotic when you try and tell anyone that you can’t handle it any longer. Suck it up they say. Take some painkillers they say. Have a baby they say. Take the pill they say. There are so many BS things said to you all and all of them are wrong. There are so many other things wrong with everything from support groups sprouting misinformation, GP’s telling people misinformation, specialists telling people misinformation and people now relying on “Dr Google” as the gospel for their healthcare diagnosis. This is where the problem all starts and in many ways ends.

So how do we fix this?

Well, education is the first step. This is not just to the public, but to healthcare professionals as well. We also need to start educating women at a young age that “Period Pain IS NOT normal” and neither are other menstrual irregularities that could be the signs of other gynaecological conditions. Early intervention and treatments and management it always going to be the key to any disease state. Thousands of years ago in China, the Yellow Emperor had a classic saying “To treat a disease once it has already started and been expressed in to the body is like trying to forge arms once a war has already started, or trying to dig a well once one if already thirsty”.

Trying to treat any disease once it has been expressed is hard work and for some diseases, nearly impossible. Prevention is the key and like any disease, we need to find ways of preventing endometriosis too. But if the disease is expressed, we need proper education to know the signs, know the symptoms and get early intervention and treatments and management as soon as possible.

Endometriosis can be managed, just like any other disease. I have asthma and I am symptom free because I manage it properly and have the training and education and proper treatments to manage it. I still have the disease, but I have learnt to manage it and be symptoms free. The same can be for endometriosis if you see the right people and get the right treatment.

But, finding these people is hard and we also need people to listen and do the treatment too. We do need people to take some ownership in there health too. I mean this is a caring way when I say this. Having had a debilitating and life threatening disease I know how hard it can be just to function, both physically and emotionally. I also know hard it was for me to find the right people to help me too. So I get it. But we still need to talk about this and be honest about ownership too. Please don’t buy into the diagnosis and the label if you know what I mean. Doing that can eat you up, make you angry/mad and then makes things worse. I know because I have been there. I now teach people to rise up, ditch the label and be the best they can be daily. But, it can be hard work, as many of you know. I get it.

So, lets start with looking at the facts around Endometriosis first and in the next lots of posts I’ll talk about the management and treatments to get women their lives back

The Facts about Endometriosis

1. Period Pain IS NOT Normal- You are not meant to get period pain. Some slight heaviness, or mild discomfort maybe, but pain you should not get at all. Pain is not normal and we need to stop saying it is.

2. A significant portion of women with Endometriosis are asymptomatic– A significant portion of women DO NOT get pain, or any symptoms at all. Just because you do not have pain, does not mean you do not have endometriosis.

3. Symptoms DO NOT correlate to the extent of the disease– As mentioned previously, some women with relatively small amounts of endometriosis will have significant pain, have lots of symptoms, while some women who are riddled with it may have no symptoms at all. This is why i do not like the staging system (1-4) because it really does not accurately describe a women’s symptoms, or have it correlate to the extent of the disease.

4. The only way to diagnose Endometriosis definitely is via surgical intervention– Scans, blood tests etc do not diagnose endometriosis. You cannot have a scan to diagnose endometriosis and you cannot have a blood test to diagnose endometriosis. The definitive diagnose IS and ALWAYS WILL BE via a laparoscopy/laparotomy, along with a biopsy and tissue taken to examine. A laparoscopy is the goal standard investigation of examining the pelvis and for investigating gynaecological disorders such as endometriosis. The laparoscopy also need to be done by what we call an Advanced Trained Laparoscopic Surgeon, who has extra years of surgical training, and who specialises in this disease and specialises in the excision of endometriosis. It can’t just be done by a regular gynaecologist and this is where many go wrong. They just haven’t seen the right surgeon first up who has he proper skills to deal with it effectively. The first surgery should always be your best surgery and early intervention and management of this disease is crucial. The longer it is there, the worse it can become. But, please know that surgery does not cure endometriosis. It is just the first stage in the management of the disease and endometriosis needs ongoing care and a multimodality approach to treat if  effectively. It needs a team to manage it properly.

5. There is NO cure for Endometriosis– At present there is no cure for endometriosis. Just as I mention my asthma before and it having no cure, the same applies to endometriosis. Once it is expressed into the body, it will always be there. Even if someone becomes asymptomatic, the disease it still there. But while there is no cure, the disease can be managed and women can become asymptomatic with the right help, right treatments and right management. I see this is practice daily.

6. Having a baby will not cure endometriosis– Many women are told to go away and fall pregnant and have a baby as this will fix their period pain and cure their endometriosis. This is a load of rubbish. Having a baby will not cure endometriosis. It may stop you having period pain for 9-10 months because you won’t be getting your menses, but you can still get other symptomatic pains and referral pains etc. Pregnancy does not fix endometriosis. The reason why women are told to go and have a family as soon as possible is because endometriosis can make it harder to fall pregnant, for some people.

7. Endometriosis may cause Infertility– While it may make it hard to fall pregnant for some women, other women with it may have no trouble falling at all. But women do need to be educated that it could affect your fertility and one of the major reasons women end up seeking help for fertility services.

8. Endometriosis is Estrogen Driven, Not caused by Estrogen dominance– Estrogens do drive endometriosis. This could be from oestrogen’s in our diet, in our environment, from hormones, drugs, plastics, abdominal fats, body fats and any small amounts of circulating oestrogen’s. Estrogens do not have to be in excess, or be dominant to drive endometriosis.

9. The Pill, or Contraceptives DO NOT fix endometriosis– While the pill and contraceptives can help with hormonal regulate and in some cases even stop the period, they do not fix endometriosis. In many cases the Combined pill can actually make it worse because of the oestrogen’s in it. Plus it then masks the symptoms of endometriosis and then when a woman comes off it, the endo is still there and for some women it could lead to them being infertile. The pill masks endometriosis and many other gynaecological issues. It does not fix them

10. You can have Endometriosis at a Young, or Older Age– Endometriosis does not discriminate age. Young girls can have it and older ladies can have it also. It can present at almost any age once the menses has started and can continue even when the menses has stopped. The symptoms may get less with menopause though.

11. Hysterectomy does not cure endometriosis– Hysterectomy does not fix endometriosis because many times endometriosis is not in, or on, the uterus and it can present anywhere in the body. It has been found in the joints, in the brain, around the heart, on the retina of the eyes, around the bowel and in nearly every part of the body. So removing the uterus does not cure endometriosis in many cases.

12. Endometriosis requires a multi modality approach– Like many diseases we all face, there is never one particular miracle cure, or miracle treatment for endometriosis. It requires a multi modality approach of surgery, proper diet, lifestyle management, counsellors, hormones, herbal medicines, acupuncture, physio therapy, plaits, exercise, pain killers, vitamins etc. This is how you diagnose, treat and manage endometriosis properly

13. Endometriosis IS NOT an autoimmune disease– Endometriosis is not an autoimmune disease. It is an autoimmune like disease because it is made worse by inflammation in the body, but it cannot be classed as an autoimmune disease.

14. There Are Hereditary and Genetic links– While we do not know the exact cause of endometeriosis, we do know that it does run in families and it there is genetic and hereditary links.

15. Endometriosis can cause many other issues in the body– Like any inflammatory disease, endometriosis can cause issues with moods, interfere with hormones, disturb sleep, cause fatigue, cause depression, exacerbate mood disorders, cause muscular pain, cause skeletal pain, have pain refer down your legs, make your joints ache, cause bowel movements to be difficult, cause loose bowels and IBS like symptoms, cause UTI like symptoms, cause bladder pain, nocturnal urination, pain with sex, pain and bleeding with exercise, ovulation pain and so many other symptoms not mentioned. It can cause many issues both physically and emotionally and people need to be aware of this. Some women are at the point of suicide and recently we have seen women take their lives, because they just have not been listened to and it has all become too much.

There is probably a few more things I need to add in here. Please feel free to add comments to add in more. But, this is a start and hopefully people can learn from this and we can start educating people on the facts around this horrible disease. Please know there is always help.

Please know the disease can be managed with the right people on board helping you. Please know there are some really good support groups like Endometriosis Australia out there.

Please know there are some amazing women ( and men like me) out there trying to be your voice and get people to listen. Hopefully one day we will get a cure and women will get the treatment and management of this disease that they so desperately deserve. Sorry for the long post. But we need to get this out there.

Take care amazing people. Keep your chins up and know that there are people who will listen too.

If you do need help with period pain, or endometriosis, please book in a consultation with me. I do see people from all over the world.

Regards
Dr Andrew Orr