Early this week, I was talking with a colleague about how I would love to be able to see all women before they head into IVF, or see them when they were a teenager to educate them and help the with a better future for their fertility and gynaecological health.
My colleague then said to me “The issue is that most women are mismanaged at around age 13 and this is why they end up having fertility issues and ongoing gynaecological and menstrual related issues later on.”
The truth is, if we really to trace back the cause, or start of a woman’s fertility, gynaecological, or menstrual related issues, it would most likely be due to mismanagement at around age 13 when she first got her period. In this video I bring light to this very introspective, and very interesting topic that many probably have not thought about. It isn’t always mismanaged by the people you think it is either.
Let’s bring better education and awareness to women’s health issues because we know that early intervention and early management if the key to better future outcomes. It all starts with education first. Have a listen to my video on this very important topic (click on the youtube video link to watch
If you, or your daughter needs help with a menstrual issue, or period pain etc, please give my friendly staff a call and ask how I may be able to assist you.
-No Stone Left Unturned
-Master of Women’s Health Medicine
-Master of Reproductive Medicine
-The Endometriosis Experts
-The Experts Program
Pelvic floor hypertonus is a condition that not many people hear about, or even know about. Often when we talk about pelvic floor dysfunction many people will automatically think of weak pelvic floor muscles often created from having children, or part of the aging process. This is where the pelvic floor muscles are too relaxing and need tightening and strengthening.
However more and more we are now seeing women, especially young women, with pelvic floor muscles that are too tight and non-relaxed and this is leading to chronic pelvic pain and other pelvic health and sexual health issues. This is called Pelvic Floor Hypertonus. For this article I will be talking about how Pelvic Floor Hypertonus affects women, even though men can have this as well.
What is Pelvic Floor Hypertonus?
Pelvic floor hypertonus occurs when the muscles in the pelvic floor become too tight and are unable to relax. Many women with an overly tight and non-relaxing pelvic floor experience pelvic health issues such as constipation, painful sex, urinary urgency, bladder issues and pelvic pain. Women with pelvic floor hypertonus may also have musculoskeletal issues that cause tightness and tension in surrounding hip, sacrum and pelvic muscles.
Pelvic floor hypertonus is not widely recognized and can often go on undiagnosed. It is certainly on the missed and dismissed list. Unlike in pelvic floor disorders caused by muscles too relaxed and are easily identified (such as pelvic organ prolapse or urinary incontinence etc), women affected by pelvic floor hypertonus may present with a broad range of nonspecific symptoms mentioned previously and below. All these related symptoms require relaxation and coordination of pelvic floor muscles and urinary and anal sphincters. Many of these symptoms can really affect the quality of woman’s life.
The signs and symptoms of pelvic floor hypertonus
The main and typical symptom of pelvic floor hypertonus is pelvic pain, or pelvic muscular pain. There can be a wide range of other symptoms including the following:
- Urinary issues such as urge frequency, frequent urination or painful urination
- Slow flow, hesitancy, or delayed start of urination
- Constipation and straining when emptying the bowels.
- incomplete emptying of the bowels
- pressure feeling in the pelvis and rectum
- pain in the pelvis, genitals or rectum
- chronic pelvic pain
- muscles spasms in the pelvis, or pelvic floor
- low back pain
- hip pain
- coccyx pain
- painful sex
If left untreated pelvic floor hypertonus can lead to long term health issues, colon and bladder damage and can also cause infection.
What causes pelvic floor hypertonus?
There is no one defining cause of pelvic floor hypertonus. Many things can cause non-relaxing pelvic floor muscles ranging from sitting too much, exercising too much, obesity, stress and also chronic inflammatory disease states. Here are some of the causes of pelvic floor hypertonus:
- Interstitial cystitis
- Irritable Bowel Syndrome
- Pudendal Neuralgia
- History of holding onto the bowels, or bladder too long
- Over exercising and over exercising the core muscles
- Being sedentary, or over-sitting too long
- High levels of stress, fear and anxiety
- Obesity or being overweight
- Child Birth, or Birth Trauma
- Injury to the pelvic floor
- Sexual and emotional abuse
- Nerve Damage
It is very important to identify the cause of pelvic floor hypertonus individually and why it is so important to see a healthcare expert, or pelvic floor specialist that specialises in this area. As with many other inflammatory conditions, a multimodality treatments approach is needed and may involved several modalities, or practitioners working together to help the individual. A pelvic floor physiotherapist may also be needed to help with exercises to relax the pelvic floor along with other modalities such as acupuncture to help with pain, relaxation and stress relief.
What are some of the things that can benefit pelvic floor hypertonus?
As mentioned before, it is important to see a healthcare expert who can identify what the cause of the pelvic floor hypertonus is and recommend a management and treatment plan moving forward. This will usually require a multimodality treatment approach, which could involve the following:
- Pelvic floor muscle relaxation techniques
- Mindfulness and meditation techniques
- Breathing techniques
- Pilates and yoga to help with stretching
- Advice on better bladder and bowel habits
- Pelvic floor and core muscle releasing abdominal massage
- Specific stretches for the pelvis, hips and sacrum
- The use of vaginal dilators, and/or vaginal eggs to help with relaxing and stretching the pelvic floor muscles
- Acupuncture to help with pain, stress and relaxation, alongside medical interventions.
- Massage to help with internal scar tissue (done by a pelvic floor physiotherapist)
- Warm baths and self care
- Use of TENS and electro-neuro stimulators to help with pain
- Biofeedback therapy
- Pain medications and muscles relaxants
- Complementary medicines (prescribed by a qualified healthcare professional)
Outlook and importance of seeing an expert
The main goal of treating and managing pelvic floor hypertonus is to relax the muscles of the pelvic floor to relieve pain and other associated symptoms.
Although living with pelvic floor hypertonus embarrassing or sometimes painful, non relaxing pelvic floor dysfunction is a highly treatable condition. It is important that you talk to a healthcare expert in this area, or a pelvic floor specialist. It’s important not to self-diagnose your symptoms, or try to Dr Google your symptoms, because left untreated pelvic floor hypertonus can lead to long term pain and health issues and also irreparable damage.
There are many conservative management approaches that can be used before resorting to hard-core pain medications, muscle relaxants and surgery. Your healthcare expert will be able to discuss all these options and ongoing healthcare management and treatments with you. The main thing is booking a consultation with a proper healthcare expert to get a proper diagnosis.
If you need help and assistance with pelvic floor hypertonus, or pelvic pain, please give my friendly staff a call and find out how I can assist you.
-No Stone Left Unturned
-Master of Women’s Health Medicine
-The Women’s Health Experts
In the last couple of weeks I have been talking about the serious complications of people not having their health managed properly. It seems to be a big issue and with my latest post, the issue of unmanaged, or undiagnosed low iron is also becoming a very serious issue indeed. So for this post I will be talking about the serious health complications of low iron.
Two thirds of body iron is present in circulating red blood cells known as haemoglobin. Each gram of haemoglobin contains about 4gms of iron and each ml of blood lost from the body results in a loss of about half a milligram of iron.
Bleeding is the most common cause of iron deficiency. This could be from either a diagnosed, or undiagnosed gynaecological issues (endometriosis, adenomyosis, fibroids, polyps, other) or it could be from a parasite infection. It could also be from bleeding as part of a gastrointestinal issue, or part of inflammatory bowel diseases (IBS, Crohn’s Coeliac disease).
There could be other reasons for blood loss in the body, or reduction of iron and many of these conditions, and the conditions above, can go unrecognised and then cause iron deficiency anaemia. Some of these issues can be very serious, or even fatal.
Excessive menstrual losses are often overlooked with many women. This is something that should not happen and should be part of the questioning with any low iron status. The problem is, unless the menstrual flow changes, patients typically do not seek medical attention for heavy menstrual bleeding. Sometimes when a healthcare practitioner asks, these patients generally report that their menses are normal. It may be normal to them, but we need to educate women that heavy blood loss is not normal and can lead to anaemia.
Because of the marked differences among women with regard to menstrual blood loss (10-250 mL per menses), patients meed to be asked about their menstrual history and about a specific history of bleeding, blood flow, abnormal bleeding in between cycles, clots, cramps, and the use of multiple tampons and pads. These are very important questions to ask and sadly many women are not being asked these questions, or having further questioning about their menstrual, or overall health, including dietary intake etc.
What is iron deficiency anemia?
Anaemia occurs when you have a decreased level of haemoglobin in your red blood cells (RBCs). Haemoglobin is the protein in your red blood cells that is responsible for carrying oxygen to your tissues.
Iron deficiency anaemia is the most common type of anaemia that women present with, and it occurs when your body doesn’t have enough iron. Your body needs iron to make haemoglobin. When there isn’t enough iron in your blood stream, the rest of your body can’t get the amount of oxygen it needs. Today in a recent post I talked about iron being like trucks, or the transporters of oxygen around the body.
While iron deficiency may be common, many people don’t know they have iron deficiency anemia. It’s possible to experience the symptoms for years without ever having it diagnosed, or the cause of the iron deficiency diagnosed either. It is a very serious issue that needs some serious attention.
In women of childbearing age, the most common cause of iron deficiency anemia is a loss of iron in the blood due to heavy menstruation or pregnancy. A poor diet or certain intestinal diseases that affect how the body absorbs iron can also cause iron deficiency anemia. Women who adopt a vegan diet will also be prone to being iron deficient and vitamin B12 deficient.
Disruption to the microbiome and leaky gut syndrome can also cause iron deficient anaemia too.
One of the best ways to treat the condition is through iron infusion, and also with iron supplements, or changes to diet. We also need to make sure the cause of the iron deficiency is addressed as well.
Symptoms of iron deficiency anaemia
The symptoms of iron deficiency anaemia can be mild at first, and some people may not even notice them. Many people are completely unaware that they may be low in iron, or are actually iron deficient.
The symptoms of moderate to severe iron deficiency anaemia include:
- general fatigue
- pale skin
- Bruising easy
- shortness of breath
- Strange cravings to eat items that aren’t food, such as dirt, ice, or clay
- Tingling or crawling feeling in the legs
- Tongue swelling or soreness
- Cold hands and feet
- Brittle nails
- Headaches and migraines
- Sore joints
- Brain fog and lack of concentration.
The serious complications of unmanaged iron deficiency.
Undiagnosed, or unmanaged iron-deficiency may cause the following severe complications:
- Heart problems.If you do not have enough hemoglobin-carrying red blood cells, your heart has to work harder to move oxygen-rich blood through your body. When your heart has to work harder, this can lead to several conditions: irregular heartbeats called arrhythmias, a heart murmur, an enlarged heart, or even heart failure.
Severe anemia due to any cause may produce hypoxemia and enhance the occurrence of coronary insufficiency and myocardial ischemia.
- Increased risk of infections- Research has shown that iron deficiency anaemia can affect your immune system (the body’s natural defence system), making you more susceptible to illness and infection.
- Motor or cognitivedevelopment delays- This mainly occurs in children. Children deficient in iron may exhibit behavioral disturbances.
- Behaviour issues and mood disorders- Behavioral disturbances may manifest as an attention deficit disorder, or mood disorder such as : Depression Unipolar depressive disorder, Bipolar disorder, Anxiety disorder, Autism spectrum disorder, Attention-deficit/hyperactivity disorder, Tic disorder, Delayed development and other some other psychiatric issues.
- Pregnancy complications- Iron deficiency can lead to preterm delivery or giving birth to a baby with low birth weight.
The neurologic damage to an iron-deficient foetus results in permanent neurologic injury and typically does not resolve on its own, or by supplementation.
- Chronic Health Conditions worsened- In people with chronic conditions, iron-deficiency anaemia can make their condition worse or result in treatments not working as well.
- Dysphagia (Difficulty swallowing)- This may occur with foods due to abnormal muscle and nerve control. This could result in choking. It can also lead to throat cancers.
- Atrophic gastritis – This occurs in iron deficiency with progressive loss of acid secretion, and causes inflammation of the gastric mucosa with loss of the gastric glandular cells and replacement by intestinal-type epithelium, and fibrous tissue
- Tiredness- As iron deficiency anaemia can leave you tired and lethargic (lacking in energy), you may be less productive and active at work. Your ability to stay awake and focus can be reduced, and you may not feel able to exercise regularly.
- Fainting– Low iron can cause fainting and this could be dangerous in many situations, especially at work places, or working on machinery, or driving a car.
- Cold Intolerance– Cold intolerance develops in one fifth of patients with chronic iron deficiency anaemia and is manifested by neurologic pain, vasomotor disturbances, or numbness and tingling.
- Issues with Brain and Optic Nerve– Rarely, severe iron deficiency anaemia is associated with papilledema (optic disc swelling), increased intracranial pressure, and the clinical picture of pseudotumor cerebri. These manifestations are all corrected with iron therapy.
- Migraines– Research has now shown that there are certain types of migraines caused by iron deficiency
- Death – Caused by some of the issues mentioned above
The importance of proper management
Hopefully now everyone can see why iron is so important and that people with iron deficiency need to see their healthcare practitioner for proper help and proper management . Iron deficiency anemia isn’t something to self-diagnose or treat. It needs to be diagnosed, treated and managed properly. In many cases an iron infusion is the best and quickest way to get iron levels back up. Have a read of my post about iron infusions. Click here
Iron infusions are the quickest way of getting iron levels back up
In the case of low, or severely low iron, supplements just are not enough. They take too long to get levels up and the damage to your body in waiting too long can also be serious. Always see your healthcare practitioner, or specialist, for a diagnosis rather than trying to manage low iron on your own, or just taking iron supplements on your own. Overloading the body with too much iron can be dangerous too, because excess iron accumulation can damage your liver and cause other complications.
This is why everyone needs to be managed by a properly trained healthcare professional with any health issue, especially low iron. If your practitioner is not able to assist you, please make sure you get a second or third opinion. Some practitioners may not be well versed in the serious complications of low iron, or know much about iron infusions etc.
If you do need help with managing the symptoms of low iron, you can call my friendly staff and find out how I can assist you. For more information please call +61 07 38328369 or email email@example.com
-No Stone Left Unturned
-Master of Women’s Health Medicince
-Master of Reproductive Medicine
-Women’s and Men’s Health Advocate
Many times I have talked about “Why a hysterectomy does not cure endometriosis” and so I have decided to talk about “When a hysterectomy should be considered”
Now, before you go any further, I need people to sit back, listen objectively and also take the personal out of this. This is a very personal topic and yes, I am a man and a male healthcare practitioner all in one, with over 20 years experience in helping women with women’s health conditions and being a voice for them also. But regardless, this topic does need to be talked about. Any negative comments, or rudeness will get the delete button immediately. Constructive discussion is always welcome.
The long and short of it is this. There are times when a hysterectomy should be considered (lack of quality of life, cancers etc) and we need to be able to give women the facts so that they can make informed choices, and also not be judged for those choices either. The fact is that for some conditions, women actually get their life back after having a hysterectomy and I talk about all of this and more in this video blog.
In this latest video post I talk about why the “No Uterus-No Comment” speech on forums needs to stop.
As someone who is a Master of Women’s Health Medicine, a Women’s Health Expert, and work tirelessly to be a voice for women’s health issues (And a Male), I have a very frank and blunt discussion about some of the male bashing hate speech comments that get thrown around various forums.
Have a listen to the latest video blog on this very important topic.
One of the things I find myself saying to parents often is “Please don’t let your daughter suffer with the wait and see approach for period pain.”
The reason I often say this is because daily I get messages from parents, mainly mothers, asking if they should wait and see if their daughters pain (and other symptoms) is miraculously going to go away. Many of these young girls have been putting up with pain for months, or longer, and still many parents are using the “wait and see” approach.
Many of these messages often start with the story that their daughter is laying on the bathroom floor in excruciating pain. The stories usually add in that their daughters may also have symptoms of nausea, headaches, vomiting and even stories of these poor young girls passing out with pain.
Then there is the usual response of “I used to get period pain and associated symptoms like this and I just had to learn to live with it”
Then comes the question I always hear so often- “Do you think I should wait and see if this just goes away, or do you think I should take her to someone to have her checked out?”
I often have to bite my tongue when responding to questions and stories such as this. If my daughter was laying on a bathroom floor each month, and in excruciating pain, there is no way I would be waiting and seeing if her pain is going to miraculously disappear. The first time she had pain, I would be off doing something about it, and I would not be taking no for an answer.
Many parents suffered period pain themselves
There is always several ways to look at this and why I always offer an empathic response. Many parents were in pain themselves and went through similar experiences. Many of these same parents were told to suck it up and that this is what a woman has to put up with each month. So to them, this is reality. This is their norm. They suffered, so it is natural for them to believe that their daughter just has to wait and see and suffer it out too.
But, as I say to these parents, these symptoms that your daughter is experiencing are not normal. Period pain and all the other terrible associated symptoms are not normal. No woman, young or older, should have to put up with excruciating pains related to her cycle, or an undiagnosed gynaecological condition.
I then go on to explain that I have daughters and that there is no way I would wait and see, before getting help. I also explain that on a health perspective, there are many dangers in letting a young woman suffer such a horrible experience.
The cause of period pain could affect future fertility
I often have to explain the implications of leaving a disease and not intervening early enough. The explanation of by not getting early intervention could mean that they may not ever have grand children, is usually enough to spur many a mother into prompt action. But, it should not have to take these words to prompt someone into action.
Gynaecological conditions cause period pain
The facts are clear now. There is enough education out there. The simple fact is that period pain (and associated symptoms) is not normal and this usually means that there is an undiagnosed gynaecological condition causing the issue. One of the most common causes being endometriosis, or adenomyosis, or both combined. There could be other facts such as pelvic congestion syndrome, or worst still, though rare, there could be something more sinister such as cancer.
Sexually Transmitted Infections
The other thing that parents may not like to admit is that their daughter may actually be having sex and has a Sexually Transmitted Infection (STI). I often have parents interject when asking if a teenager is sexually active. Many a parent answer “No” on the teenagers behalf, only to then learn that their little girl is having sex.
Sexually transmitted diseases (STI’s) can cause permanent damage to reproductive organs and future fertility if not treated early enough. The reality is that many young girls, and boys, are having sex at a very young age, regardless of what parents may believe. Parents do need to open to the possibility that their child’s pain could in fact be related to being sexually active.
The things parents need to know
The things I am trying to educate all parents on are the following:
- No matter what anyone tell you, health professional included, ‘period pain is not normal’
- Please do not use the wait and see approach when your daughter is in pain, and has been for months.
- Women do not needlessly need to put up with pain each month.
- Early intervention is the key to treating and managing any disease or health issue
- Teenagers are not too young to have endometriosis, or other gynaecological issues.
- Many gynaecological issues are hereditary, so if a parent had period pain, or a diagnosed gynaecological issue, then there is a good chance their daughter will have the same.
- Parents should not feel guilty, or blame themselves for passing on hereditary issues. All of us have faulty genes.
- Regardless of upbringing, or moral stances, teenagers are having sex earlier these days
- Teenagers can have sexually transmitted diseases
- The earlier intervention is enacted and proper treatment and health management administered, the better the future fertility and health outcomes are for young woman.
- Without early intervention, some parents may never become grandparents.
- General practitioners are no gynaecologists, so please make sure you get referred onto a proper specialist. If not, find another GP.
- If you don’t get help with the first healthcare practitioner you see, please remember the value or a second, or tenth opinion.
I do get that many parent’s have been led to believe that period pain, and other associated symptoms are just part of live and something that I woman just has to put up with. I am sorry for those that were told this and then have put up with this when they didn’t have to.
Period pain is not normal
Please know that you daughter does not need to put up with these symptoms. Period pain is not normal and early intervention is the key to help your daughter live a happy and pain free life. It could really also help save her from the heartache many women have to live with daily. It could also help with her being able to have children of her own.
Do not use the wait and see approach for period pain
Never use the wait and see approach when it comes to period pain and the other associated menstrual symptoms. You daughter will thank you one day and I am sure her children will thank you too. Lead by example so that your daughter can lead by example to daughter, or daughters too.
If you do need help with your daughters period pain, and other associated symptoms, please give my friendly staff a call and find out how I may be able to help. There are in person and online consultation available. Conditions may apply with online consultations. My staff will explain all this to you when you make your enquiry, or book a consultation.
-No Stone Left Unturned
-Master of Women’s Health Medicine
-The Women’s Health Experts
Millions of women world-wide suffer from chronic pelvic pain. One of the causes of chronic pelvic pain is a condition called Pelvic Congestion Syndrome and it is not often talked about. I thought it was important to share this information to bring more awareness to this syndrome.
Pelvic congestion syndrome does share many of the same symptoms of endometriosis and adenomyosis and it important to have proper differential diagnosis and rule other causes of pelvic pain out first. Sometimes the varicose veins that cause pelvic congestion syndrome can be present alongside endometriosis and adenomyosis, or other pelvic issues.
In the past, a diagnosis of chronic pelvic pain left many women frustrated with few treatment options and a lack of available resources. Their doctors were often left perplexed, despite the endless negative laboratory test and imaging data as well as inconclusive consultations obtained.
In the last 10 years, improved medical understanding and increased awareness have lessened the confusion surrounding this condition and its distinct association with pelvic congestion syndrome (PCS). There are now more minimally invasive surgical solutions which give affected patients more treatments choices as well.
So what is Pelvic Congestion Syndrome (PCS)?
Pelvic congestion syndrome (PCS) is a chronic condition that occurs in women when varicose veins form below the abdomen within the pelvic region. Pelvic congestion is just like the varicose veins that some women have in their legs, but it affects the veins of the pelvis. Blood backs up in the veins, making them become enlarged and engorged. Pelvic congestion can also cause chronic pelvic pain in some women.
What are the symptoms of Pelvic Congestion Syndrome?
The main symptom of pelvic congestion syndrome is pelvic pain that lasts at least 6 months. The pain may be a heavy or aching feeling. Or the pain may be sharp. Usually the pain is only on one side, usually the left side. At times you may feel it on both sides. The pain is often worse at the end of the day. If PCS occurs in pregnancy it often first starts during or after a pregnancy. It may worsen after a later pregnancy.
Symptoms of Pelvic Congestions Syndrome can include the following.
- Pain starts 7-10 days before your period
- Pelvic pain is worse when you sit or stand
- Lying down relieves pelvic pain
- Varicose veins around the vulva, buttocks, and legs
- Abnormal vaginal discharge
- Swelling of the vagina or vulva
- Tenderness of the abdomen
- Pain during sex
- Dysmenorrhea (painful menstruation)
- Abnormal bleeding during menstruation
- Increased urination
- Irritable bowel symptoms
- Hip pain
- Lower back pain
- Aches in your legs
The syndrome often causes a constant dull pain in the pelvic area that is said to worsen at different times of the cycle and in different situations. Experts believe it can be the source of pain in up to 30% of women who have chronic pelvic pain.
How is at Risk?
It’s more likely to develop in women who have previously given birth, but it can be found in women who have not had children. It is also hereditary so if someone in the family has it, you may be at a higher risk of having it.
What Are The Causes of PCS?
It is still not fully understood what the cause of pelvic congestion syndrome is. There may be multiple factors and causes.
Enlarged veins in the pelvis seem to play a major role. These large veins do play a major role in those that have chronic pelvic pain, but many women have enlarged veins and no symptoms.
Pregnancy may increase the risk for pelvic congestion syndrome. This is because veins enlarge during pregnancy to support the increased blood flow. This can permanently enlarge the veins and lead to symptoms.
Just like endometriosis and adenomyosis, hormones may also play a role in pelvic congestion syndrome. It is though that estrogen may play a big part of this by making veins wider (dilates). We do know that estrogen does drive disease inflammatory states. We also know that PCS is less common after menopause when estrogen levels tend to be lower.. Other hormones may also cause veins to grow wider and cause symptoms.
Excess weight and increased body fat may also cause increased inflammation and estrogenic response that leads to pelvic congestion syndrome.
Other factors such as dietary and lifestyle factors may exacerbate this condition as well.
How is it diagnosed?
PCS can be quite difficult to diagnose, and will need a multimodality approach to be able to firstly diagnose this properly and then apply appropriate treatment. PCS often requires a multidisciplinary approach because the differential diagnosis is quite long and varied. As mentioned before, some of the symptoms are the same as other inflammatory conditions such as endometriosis and adenomyosis. Multiple diagnostic procedures are needed to eliminate other possible causes for your symptoms. These procedures can include:
- Laparoscopy (keyhole surgery)
- CT scan
- MRI scan
Ultrasound is often preferred as the first step in diagnosing PCS, as it is possible to detect the varicosities as well as assess the blood flow. The only problem with ultrasound is that is that it may not always pick the varicosities up.
MRI may be needed, but even then, laparoscopy is the only procedure to definitely diagnose this condition. I often explain to women that if they have been in pain for a long time, the best option is a laparoscopy. This can also be used to exclude other pelvic pathology and also check to see if there is endometriosis etc too. Sometimes the varicosities may need to be tied off surgically as well and can be done via laparoscopy. Laparoscopy is the gold standard investigation of the pelvis and why it is the best option.
There may need to be input from other health professionals and modalities such as gynaecologists, anaesthesiologist, gastroenterologist, advanced trained laparoscopic surgeon, neurologist, haematologist, oncologist, psychiatrist, and urologist or urodynamic specialist may also be necessary. If someone sees a lot of this syndrome then they will be able to differentiate this without the need of involving too many other areas of medicine, but all other pathology and disease states do need to be carefully ruled out first.
When I help women with PCS, I have a very specialised team of healthcare professionals I work with that see this syndrome often and know what to look for very quickly and promptly. This is why it is very important to see the right people who know about these particular areas of women’s health conditions.
Treatments for Pelvic Congestion Syndrome
Treatment for pelvic congestion syndrome is usually aimed at reducing and alleviating symptoms. Unfortunately, like endometriosis, there is no definite cure for the condition, and it can be challenging to treat if you don’t get to see the right healthcare practitioner, or healthcare team.
There are medications available to help relieve symptoms of PCS and these can include:
- NSAIDs (nonsteroidal anti-inflammatory drugs)
- chronic pain medications (such as gabapentin plus amitriptyline)
The most successful treatment currently is a minimally invasive surgical procedure called pelvic vein/ovarian vein embolization (PVE/OVE). This procedure blocks off the faulty varicose veins so that they can no longer enlarge with blood, thereby relieving the pain. that are believed to be the source of pain.
Embolization (PVE/OVE) offers a safe, effective, minimally invasive treatment option that is less expensive to surgery and less invasive. It is an outpatient hospital procedure which requires only conscious sedation. Once the procedure is performed, you can return home a few hours later the same day. Medical literature shows that the procedure provides complete or partial relief in approximately 90% – 95% of the cases. As with any procedure, there are risks, and not all women may be appropriate for this treatment option.
A laparoscopy may still be needed to definitely diagnose the varicose veins first, before embolization can be performed. This is why diagnosis and treatment of PCS does require a step by step multimodality approach. This is something that needs to be clearly understood.
PCS isn’t a condition that is life threatening, but it does have the potential to significantly affect your quality of life. Symptoms such as chronic pain, pain during sexual intercourse, and dysmenorrhea can lead to a decrease in physical activity, loss of function, and depression. It can make daily life very hard and make it difficult to function in your personal and work life.
A diagnosis does not necessarily mean you will be affected to this extent and PCS varies greatly in terms of severity for each person. Not all women with PCS will have their daily life affected and some do not get pain at all.
The good thing is that there are treatments available to minimize the symptoms and help sufferers cope with this condition. It is important that you talk to your healthcare practitioner if you do have any of the symptoms of PCS.
It’s also important to talk to your healthcare practitioner about counseling, if needed, to help you cope with the significant chronic pain that can go along with having PCS. Chronic pain can impact on an emotional and psychological level and this can then lead to further exacerbation of pain. Many people just do not realise the impact the stress and emotions and mood disorders can have on pain conditions.
If you do have chronic pelvic pain and need assistance with diagnosis and management please give my friendly staff a call and ask how I may be able to assist you. I also work in with a good network of healthcare professions to help my patients get the best care possible. My motto is No Stone Left Unturned and I apply this to everyone that comes to see me for assistance with their health condition.
-No Stone Left Unturned
-Master of Women’s Health Medicine
-The Women’s Health Experts
As a healthcare practitioner with a special interest in women’s health, more and more I am seeing women presenting with all the symptoms of Adenomyosis. This is why this post is called “Let’s Talk About Adenomyosis”.
Just like endometriosis, many women have had this condition missed and dismissed and then have to suffer the consequences and think that they just have to put up with it month after month.
Some women are completely unaware that they have adenomyosis. Those that have already been diagnosed with endometriosis often believe that all their symptoms are just related to this disease only, when it fact, they could have two diseases creating all their issues.
Many of the symptoms are the same as endometriosis, except that women will usually have heavier menstrual bleeding, or irregular bleeding issues.
Women can have both endometriosis and adenomyosis at the same time and now research is showing that they are basically one in the same disease, but just in different locations.
What is Adenomyosis?
Adenomyosis is defined as the presence of endometrial glandular tissue occurring deep in the endometrial lining (myometrium). The exact cause of adenomyosis is unknown, but current research is showing that it is a similar process to how endometriosis is caused.
Histologically both endometriosis and adenomyosis are one in the same disease state, but just occurring in different locations. We know that both diseases are driven by estrogen and that they have all the same signs and symptoms. Adenomyosis and endometriosis are not caused by estrogen dominance either. Even small amounts of estrogen will drive both diseases.
The only difference between the two disease states is that adenomyosis typically causes more heavy bleeding symptoms. The abnormal bleeding occurs when the ectopic endometrial tissue induces hyperplasia and hypertrophy of the surrounding myometrium. This causes uterine enlargement and subsequent changes in vascularisation (the new vessels may also be more fragile than usual) in addition to an increase in the surface area of the endometrium.
One of the key diagnostics for adenomyosis is the presence of an enlarged uterus on ultrasound, or via MRI. The enlarged uterus can also impact the surrounding structures and often impacts the bladder, leading to urinary frequency and other bladder issues.
Adenomyosis can also have the same bleeding symptoms as fibroids but correct diagnosis and investigations, will differentiate the two and ensure correct management moving forward.
What Are the Symptoms of Adenomyosis?
As mentioned previously, adenomyosis has all the same symptoms as endometriosis. Just like endometriosis, some women often have no symptoms (are asymptomatic), and are only diagnosed when they are having issues trying to conceive.
The main symptoms of Adenomyosis are:
- Heavy, prolonged menstrual bleeding
- Severe pain and menstrual cramps
- Abdominal pressure and bloating
- Bladder issues (frequency, urge frequency, incontinence)
Other associated symptoms such are:
- Irregular bleeding
- Pain with bowel movement
- Irritable Bowel like symptoms
- Urinary Tract Infection (UTI) like symptoms
- Mental and emotional disturbances (depression, premenstrual dysphoric disorder)
- Pain with intercourse
- Musculoskeletal pain
- Lack of quality of life
Diagnosis of Adenomyosis.
Ultrasound is the most common (and indeed most useful) first-line imaging tool used to diagnose adenomyosis in a women presenting with any abnormal uterine bleeding. While ultrasound cannot definitively diagnose adenomyosis, it can help to differentiate and rule out other conditions with similar symptoms.
Sometimes saline solution is injected in the uterus at the same time as ultrasound is performed to give better imaging and to help evaluate the symptoms associated with adenomyosis. This is called sono-hysterography.
While trans-vaginal ultrasound (TVU) can be used, it can also miss the disease, especially if the user doesn’t have an expert eye, or extra training, or specialises in the diagnosis of adenomyosis.
MRI is considered a much better tool for the finding of adenomyosis, but it is a more expensive option. Even though ultrasound is a cheaper option, it can be inaccurate.
Blood tests cannot diagnose adenomyosis, or endometriosis.
The only proper way to definitely diagnose adenomyosis is via surgical intervention and a biopsy, but this is rarely done prior to a hysterectomy due to risk factors of damage to the uterine lining. Unlike endometriosis, the disease cannot be excised and the only cure for adenomyosis is hysterectomy.
Treatment and Management Options For Adenomyosis
The treatment and management of adenomyosis will depend in part on your presenting symptoms, their severity, and whether you have completed childbearing.
The medical management options for adenomyosis are usually in the form of hormonal therapy (the Oral Contraceptive Pill, Mirena IUS or other types of progestogen therapy) or surgical.
The surgical options are endometrial ablation, uterine artery embolism and hysterectomy. When considering surgical therapy it must be acknowledged that endometrial ablation and uterine artery embolism is less effective compared with the more definitive but more invasive option of hysterectomy.
Research does show that a significant portion of women, who choose to do endometrial ablation, or uterine artery embolism, will end up needing a hysterectomy. Hysterectomy is not the major procedure it was years ago and many are done laparoscopically and done intravaginally. This also helps with the recovery time. It all gets back to quality of life for many women with endometriosis. This is why hysterectomy is now a better option than other surgical interventions.
While hysterectomy is not something to be taken lightly, we do need to be real about quality of life and the ongoing pain, other associated symptoms, long term bleeding and the dangers of long term anaemia that adenomyosis can cause to a woman. Many women often quote getting their life back and wished that they had the hysterectomy sooner, rather than putting up with the lack of quality of life. Hysterectomy is a cure for adenomyosis, but it is not a cure for endometriosis.
Other Management Options For Women With Adenomyosis
- Medical treatments(pain medications, iron infusions)
- Complementary medicines (Acupuncture, Chinese herbal medicine, vitamins and nutrient support),
- Nutrition and diet
- Counselling & Psychology
- Meditation and Mindfulness
- Pain management clinics
- Exercise therapy(weight baring exercise, resistance training)
- Core strengthening(pilates, yoga)
- Pelvic floor management(Pilates, Kegels Exercises/Kegels balls, Vaginal stone eggs),
For women who do not want to consider surgical options, adenomyosis requires a multimodality/team approach for ongoing management, treatment and support. In most cases it will need a combination of the therapies above, or all of them, in conjunction with medical interventions and medicines.
In nearly all cases, treatment and management is the same as endometriosis, except there needs to be more focus on the heavy bleeding symptoms. I always apply a multi-modality approach to assist all my patients who have adenomyosis, or endometriosis, or both combined.
Mild symptoms may be treated with over-the-counter pain medications, complementary medicines and supplements and the use of heating pads to ease pain and cramps. It is important to talk to your healthcare practitioner about treatment options to suit your individual needs and individual symptoms.
Outlook For Women With Adenomyosis
Adenomyosis is not a life-threatening condition, although if some symptoms, such as anaemia and emotional disturbances, aren’t managed properly, or early on, it could potential be life threatening. Many of the symptoms such as heavy bleeding, pelvic pain, pain with intercourse, anaemia and bladder and bowel issues can, and do negatively impact a woman’s life.
Women with adenomyosis are often anaemic and long-term anaemia can have serious health consequences. See my post of serious consequences of iron deficiency. Click here
Many women with adenomyosis, if not all, will need an iron infusion if their iron levels are low. See my post “Could you need an Iron Infusion?”
While surgical options such as hysterectomy can cure adenomyosis, there are both medical and complementary medicines available that may help alleviate the symptoms of adenomyosis.
Adenomyosis and associated symptoms can resolve on their own after menopause. If women have endometriosis as well, they will often require ongoing treatment and management after hysterectomy, as hysterectomy does not cure endometriosis. As mentioned previously, hysterectomy will cure adenomyosis.
Anyone with symptoms of adenomyosis should consult a medical specialist, a healthcare practitioner that specialises in adenomyosis and endometriosis.
If you do need help and assistance with the management of adenomyosis, the please call my friendly staff to find out how I may be able to assist you. My motto is ‘no stone left unturned’ and I apply this to every person I see and help. I also have a network of other healthcare professionals I work with as well.
-No Stone Left Unturned
-Master of Women’s Health Medicine and Master of Reproductive Medicine
-The Endometriosis Experts (incorporating adenomyosis as well)
Hey everyone. I’ve just recently put up a post about the facts about why hysterectomy does not cure endometriosis.
It seems this is a very contentious issue and many people are not understanding the facts, or how endometriosis presents in the body. I also think that some people just haven’t read the actual article, as I do explain all of the reasons why.
But, it does seem some people are still not getting the reasons why, or have been told the wrong things. As usual, I am here to give the facts and this is what I am here to do with this post.. Give the facts.
I am sorry for many of the journeys you have been on too and that some of you are not being listened too as well. That is why I am here. To raise awareness and give the facts and help women with endometriosis have a voice.
This is to also raise awareness about adenomyosis too. Many really do not realise that they have this disease state, or have it coinciding with endometriosis as well.
So, I have done up the video blog to explain things in more detail and hopefully it helps all of you understand things better. It is also so people can see a visual explanation and see why hysterectomy will not “Cure” endometriosis.