The Top 24 Things That Will Cause A Flare In What You Thought Was Endometriosis & Adenomyosis Symptoms, But Maybe Isn’t (13-24)

Posted on October 25, 2020October 25, 2020 by Andrew Orr

In the second part of my posts about the top 24 things that will cause a flare in what you thought was endometriosis and adenomyosis symptoms, but may isn’t, I continue with the next 12 causes of what you think is endometriosis, or adenomyosis symptoms, may just be caused by something else?

In this post I continue to bring awareness to the fact that sometimes it is not always Endometriosis, or Adenomyosis causing your current symptoms. It may be one of the following facts only, or in combination. What we need to remember is that many women with endometriosis, and adenomyosis, often have other issues that are flaring their current symptoms, and often present the same as endometriosis and adenomyosis, in their symptomology.

We also know that many other causes of flares of symptoms are often overlooked, and even dismissed, just as endometriosis and adenomyosis is often missed and dismissed.

Many women may have other issues going on at the same time as having endometriosis, or adenomyosis, and it is possible to have both endometriosis and adenomyosis combined and well as having other health issues in combination as well. Just remember that not all your symptoms may be endometriosis, or adenomyosis, and why it is so important to see and expert in these conditions.

If you do need and expert and need help with endometriosis and adenomyosis, please give my friendly staff a call and find out how I may be able to assist you.

Let’s have a look at the next 12 causes of “What You Thought Was Endometriosis and Adenomyosis Symptoms, But Maybe Isn’t”

Causes of a Flare of What You Thought Was Endometriosis and Adenomyosis Symptoms, But Maybe Isn’t ( 13-24)

13.Tight pelvic floor muscles – 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. Have a read on my previous post about this. (Click here to read)

14.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. 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. This is why proper differential diagnosis is very important as this can be missed very often, or completely overlooked. Have a read of my previous post about IC (Click here to read)

15.Pelvic Congestion Syndrome– 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. 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. Have a read of my previous post about PCS (Click here to read)

16.Constipation and full bowel- A common cause of pelvic pain and abdominal pain and bloating and caused by constipation and a full bowel that is slowly backing up and starting to compact. In serious cases, the bowel can compact and even perforate if not addressed soon enough. When the bowel is not fully voided, it can lead to backing up of the bowel. Many people are still moving their bowel each day, but just do not realise, it is not being voided properly. This can lead to pain, gastrointestinal issues and also feeling unwell, due to not voiding waste from the body. It is a very commonly overlooked issue. This is why women need look at restoring the microbiome properly and also drinking enough water, eating enough fibre and also creating good bowel habits and not holding on too long at work.

17.Lack of sleep – Lack of quality sleep is a major issue for many women and is a common cause of their fatigue, increased pain, and exacerbation of symptoms, interference of moods, and a whole range of health issues physically and mentally. Sleep deprivation leads to reduction in hormones such as melatonin, which is a precursor to serotonin and then affect the moods etc. Lack of sleep also interferes with the other hormones in our body too. Lack of sleep also stops the body from repairing and can lead to increased inflammation within the body. We know that shift works do have a lot more disturbances with their menstrual cycles and also have lower fertility rates.

18.Over-exercising– Over-exercise can lead to tight pelvic floor muscles and hypertonus, but it can also lead to decrease body fats as well. Body fat plays a regulatory process with hormones and fertility. A significant decrease in body fact (10-15%) can lead to decreased hormone production and actually stop the menses and interfere with fertility. Over exercise can also cause stress and inflammation in the body and can also lead to adrenal exhaustion and fatigue. It is all about balance.

19.Lack of exercise– Lack of exercise if a big factor in a lot of people’s health issues. Lack of blood flow and lack of circulation to muscles and tissues, especially the uterus and vagina, can have some serious consequences for women’s health and gynaecological conditions. Without proper microcirculation into the uterus, and vagina and reproductive organs, these areas can become highly stressed, lack vital nutrients and then leads to inflammation, pain and other irregularities. It is a catch 22 situation. Too much exercise is not good, but similarly, not enough exercise is just as bad for us. While sometimes we may not feel like exercising, the fact is, research has shown that regular exercise can, and does help with pain, and other symptoms of endometriosis and adenomyosis.

20.Environmental Estrogens– According to a landmark US study published by the US department of environmental health, there are 87,000 plus environmental estrogens we are exposed to in all countries around the world, some being worse than others. These can be anything from plastics, detergents, petroleum products, chemicals and even the contraceptive pill ending up in our water ways. These endocrine disruptors (AKA as environmental estrogens) can interfere with hormones within our body and also lead to inflammation and many health issues. They have also been linked to the increase in lower fertility rates and the increase in expression of genetic mutations within the body. Endometriosis and adenomyosis is driven by estrogen and this may be a big factor in the increase in women with endometriosis and adenomyosis.

21.Lack of blood/increase of blood circulation– The microcirculation of the uterus, vagina and reproductive organs is a very important one and one of the reasons getting proper blood flow and improving microcirculation into these areas is important. I talked about this in the lack of exercise part. It is also important to check women for hereditary blood clotting and also bleeding disorders. All women with gynaecological and fertility issues should be screened for blood clotting disorders via prothrombotic studies and also bleeding disorders such as Von Willebrands Disease, when suspected.

22.Musculoskeletal issues– Women with postural issues, or their spine out of alignment can also experience referral pain, and pelvic pain due. It is important to have musculoskeletal causes of pain assessed by a qualified healthcare professional (physio/chiropractor/osteopath). When muscles are too tight, it can cause sublaxations, which can then impinge on nerves and also cause referral pain and other health issues within the body. Damage to nerves and tissue, such as pudendal nerve neuralgia can also cause pain and referral pain in the lower abdomen, pelvis and vagina.

23.Excess weight and body fat– At present up to 70% (or more) of Australians, and Americans, are either overweight, or obese, so we can no longer ignore what the consequences of these statistics mean. We know that excess weight and excess body fat is linked to serious health consequences. Excess body fat in men and women leads to higher levels of the hormone leptin. Excess body fat is also now referred to as obestrogens, as they cause the same health consequences as environmental estrogens (known as endocrine disruptors). These excess body fats and higher levels of leptin do impair production of sex hormones and also reduces fertility. It can also lead to poorer sperm quality, poorer egg quality and can also increase the risk of miscarriage. Excess body fat, especially excess abdominal fat, is also linked to insulin resistance, metabolic syndrome and other health issues. It also interferes with the regulation of sex hormones and sex hormone binding globulin (SHBG). This can then increase the risk of irregular cycles, PCOS, endometriosis, adenomyosis, miscarriage and other factors affecting fertility. Excess body fat can also be a major driving factor of endometriosis and adenomyosis, due to the estrogenic effects it has. This is why reduction in body fat and a healthy diet and healthy lifestyle is imperative in the management of women’s health and fertility.

24. Iron Deficiency– Iron deficiency can be a very serious issues, and many women do not realise the health risk associated with it, and how often it goes undiagnosed. It can lead to disruption of hormones, and can lead to fatigue and exacerbation of pain and emotionally generated symptoms. Let’s face it, without iron, you aren’t going to be transporting oxygen around your body and then your muscles, brain, hormones and circulation suffer as a result of this. Women with endometriosis and adenomyosis are nearly always iron deficient from the heavy blood losses they suffer, or the internal bleeds they get from flares of endometriosis lesions. Have a look at my previous past on the serious consequences of low iron and why managing iron levels is so important (Click here to read)

The Serious Health Complications Of Low Iron

Posted on February 25, 2020February 25, 2020 by Andrew Orr

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
weakness
pale skin
Bruising easy
shortness of breath
Palpitations
dizziness
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
Tachycardia
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.

Final Word

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 info@drandreworr.com.au

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicince

-Master of Reproductive Medicine

-Women’s and Men’s Health Advocate

The Complications That Can Result From Unmanaged Endometriosis

Posted on February 11, 2020February 11, 2020 by Andrew Orr

A lot of the information about endometriosis, is more about it’s symptoms, time to diagnosis and future fertility outcomes. While it is necessary to educate people about these things, nobody is really talking about the serious complications of unmanaged endometriosis. This is not to scare people, or create fear, but at the same time it does need to be talked about and for all concerned to know how serious this disease state can be at its worst.

We know that many women are missed and dismissed when it comes to endometriosis. It often takes up to 10 years, or even more for some women, before they are definitively diagnosed. Some women are never diagnosed and end up suffering a terrible life because of it. Some women with endometriosis are asymptomatic (meaning no symptoms) and often only get diagnosed as part of fertility evaluation, when they may be having trouble conceiving.

The symptoms of endometriosis are easy to see

The symptoms of endometriosis are very easy to see, if someone knows what they are looking for and knows the right questions to ask. Sure, a definite diagnosis via laparoscopy is still needed, but there are some very clear-cut pointers that a woman may have the disease. But due to lack of education and lack of true experts in this area means that lots of women are missed and dismissed, and that is a fact.

The vicious cycle of mismanagement

But while there are inadequacies in the healthcare profession when it comes to endometriosis, not all mismanagement can be blamed on healthcare professionals. There are people who are not seeking proper help soon enough, and some not at all, and this can lead to long-term complications too. We also have women trying to manage their own disease through advice of friends, social media groups and Dr Google as well. This then creates one hell of a mismanaged cycle that does not help anyone.

I can see the issues from all points of view, especially those who suffer the disease. But as a healthcare professional with a special interest in Endometriosis, I have had my fair share of non-compliant patients too.

While many have been let down through mismanagement, lack of funding and education, being missed and dismissed etc, there are many women who are self sabotaging as well. I have seen many not take on advice, recommendations and proper management of their disease, that could help them, then these same people scream high and low that the system has let them down. There are some who are just happy to live with the disease, as it is their only way of seeking attention. This is a fact also and we need to talk about it.

This is what has prompted me to do this post so that all concerned get to know what the serious side of mismanaged endometriosis is. Sometimes it is only via the serious harsh side of reality, that all concerned may actually get some help and some serious attention be bought to this disease state.

The common symptoms of endometriosis

We know that many women suffer greatly at the hands of this disease. Women with endometriosis can get the follow common symptoms:

Period pain
Pain with intercourse
IBS like symptoms
Gastrointestinal issues
Chronic constipation
Chronic diarrhoea
Pain on bowel movement
Bleeding from the bowel
Chronic abdominal pain
Severe bloating (endo belly)
Chronic bloating
Aversion to foods (even if they are not the trigger)
Ovulation Pain
Ovary pain
UTI like symptoms (with no infection present)
Migraines and headaches
Chronic pelvic pain
Pelvic and rectal pressure feeling
Musculoskeletal pain
Chronic nerve pain
Fluid retention
Iron deficiency
Mood swings
Anxiety
Depression
Mood disorders
Infertility
Other symptoms

Early intervention and management is crucial

Women’s lives are greatly impacted by this disease and it is important that not only healthcare professionals understand this but also sufferers of the disease. Early intervention and proper ongoing management is the key to helping this disease and everyone needs to be aware of this. Being missed and dismissed, or waiting too long to help, can really have some serious consequences if this disease is left to grow and spread and cause serious damage in the body

The serious consequences of mismanaged/unmanaged endometriosis

While we have talked about the common daily symptoms that many can put up with, we also need to bring attention to just how serious this disease can get. Let’s face it, it can and does spread like cancer and it can spread to every organ in the body. It has been found in the joints of bones, fingers, in the liver, around the lungs, around the diaphragm, around the heart, on the bowels, on the bladder, on the ovaries, on the pelvic, in the fallopian tubes, one the retina in the eyes and it has even found in the brain.

There is no doubt that this disease can be very devastating for anyone who has it, but what happens in the worst cause scenario, if it is left unmanaged.

The following can be serious complications of unmanaged endometriosis:

Haemorrhage from the ovaries
Ruptured ovaries
Ovarian torsion
Obliterated fallopian tubes
Ruptured endometrioma
Endometrioma infection
Pelvic infection
Obliteration of the pelvic cavity
Peritonitis
Sepsis
Compacted bowel
Obstructed bowel
Perforated bowel
Bowel haemorrhage
Torsion of the bowel and intestines.
Ureteral Obstruction (Blocked ureters)
Renal infection
Bladder obstruction
Painful bladder syndrome
Severe adhesions
Significant scar tissue build up
Significant fluid build up in the pelvic cavity.
Multiple organs adhered together
Diaphragmic adhesions
Liver damage
Perihepatic adhesions
Pericardial endometriosis
Cardiovascular events
Stroke
Chronic nerve pain
Pudendal nerve neuralgia.
Chronic musculosketal, or spinal pain
Arthritic like pain and associated symptoms
Chronic Migraine and neurological events.
Malignancies and cancers (rare but more research being done)
Hysterectomy
Recurrent miscarriage
Absolute infertility
Opioid dependency and addiction
Death from opioids medications
Complications from medications and hormonal treatments
Psychotic disorders
Mania
Incapacitation
Suicidal tendencies and thoughts
Suicide
Death (rare from endometriosis directly, but can be from associated factors related to endometriosis and also taking ones own life)
Other

Women with endometriosis need to see an “Endometriosis Expert”

This is why endometriosis needs to be managed properly and managed by a healthcare professional that specialises in the management of endometriosis and associated symptoms. You need to see and Endometriosis Expert.

People cannot treat, or manage the symptoms of endometriosis on their own. This is why it is so important to have the right care and also have a multimodality/team approach to endometriosis. No amount of google searching is going to help people treat endometriosis on their own. You need to find an endometriosis expert.

At the same time more education needs to be given to GP’s and other healthcare professionals about endometriosis. Too many women are being missed and dismissed because of lack of practitioner understanding and education at the front line. Women need to see healthcare professionals that specialise in endometriosis and endometriosis experts for this disease, not just a GP. Women also need access to advanced trained laparoscopic surgeons who specialise in excision surgery, not just a regular gynaecologist who is not advanced trained. I have talked about this often.

Endometriosis is not just about period pain

Lastly, we need to educate ‘all’ that endometriosis is not just about period pain. Endometriosis can present with many different signs and symptoms ranging from gastrointestinal symptoms, extreme bloating, bladder issues, bowel issues, IBS symptoms, migraines, fluid retentions, pain with intercourse, pain on bowel movement and so many other symptoms mentioned before. There is also the long-term impact on fertility for up to 50% of women too.

This is why early intervention and management of teenagers presenting with the disease symptoms is crucial. The longer the disease is left, the more damage it can do and all women deserve to be mothers (if they chose) and deserve a normal happy life. We also need to recognise the psychological impact of the disease and how this can present in someone with the disease as well.

Women are dying because of being mismanaged/unmanaged

Let’s face it, there are women dying because of this disease. Maybe not as direct result, but definitely indirectly. No woman should ever be pushed to the point where she cannot handle her pain and symptoms any longer and be only left with the choice of taking ones own life. This is exactly we need to bring more education to all about this disease. This means both healthcare practitioners and people with the disease itself too.

People need to be managed properly and by professionals. We need to start bring education and attention to this, so that people do not try to manage this disease on their own, and practitioners are held more accountable for dismissing women as well. Because if we don’t the complications of this can be very severe and sometime they can be fatal also.

Endometriosis awareness month is next month and I want to see all women with endometriosis being managed properly and seeking the right help. There are endometriosis experts out there who can help you if you have the disease and the associated symptoms. No woman should be doing this on their own.

Let me help you

If you so need help with managing endometriosis and the associated symptoms of endometriosis, please give my staff a call and find out how I can assist you. I have options for in-person consultations and online consultations. I use a multimodality/team approach and I also work in with some of the best medical healthcare professionals and surgeons in the country. I will always make sure you get the best care, best support and best management possible. I will also hold your hand every step of the way and make sure your every concern is listened to as well.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicine

-The Endometriosis Experts

When A Hysterectomy Should Be Considered

Posted on January 22, 2020January 22, 2020 by Andrew Orr

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.

Let’s Talk About Adenomyosis

Posted on November 12, 2019November 12, 2019 by Andrew Orr

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)
Anaemia

Other associated symptoms such are:

Irregular bleeding
Pain with bowel movement
Irritable Bowel like symptoms
Urinary Tract Infection (UTI) like symptoms
Fatigue
Mental and emotional disturbances (depression, premenstrual dysphoric disorder)
Pain with intercourse
Infertility
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
Physiotherapy
Exercise therapy(weight baring exercise, resistance training)
Core strengthening(pilates, yoga)
Pelvic floor management(Pilates, Kegels Exercises/Kegels balls, Vaginal stone eggs),
Urodynamics

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.

Final Word

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.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicine and Master of Reproductive Medicine

-The Endometriosis Experts (incorporating adenomyosis as well)

Let’s Talk About Iron

Posted on May 8, 2019May 8, 2019 by Andrew Orr

Let’s talk about iron. After my recent post about me having haemochromatosis and the importance of regular venesection and proper screening, I thought we should talk more about iron.

We need to not only talk about high iron and genetic disorders, such as haemochromatosis, but also talk about iron deficiency and proper screening and management of that as well.

In this video post I talk high iron, low iron and everything in between. I also talk about genetics and auto-recessive genetic pathways and the parental mode of inheritance. This also goes for many other health conditions we see in people.

Please remember that early intervention, early screening, early treatments and early management is the key to any disease state.

Why Iron Deficiency and Anaemia Should Be Take More Seriously

Posted on December 11, 2018September 8, 2019 by Andrew Orr

One of the common things I am seeing in women of all ages is iron deficiency and anaemia. Many women have very low levels of iron and are unaware of the dangers this may pose to their short term, and long term health.

We are also seeing women being hospitalised and seek emergency help due to iron deficiency and anaemia and this highlights that there is inadequate management and detection of a very preventable condition. It also means that many women are not taking this matter seriously enough and often put off seeking screening and then aren’t having their iron levels managed properly.

I need to let all women know that having low iron can be very dangerous. It is something that should not be glossed over, or taken lightly. Iron deficiency can and does cause short term and long term health complications.

Iron deficiency can raise the risk of the following health conditions

Coronary heart disease
Stroke
Osteoporosis
Compromised immune system
Increased risk of infections
Tachycardia
Heart failure
Enlarged heart
Lung problems
Muscle aches and cramps
Restless leg syndrome
Delayed growth and development (mainly in children)

These are just some of the health issues that being low in iron can cause and it very important that we start educating all women and healthcare providers about the importance of iron.

What are the symptoms of Iron Deficiency and Anaemia?

Fatigue
Weakness
Dizziness
Fainting, or feeling of feeling faint
Pale skin
Breathless
Frequent headaches
Palpitations or racing heart
Easily irritated
Difficulty in concentrating
Cracked, or reddened tongue, sore tongue
Loss of appetite
Strange food cravings such as wanting to eat dirt, or clay
Cold hands and feet
Brittle nails
Hair loss
Tingling, or crawling feeling in the legs

Iron deficiency is a very common cause of fatigue and other health issues in women and men, but is more commonly seen in women. Iron deficiency is also the most common cause of anaemia.

What are the causes of Iron Deficiency and Anaemia?

Heavy menstrual bleeds
Endometriosis
Adenomyosis
Fibroids
Polyps
Coeliac disease
Inflammatory Bowel Disease
Stomach or intestinal ulcers
Pregnant and Breast Feeding Women
Certain Cancers
Vegetarians and Vegans
Eating disorders and food restriction
Girls going through puberty
Certain illnesses

Heavy menstrual bleeds and gynaecological condition’s such as Endometriosis, Adenomyosis, Fibroids and Polyps are some of the main causes of iron deficiency and anaemia in women. This is closely followed by dietary inadequacies and food and nutritional restriction.

Many women have undiagnosed gynaecological conditions which are the cause of their iron deficiency and anaemia. Some of these gynaecological conditions will require surgical interventions to be diagnosed properly.

How are Iron Deficiency and Anaemia Diagnosed?

Your healthcare provider can organise routine blood tests to test for iron deficiency and anaemia. These will include the following

Full Blood Count (FBC)
Iron Studies

These tests will provide the following information on :

The Total Iron level in your blood
Ferritin levels
Total iron-binding capacity (TIBC)
Iron saturations levels
The red blood cells size and colour (RBCs)
The white bloods cells (WBCs)
Haemoglobin
Hematocrit ( the percentage of blood volume that is made up of RBCs
Blood platelets

Other tests

There are other tests to check for the cause of iron deficiency and anaemia and these could include stool analysis (check for blood in stool), endoscopy and colonoscopy ( surgical intervention gastrointestinal bleeding) and laparoscopy (key hole surgery for gynaecological conditions)

Treatments for Iron Deficiency and Anaemia

Diet– A healthy diet that is rich in proteins, vegetable and iron rich foods is the best way to ensure your iron levels stay at optimum levels. A proper diet should include leans meats, seafood, nuts, seeds, healthy oils, green leafy vegetables and other coloured vegetables, and moderate fruit intake.

Supplements– Supplements will help to keep iron levels and vitamin B12 levels in optimum ranges. Iron supplements are very much needed if you are vegetarian, or vegan. There is now research to show that women who experience fatigue will benefit from supplemental iron, even if their iron levels and ferritin are within normal range. Those with heavy menstrual cycles, or those whom have inflammatory bowel issue should also be supplementing

NB- All iron supplements should be taken with vitamin C to help with absorption. Many iron supplements also cause constipation and therefore you should get a good one that does not interfere with your bowel habits and is more easily absorbed. Many of the mineral based iron products are not absorbed well and do cause gastrointestinal upset.

I always recommend a specific practitioner only brand to my patients because it is better absorbed, and it does not interfere with the bowel habits.

Iron Infusion– Sometimes when iron gets too low, supplements just will not be enough to get iron levels up to where they should be quick enough. This is where iron infusions can be very effective. Please see my post on when you need to use and iron infusion. (Click here)

Treating the underlying cause of bleeding

Supplements will not help if the cause of the iron deficiency and anaemia is from excessive bleeding. It may help a little, but it will not be enough. Even iron infusions will only be short lasting if you don’t treat the underlying cause of the bleeding issue. Extreme cases may even need a transfusion to get iron levels and blood levels back up to optimum. This is why it is important to screen for underlying gynaecological conditions that can cause heavy and excessive bleeding.

If you are getting low in iron if means there is something wrong and there is a deficiency that needs to be addressed. Please do not take iron deficiency lightly and always be prompt to find the causes and restore optimum levels of iron in the body.

Prevention is a must

Prevention is always the best way to treat any health condition and this goes for iron deficiency as well. Ensuring you eat a healthy diet with iron rich diet is a great start. As said before, vegetarians and vegans are going to have to supplement and work really hard with their diet to ensure they get adequate iron. Even then it can still be hard as plant based foods just do not have the iron levels that meats, eggs and seafood’s have.

Make sure you also have lots of vitamin C in your diet to help with iron absorption and it is a good idea to supplement with vitamin C to ensure you get the right daily intake.

Final Word

If you do think you might be low in iron or have anaemia, please make sure you talk to your doctor, or your healthcare practitioner. Please do not supplement with iron without checking your levels first. Having too much iron can be dangerous and you also need to make sure you do not have hereditary high iron (haemochromatosis), which can present with the same symptoms as low iron.

If you are found to be low in iron, then please make sure you take prompt action to restore your iron levels and also make sure you are screened as to why you are low in iron in the first place.

Iron deficiency and Anaemia can be very serious and should never be taken lightly. Please always consult with your doctor, specialist, or healthcare practitioner for the most effective ways to keep your iron levels in healthy ranges.

Take care

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

-The Women’s Health Experts