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Insights into Endometriosis

Recently I posted a story about endometriosis being aired on SBS television. I am sure many people watched it and it is great to see that sufferers are finally being recognised. It is important that sufferers are finally being recognised and that there is more education about this disease.

But, is education and awareness enough?

Well, ‘yes’ and ‘no’. I always say this when I am asked this question. Yes, it is great to get education and awareness out there, but what are we doing to support those who are struggling daily?

Any education and awareness about this horrible disease is great. It is a huge win for sufferers when we do see programs go to air and aren’t scared to ask people their experiences of living with a disease state.

I do think those that were involved and those that are driving this awareness need to be applauded. Getting media to listen is one of the best ways to bring awareness to the disease states such as endometriosis.

While there was lots of information shared, I do believe more could have been talked about. I was a little disappointed to hear that the opening line was more about associating endometriosis and periods. We know endometriosis and its symptoms can be there daily, not just around the menses. But, it does open up discussion for more programs and media recognition for those with endometriosis, or any gynaecological condition really.

I’ll talk about the good things, the not so good things and everything in between. Let’ have a look what was talked about and some of the things that should have been talked about as well. I do realise time constraint mean that not everything can be talked about either.

The important things that were talked about

  • Millions of women world-wide suffer this disease
  • Millions of suffers do have a wide range of symptoms that vary with each individual
  • Period Pain IS NOT Normal
  • There is no cure for endometriosis
  • Millions of women world-wide have been led to believe their symptoms are normal, when they aren’t
  • Women are being missed and dismissed daily and told to basically suck it up
  • Many women take more than 10 years to be diagnosed
  • GP’s and other healthcare people are missing the disease and also failing to refer on
  • Many women are misdiagnosed for other disease states such as IBS, gastro etc
  • When presenting for medical help, many women are told they just have a gastro virus, or it may be an ectopic pregnancy
  • Endometriosis affects the daily life of sufferers and their partners and family as well
  • Partners can be affected by watching their loved one go through this disease state
  • Intimacy and a happy healthy sex life can be hard for sufferers due to pain and associated symptoms
  • Many endometriosis sufferers have to take pain killers daily, just to get through their day
  • Endometriosis requires a laparoscopy to be diagnosed
  • Scans and blood tests cannot diagnose endometriosis
  • Women need a highly specialised surgeon when needing to have the disease diagnosed and cut out
  • Despite the best medical treatments available, women are still in pain daily
  • Many women will require multiple surgeries to deal with endometriosis
  • Despite multiple surgeries, women are still in pain and have all the associated symptoms of endometriosis.
  • Women will need hormones, pain medications, pain management and psychiatric help dealing to be able to deal with endometriosis
  • Often pain and associated symptoms are not managed well at all
  • Women who suffer endometriosis are holding down jobs and many people are unaware they are suffering this disease
  • Many women with endometriosis cannot hold down fulltime employment either
  • Women are not being told the facts about endometriosis
  • Many healthcare practitioner do not know the facts about endometriosis
  • Women of all shapes, sizes and colour have endometriosis
  • Endometriosis is just as common as many other well-known disease states, yet little is known about it.
  • Complementary medicines such as acupuncture and Chinese medicine may help women with endometriosis (although this was brushed over very quickly)
  • Genetics/hereditary links are now known to be a big part in the disease expression

Important things that were not talked about

  • Endometriosis pain and associated symptoms do not just happen around the menses
  • A significant portion of women with endometriosis are asymptomatic (meaning no symptoms) and are only diagnosed through needing to assess for other issues such as fertility investigations
  • Not all women with endometriosis will experience fertility issues
  • Pregnancy does not cure endometriosis
  • Hysterectomy does not cure endometriosis
  • Endometriosis is Estrogen driven and not caused by estrogen dominance
  • Progesterone in suppressive to the disease
  • Pain levels are not related to the extent of the disease
  • Teenagers are not too young to have endometriosis
  • Certain combined contraceptive Pills that contain estrogen, could be making the disease worse, or in fact helping mask and then drive the disease
  • The facts around endometriosis need to be standardised and more freely available
  • Despite the best medical treatment not working for some women, we need to educate about other alternatives, including complementary therapies
  • Women with endometriosis do need a multimodality (team) approach to manage their disease state and daily symptoms
  • There needs to be better funding to help women access all services they need for endometriosis and the associated symptoms
  • Too much surgery can be just as bad as not having surgery
  • The first surgery should always be a sufferer’s best surgery
  • Women with endometriosis need to see and advanced trained laparoscopic surgeon who specialises in endometriosis and is an excision specialist.
  • Not all gynaecologists are advanced trained and not all gynaecologist will be able to effectively manage endometriosis
  • Most of the good advanced trained surgeons do not do public work. Some do limited work, most don’t.
  • Women and healthcare practitioners need to be educated about the facts are endometriosis
  • GP’s and other healthcare providers who are the first point of call for women, should be better educated about endometriosis and the associated symptoms
  • Women with endometriosis can have adenomyosis, PCOS and other gynaecological diseases at the same time
  • Women who suffer bad symptoms of endometriosis have contemplated suicide, or had suicidal thoughts
  • Women with endometriosis will require help with depression, anxiety and other mood disorders
  • Many women with endometriosis are addicted to pain medications and opiates and are not monitored , or managed well
  • Many women cannot function without some of the pain medications and the alternatives that are not as addictive need to be discussed
  • Diet and lifestyle changes can help with reducing the symptoms of endometriosis and may help with reducing some of the inflammation driving the disease
  • Healthy gut bacteria and restoring the microbiome can help with some of the symptoms associated with endometriosis and the inflammatory processes around endometriosis
  • Exercise may assist with the symptoms of endometriosis

There are probably many other things that need to be discussed, but, for now this is a great start. Any awareness is a great outcome and again those that were involved need to be applauded and commended. The sufferers, the specialists, the partners, the families, the media people and everyone involved deserve to be praised for this story. We now just need to take it to the next level of education and awareness for the sake of those and their families that suffer from this horrible disease.

There is no cure for endometriosis and even with surgery and the best medical interventions; women will still suffer the daily consequences of the disease. The best way to treat and clinically manage endometriosis is with a multimodality (team) approach that requires many different modalities and medicines. While there is no cure, with the right interventions and management women can become asymptomatic (meaning no symptoms).  We now just need governments to provide better funding to this with endometriosis and those who will ultimately be involved in their care.

Let’s hope that with awareness and education, this brings further funding and changes. We also need for more programs to be aired on the media to talk about what women with endometriosis can do to manage their disease better and where to access the help they so desperately need.

Take care

Regards

Dr Andrew Orr

– No Stone Left Unturned

– Endometriosis Expert

– Women’s and Men’s Health Advocate

Dr Andrew Orr Logo Retina 20 07 2016

Dr Andrew Orr Logo Retina 20 07 2016

 

 

 

 

 

 

 

 

 

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Is it Endometriosis, or Adenomyosis, or both?

Endometriosis and Adenomyosis can often present with the same symptoms and many now believe they may be one in the same disease, just in different locations. Despite both of them sharing similar symptoms, there are pointers for properly trained professional to which disease may be presenting. Both diseases are often missed and dismissed as well. To learn more about Endometriosis, or Adenomyosis please click on the hyperlinks.

I have recently put up posts about hysterectomy not being a cure for endometriosis. It often causes lots of people to question this statement, because some uneducated healthcare practitioner has told them differently. Some may have had some relief from having a hysterectomy and now believe their endometriosis has gone.

Before I go any further, I do need people to know the facts. Hysterectomy DOES NOT cure endometriosis, but is can help Adenomyosis. There is no cure for endometriosis. I have explained the reasons why in my resent post Hysterectomy DOES NOT cure endometriosis. Please click on the hyperlink to find out the facts.

Many women who have Endometriosis, or Adenomyosis are often missed and dismissed for up to 10 years or more, before a diagnosis is made. This is due to the fact that many healthcare practitioners do not know the symptoms of these disease states, or dismissed them as being normal. That is a fact. This is why it is important to see someone who specialises in Endometriosis, or Adenomyosis.

With both Endometriosis and Adenomyosis, they share many common symptoms such as:

  • Painful periods
  • Pain with intercourse
  • Ovulation Pain
  • Dark and clotted menstrual blood
  • Digestive upset
  • Pain on bowel movement
  • Bowel or bladder issues
  • IBS like symptoms
  • Pelvic pain and rectal pressure
  • Infertility

What is the difference between Endometriosis and Adenomyosis?

The one thing that usually sets them apart is that Adenomyosis usually has more heavy menstrual bleeding, abnormal uterine bleeding and more flooding symptoms. Endometriosis can have this too, but usually adenomyosis presents with more blood loss symptoms and abnormal bleeding.

Endometriosis ‘cannot’ be definitively diagnosed via ultrasound, or MRI, but adenomyosis can be diagnosed via both of those methods. Endometriosis can only be definitively diagnosed via surgical intervention (laparoscopy). This is the biggest difference with the two disease states. The other thing is that both disease states can be present at the same time and quite often do.

The biggest issue for many women is that when one disease state it found, the other one is quite often overlooked, or misdiagnosed. Many women, and healthcare professionals, are unaware that both the disease states can be present at the same time and this is a real issue.

Hysterectomy will help Adenomyosis, but it ‘will not’ cure Endometriosis.

As I have mentioned earlier, hysterectomy does not cure endometriosis, but it can help adenomyosis. Many women have been led to believe that hysterectomy will cure their endometriosis and associated symptoms, but this is not true. Some women who have had a hysterectomy and then think they are getting relief from symptoms of endometriosis, but are actually getting relief from adenomyosis not being there anymore. It is just that they did not know it was there, they have never been diagnosed, and then believe their endometriosis is cured. Once the uterus is removed, the adenomyosis is removed too. Then all the adenomyosis abnormal bleeding, period pain and period related symptoms are usually gone as well.

The only trouble is, if a woman has been diagnosed with endometriosis, the endometriosis will still be there. That is a fact. Endometriosis does not miraculously go away after a hysterectomy. Endometriosis is not in the uterus. Some symptoms (usually the menstrual related symptoms) can settle for some people, but for many it does not. Regardless the endometriosis will still be there and can continue to grow and cause havoc elsewhere in the body too.

Proper investigation is important

When women come to see me for help with Endometriosis, or Adenomyosis, I always make sure they are investigated for both disease states. If a women has abnormal uterine bleeding, or heavy menstrual bleeding and they have only been diagnosed with endometriosis, I will always make sure that they are investigated to see if they have Adenomyosis as well. I will also screen for genetic issues such as Von Willebrand’s Disease and other pelvic pathology that may cause bleeding as well. It is also very important that women with both Endometriosis, or Adenomyosis, or both are are also screened for iron deficiency too.

Hope this explains a little bit more about Endometriosis and Adenomyosis and a bit more about which disease state hysterectomy will, or won’t help.

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Women’s Health Expert

Dr Andrew Orr Logo Retina 20 07 2016

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Why Early Puberty Is More Common Than Ever

In today’s modern world we are seeing more and more young girls going through puberty much younger than they used to. We do know that girls as young as 7 years old are getting their menstrual cycle and going through all the changes of puberty, yet these poor children aren’t able to fully comprehend the emotional changes that go with it, or what this means for them on a reproductive level. Researchers Blame Childhood Obesity, Endocrine Disruptors and I will discuss this at length for you all.

It wasn’t that long ago the average girl would begin menstruating around the age of 16 or 17. On average, the general consensus would have been that girls could be starting to begin menstruation around the age of 14 years old. By early 2000’s, that age had fallen to less than 13 years old and now it has fallen again to being as young as 7 years old.

What we forget is that even before a girl gets her first period, there are signs of maturation that signal impending changes, and these come even earlier. So actually, some of these girls are beginning their puberty phase when they are 5 years, or 6 years old. A generation ago, less than 5 percent of girls would see these changes in their bodies— being breast growth, body hair, acne, pubic hair and all the other things that go with puberty. But now many of these young girls are seeing this around 7 years old, with an average age being 8 years old, for all of these changes to start to happen. This is definitely becoming the increasing norm and some experts think this age is still falling. Some doctors see fit to begin assessing girls for puberty-related changes at age 6.

Early Puberty

Classically, precocious puberty has defined puberty that begins before age 8 in girls and 9 in boys, but this is no longer universally accepted. In general experts are now saying that 7 years old is now probably a normal age to have some signs of puberty. While they are some that may not agree, we do need to start asking the big questions as to why this is happening?

So far, researchers haven’t proven any physical risks that come with early maturity. Although this could pose a significant risk to their ongoing fertility, bone health and also be putting women into menopause earlier too.

Many researchers have suggested that the main risks that come along with precocious puberty are not biological. Recent studies have found that girls who began the process early had an increased risk of depression during their adolescent years. There are also social risks that can disrupt a girl’s healthy development.

Puberty can be very confusing and emotionally damaging for girls, as they may face “sexual innuendo or teasing” long before they’re ready for it, according to researchers and experts. Early puberty may change the way a girl behaves, along with the way others behave towards her. This could pose other significant risk factors such as early pregnancy, but also exposure to STI’s and many other things these young girls are too young and too naive to know. This could even lead to earlier use of alcohol and drugs as well.

Why Is It Happening?

One of the biggest issues for young girls, and women in general, is changes in diet and higher use of highly processed foods and high intake of grains. This leads to higher levels of insulin and then the body storing more fats and stops the burning of fats and this then also creates inflammatory disease in the body. High insulin levels also lead to higher levels of estrogen in the body too. This is leading to more children being overweight and problem with changes to hormones, their cycles and gynaecological conditions. Childhood obesity rates have increase exponentially in the past 30 years, with more than one-third of children and adolescents weighing in as overweight, or obese. What people fail to realize is these Fat cells produce estrogen ( now known as Obestrogens), which plays a central role in stimulating breast growth in girls, causing problems with hormones, causing gynaecological conditions and playing a major factor in them getting their cycles much younger.

Researchers and experts are saying that obesity is leading to earlier puberty and this theory is well supported by the fact that these girls’ breasts are developing at a much younger age, and the age at which they start to menstruate has declined. The ovaries control menstruation, signaling that earlier breast development may be occurring because of different variables such as diet and environmental factors

There may be are other factors at play, other than diet, lifestyle and obesity though. Girls at a normal weight have been starting puberty earlier as well, though at a lower rate than these girls whom are overweight, or obese. Chemicals known as endocrine disruptors, such as the phthalates used in the production of plastics, as another potential contributor to early puberty have been cited as the most likely cause. They mimic estrogen and also cause disruption to the reproductive function and could therefore cause precocious breast growth and issues with the menstrual cycle. We know that there are over 87,000 chemical found in our foods, plastics, and preservatives and even in our water ways from detergents and even small traces of the contraceptive pill making its way into our water we drink as well. Others have said stress during childhood can play a role in prompting puberty as well.

Many children now face far more stresses that did in generations gone by, with many children growing up in families with a lot of domestic violence, arguing at home, or violence in their neighborhood are more likely to develop earlier. There have been studies and research that has suggested that girls who grew up without their biological father were twice as likely to get their period before age 12.

Scientists are even researching prenatal variables. Researchers now know that the parental mode of inheritance, through genes, is one way parents health, diet and lifestyle is being passed onto children. One study found that overweight mothers who developed gestational diabetes while pregnant gave birth to daughters who would start puberty earlier in life, regardless of what the girls themselves weighed. But, we also now know that the sins of the fathers can play a part in a child’s development. If the father isn’t healthy at the time of conceptions, or has genetic abnormalities, or genetic issues, these can be passed through the sperm and then onto a child, who then is affected with this issues that get expressed later, or now early, in life.

Regardless of whether its cause is environmental, genetic, biological, or some combination, precocious puberty may be reaching a biological breaking point.

This is why we need to be more aware of our children’s health early on, but we also need to be aware of our own health, before conceiving too, as we can pass our genetic disposition onto our children.

Teenagers and younger women are not too young to have gynaecological issues

Early intervention and prevention is the centre of managing any issue such as this and this is why we need to teach our children better eating habit, having a healthy active body and also being in touch with their bodily functions and emotions at a young age

Period pain and menstrual irregularities are not normal and we need to teach young girls this. We know that teenagers and younger women are not too young to have gynaecological issues such as Endometriosis and PCOS. Please see our article of what a proper menstrual cycle should be like to familiarize you and your daughter with this. The earlier you get onto menstrual issues and gynaecological issues, the better long term prognosis they have for their health and future fertility overall.

If you or your daughter need help with menstrual issues and know more about better menstrual health, please book in and see me sooner than later. As I have said before, the earlier we start educating young women on what is right, then better is for them later on in life and for their future health and fertility

Take care

Regards

Dr Andrew Orr

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

-Leaving No Stone Left Unturned

Endometriosis Awareness Hysterectomy does not cure endometriosis

Hysterectomy Does Not Cure Endometriosis

One of the things I get asked to comment on often by women, colleagues, media etc, is “Will Hysterectomy Cure Endometriosis?”

Every time I hear the question asked, or hear of women being told that hysterectomy will cure their endometriosis, I almost cringe and have to stop myself from swearing. The fact is this, and I want everyone to know this. Hysterectomy “DOES NOT” cure endometriosis. It never has and it never will and I am going to explain why.

Endometriosis is typically not found in the uterus as it is endometrial like tissue that grows outside the uterus. Endometriosis is really normal tissue, growing in abnormal areas. It can grow on the bowels, bladder, pelvic wall, utero-sacral ligaments (USL’s) and it can spread to nearly every part of the body. It is also one of the most misdiagnosed disease states in women and can take up to 10 years to diagnose on average. Some women are never diagnosed and many take up to 20 years, or more, to be diagnosed. This means that a hell of a lot of healthcare people miss it along the way. That is a fact. It also means a hell of a lot of healthcare people do not know much about the disease as well. Another  fact as well. Let’s not get started on the surgical side of this either. I have explained this in other posts (Click Here)

The other fact is there is a lot of BS (Bullshit) put out there about endometriosis by uneducated healthcare practitioners, media and general public alike. Again this is a fact.

One of the biggest pieces of misinformation is women being told that hysterectomy will cure endometriosis and is the solution to all the symptoms they are getting. Not only is this not true, but it is downright reckless, misleading and bordering on negligence. It is also causing women to have a healthy uterus removed and many to undergo a procedure that is not even going to cure their disease. There is no cure for endometriosis at this present time.

Why Won’t Hysterectomy Cure Endometriosis

Firstly, there is no cure for endometriosis. That is a fact.

Secondly, endometriosis is outside the uterus. As I have said before it can grow on the pelvic wall, the bowels, the bladder, the ovaries, the fallopian tubes, the USL’s and it can spread to the diaphragm, the lungs, the pericardium, the heart and nearly every part of the body. That is the truth.

Now, if the disease is not in the uterus, how is taking the uterus out going to be a cure for the disease?

Well, it isn’t a cure and this is what we need for people to know. Sure, menstrual related symptoms like period pain, heavy bleeding, clotting etc may be stopped due to a hysterectomy and not getting a period anymore. But, that is it really. Endometriosis will still be there and so will many of the non-menstrual related symptoms. Worse still many then think, or have been told, that the endometriosis is gone and that the symptoms they are experiencing post hysterectomy are not from endometriosis. The fact is, the endometriosis is still there and those symptoms are still from endometriosis. Many women are then led to believe the symptoms are in their head, or then told to go and see pain specialist and suck it up basically. That is what happens.

The other thing is, many women who have pain with their menses and heavy bleeding may have another condition called Adenomyosis and may not even know they have it. Hysterectomy will help adenomyosis, because this is confined the uterus. So when women say they got relief from having a hysterectomy, they may have just had adenomyosis and not even known they had it. They may also just be having symptomatic relief from menstrual related symptoms from not having their period. Adenomyosis and endometriosis often go hand in hand too and many do not know they have both disease states. Many now believe they are one in the same disease, but just in different locations. But, regardless, endometriosis will still be there regardless of whether a woman has a hysterectomy, or not.

No matter what anyone tells you, hysterectomy will not cure endometriosis. If endometriosis has been diagnosed, then it will still be there regardless of the uterus being taken. This is what we need all to know. Many women are told hysterectomy will be the cure to their endometriosis only to find the symptoms come back again after the procedure is done. The women I feel sorry for are the ones led to believe that hysterectomy will be the great savior for all their symptoms, only to find out it isn’t.

Let’s not forget that endometriosis symptoms don’t always relate to the menses either. Women with endometriosis can be in constant pain at anytime in their cycle and pain can also be cyclic, regardless whether the period is due or not. “Endo Belly” can strike at anytime. Women can go from having a flat stomach one minute, to looking like they are pregnant the next minute, and then back again. Then we have all the other physical and emotional symptoms as well.  Hysterectomy is not going to fix any of that. Again hysterectomy will only help with the menstrual related physical and functional symptoms and endometriosis will still be there.

There is only one way to deal with endometriosis and that is via a multi-modality approach and manage the disease properly. I have written many articles about this and spoken about it at many seminars and events. If you want to find out more about how to manage endometriosis please click here 

I need every woman with this horrible disease to know that Hysterectomy WILL NOT cure endometriosis. No matter what anyone says to you, it won’t cure the disease. That is a fact and we need to start getting this information out there and stop those spreading the misinformation to be educated properly. If anyone tells you that hysterectomy will cure endometriosis, tell them they are misinformed. The endometriosis will be there still. If you, or someone else, needs to know the facts about Endometriosis, you can always direct them to my Endometriosis Facts Page or visit Endometriosis Australia’s page as well.

Let’s end the silence and also put an end to the misinformation as well. Lastly, always remember that Period Pain IS NOT normal either.

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Expert

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Are we really doing enough for women with Endometriosis?

I often myself “Are we really doing enough for women with Endometriosis?”

That is a hard question to answer in one way, but easy to answer in others. But, the bottom line is that we really aren’t doing enough for women with this terrible disease.

Now, before I continue and start with what I am about to stay and before anyone takes this the wrong way and gets upset (which isn’t my intent), let’s look at the positives around endometriosis.

There has been more awareness of the disease than ever before and awareness brings about change. But unfortunately that change can also be slow. But, it is a step forward in the right direction. At least there is now some government recognition is some countries like Australia. It is about time though and we need all countries to step up on this front. Governments also need to do more, including ours here.

Yes, we have surgical interventions, pain killers and hormones to help those who suffer the disease. All of these things, either in isolation, or in combination can help women with the disease. Some women even become asymptomatic (meaning no symptoms), after certain interventions, or a combination of all interventions combined. That is what we would like for all women with endometriosis.

Surgical intervention can control active lesions and the inflammation and symptoms they cause. Pain meds can help control pain, but after a while women will need stronger pain meds to control the pain. The body will get used to the level of pain meds and there are also high side effect profiles. Hormones such as progestins and GnRH agonists can help with the control of symptoms, help with pain and inflammation and also help with the suppression of microscopic and active lesions. But, again it isn’t enough.

We know that despite the current medical model of treatment that women are still being missed and dismissed, women are still in pain, women are still having numerous symptoms, women are having high levels of anxiety, basic bodily functions are being denied or hard to achieve, and women are being offered multiple surgeries, because that is all that the medical model can provide for them. That is the pinnacle and once that is reached, then this leaves very little options left.

Women are then offered radicle treatments and removal of body parts and that is not the answer to their often horrible daily journey either. Hysterectomy does not cure endometriosis, not at all. But it is still being offered as such by the ignorant, ego driven and uneducated out there still. Sure, it can stop you having a menstrual cycle. Sure it can help with symptoms associated with the menses. The trouble is that many women that get relief from hysterectomy actually have adenomyosis as well, or in isolation (usually missed diagnosed or missed completely), which a hysterectomy will help, and these symptoms are then controlled permanently by this procedure. But, the problem then is that these women think that their endometriosis is gone and cured. Not so. If endometriosis has been diagnosed, it will still be there and it can still cause inflammation, and flares, and gastrointestinal symptoms, destabilise moods, causes endo belly, still spread throughout the body, still wreak havoc on bodily functions and most likely still need interventions of some sort.

Many women with the disease are at the point on suicide some days; let alone asking them to undergo reproductive suicide. I am sorry to put it so bluntly, but that is what it is. I have seen young women who have being told that the only way to cure their endometriosis is to undergo reproductive suicide and permanently halt their chance at having a family, all due to ignorance and being told BS, heartless, unethical statements like that. Just go and chop out your uterus and you will feel better they say. No woman should ever be faced with that option because there are ways to manage this disease that many have not even been told about, or even begun to explore. I want every woman to know that hysterectomy does not cure endometriosis and that is a fact. I also want women to know there are options for a normal life, outside the current medical model, or to be used in conjunction with the medical model.

The other issue is that like the fashion industry and their assault of women through marketing, we also have pharmaceutical companies trying to mislead women to believe they have the latest and greatest “fix all” pill for their endometriosis. Again, much of that is just over marketed hype and remarketing of medications and hormones that we already have and are just being sold under another patent and another name. Many women work out very quickly that the benefits being marketed are not forthcoming and are again left with the feeling of despair. I would love to see a new medication to help women. I would love to see the cure all pill appear on the market, but unfortunately there is no such thing, it does not exist and probably will not exist in the near future either.

We also now have women basically addicted to pain medication, because without them, they cannot function in a day to day life. This then leads to judgment by many and we are now seeing women being viewed as ‘druggies’ so to speak. Many women are also being questioned at pharmacies, even when they have a doctor’s script. We also have medical centre GP’s refusing women pain medication because they just have not listened to the women and her symptoms and that she in fact has endometriosis. All they hear is “Here is another addict trying to get pain meds”. No, this woman is in pain and you are not listening to her, or even able to understand the level of distress and pain she is in daily. Sure, pain meds are addictive and they have side effects, but what other options do we have for these poor women? Until someone comes up with a better solution, on a medical level, then this is what women with endometriosis have to do in order to survive their day.

So, yes, while we have come far in awareness and recognition etc, which we desperately need, but we are still stuck in the dark ages as far as medical diagnosis, disease classification, interventions and true clinical and overall health management of the disease. What women with endometriosis need is an individualised, case by case, individualised, multidisciplinary approach to fully treat and manage the disease but this is not happening.  Much of this is due to ego, certain marketing, suppression of research by pharmaceutical interests, lack of funding, lack of education, lack of awareness and people not willing to research or explore new ideas around this disease that don’t fit the model they want to explore, or believe.

There are ways to treat this disease effectively and it requires a multi-modality approach to do so. It requires the team approach that I always talk about. There is good research and evidence out there to suggest that there are some great treatments and management options outside the medical model, which can also be used alongside medical options to enhance treatments and overall health for those with endometriosis. We just need more education, more research, more funding, more open mindedness, less suppression of research and education by those with monetary interests in certain areas of medicine, more subsidisation for affordable treatment options and certain people letting go of old belief systems and ego so that new thought processes and education can occur.

While awareness is great and it brings recognition to those with the disease, we also need to then give those same people ways to manage and treat the disease as well and stop viewing these women and druggies, or hypochondriacs, just because the medical system hasn’t caught up with what these women actually go through and what they need to live on a day to day basis.

I’ll talk about some other options for the treatment and management of endometriosis in some upcoming posts. In the meantime please know there are better ways to manage this disease and while I would love for there to be a “one pill” or “one treatment fix all’ approach, I am sorry but that does not exist and we will probably not see that exist either. We can hope, but please don’t hold your breath waiting. Sorry for the rant, but it need to be said and more needs to be done.

Regards

Dr Andrew Orr

-Reproductive Medicine and Women’s Health Expert

-Women’s and Men’s Health Advocate

-No Stone Left Unturned

Dr Andrew Orr Logo Retina 20 07 2016

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Expectation Versus Reality When It Comes To Hospital Emergency Departments

Before I start on this latest post, I do just want to say how amazing the people are who work in Accident and Emergency departments around the world. As someone who has a disease state that can be fatal, I know all to well how the amazing efforts at accident and emergency departments can save lives. I should know, because they have saved my life a few times I can tell you.

The reason for this post is that everyday I get messages from people in chronic disease state, such as endometriosis, and many of these messages often complain that they went to their local hospital emergency centre and they did nothing for them. Many of the messages are saying “I waited for hours in pain”, or “the emergency staff did nothing and then sent them home”, or messages such as “The didn’t fix me”

One of the things I always tell my patients is that if they are in pain, and it is after hours, or they cannot get a handle on their pain, then they should go to their nearest A&E (Accident & Emergency) and seek help. But I am also very clear with my patient’s expectation around what emergency centres are there for, or will do for them.

Accident and Emergency Centres at hospitals are there for exactly that; Accidents and Emergencies. They are there to help with people who have been in accidents, the critically ill, the dying, and those that require emergency assistance. Emergency departments are trained to assess who needs help now and who doesn’t.

There is scale of who requires immediate help and who doesn’t. People who have been in near fatal accidents, people with open wounds, close to death, people having heart attacks, asthma attacks and anyone who could possible die from their suffering, will always be attended to first and if need be with be admitted and monitored accordingly. For the rest of the people it is simply this.

  • How bad is your pain?
  • How long have you had it for?
  • and Could it possibly kill you if we leave it too long for you to receive care?

If the answer is that it isn’t going to kill you, but you are definitely in a lot of pain, you will receive treatment. When and how long that takes, compared to critical patients, all depends on how busy the emergency department is that night, or day.

What I do need to reiterate is that emergency departments jobs are to basically assess if your condition could kill you, then administer appropriate treatment, get you out of pain and then either send you home, or admit you if it is absolutely necessary. That is it really. They are not there to fix your chronic condition. They are there to ease your pain, administer appropriate treatment, save your life if necessary, and then work out if they send you home, or send you to intensive care for critical monitoring, or admit you to the general wards.

If you are assessed properly and your pain etc, has been controlled and then sent home, what should happen then is that you should be given medications to control your condition when you get home, given an action plan and also a referral to your local GP, or healthcare professional to help you in managing your disease state, or pain state, properly. This is to ensure you get proper care. Sometimes you may even be referred back to the hospital you have just been to but to an appropriate department for your condition, or disease state.

But does this always happen like this?

Well, not always and it just depends how busy the emergency centre was and how far down their emergency scale you were. If you weren’t dying, it may seem like they are saying to you “we fixed you up, we helped your pain and then sent you on your way with no help”.

But in reality they have got you out of pain and then have administered appropriate care and treatment, but it may not just be in way your expectation was. Please just remember that A&E’s are there to help you get out of pain and then basically send you home, or admit you if needed. That is it really.

If your pain levels have escalated, or become acute, more often than not it is because your condition isn’t being managed properly, or as well as it could be.

  • Maybe the healthcare practitioner managing you just isn’t as educated on your disease state as you thought.
  • Maybe your medications are wrong.
  • Maybe you haven’t been taking your medications properly.
  • Maybe you have been self-prescribing too long and need to see someone for better care.

There could be many factors to why your disease state has flared

  • Could you flare up be due to stress, or emotional factors?
  • Are you sleeping properly?
  • Are you eating a proper balanced nutritional diet?
  • Have you been drinking too much alcohol?
  • Are you drinking enough water?
  • Are you exercising enough and moving the body enough?
  • Are you taking your medications properly?
  • Could you need surgical intervention?

There are so many reasons why disease states can flare, or pain cycles can start. Sometimes there is no answer to your pain, or disease state flaring.

As I have stated before, places such as the A&E (Accident and Emergency) are there to help people in chronic, or acute pain states and assess you properly to make sure everything is ruled out and then control your pain and have you managed accordingly. Most of the time, if things are not critical they will send you home, but usually after making sure you are managed properly first. If this doesn’t happen, then you need to ask the questions as to why, and then ask questions of the powers that would be, if necessary. If you are truly in pain, then you should not go home and you need to voice your concerns as to why you need to be looked at further. Sometimes it really is “He/She who cries out loudest, gets heard”

If you do have a diagnosed condition such as endometriosis, it may be best not to let some A&E’s know you have this condition, due to them probably not going to fully understand your condition, and put you in the period pain basket, and probably not take you seriously. I am not saying this happens all the time, but it does happen and I hear this often. But, just remember that A&E departments are specialised in some disease states such as endometriosis either, so you need to take that into consideration. But they need to take into consideration that you are in pain and that it isnt just simple period pain, or you are being dramatic. If you weren’t in real pain, you wouldn’t be there. So, just a precautionary word… dont tell them you have endometriosis, if that is what your are there for. Let them do a proper assessment and control your pain first and if they work that out, then they have done their job anyway. If they don’t work that out, they will at least manage your pain and then try and work on why you are in pain. If necessary, they will admit you until they can work it out,  so win win situation.

But, even after all this, if your pain, or disease state has reached its peak point, it means that you aren’t being managed properly, you need proper management, or you may in fact need surgical intervention, along with appropriate treatments and clinical management moving forward. Once this is addressed then you need to do the following also

  • You need to eat a healthy low inflammatory based diet
  • You need to make sure you address the emotional aspect of your health
  • Address stress levels
  • Make lifestyle changes
  • Address weight and body fat (lose or gain weight/body fat)
  • Drink adequate water and electrolytes to stay properly hydrated
  • Exercise and move your body to promote blood flow and circulation
  • Get some acupuncture
  • Get some herbal medicines and nutritional supplements
  • See a chiropractor, or osteopath
  • Do a mindfulness course, or learn some meditation
  • Get at least an hour of “You Time” daily
  • Take your medications as prescribed
  • Book in with your healthcare practitioner and get a proper pain management, or disease state management protocol going
  • Improved your gut health and microbiome
  • Be positive and look at positive words and affirmations
  • Stay away from negativity and negative people
  • See a pain management specialist if need be
  • If something isn’t working, then change it. This may also mean changing the person you are seeing. It may also mean changing self, or self-beliefs.

Lastly, never self prescribe, or try to manage your own disease state. Nobody can manage their own disease state properly, no matter how much they know, or how hard they try. Always seek proper help and clinical management from a properly trained healthcare professional who specialises in your disease state

I hope this has helped everyone understand a little more about what emergency departments do, or are supposed to do, when it comes to pain and critical care. We really do need to be aware of expectation, versus reality for this type of care and what emergency centres actually do. I also want people to know what they can do also need to be proactive in their disease states and helping manage their disease state and symptoms properly. With proper care and proper management, you truly can reduce symptoms, reduce pain, reduce flare ups and also live a fairly normal life as well.

Lastly, when pain does get too bad, or your are unable to control your disease sate properly, it means you need to get proper help and this also means seeing an appropriately trained healthcare professional to assist you in every aspect of your disease. Please do not try to do it yourself, or google it, or ask friends for advice. Always see a healthcare professional who is trained to deal with your disease properly and administer appropriate care, treatment and management moving forward. If your current healthcare professional isn’t assisting your properly, I am the first person to tell people the value of a second, or tenth opinion.

Take care

Regards

Dr Andrew Orr

– No Stone Left Unturned

– Women’s and Men’s Health Advocate

Dr Andrew Orr Logo Retina 20 07 2016

 

 

The facts about endometriosis

The Facts About Endometriosis

Many things you have heard about period pain and endometriosis are wrong. These are the facts about Endometriosis

 

Endometriosis Awareness Period Pain IS NOT Normal                       Endometriosis Awareness Teenagers are not too young to have endometriosis 1

 

Endometriosis Awareness Hysterectomy does not cure endometriosis                       Endometriosis Awareness Pain Levels Are Not Related To The Extent of The Disease Present

 

Endometriosis Awareness Endometriosis can only be definitively diagnosed by a laparoscopy                       Endometriosis Awareness is not caused by estrogen dominance

 

Endometriosis Does Not Always Cause Infertility                       Endometriosis Awareness pregnancy does not cure endometriosis

 

There is no cure for Endometriosis                       Endo takes up to 10 years to be diagnosed

Regards

Dr Andrew Orr

-No Stone Left Unturned

Dr Andrew Orr Logo Retina 20 07 2016

The facts about endometriosis

Endometriosis Facts

Many things you have heard about period pain and endometriosis are wrong. These are the facts about Endometriosis

 

Endometriosis Awareness Period Pain IS NOT Normal                       Endometriosis Awareness Teenagers are not too young to have endometriosis 1

 

Endometriosis Awareness Hysterectomy does not cure endometriosis                       Endometriosis Awareness Pain Levels Are Not Related To The Extent of The Disease Present

 

Endometriosis Awareness Endometriosis can only be definitively diagnosed by a laparoscopy                       Endometriosis Awareness is not caused by estrogen dominance

 

Endometriosis Does Not Always Cause Infertility                       Endometriosis Awareness pregnancy does not cure endometriosis

 

There is no cure for Endometriosis                       Endo takes up to 10 years to be diagnosed

Regards

Dr Andrew Orr

-No Stone Left Unturned

Dr Andrew Orr Logo Retina 20 07 2016

help 3049553 1920

But what do I do and who is going to help me?

Many years ago I was asking this same question, “But what do I do?” and “Who is going to help me?”

Like so many others, I know all too well about having a chronic health condition and living with that daily. Yes, I too have a chronic disease state and I also know what it is like to live in that chronic disease state. That is why I understand what many of you go through daily. I may not know what it is like to live with your disease state, but I know what it feels like to live in chronic disease state and have to live with the consequences of that disease.  I also know what it is like sitting there thinking that nobody seems to be able to help me and one seems to be getting nowhere with this. Then the vicious cycle of then doing nothing, because one believes that nothing works and nobody can help, and then nothing gets done and the symptoms continue and then you get even more and more frustrated. Yes, I have been there too. This is why I do what I do now and why I want to help others get out of their rut, and help them overcome their disease and learn to manage their disease better to then have a better life.

But unlike many others, I do know the power of positivity and know that once I put my mind to something and commit to it, then I’ll do as best I can and it also helps get the process going.  I also know that in order for something to change, that I also had to be proactive and make things change. It is that old saying “If you don’t change anything, then nothing changes”

So one day I sat down and said “Right, let’s just forget about whom I have been seeing, forget the blame game etc and let’s just really look at this objectively. What do (I) need to do to create a change?” and “Can I do all these changes on my own?”

Sometimes asking these sorts of questions about yourself can be quite confronting and when you do, you also need to be completely honest with yourself and have those around you be honest with you also. Then you have to take that advice, listen to what people are saying and then go about finding someone to help you and then actually make the necessary changes that are needed. But, finding someone to help can be really hard too. Like every other profession, or industry, or workplace etc, there are good and bad people in what they do. Unfortunately finding the good people to help can often be hard, but it doesn’t mean they are not out there. There are good people out there, and people who are excellent at what they do, but it also means not being sceptical and also having an open mind, otherwise you will just give up and not do anything again. Then you end up being in the vicious ‘poor me’ cycle again and that isn’t going to help anyone. This is where a good counsellor or psychologist can help and be impartial and be objective in what you need to do to move forward.

Then I also learnt that I had to stop the blame game and had to learn to stop making excuses. I know all too well that it was much as it is easy to blame others and blame things for not working, but at the end of the day we are all in charge of our own health, our own lives and what happens to our body too. Well, to a point anyway. I do know that sometimes you just can’t help genetics and hereditary disease, but at the same time, these disease states can be managed “If” you get proper care.

I remember a good friend sitting me down and talking to me about what I should do and also some of the questions this friend asked me. Some of the things he said to me and insights he shared with me were things like these.

  1. “Are the people you are seeing good at what they do?”
  2. “Have you noticed any changes after the treatments they have prescribed?”
  3. “How long have you been seeing these people for?”
  4. “What are your expectations around the treatments they have prescribed for you?”
  5. “Have you actually been doing the treatments they have prescribed”
  6. “Have you been taking the prescribed treatments and advice seriously and doing it properly?”

This friend of mine said to sit there for a minute or so and really reflect on what he was asking and be completely honest with myself.

He said to me “You know how some people come to see you and then they go away and then don’t take on any of the recommended changes and don’t do the treatments and then expect for things to miraculously changes and you to somehow just fix them without them having to do anything….. are you one of those people too?”

Not something I wanted to hear, but I did appreciate the honesty. I could relate to what he was saying because if one doesn’t do the necessary recommendation, or do the treatment, then one isn’t going to get better and then you can’t blame the person you are seeing if it all goes pear shaped.

Then he said to me “You can’t keep doing the same thing over and over again. If it isn’t working, you can’t then expect a different outcome each time, or just hope that all of a sudden it works.”    He then went on to say “I’ll put it to you this way. If you keep running into a brick wall and then it hurts and you fall over and then get back up again and try to do it again thinking it might not hurt this time, and expect a different outcome, when you know it is going to hurt, then you need to start asking yourself some serious questions”

Then he said to me “Let’s really look at expectation versus reality. You have had this disease state for a really long time, but in your own mind you want it fixed straight away, or after a few days, or after a few weeks.  The thing is… it isn’t going to happen.” He then continued “You know all too well that if you have had a disease state for years it isn’t going to fix overnight and that it is going to take months, or may even take a year or more to fully get on top of it, depending on the severity and what is going on”

This friend also said to me “Sometimes pain levels and symptom and all a matter of expectation versus reality too. Sometimes you think you aren’t getting better, when in fact you actually are. If someone where monitoring you properly you may have started out at 10/10 pain and may now be 5/10, which is an improvement. But, because you are still in pain, you won’t see it as such until someone points out the difference. It is all relative to what you believe versus what is actually happening ”

Lastly he then put it rather bluntly to me “Who the bloody hell have you been seeing and are they any good?” then he added “Because we all know there are people out there you wouldn’t send your dog to and the good ones are few and far between. Btw, who sent you there in the first place?”

He then added one more thing in “You can’t try and do this yourself, or try and treat yourself because that isn’t going to work and this is not your area of expertise. Go and see someone for advice and help and don’t be like many others and try and (Dr Google), or try and self-manage your own disease. That will end in tears”

So, after my brutally honest, but helpful, conversation with my friend, I did have a big conversation with myself and realised some things. These same things I now share with my own patients.

  1. Not everyone you see is good at what they do and if someone isn’t helping you, then you need to find someone that will. This is why now I always say to people that never underestimate the power of a second, or tenth opinion. Never give up until you find someone who will listen and then really help you.
  2. When you get a referral to someone, do your research and make sure the person you are seeing is well qualified to be helping you and your condition. You need to ask them the big questions and don’t be scared in asking the big questions. If they don’t seem qualified to help you, then find someone else. Also make sure your surgeon is advanced trained, if one is needed and also specialises in your disease state.
  3. Look at who is referring you. Look at what their knowledge of the area you need help with. It is your friend referring that may have no idea? Is it mum, or dad referring? Make sure the person referring you has a good knowledge base of the person they are referring to and also has a good understanding of your disease. Sometimes the people referring you have no idea and then refer you to someone mediocre. It is all about perception and sometimes perception of who is good and who isn’t might be a little distorted.
  4. Look at how long you have had a disease for and look at what your expectations are around how long it may take to see some changes? Then ask the person you are seeing for an honest opinion about how long they would expect to see some changes happening. No long term health issues fixes overnight and the longer you have a disease for, the longer it is going to take to help it and see some real changes.
  5. If you are asking to make changes and do a certain treatment and management plan, then make sure you do it 100%. For changes to happen you have to follow the advice given and stick to it. Forget what Dr Google says. If a professional with years of training tells you to follow their advice, then make sure you give it a chance and actually do it. You also need regular follow-up consultations and regular management to oversee those changes and also talk about any concerns and also talk about changes as they happen. You need to document changes and actually be managed properly. If a treatment isn’t helping, or you perceive it isn’t helping, then have a chat with your healthcare practitioner about this. If something really isn’t working, then you need to change something, or change the person you are seeing until you find someone who can help you.
  6. Pain levels and symptoms and healing times can sometimes be distorted when you are in pain. When you are in pain, or have bad symptoms sometimes you don’t always realise you have had changes, because you are still in pain and have symptoms. As my friend mentioned to me, sometimes you may have started at 10/10 pain, or symptoms, but now you may actually be 5/10 pain and symptoms. That is actually a big change and means you are getting better, but because you are still in pain, or have symptoms, you may not be able to see this until it is pointed out. As long as you are progressing and moving forward then this is good and something to give you hope that your treatment is working.
  7. You are always going to have bad days. Even with the best treatments and best management, everyone will have bad days and these are the days you need to be careful about and not get negative about. Shit happens. Bad days happen for everyone and we all have to be aware that while the bad days will happen, as long as you are moving forward, even if it is step by step, then this is a good thing. Like they say “Two steps forward, one step back”, which still means you are one step ahead of where you were.
  8. Don’t try and treat yourself. It is good to be educated and good to be informed etc, but relying on Dr Google, or friends advice etc, can be a bad thing too. We don’t try and cut our own hair, or fix our own car, or make our own medicines etc, so we shouldn’t try and fix ourselves either. We need someone who can be objective and someone who is actually qualified in the area that we need help with to get the best results.
  9. Many disease states need a ‘team’ or multimodality approach to give you the best results possible. We know that despite the best medical treatments, that many people are still in pain etc and it isn’t until they incorporate other therapies, that they then start getting positive results. Be open to trying new therapies and new things that may help you.
  10. If you do ever need to go to the emergency department for your disease, just remember that the emergency department isnt there to fix your chronic disease. They are there to stabilise your pain and stabilise your symptoms and once that is done, they are more than likely to send you home, if you aren’t in any medical danger. If so they will admit you. But part of critical care should be making sure you are referred to someone who can manage you clinically moving forward. The reality is that sometimes this doesn’t always happen.
  11. Never ever let the disease own you. You are not the disease and it does not own you and we need to be careful of not buying into the label and then letting the disease and the label consume us. Take back your power and be positive and use that to help you overcome the disease and being owned by the label.
  12. Be kind to yourself. That means eating good foods, exercise, lifestyle changes and getting out into the sunshine daily. Many foods that we eat are inflammatory and only add to the inflammatory disease process you are dealing with already. Create good gut health to build up your reserves of health gut bacteria to help your body and help your immune system. Get the body moving and get the circulation and blood flow moving to nourish the body too.
  13. Last but not least, never underestimate the power of the mind, or how emotions can be a big part of a disease state and some of those disease states symptoms. We check in our tax to the accountant, we check in our health with the GP, we check in our hair to the hair dresser, but when do we actually check in our emotions and our thought processes. Never underestimate the power of talk therapy and seeing a counsellor etc. The body mind connection is a big part of many diseases. Never underestimate the power of stillness and mindfulness and bringing the body to rest and being mindful of your life and what may be needed to help your health. There are people who can help you with mindfulness and meditation and creating that positivity in your life

Having lived with a chronic disease state for most of my life, I do know how challenging it can be for people and to find that strength and courage to actually get up and do something about your health. It can also be disheartening when the people you have seen have missed and dismissed your disease too. It all just compounds and adds to the daily burden of what you are going through. But, never let those things stop you from finding someone who can help, or finding the strength to get up and make the necessary changes you need to make a better life for you. I think that having a disease is sometimes like learning to ride a horse. You may fall off many times, but you need to just get straight back on again until you master the art of staying on and being a good rider and being in control. But even the best rider is going to fall of every now and again, and that is ok too.

Just remember that there is always help out there and there are people who will listen and who do specialise in the area you need help with. Lastly, for you to get better, it also needs for you to be a big part of the driving force behind that and actually do the work needed. Don’t just sit there in ‘poor me’ mode. Get up and get yourself out there and do what you need to do for you. If something isn’t working then change it. Just remember that in order for a change to take place, something has to change. Something that means you changing your belief and your thinking too. It might also mean changing the healthcare provider you are seeing too.

As someone who has been there, I hope this helps you all get the help you so desperately deserve. Just remember that if you don’t know what to do, or where to get help, please know I am here to help you as well. You can always book in a consult (in person, or via online) and I can help assist you with your health, and also point you in the right direction too.

Regards

Dr Andrew Orr

-No Stone Left Unturned

Dr Andrew Orr Logo Normal 20 07 2016

Dr Andrew Orr Logo Normal 20 07 2016

Causes of bleeding in between cycles

Why am I getting bleeding between my periods?

Vaginal bleeding between periods can be common and is not generally a cause for concern. Most of the time women will get just very light pink coloured watery flow, or just some spotting. There can be many reasons why a woman would be getting bleeding between periods, which includes hormonal changes, injury, or an underlying gynaecological, or health condition.

While bleeding between your periods may not be cause for concern, on one level, the ideal situation is to not have any form of bleeding at all and if you do get bleeding between your cycle, it is a good idea to have this investigated, just to be on the safe side.

What a proper menstrual cycle should be like

I have done quite a few posts on what a proper menstrual cycle should be like, but I will go over this again just briefly

A proper menstrual cycle should be between 26-32 days in length and really only have about 3-5 days flow. Any longer than this can be too long and put a woman at risk of being low in iron, especially if this happens all the time.

The blood flow should be a nice red consistency, no clots, with no stopping and starting, and women shouldn’t have too many digestive disruptions, and really, a woman should not be getting pain with her cycle. A little bit of distention and knowing the period is coming is fine, but there should not be pain at all. If you have to reach for the pain killers and the heat pack, or are doubled up in pain, this is not normal and you need to get this checked out.

What are the causes of bleeding between periods?

As mentioned before, there can be a variety of reasons for breakthrough bleeding, some of which are no cause for concern at all. Some however do need to be investigated.

Below are some of reasons for bleeding between periods:

Ovulation

When an egg is released from the ovary, it does create a tiny wound, through which the egg will then travel through the tubes and prepare to make its way to be fertilised, or then shed with the menstrual flow. At ovulation, this tiny wound can also create a tiny amount of bleeding, which can be seen as spotting during the ovulatory phase of a woman’s cycle.

Implantation bleeding

When an embryo implants into the uterine lining and begins to grow, many women experience spotting around this time. This is called implantation bleeding. They may also experience some slight cramping at the same time and all of this is quite normal. Some women may then experience some lighter bleeding as the embryo grows further. They usually get some light spotting, which can be a light pink, or a brown colour. Sometimes it can be more like fresh blood. While this is normal, it is a good idea to get this checked out just to be on the safe side and to also put the pregnant mothers mind as ease too.

Miscarriage

Bleeding between menstrual periods can be an early sign of a miscarriage. Many women may not even know they are pregnant and may be completely unaware they are having a miscarriage.  While it is generally thought that once a woman reaches twelve weeks gestation everything is generally going to be ok, miscarriages can occur at any time during pregnancy.

Termination

After having a termination women can bleed for some time after the procedure, or taking the medication to start the abortion process. If bleeding continues and is very heavy, women need to seek medical advice.

Polyps 

Polyps are small growths that can develop in the uterus or on the cervix. They are often a cause for unexplained bleeding between the cycles. Polyps do need to be removed as they can prevent implantation happening and they can also turn cancerous if left behind. Polyps are a very common cause of bleeding between periods.

Fibroids

Fibroids, or myomas (also known as leiomyomas, or fibromyomas) are growths, or benign (non-cancerous) tumours that form in the muscle of the uterus. Up to 40% of women over the age of 40 years have fibroids and as many as 3 out of 4 women develop fibroids in their lifetime.

Fibroids can cause heavy bleeding, extended bleed and painful periods. They can also cause infertility, miscarriage and premature labour. In many women, they will not cause any problems at all. Fibroids are a very common cause of bleeding between the cycles.

Polycystic Ovarian syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is a very common condition that can cause irregular periods, absent periods, and can also cause bleeding between periods. PCOS can also cause other issues such as acne, weight gain, infertility and hormonal and emotional disturbances.

Endometriosis or Adenomyosis

One in ten women are diagnosed with endometriosis and many more do not even know that they have it. Endometriosis and Adenomyosis are very closely related, with endometriosis usually being more superficial disease and not confined to the uterus,  and adenomyosis being deep within the uterine tissue. Chronic conditions such as endometriosis and adenomyosis, can cause bleeding or spotting between periods.  These conditions may also cause heavy or painful menstrual periods and cramps between periods. Adenomyosis will usually cause more bleeding symptoms along with pain etc.

Sexually transmitted infections (STIs)

Some sexually transmitted infections (STIs) can cause pain, vaginal bleeding and spotting. If you do suspect you may have a STI, you need to see your doctor for investigation and treatment.

Injury to the vaginal wall

During sexual intercourse the tissue of the vagina can be damaged and this can then cause bleeding. If the vagina is too dry, lack of arousal, and not lubricated enough this is more likely to happen. It can also happen if there is atrophy in the vaginal tissue as well. This is called atrophic vaginitis.  This is more likely to be seen when a woman is going into menopause, or undergoing cancer treatments, or has diabetes.

Menopause or perimenopause

The menopausal stage of life and especially the perimenopause stage, can be a cause of irregular menses and irregular bleeding. It can also cause spotting, or heavy bleeding too. Perimenopause is the period leading up to menopause. This stage of a woman’s life can last for up to 10 years as hormone levels in the body change and can be unstable.

Hormonal contraceptives

Hormonal contraceptives are a common cause of bleeding between periods. They can also cause irregular bleeding and this can be quite usual in the first 3 months of using the contraceptive. If a woman misses takin her oral contraceptive, it can also cause irregular bleeding, or a withdrawal bleed.  Intrauterine Devices (IUD’s) like the Mirena, will often cause irregular periods and irregular bleeding in the first 3 months after it have been inserted. If bleeding lasts for longer than 3 months on any contraceptive, it is a good idea to seek medical advice and get investigated and managed properly.

Emergency contraception

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

Certain cancers

Vaginal bleeding between periods can also be a sign of gynaecological cancers in women. Most bleeding that women get is not serious, but it still needs to be checked.  Cervical cancer can affect women of any age. Bleeding between the cycle, or after intercourse, and pain after intercourse, or unpleasant smelling discharge can be symptoms of cervical cancer and these all need to be checked by your doctor, or gynaecologist.

Uterine cancer tends to occur in women over 50 year of age. One of the early symptoms of uterine cancer can be vaginal bleeding. Uterine cancer mostly affects women are in the menopause and no longer have periods, so this is why any bleeding after menopause needs to be investigate and seen as not being normal.

Stress

Yes, stress can cause abnormal bleeding and also interfere with a woman’s cycle. Increased levels of stress can interfere with hormones and this can lead to bleeding, irregular cycles, or pain with cycles too.

When to see a doctor

If vaginal bleeding between periods is heavy, persistent, or unusual then a woman should go and see a specialist, or a gynaecologist, who is a specialist in this area of medicine. As mentioned previously, while some causes of bleeding are not serious, some are and need to be properly investigated and properly managed medically.

Treatment and prevention

All women should keep a record of their menstrual cycle and when the period starts and how long it lasts for. Any abnormal bleeding should be recorded so that you can show your healthcare specialist if need be. Any abnormal bleeding should be investigated and the treatment will depend on what the underlying cause is.

Women should try and see their healthcare specialist for regular pap smears and regular check-ups for gynaecological health.

If women are getting small tears and bleeding caused from dryness in the vagina, then there are water based lubricants that can be used to help with lubrication and to moisturise the surrounding tissue.

There is no cure for gynaecological and reproductive issues such PCOS and Endometriosis, but these disease states can be treated and managed to give women a normal life. Proper treatment of these issues needs a “Team”, or multimodality approach using medical options, surgical interventions, pelvic floor specialists, acupuncture, herbal medicines, hormone therapies, and diet and lifestyle changes. It is about using what works for the individual and not a blanket one treatment fits all approach.

Last but not least, all women should know that period pain is not normal and that irregular bleeding really isn’t normal either. While most causes of bleeding are not life threatening, they still need to be investigated and checked out properly. Never ever put off seeing a specialist if you have abnormal bleeding.

Regards

Dr Andrew Orr

-No Stone Left Unturned

Dr Andrew Orr Logo Normal 20 07 2016