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

Dr Andrew Orr Logo Normal 20 07 2016

 

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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

Dr Andrew Orr Logo Retina 20 07 2016

 

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Sex During Pregnancy

It is completely safe for a woman to continue having sex throughout her pregnancy unless her doctor, specialist, or midwife has told her otherwise. Not only is it completely safe to have sex during pregnancy, having sex can have some benefits also.

Being a Reproductive Medicine and Women’s Health Medicine Specialist, I see lots of beautiful pregnant bellies. It is so nice to see all those pregnant bellies and some I have been a big part of them being able to fall pregnant. Personally I think women look their best when they are pregnant. They look so radiant and beautiful and let’s face it, everyone loves to see a pregnant belly and comment how beautiful the mum to be looks. I am sure some women may not feel that way on the inside, but I can tell you that women do get that glow and radiance when they are with child.

When a couple first gets the good news about being pregnant.one of the things I always get asked is “Can we still have sex during the pregnancy?”

The answer will always be “Of course you can”, unless there is something that may prevent that from happening. To be honest, sex during the early stages of embryo growth can actually assist implantation and sex can also help with the increase blood supply to the endometrial lining, which then helps feed and nurture the growing embryo and then later, baby.

It is important for couples to know that sex will not harm the baby at any stage during a normal, healthy, uncomplicated pregnancy. Can I just tell the guys that the uterus (womb) is closed off by the cervix and no man’s penis is ever going to get through that, or in many cases even reach it. They wish they were that big …lol

A woman may not feel like having sex in the first trimester, due to morning sickness, or some early bleeding etc, but I often have to have a joke the males that they are the ones that may be saying “No” later on in the pregnancy. A woman’s sex drive may increase at certain stages of the pregnancy, and this is important for couples to be aware of. It can also be a great time for the couple to bond and come closer together, through increase levels of intimacy. Some men become even more attracted to their partner during pregnancy as the results of different hormone, pheromones and changes to body shape, such as increased breast size.

During pregnancy sex can have many benefits for both the male and female. It can have the following benefits

  • It can help with early implantation and assisting the embryo to implant and grow
  • It can bring a greater level of intimacy and bonding for the couple
  • It can increase the libido of the couple
  • Increased hormones and increased blood flow to the genitals can mean better orgasms for women.
  • Sex can increase the couples immune system and also keep them fit and healthy
  • Sex during pregnancy can increase endorphins which make a couple more happy

The only issues couples may face is that as the belly grows bigger, they may have to adopt certain positions that are more comfortable for the woman. A pregnant woman may be more comfortable where she is in positions where she can control the speed and depth of penetration. Lastly, oral sex is completely safe during pregnancy as well.

Sex and labour

There have been many studies to show that vaginal sex during pregnancy has no increased risk of preterm labour, or premature birth. As mentioned before, if there are concerns, you can speak to your specialist, midwife, or doctor.

When trying to induce labour, sometimes a midwife, or specialist may recommend for you to have increased levels of sex to try and bring the labour on. Many people think it is about the prostaglandins in sperm, which can help ripen the cervix, but it is more about the female orgasm. When a female orgasms, not only is there increased blood supply to the female genitals and uterus etc, but it also helps with hormone activation, such as oxytocin, which is known as the love hormone. But this hormone can help to activate labour at the time a woman is due. It won’t help activate labour any other time in the pregnancy though.

It is possible that sex and orgasm could induce Braxton-Hicks contractions late in pregnancy. Braxton-Hicks are mild contractions that many women experience towards the end of their pregnancy. However, these contractions do not mean that a woman is in labour, or close to being in labour, so they really are of no concern.

When you may need to avoid sex

As mentioned before your specialist, midwife, or doctor are the best people to advise you when to avoid sexual intercourse during her pregnancy. Always consult with your specialist, midwife, or doctor if you are worried about any abnormal signs during pregnancy.The main times that sex might need to be avoided are:

  • There are problems with an incompetent cervix, or issues with early labour, or threatened miscarriage
  • Any Bleeding, or unexplained vaginal bleeding
  • Leaking amniotic fluid
  • If a woman’s waters have broken

Sex after giving birth

This will depend on many things and usually a woman will know when she is ready to have sex again. All new mothers need time to heal and recover after giving birth, or after a C-section.  Women can return to sexual activity whenever they feel they are ready to do so. Some women may not feel like sex for a while after the baby is born and partners need to be aware of this.

Just to recap

In most cases, sex is completely fine during pregnancy and poses no risk to the mother or baby. Pregnancy can be a time where the couple can enjoy more intimacy and bonding with increased sexual activity. Like I mentioned before the only thing to be aware of is that some positions might become more or less comfortable as the pregnancy progresses.  It is important for a couple to continue to have a healthy happy relationship during the pregnancy time and to continue to have a healthy sex life throughout the pregnancy as well.

Regards

Dr Andrew Orr

Reproductive Medicine and Women’s Health Medicine Specialist

-The Brisbane Baby Maker

-No Stone Left Unturned

Dr Andrew Orr Logo Retina 20 07 2016

Fertility Diet for website

Mediterranean Style Diet May Help to Improve Pregnancy Rates for Couples Undergoing IVF and Assisted Reproduction.

New research published in Human Reproduction, has found that those who follow a “Mediterranean” style diet at least six months before assisted reproductive treatment have a significantly better chance of becoming pregnant and giving birth to a live baby than women who did not.

As part of my Fertility Program, one of the first things I talk to couples about is the importance of a healthy diet that has adequate protein, lots of vegetables, seeds and nuts, healthy oils, adequate water intake, electrolytes and cutting out all the refined carbohydrates that cause inflammation. The hard thing is that I hardly see a couple following those health food principles, with many not even really knowing what a health diet is. The diet that I promote is a Primal based diet.

Previous studies have shown that when refined carbohydrates are cut out and replaced with proteins, essential fats and good carbohydrates, such as fruit and vegetables, that the clinical pregnancy rates shot up by 80%. (Fertility & Sterility 2012 Volume 98 issues 3 Page S47)

In this new study, researchers focussed in dietary patterns rather than individual nutrients, food, or food groups. They found that those who ate lean protein, more fresh vegetables, fruit, fish and olive oil, had a 70% greater likelihood of achieving a successful pregnancy and birth compared to women who didn’t follow this style of diet.

The research outcomes found that out of the 244 women in the study, 229 women (93.9%) had at least one embryo transferred to their wombs; 138 (56%) had a successful implantation; 104 (42.6%) achieved a clinical pregnancy (one that can be confirmed by ultrasound); and 99 (40.5%) gave birth to a live baby.

The most important message to come from the study is that women attempting to have a baby should be encouraged to eat a healthy diet, such as a Mediterranean style diet, because it may help increase the chances of successful pregnancy and successful live birth.

The researchers did note that when it comes to conceiving a baby, diet and lifestyle are just as important for men as for women. Previous studies from the same research group showed that male partners that adhered to the same sort had better semen quality.

A healthy diet is important for all couples prior to trying to conceive and should be a part of any preconception planning by all healthcare practitioners assisting couples with fertility. While this study focussed on improving assisted reproduction pregnancy rates, this style of diet should be adopted by any couple wanting to have a baby and should be implemented at least 6 months prior to conceiving. This is why it is essential for all couples to receive counselling and guidance on the importance of a healthy diet and having a healthy lifestyle as well. This is a foundation of my fertility program that has helped over 12,500 babies into the world and continues to help many more couples reach their goal of becoming parents.

Regards

Dr Andrew Orr

Reproductive Medicine and Women’s Health Medicine Specialist

-No Stone Left Unturned

-The Brisbane Baby Maker

Dr Andrew Orr Logo Retina 20 07 2016

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Zinc Deficiency Affects Egg Quality and Early Stages of Egg Development

A new study shows that zinc deficiency can negatively affect the early stages of egg development, reducing the ability of the egg cells to divide and be fertilised. This may affect fertility “months” in the future and why preconception planning is so important for a couple. The researchers will be presenting their results at the American Physiological Society annual meeting at Experimental Biology 2018 in San Diego.

Millions of couples around the world struggle with fertility issues and the ability to conceive a child. While there are many factors that can make conception difficult, ovulation disorders and sperm issues are a leading cause of couples not being able to conceive. Researchers are finally looking into how vitamins, amino acids and micronutrients affect fertility and in particular the early stages of egg development.

The availability of micronutrients, through diet, amino acids, antioxidants and vitamin supplements, in the ovarian environment and their influence on the development, viability and quality of egg cells is now the focus of a growing area of research. Sperm also need micronutrients, antioxidants, vitamins and nutrients for optimal growth and development too. This is nothing new to me as this is something I have always focussed on for many years as part my fertility program and as a part of preconception planning and making sure that the couple are in optimal health before trying to conceive.

In human and mammals, the ovary is made up of thousands of structures called follicles, which consist of one oocyte surrounded by layers of support cells, known as somatic cells. At puberty, the body starts to prepare groups of oocytes for maturation, ovulation and fertilization. While a female grows groups of oocytes, which begin to mature each month, only one will be ovulated and have the chance of being fertilized. Many things can influence whether an oocyte will mature correctly and the go on to one day be ovulated, including the presence of sufficient levels of certain micronutrients. To date this has probably been poorly understood by many.

Scientists have recently found more and more evidence to show that zinc is a key player in oocyte development and have been assessing the effects of zinc on egg development extremely early on in the development and maturation of oocytes.

Previously Fertility research and treatment has primarily focused on the larger follicles, called antral follicles, which respond to signals from the pituitary gland to be ovulated. In humans, preantral follicles have to keep growing for about 90 days before they are ready to ovulate. This is why it is important to focus on egg and sperm quality months before conception is to take place, because this is when both egg and sperm are still growing and maturing and need vital nutrients to develop properly.

In this new research they have examined the smaller preantral follicles, which are still growing and don’t respond to the ovulatory signal yet. Previous studies showed that zinc levels are critical in the antral follicle, but no one had tested the effect of zinc deficiency on preantral follicle growth.

The researchers collected preantral follicles and then matured them in a special cell culture medium. They compared eggs matured in a zinc deficient environment to those grown with normal levels of zinc. The researchers found that preantral zinc deficiency:

  • Impaired the egg cell’s ability to properly divide (meiosis), which is a necessary step before successful fertilization can occur.
  • Led to smaller and more immature egg cells early in development
  • Hindered and disrupted growth of the cells
  • Caused problems with development of somatic cells and elevated certain cell markers.

The new research shows that zinc plays an important role in oocyte growth at an earlier stage than previously investigated, which is during development and before division. The research also showed why preconception nutrients are needed months before the eggs fully develop to give the best outcomes for a healthy pregnancy.

It is estimated that about 17 percent of the global population may be deficient in zinc, due to poor dietary intake their diet. But the estimate may not include cases of marginal zinc deficiency, where people may be getting zinc in their diet, but not enough for their recommended levels. People that are more susceptible to zinc deficiency are those with dietary and disease factors such as irritable bowel syndrome, Crohn’s disease, gastrointestinal disorders and liver disease, those with eating disorders, those with certain dietary restrictions, such as vegetarians or vegans, who may not then be taking supplemental zinc.

Preconception planning, care and management is so important for a healthy pregnancy to occur and should start months before trying to conceive. This is to ensure that the sperm are in optimal health and quality and also to make sure that the egg quality is optimal and in the best quality it can be as well. This is what I do for all my fertility patients and is a crucial part in the high success of my fertility program that has now helped over 12,500 babies into the world.

Regards

Dr Andrew Orr

(Reproductive Medicine & Women’s Health Medicine Specialist)

-The International Baby Maker

-No Stone Left Unturned

Dr Andrew Orr Logo Normal 20 07 2016

Weeding Out Endometriosis

Explaining endometriosis to people is not always easy and sometimes you have to use analogies that seem strange at first, but once you get the gist of where I am going with it, it will all make sense. But before I start, I always like to say that please take the personal out of things and just know that what ever analogy I use, it is with good intention and always about helping others.

I just know that when I used the “Endo is like Rust” analogy, which is what it is like, a few people took it to heart as though they had a rusty uterus and this is what I was saying. Not so. Please know that I have loved ones with this horrible disease, so I am here to help, and my main aim now is to help as many people as possible with what I know, and how to treat people properly. I am also about getting the message out there so that women to not have to remain silent about this disease any longer. My motto is, and always will be, “Period Pain is Not Normal”

So, sit back, take out the personal and know that I am writing from a place of caring and sharing and a place of getting the message out there to help you all. Sometimes you just have to tell it how it is, in order for people to sit up and listen, so here we go J

Many of you have read my article of “Rust Never Sleeps and Neither Does Endometriosis” and the reason I wrote this is because endometriosis and how it attacks the body, is very much like how rust attacks metal. If you haven’t read the article, please do so that you can see what I am trying to convey.

Recently I have been doing lots of speaking events and seminars on Women’s Health and also presenting for workshops on Endometriosis. It is so great to get the message out to the world, so that both the public and healthcare professionals can be educated on this subject. We need to stop having this disease “Missed” and women being “Dismissed” as I am always saying now. This disease should not be taking 8 years from onset to definitive diagnosis. It used to be 12 years. This is disgusting, to say the least, and there is no excuse for this to be happening, except poor education, sloppy diagnosis, lack of training, negligence and dismissive egos that need an attitude adjustment.

But, in saying that, we also need to teach women to be empowered and not just put up with being told “This is normal”, or “Just go on the pill and it will fix it”. That is bullshit (sorry). But it is true. There needs to be a better way and we need to stand up and say “Enough”. But we also need to not let the disease define you and get caught up in the blame game either. We also need to get people to stop “Dr Googling” too, as this is also spreading the misinformation. It is great to be educated, but good old “Dr Google” is full of false information and research shows that up to 75% of the health information that the public can access on google, is either wrong, or only partially true.

Now that I have had my little rant about the injustices of many, I would like to share what I have been sharing to others about what endometriosis is really like and how hopefully we can prevent it from returning, hopefully for good. I do know this is possible with the right care, right follow up treatments and right team of people helping. I see it daily and know what I share to be true. But, again it requires the person to follow the advice given and then to get the information out there. It also requires people to not be defined by their disease and break free from these chains to open their minds to the possibilities of new thought, new treatments and new ways of doing things. We need to not be caught up in what may cause the disease, but what we can do to help those with it now.

Of course prevention is crucial and so important, but once the disease is expressed in the body, what caused it is irrelevant. We can argue about the hypothesis of what may be the initial causal factor until the end of time, but that isn’t helping those with the disease now. The most important factor is how we can help those with it live a normal life and hopefully be free of the disease completely. At least we can look at hopefully giving people a better quality of life than the one they are living each day. From my experience, I do know that this is possible with the right team of people working the help the individual.

To be honest, the most likely cause of this disease is now known to be genetic links, or chromosomal, most likely through the parental mode of inheritance. Gene therapy is probably going to provide the biggest breakthrough in this disease in the years to come. But like any breakthrough, we just have to wait and see what happens there. You heard it here first. I do believe genetics does play a big part, but like any disease, it is not the only contributing factor. But, all this aside, we need to focus on the here and now to help those who need help now. In order to make change, you need to make those changes required. If you change nothing, nothing will change. I also get how hard it is for those whom have suffered so long to pick themselves up, to make those changes. Believe me, as someone who has been through a major life threatening illness and pain and crawled their way back to good health and do what I do now, I get it. I’ve been to that point of wanting it all to just stop and I get what many women put up with on a daily basis. Pain is pain, no matter where it has stemmed from.

Getting back to the subject at hand, I have now been explaining that Endometriosis is like a weed. Why would I explain it like this?

Like a weed, endometriosis grows and spreads. You can physically remove the weed (surgical), but unless you control the regrowth, seeds have been dropped (endometriosis regrowth) and then the weeds pop up again and start to grow once more. Sound like endometriosis too you?

Like any weed, it needs certain things for its regrowth. We have just talked about the dropping of the seeds ( regrowth) but it needs a food and fuel source to make it grow (estrogens, insulin, inflammatory response from external factors, stress etc). Then once the seeds are fed, the regrowth continues and then the garden is infested with the weed plague once more. Then you need to try and physically removed the weeds again once more and so the cycle begins again. Are you seeing what I am getting at yet?

Just like these weeds, endometriosis is often removed and many people then either believe they are fixed, or they do not do anything post surgery to prevent that regrowth. Before they know it, they again have to go back for more surgery. Often when people to control the regrowth (Progestins, Mirena etc), they are only employing one method, for which is either not effective enough, or the weed (Endo) is now resistant too.

This is why we need to employ a multimodality approach post surgery to hopefully complete eradicate the weed regrowth and halt the life cycle of these seeds being spread and to start growing again, thus starting the horrible cycle all over again

Now that we can see how endometriosis is really like a weed that can spread throughout our garden, we need to look at what we can do to hopefully stop it coming back, or spreading into other parts of the body.

Like I said, treatment must be individualised, using a multimodality approach, taking the clinical problem in its entirety into account, including the impact of the disease and the effect of its treatment on quality of life. Pain symptoms may persist despite seemingly adequate medical and/or surgical treatment of the disease.

The real focus needs to be on prevention and treatment strategies post surgery. Even better still, lets prevent it before it starts

There is an ancient Chinese saying – “To try and treat a disease once it is fully expressed into the body is like trying to forge arms once a war has already started, or like trying to dig a well once you are already thirsty – Yellow Emperors Classics of Internal Medicine”

The same goes for endometriosis. Once the disease is there and expressed into the body, it is hard to treat, especially is known methods of treatment are failing and this individualised, multimodality approach is used.

A Multimodality Approach Needs To Include:

  • Surgery
  • Pain Management
  • Hormone Therapy
  • Counselling
  • Lifestyle changes
  • Exercise
  • Pilates/Yoga
  • Changes to Diet
  • Traditional Chinese Medicine
  • Acupuncture
  • Holistic Medicine
  • Anything people have tried and has worked for them

The Royal College of Obstetricians & Gynaecologist guidelines for the “Investigations and Management of Endometriosis” have the following quote:

“Many women with endometriosis report that nutritional and complementary therapies such as homeopathy, reflexology, traditional Chinese medicine or herbal treatments, do improve pain symptoms. They should not be ruled out if the woman feels they could be beneficial for her overall pain management and/or quality of life, or work in conjunction with more modern medical therapies.

This is why it is vital to take careful note of the woman’s complaints and to give her time to express her concerns and anxieties, as with other chronic diseases, just as I do for all of my patients. Healthcare providers actually need to listen to the woman and her concerns. Women need to be listened to and be heard and be nurtured

It is also important to involve the woman in all decisions, to be flexible in diagnostic and therapeutic thinking, to maintain a good relationship with the woman and for healthcare providers to seek advice where appropriate from more experienced colleagues. This is something that I try to educate all my patients with and something I also try to educate healthcare providers with when I do my seminars and speaking events about Women’s Health issues and diseases like endometriosis.

But while there are thing that healthcare providers need to do, there also things you must do also. These include

  • Reducing Stress
  • Look at Emotions and How They Affect You
  • Exercise
  • Get “You Time”
  • Eat more protein and less High GI Carbs
  • Eat less process and package foods that we now call “Carbage”
  • Loss some weight if you have excess fats (which spike estrogens)
  • Gain some weight if you are underweight.
  • Do Something You Love (At least once per week)
  • Laugh Often (Even if some days you feel like crying)
  • Spend Time With Friends and Loved Ones
  • Make Love J ( Climax and Oxytocin are your friends)
  • Do Not Let The Disease Define You
  • Don’t Buy Into The Label
  • You are more than this disease
  • If something is helping, then continue with it, no matter what anyone tells you
  • Just remember that “You” are uniquely “You”

Please remember these words :

  • Do Not Let The Disease Define You
  • Don’t Buy Into The Label
  • You are more than this disease
  • If something is helping, then continue with it, no matter what anyone tells you
  • Don’t buy into everything you read on the internet, social media, or “Dr Google. To be honest, I ban “Dr Google” with my patient (haha)
  • Make sure you have a good laugh each day, but remember it is also OK to have a good cry too
  • It is OK to unplug every so often
  • It is OK to take the “Superwoman” cape off every so often too.
  • Remember “You” are uniquely “You”

This is why it is so important to not get caught up in what others have done, or tried and may not now be working for you either. We need to look at you as an individual and treat you as such. What works for one person, may not work for another. This is why an individualised multimodality approach is needed to help prevent and treat this horrible disease and we often need a team of people, on the same page, to help treat this properly.

Don’t forget to “Get A Second Opinion”, or a Third, or Fourth, or Tenth one if needed

In many other areas in life we will get multiple quotes, and opinions. Yet, when it comes to our health, we often only get one quote, or maybe two.

Just because someone has your history, or is nice to you, or maybe recommended by a friend etc, does not make them a good practitioner. It does not mean that you cannot get another opinion. If someone isn’t helping you, then you need to look at changing, no matter who they are, or how well they know your history. Not every specialist you see is a good surgeon either, so please remember this. You need to have someone who specialises in endometriosis and who has done advanced surgical training, not just minimal training. There is good and bad in every profession and the medical profession is not exempt from this either. Neither is the complementary medicine profession, or allied health care profession exempt from this either. Your health is important and so is the value of another opinion. Not every practitioner has all the answers. If someone isn’t helping you, then don’t be scared to change.

Lastly please remember to know that there is always help out there. I am always here to help and I am a specialist in this area, alongside many other Women’s Health issues and Gynaecological issues. You can always come and see me in person, or make an appointment via skype, for those who live at a distance. I have a great team of people I work with to give you the best help possible. I have a team of some of the best health care professionals there is and I make sure all of them are at the top of their game in their chosen profession.

Let me be the conductor of your health issues and help you get the treatment and advice you so desperately deserve. I am here to listen to you and hear you. I make sure you don’t have things “Missed” and aren’t “Dismissed “ and why my treatment motto is “Leaving No Stone Unturned”. I am out there as a voice for women and being a crusader for women’s health everywhere. I don’t mind stepping on a few toes, and ego’s to get you the best help possible J

Take care and remember that “Period Pain Is Not Normal” and neither are and other “Menstrual Irregularities” that women face on a daily basis. I know what you go through daily and I am out there making sure you all get heard. Let’s end the silence on this horrible disease for you, and the ones close to me whom I love, adore and care about also J

Regards

Dr Andrew Orr

Reproductive Medicine and Women’s Health Specialist

“The Brisbane Baby Maker” & “Women’s Health and Endometriosis Crusader”

Helping you with Women’s Health & Reproductive Issues

Girl Taking Medication

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

Dr Andrew Orr Logo Normal 20 07 2016

 

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A new male contraceptive compound can immobilise sperm temporarily without side effects

The responsibility of contraception and the contraceptive pill may now no longer be left up to women, as a new potential “Male Pill” has been developed.
A new male contraceptive has been made that can immobilise sperm temporarily and affecting their ability to swim, which significantly limits their fertilisation capabilities. The new pill contains a compound called EP005 and binds to sperm to slow down their overall motility and mobility without affecting hormones and causing other side effects.
This exciting new compound could lead to a potential “Male Pill” without side effects. The findings were published in a new study in the journal PLOS ONE on April 19 2018.
The researchers at the University of North Carolina have explained that the EPO55 compound turns off the sperm’s ability to swim, which significantly limits the sperm’s capability to fertilise an egg. This makes it an ideal option for a non-hormonal male pill.
At present women are left to take the responsibility of contraceptives and these can and do have side effects. The only safe forms of contraception for men are condoms, or vasectomy. There have been clinical trials on hormones that target the production of sperm, but these affect the male hormones and have lots of side effects.
The researchers found that sperm motility was affected thirty hours following a high-dose intravenous infusion of EP055. They also found that no physical side effects were observed.
The studies also showed that the EP055 compound is also reversible. The researchers found that at 18 days post the infusion that the sperm motility had completely recovered and were back to normal. The research was conducted on male monkeys.
The researchers have indicated that more work is needed before EP055 becomes available for human use. The research team has also begun to test a pill form of the compound and are going to test the new pill on its effectiveness against pregnancy.
Dr Andrew Orr
Reproductive Medicine and Women’s Health Medicine Specialist
-No Stone Left Unturned

Dr Andrew Orr Logo Normal 20 07 2016

Bladder Endometriosis

What is Bladder Endometriosis?

Endometriosis is a condition where tissue resembling the uterus lining grows outside the uterus, such as on the ovaries or fallopian tubes. Endometriosis can spread to every organ in the body and can grow inside, or on the outer surface of the bladder.This is what is known as Bladder Endometriosis.

To learn more about endometriosis and to learn about the symptoms of this disease, you can click on this link to find out more (Click Here)

If endometriosis forms in, or on the bladder, it that can cause severe discomfort and pain. It can also make a woman want to urinate more and also with urgency, pain, burning and frequency. There are other bladder conditions with the same, or similar symptoms, but endometriosis can also aggravate these conditions, or be present at the same time as well. I will discuss the other forms of bladder pain and interstitial cystitis, which can have similar symptoms to endometriosis affecting the bladder, or bladder endometriosis.

Prevalence
Bladder endometriosis is not common. Reports state that around 2 percent of women with endometriosis may have endometrial growths in their urinary system, with endometriosis growing in, or on the bladder. But even if endometriosis isn’t on, or in the bladder, it can still cause issues with the bladder and cause associated symptoms.

What are the Symptoms of Endometriosis in, or on the bladder?
One of the main symptoms bladder endometriosis is pain when the bladder is full and a woman needing to urinate more frequently. It can also cause symptoms resembling a urinary tract infection, but no infection will be found to be present.  Women do need to be aware that a significant portion of women with endometriosis are asymptomatic (meaning no symptoms) and may not be aware that they have endometriosis until they have investigations for another reason, such as not being able to fall pregnant.

Some women are more likely to notice symptoms of endometriosis around the time they are due to have their menstrual cycle.

Other symptoms of bladder endometriosis may include the following:
• More frequent need to urinate
• Needing to urinate urgently
• Feeling pain when the bladder is full
• Stinging and burning or painful sensations when passing urine
• Seeing blood in the urine
• Experiencing pelvic pain
• Having lower back pain, more on one side of the body

Diagnosis
The definitive diagnosis for endometriosis is via a laparoscopy as this is the gold standard investigation for investigating disease states inside the pelvic cavity. A biopsy is usually taken at the same time to check the microscopic implants of endometriosis, which cannot be seen visually. Normal ultrasound, transvaginal or abdominal, cannot diagnose endometriosis. Blood tests cannot diagnose endometriosis either.

If Endometriosis has spread inside the bladder a cystoscopy would be needed also. A cystoscopy is where a small scope is inserted into the bladder and the specialist can then see if there is endometriosis, or other inflammatory disease in the bladder lining.

The specialist will then see what stage the endometriosis is at. This is a staging system from 1-4, but this is only to let the surgeon know how much of the disease is present. The staging system does not have anything to do with pain levels, as pain levels “are not” related to the extent of the disease. A woman with stage 1 endometriosis could have more pain than someone who is stage 4, and someone who is stage 4, may not have any pain, or associated symptoms at all.

Treatment
There is no current cure for endometriosis. However, the condition can be managed through a multimodality approach that involves surgery, hormones, pain medication, physiotherapy, herbal medicines, acupuncture, yoga, pilates, diet, lifestyle changes, counselling and an individualised approach. Women with endometriosis need a team approach.

Surgery, via a laparoscopy, is the most common treatment, and definitive diagnosis, for those with endometriosis. If endometriosis had been found in the bladder transurethral surgery will be done at the same time. This involves a scope inside the bladder to cut away any endometriosis in the bladder lining. Sometimes a partial cystectomy is needed to remove an affected part of the bladder.
While surgery is a much-needed part of the treatment and diagnosis of endometriosis, it is not a cure. Endometriosis can, and often does, grow back again, even with the best medical forms of treatment.

Fertility
Bladder endometriosis does not have any effect on a woman’s fertility. However, endometriosis does grow in other parts of a woman’s body and reproductive system such as the ovaries, which may affect a woman’s likelihood of conception. But, endometriosis does not always affect fertility.

The Difference Between Bladder endometriosis interstitial cystitis
When endometriosis gets in the bladder it can cause very similar symptoms to another bladder condition called interstitial cystitis. This can often make it very hard to differentiate on symptoms alone. It is also very possible to have both interstitial cystitis and endometriosis present at the same. This is why further investigations are needed to definitively diagnose both these conditions.
I will do a separate post on interstitial cystitis so that people know more about this inflammatory condition that affects the bladder

Outlook for Women With Bladder Endometriosis
At present there is no real known cause of endometriosis and only speculation as to what the true cause is. We know that endometriosis is estrogen driven (not from estrogen dominance), but the most likely cause is probably due to genetic reasons and being a hereditary condition passed on through the parental mode of inheritance and then expressed into the body. The how, when and why will hopefully be answered in the not too distant future hopefully.

Women with endometriosis in the bladder do need to be careful and managed properly as it can cause kidney damage. There is also some research to show that endometriosis in the bladder can lead to cancer in the bladder, but this is thought to be very rare.

For now, anyone with endometriosis needs to be clinically managed properly through a multimodality team approach mentioned before. Let’s get more education out there so that women with this horrible disease have a voice and we end the silence for these women as well. Hopefully through education, funding and further research, this leads to the cure that women with endometriosis so desperately deserve.

Regards

Dr Andrew Orr                                                                                                                                            (Reproductive Medicine & Women’s Health Medicine Specialist)

-No Stone Left Unturned

-Period Pain IS NOT Normal

Dr Andrew Orr Logo Retina 20 07 2016

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Genetics & Gene Sequencing May Be The Path To a Cure for Endometriosis

I have always said that the biggest inroads to the management and treatment of endometriosis will come from the area of genetics. I’ve also said that if there is going to be a cure, this will be the pathway that is comes from.

New research published in the New England Journal of Medicine has revealed that Gene sequencing has found a set of genetic mutations which may help to develop molecular tests to distinguish between mild and aggressive types of endometriosis. This is a big step forward into finding out more about endometriosis and developing better medical treatments and management strategies. Hopefully one day it will also lead to a cure for women with this horrible disease.

Endometriosis is a painful disorder in women which uterine tissue grows outside of the womb, most commonly into the abdomen, and will affect at least 1 in 10 women. It can spread to every part of the body.

Many women with endometriosis will experience symptoms of abdominal pain, migraines, pain with sex, ovulation pain, IBS like symptoms, UTI like symptoms (without infection present), menstrual cramps, abdominal distension and possible issues with infertility.

Endometriosis can affect both physical and mental health in sufferers. While a portion of women with endometriosis get pain and associated symptoms, it needs to be noted that a significant portion of women with endometriosis are asymptomatic (no symptoms) and would not even know that had it, until they are investigated for fertility purposes.

This discovery helps moves towards developing genetic based systems for classifying endometriosis to sort out which forms of the disorder needs more aggressive treatment. Presence of the unusual set of mutations suggest that while origins are rooted in normal endometrial cells mutations change their fate, the mutations identified have links to genetic mutations found in some forms of cancer. Abnormal endometriosis tissue growth will often spread throughout the abdominal cavity but rarely becomes cancerous with exception to a few cases when the ovaries are involved.

The close links to cancer have always baffled scientists, as endometriosis does behave like a cancer the way it spreads, and now they have found some of the same mutations found in cancers, in some of the endometriosis lesions. But again, endometriosis rarely turns cancerous, except if it does spread to the ovaries, but there have been some studies to suggest links that women with endometriosis may be at more risk of endometrial cancer.

In this latest research, the research scientists analysed the samples looking for mutations or abnormal changes in DNA and filtered out normal variations in genes which commonly occur. At least one or more mutations in endometriosis tissue that were not present in their normal tissue, in which the number and type of mutations varied per endometriosis lesion and each woman.The types of mutations found were among the most common mutated genes found, which are all known for DNA repair, controlling cell growth, and cell invasion.

The researchers are working on additional studies to investigate whether patient outcomes correlate with the mutations. Testing which can sort lesions into less or more aggressive has potential to help decide how to monitor progression as well as control and treat the endometriosis. It may also be possible to develop new treatments which use agents that block gene related pathways specific to an individual’s disease.

Women are normally prescribed anti-hormonal treatments, which block estrogen to shrink lesions. Endometriosis is estrogen driven and is not from estrogen dominance, as some people would have women believe. Even small amounts of estrogen can drive the disease and cause the expression of the lesions. When endometriosis occurs on the ovaries and forms a large cyst, or endometrioma, it is typically removed as it increases the risk of developing ovarian cancer in some women.

While this new development is not a cure for endometriosis, it is providing new insights into the disease, which will hopefully one day see a cure in the not so distant future. Lets help end the silence for women with this horrible disease by getting more awareness out there and let us hope that the cure will eventually come one day soon.

Regards
Dr Andrew Orr
Reproductive Medicine and Women’s Health Medicine Specialist
-No Stone Left Unturned
-Period Pain IS NOT Normal
Dr Andrew Orr Logo Retina 20 07 2016