Category Archives: Traditional Chinese Medicine

Early Intervention & Early Management Is Vital For Gynaecological Conditions & Menstrual Issues

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By now many of you would know my stance on Period Pain not being normal and that the sooner you get the cause treated and managed the better one is going to be in their day to day life.

Unfortunately not everyone knows that Period Pain is not normal and neither are some of the other symptoms women get each month with the onset of their menstrual cycle. Having heavy bleeding, bleeding in between cycles, menstrual cramps, severe pain, irritable bowel like symptoms, dark clotting, ovulation pain, bowel and bladder pain and urgency etc, are all not normal symptoms that a woman should endure with her cycle. Getting these symptoms at any time of your cycle is not normal either.

Early intervention and early management is the key to any disease state in the body and this definitely applies to menstrual issues and gynaecological disorders. Once a disease is expressed into the body, it can be very hard to treat, especially if it is left a long time and then inflammation spreads to other parts of the body, or in close proximity to where the initial disease was first expressed.

One of the reasons that prompted me to do this post was after a young woman, now in her 30’s, had contacted me and thanked me for helping her back when she was in high school. Since then I have known all of her family well and helped with maintaining their health. At the time she was about 14 years old and showed all the signs and symptoms of endometriosis. She was in so much pain each month, when her cycle came, and she was often curled up on the floor with nausea and vomiting from the pain. Everyone, including GP’s etc, had told her this is normal and that she needed to get used to it. They also told her that she is too young to have endometriosis, or any major gynaecological condition.

That is so bad. Please, please know that period pain IS NOT normal and that teenagers are not too young to have endometriosis. To be honest, they are now finding endometriosis in young girls under 10 years old. Many gynaecological issues can start very early on in a woman’s life, especially if there are hereditary factors involved.  Gynaecological and menstrual issues can be passed from generation to generation, so if mum, or your grandmother, or someone in your family tree had menstrual issues, or a gynaecological condition, there is a good chance that you may inherit this as well.

The long and short of it all was that her mother was also getting frustrated at everyone not helping and somehow ended up finding out about me and ended up in my clinic. From there I got her into one of the advanced trained laparoscopic surgeons I work closely with as soon as possible and this is where stage 4 endometriosis was found and excised properly.  Without coming to see me, this poor girl would never have found the cause of her menstrual pain and associated symptoms. I then did all her management of her disease moving forward. The main thing that this young girl and her mother were worried about was how this was affecting her education and daily life, but how this could also affect her future fertility.

The one thing I know is that the sooner there is intervention and treatment, the better the prognosis for a woman’s future fertility is. The one thing I do know is that endometriosis doesn’t always cause infertility, but it can make it harder to fall pregnant, if it isn’t managed early enough. The longer you leave a disease in the body untreated, the worse it gets, and then the symptoms get worse and the worse the future outcomes may be.

Lucky for this young lady is that she did have early intervention and management and she has proudly messaged me to tell me that she has had her 3rd child and that she puts it all down to me helping her when she was younger. I have many women message me and tell me much the same thing. It is so important not to leave these things just because you are being told it is normal. What the hell is normal about being in so much pain that you feel like you could die?

All too often I see women having gynaecological conditions, like endometriosis, missed and dismissed and that the longer that the disease has been dismissed, the harder it is going to be to treat. That is a sad fact for many women and some will have to endure repeated surgeries due to being missed and dismissed and have a life of issues, if their issue isn’t managed properly either. Many have not seen the right healthcare professionals, or the right surgeon either.

I have discussed in many of my previous posts.  Please have a read of my previous posts about this subject and the seeing the right team of people. This is why it is so important to have early intervention and also see a proper advanced trained laparoscopic surgeon who specialises in the excision of disease states like endometriosis. Then there needs to be proper management and treatments and lifestyle changes administered to help with suppression of the disease state, helping with inflammation and improving quality of day to day life.

There needs to be a multimodality/team like approach to the management of women with gynaecological issues, as there is no one single fixes all approach, with any medicine. While surgery may be a necessary part of the overall management of disease states such as endometriosis, it isn’t the saviour that many perceive it to be. Surgery does not sure endometriosis and there is no cure for the disease at present time. Once you have it, it is there for good.

Surgery is a necessary but small part of the overall picture that needs to combine many other treatments and modalities to give the best outcome for a woman overall. Once the surgery is done you need to look at managing and suppressing the disease and this is done by lifestyle changes, dietary changes, acupuncture, physio, herbal medicines, hormone therapies, pilates, yoga, pelvic floor and core exercises and many other modalities depending on one’s individual symptoms.

When I treat women with gynaecological conditions, or menstrual issues, I make sure they all get an individualised, person centred, caring approach tailored to how they are presenting rather than a one treatment for all approach that many seem to get. You won’t get the results you need that way because we are all individuals with different needs and different symptoms overall.

Lastly, please remember that period pain and menstrual irregularities are not normal and that the earlier you get onto it and get it treated and managed, the better your future outcomes will be.

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Period Pain IS NOT Normal

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Stop Telling Women That Period Pain is Normal

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After seeing my 10th case of misdiagnosed Endometriosis this week, and goodness knows what else, I can say that I am well and truly over it and about to scream.

I am about to scream if I hear that one more woman, young or old, is told by their healthcare professional, GP, specialist, best friend, mother, facebook buddy etc, that period pain is normal.

Period pain IS NOT normal. It is far from normal and we all need to stop telling our daughters, sisters and women of this world that it is.

I think that anyone that says that need to come and work with me for a day and see the ramifications of women believing that period pain is normal, just because their doctor, healthcare professional, friend, or mother told them that it is.

I think I should post up some rather gruesome pics of women’s reproductive organs stuck together, their insides bleeding, and their pelvis completely obliterated. Yes, obliterated. That was the words that one of the surgeons used today to explain the insides of a woman that had been told that there is nothing wrong, just suck it up, scans haven’t found anything and just go on the pill and btw, period pain is normal.

No it bloody well isn’t (sorry for swearing but time for diplomacy is over). Women need a voice and need to be heard. Some of these poor women may not be able to have children, or have a healthy sex life, or be able to feel the pleasure of wonderful sex without pain, or ever hold their own baby, because they have been told to suck it up and be told that period pain is normal.

Period pain IS NOT normal and the sooner we get everyone to know this important fact the better. Sure, a little bit of discomfort can be normal. By that I mean just a tiny bit of pressure and basically knowing your period is about to come. But pain…. That is not normal. If you, your friend, your daughter, your sister, your wife, or any other woman you know, has to have days off work, days of school, is laying on the floor in pain, taking pain killers to get through the day, or beginning of their period, then that IS NOT normal.

Please get them to get a referral and see a good specialist who will listen to them and not dismiss them and may miss a gynaecological issue that could affect them for the rest of their lives. No… scans and blood test etc, do not always find the cause of period pain. Have a read on my other posts about this.

If you cant find someone that will listen and help, then book in a consult with me and I will assist you in getting you properly investigated and properly managed moving forward

My motto is “No Stone Left Unturned”and my other motto is “Period pain IS NOT normal”. If you are in pain with your menses, or even any any other time during your cycle, or having pain with sex, or pain with ovulation, pain with bowel movements, pain for no known reason at all, then you need to get something done about it.

I think if I hear one more poor woman get told that Period Pain is normal, I am going to start sending those people gruesome pics of all the insides of women who have been told that period pain is normal, only to find out that it isn’t and all the reasons why.

Sorry for the rant, but our daughters, our sisters, our wives, our female partners and women all over this world deserve better.

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Period Pain IS NOT Normal

-The Endometriosis Experts

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Getting a handle on pain with proper pain management

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One of the things that I see not managed very well is pain. I think much of this comes around a perception that we should be able to manage pain with over the counter medications and some of it is also not really knowing what to do, if what we are doing for ourselves, or are currently doing, isn’t working. Some of it is also that healthcare practitioners aren’t managing it well either.

Now, before I start talking about pain, and so that people understand where I am coming from, I need for people to know one thing.  Everyone’s pain levels are different and everyone’s cause of pain is different too.

I also know what it is like to live with pain daily and manage a chronic condition that causes pain and affects one’s life. So I understand pain and understand it well and I sympathise with anyone who is in pain. So I just ask for people to take the personal out of this, just listen and hear what I am going to say.

Again I have lived with chronic and acute pain daily and I know what it is like and I have loved ones who have to manage it daily as well. So what I am about to talk about is coming from a place of caring, wanting to help and also knowing how to manage pain on a clinical level as a healthcare professional.

Every day I see people posting in closed groups asking for help with pain and things they can do to manage pain. It breaks my heart hearing what some people put up with, or if I see they aren’t being told the right thing, or being clinically managed properly.

Often I see people putting up with pain because they fear going to the hospital, seeing their specialist, seeing someone else,  or that they should be able to handle it themselves.

No matter what, constant and acute pain is not good for the body and it also means that there is something wrong and it needs to be attended to. The longer pain is there, the more damage it does to your body on a cellular level. Long term pain causes cellular death and disrupts nerve pathways, pain pathways and emotional pathways to the brain too.  This is why proper pain management is so important.

The thing is, pain needs to be managed, just like any other health issue, and if it isn’t managed, or managed well, then it can really affect ones physical and emotional wellbeing. I know people will say that long term medication isn’t good, and it isn’t, but long term unmanaged pain can be far more detrimental than any long term medication. It truly is a catch 22 situation.

When pain gets to a point where over the counter medications aren’t working, or even some prescription medications aren’t working, then something needs to be done about it.

This either means surgical intervention, or it means that you need stronger medications and you need this in the form of proper medical management of that pain.

It may also means other therapies and treatments outside of what you are currently using and being managed with. It also requires working on the emotional pathways that may also be exacerbating pain. This is why talk therapy and working on emotions is such and important aspect of pain management. You need that multimodality approach for proper effective pain management.

Many times when I hear that people are in pain, one of the things that stops them doing anything is that they perceive that nobody is going to help them because what they themselves have tried, hasn’t worked.

I wish I could get it through to people in pain, that the best thing they can do is go and get the pain managed properly. This often means a trip to the nearest hospitals emergency department and I think this is where people then talk themselves out of it. It is always better to go and be managed properly, than sit at home still in pain. Once pain is managed properly, then you need to see someone who can help your pain, and your condition properly moving forward.

When people come to see me and then I have to refer them for surgery, one of the things I always talk about and have an action plan for is pain management. I always tell my patients to properly manage pain after surgery and even do precautionary pain management post-surgery.

I always give my patients a handout and action plan for pain management, whether they need it or not.  After surgery there is often a bit of illusion state around pain, because there have been anaesthetics used and other heavy duty sedatives. So often people wake up in recovery and think the pain isn’t as bad as it is, because it is being masked from the anaesthetics.

Then they go home and don’t bother to keep up their pain meds and then the pain kicks in and then it is really hard to get back on top of it again once it starts. Once the pain cascade starts, then it is really hard to then try and get back on top of that pain yourself.

This is why it is always good to take precautionary pain medications for a few days (or longer) post-surgery and then taper them down and start using some other alternatives to manage the pain. I’ll discuss some great alternatives for pain management later on, but for now, let’s just talk about the medical and pharmaceutical options.

The basic same principles also apply to people who have flare ups with pain, or have chronic, or acute pain. It needs to be managed and it needs to be managed as soon as possible. The longer you are suffering in pain, the harder it is to treat and get under control.

Sure, try all the conservative treatments for pain such as over the counter medications, herbal medicines, acupuncture, yoga, meditation etc, but if those aren’t working well enough, or aren’t working at all, it is time for medical intervention. The same goes in reverse too. You also need to look at the emotional aspects and cause of pain too. Again, you cannot treat one without the other.

Sometimes the body has been in pain that long, that you also need to turn that response off, because it has actually become a habit, rather than the body actually still being in pain. This one is a bit tricky to explain to people, but in essence what we need to do is actually tell the body it isn’t in pain any longer, so that it switches off that response in the brain.

Getting back to acute pain, and when pain is getting out of control, this is where I need people to listen. Many times I see people posting in groups, telling their support group and that they are in pain and saying things like that they feel it would be pointless to go to the hospital, as they usually do nothing to fix their issue.

The thing is sure, emergency departments aren’t there to fix chronic conditions, but, they are there to help you get out of pain, or patch you up, and then refer you on for appropriate management if need be.

Now, before I talk about this next bit, if you are in acute pain and do not know what it is from, you need to go and get that pain looked and get it under control. You can either consult with your healthcare provider (GP etc), or go to your nearest Emergency centre.

Speaking about emergency centres and hospitals, I need to let people know that there is no shame in going to these places to get your pain under control properly.

I also need people to know that emergency centres (A&E) are not there to fix your long term issue. They are there to assess imminent danger, control pain etc and then patch you up and refer you on to other specialists in the field of what your particular issues is. That is it.

All too often people do have a perception that if they turn up to emergency department, their long term health issue is going to be fixed. That is not their job. Again they are there to assess danger, control pain, stop your dying (if that is needed), then refer you on for appropriate management.

Sometimes that means staying in hospital until you are stabilised. All too often I hear people saying that they went to emergency and they did nothing. Well, I doubt they did nothing. They would have assessed you, medicated you (if necessary) and if your condition isn’t life threatening, you would most probably be sent home. That is what they do.

This gets me back to those in pain and are trying to talk themselves out of going to hospital, because apparently, through past experience, or someone has wrongly told them, that they won’t be able to help you. This is wrong.

If you are in acute pain, you are best going to your closest emergency centre, where trained people, not our untrained internet buddies, can assess you properly and then help you with pain and stabilise you.

If all emergency do is control your acute pain and make sure you aren’t dying and are stable, then they have done their job. Controlling someone’s pain can actually stabilise the body in more ways than one. Once that pain is stabilised, then what you need to do is ask them for medications to be continued to actually help with the pain cycle.

You can also continue on with previously prescribed medications to control that pain, now that stronger medications have been administered and your pain levels have lowered. This then buys you time to see your regular healthcare provider as soon as possible and talk about a better pain management plan.

If that said provider isn’t managing you properly, then you need to get a second, or third, or tenth opinion. Look, every profession has people who are not good at their job and some healthcare professional are crap at things like pain management. So, find someone who can help you with ongoing pain management. If you can’t find someone, then message me for details of someone who can. Better still, book in a consult to see me, where I can assist you and your condition and help you get the best help, advice, care and proper health management possible.

There are now also some pain modulators (neuro-modulators) and implants that are being used to control pain too. People are also getting great results with botox and other injectables. There are many options for pain management now and as said before, it does require seeing the right people and also using a multimodality treatment approach.

This also requires working on the emotional aspect too. Yes, I am mentioning it again so people finally get that we also need to deal with the emotions, if we are to manage pain properly.

Last but not least, sometimes you need to look outside the medical model, for help with pain. Actually I believe it is essential. Sure, get your acute pain managed with medical intervention, but you may also need to look at complementary medicines for ongoing pain management, especially chronic long term pain.

No medicine has all the answers, so this is why I am very passionate about people using a multimodality approach to their health issues and especially for pain management. I always say to people that if what you were doing currently is helping, then you wouldn’t be in pain and if you are still in pain, it means you need to change something, or look at other ways to manage it. Unfortunately while modern medicine saves lives and can help us in so many ways, it doesn’t have all the answers either.

If you aren’t getting the help you need, then book in a consult with me and I will do my best to get you the help and care you deserve and should be getting. I also have a great network of trusted professionals I work with if it is outside something that I do, or if you need that team approach for your condition. I have my trusted team and that is what you may need too.

One more thing, for anyone, pain is the sign that something is wrong in the body and means it needs to be addressed. Oh and always remember, period pain is not normal either.

Take care

Regards

Dr Andrew Orr

-Women’s & Men’s Health Advocate

-No Stone Left Unturned

-The Women’s Health Experts

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Asking the Right Questions about Period Pain & Gynaecological Issues.

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All to often women have gynaecological disease states “missed” and “dismissed” because their healthcare practitioner was not asking the right questions about period pain and gynaecological issues.

I didn’t know how I was going to start this post, or begin to talk about what I am about to talk about, other than I got some inspiration after a text message, and a phone call later on,  from my eldest daughter some time ago.

I will talk about that soon. But let’s talk about some of the phone calls and messages I get from people every day and how some of these messages gives me a heads up into what may be going on for these people and then getting them in for a proper consult and the right help.

Every day I get phone calls, emails, Facebook messages etc, from women (young and older) who are experiencing period pain, menstrual issues, and other related symptoms and nearly all of them have the same story.

“I have been to the GP and I have had blood tests and scans and they say that there is nothing wrong”. This is what I hear all so often.

It happens so often and it is like there is a script written for these poor women who just want to get out of pain and get some sort of normal life back. I get so annoyed when I hear this repetitious line. Not at the people telling me, but knowing that these poor women really haven’t been investigated properly at all and probably won’t be unless they come and see me.

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

It read “Hey Dad, is endometriosis hereditary?”

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

I anxiously awaited the next reply and thankfully she was asking on behalf of a friend. But this poor friend had been experiencing really bad period pain and had basically had blood tests and scans and been told that everything was normal.

Apparently one of the scans showed some fluid in the Pouch of Douglas (POD), which can actually be a sign of endometriosis and inflammation. Worse still, this poor girl’s mother actually has endometriosis and nobody is putting two and two together and asking the question “I wonder if the daughter may have it too?”

Well, there is more than a good chance that she does have it and thank goodness my daughter actually knows the signs and knows that scans and bloods tests cannot diagnose many gynaecological issues, especially endometriosis.

Lucky my daughter also knows that you need to see an advanced trained laparoscopic surgeon who specialises in the excision of endometriosis and has done years of extra surgical training to specialise in these disease states. The good thing is that she knows that you cannot just see a regular gynaecologist to get this done.

But, not everyone is as fortunate as my daughter to know this and help her friend to come and see me to help her see my surgeon and then I can help her with management of the disease, if found (which is highly likely) after the surgery.

The other good thing is that my daughter knows there is no cure for endometriosis and that surgery isn’t going to fix the problem either. She knows it will help, and is needed, but after the surgery, the management post surgery is the most important, for disease states like endometriosis.

Unfortunately not many people know this and don’t have the disease managed properly post surgery. Women with endometriosis and some other inflammatory gynaecological issues will need a team approach, or a multimodality approach  post surgery, because even with the best medical intervention, it really isn’t enough and why so many women have the disease and symptoms return, or may still be in pain and have other recurring symptoms.

There is never a one treatment, one pill, fix all approach to disease states such and endometriosis. This is where so many go wrong.

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

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

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

All those 5 questions can tell me much about what some of these poor women have had done, or haven’t had done, and then I can formulate an appropriate treatment plan and management for these women moving forward.

It is always hard explaining to the ones that have had surgery before that they haven’t seen the right surgeon and that they are going to need further surgery. The hardest thing for me is seeing women on support pages about to have their first surgery and I always worry that they aren’t seeing the right surgeon and if they don’t, there is a good chance that they are still going to be going through the same issues, over and over again, until they find the right person to help them.

If only I could see all these women before they did anything, so that they can be given the right information and the facts and be managed properly.

The good thing is that when I do get to see women who chose to see me, I can explain to them the facts and the right information and then why and how with a proper surgeon, that it can make a huge difference to how they are feeling and their recovery and management post surgery.

I can also explain how surgery really is necessary, but is only a small part of their overall treatment and management of their disease moving forward. I can also explain the facts around their disease moving forward too and make sure that women under my care are given the right information, the right investigations and right management going forward.

This is why my initial consultations take about an hour and a half and we go over everything from their health history, medical history, hereditary issues, diet, lifestyle, surgical intervention, medications, natural medicines, blood tests, scans, investigations, sleep, sexual health, libido and everything that a woman needs to know about her particular issues.

It is also about listening to a woman’s concerns and complaints and really hearing what she has to say and is experiencing.

Then I formulate a treatment plan and management and 20 page report of findings for them for what we are going to be doing to help them moving forward.

I also give them a step by step treatment plan of treatments and medicines etc they will need too. That is why my motto is “No Stone Left Unturned”, because there is no stone left unturned and I also make sure they see the right people (surgeons and anyone else that they may need to see).

If there are things that I can’t do (surgery etc), I make sure that my patients only see the best people, in my trusted network,  and then I can help manage their disease state alongside other specialists and medical interventions.

I wish I could see every woman before they went for any investigation, or surgery, so I can point them in the right direction and help them manage their gynaecological condition properly.

This is why I am so passionate about doing my posts on social media, or giving time for charity events to talk about women’s health issues and gynaecological issues such as endometriosis, adenomyosis and PCOS.

It is why I do healthcare practitioner education and seminars to help educate them better too, so that they can help their patients better and not miss and dismiss them.

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

Lastly, I cannot say it often enough….. Period Pain “IS NOT” normal and if you, or your daughter, or your sister, or your mother, or cousin, your best friend, or anyone you know has period pain, especially bad period pain and other symptoms, please, please, do not tell them that this is normal.

Period Pain is not normal and women who are experiencing period pain need to see someone who specialises in women’s health and gynaecological conditions, so that they can be investigated properly and have their issues managed properly too.

If you do need assistance with a women’s health issue, you can make a booking to have a consultation with me. Please call my friendly staff to find out more.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Care Advocate

-The Endometriosis Experts

-The Women’s Health Experts

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The Truth About Natural Killer Cells & Miscarriage

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On a daily basis we get people, who are having failed IVF cycles, calling my clinic looking for some miracle pill, to supposedly eradicate the body of natural killers cell and wipe them off the face of the planet in some war like rage, all because they have been told this will bring an end to their fertility woes.

I wish it was that easy and when my staff go on to explain that treating natural killers cells (uterine killer cells), and especially looking at the cause of natural killer cells (uterine killer cells), is complex, there is no one miracle cure, nor some magic pill, people get annoyed and hang up the phone in a huff ,without listening to the reasons why.

One of the things I always say, when people ask me about regulating natural killer cells for fertility purposes, is “How long is a piece of string?”

This is because this subject is very complex and there are many reasons why natural killer cells may be impacting implantation. So, hence the response is always going to be “How long is a piece of string?”

While Natural killer (NK) cells have an important role in the early responses to viral infections, they have also been linked with failure of pregnancy.

Increasingly, clinics are offering blood tests, at an increased cost to the patient, to measure the number and activity of circulating NK cells. As a result of these investigations, many women are offered treatments such as steroids, intravenous immunoglobulins, and tumour necrosis factor blocking agents. The scientific rationale for these tests and treatments, however, is not always supported by our current knowledge of the function of uterine NK cells.

So, I thought it was about time I set the records straight on the BS information, that seems to being handed around as gospel, by money hungry fertility clinics run by big health conglomerates, and by the rotten Dr Google, about natural killer cells (uterine killer cells) and these supposed miracle pills, that will miraculously fix someone’s fertility issues.

Let’s Look at the Facts about Natural Killer Cells Relating to Miscarriage

  1. There is no miracle pill, or one supposed miracle treatment, or a one pill solution to treat, or get rid of natural killer cells. You do not want to get rid of NK Cells.
  2. Natural Killer Cells are a natural part of the immune system designed to target inflammation, kill of cancer cells, kill off bacteria and protect the body from harmful invasion of foreign organism
  3. There is huge difference between natural killer cells that are circulating in the blood stream, compared to uterine killer cells
  4. Uterine Killer Cells are in large numbers during a pregnancy to protect the embryo
  5. Natural Killer Cells are only in large number and are only being sent out by the immune system because there is some inflammatory process going on in the pelvis, or the rest of the body
  6. You cannot regulate Natural Killer Cells numbers unless you first address the inflammatory process that is causing them to be in high numbers in the first place (Eg- Inflammatory gynaecological conditions such as PID, Endometriosis, PCOS, Adenomyosis, Adhesions, STI’s, CIN, HPV, Herpes etc)
  7. Many people have not had the proper initial fertility investigations and testing needed to actually fall pregnant in the first place and looking at Natural Killer Cells, before all that proper testing etc is done, is actually not assessing the patient properly.
  8. If you do not treat the cause of the Natural Killer Cells being in high numbers, you will not be able to reduce the numbers of Natural Killer Cells that are actually doing the job they are meant to do, which is …. Protect the Body.
  9. Many of the so called treatments for Natural Killer Cells, regarding fertility, have never been approved for such treatment and research on it is still inconclusive.
  10. Some of the treatments being proclaimed as miracle cures (Intralipids etc) are purely money making exercises that are preying on the vulnerability of people who have been told wrong information and have this perception of some killer being inside their body attacking their embryos.
  11. Intralipids have never been proven to treat Natural Killer Cells and are derived from highly inflammatory soy based compounds, which then in turn can cause more inflammation.
  12. The drugs used in the treatment of Natural Killer Cells are steroidal based and carry many side effects and are for more harmful to the body that any natural killer cell will ever be. The steroids are also a category C drug that has been shown to have an effect on the neonate
  13. Steroids, such as Prednisone, do work on regulating NK cells, but they do so by suppressing the immune system, thus compromising a person’s immunity. There are also risk to peoples minerals by using these long term and there are also other side effects to the body.
  14. Natural Killer Cells are there to protect the body, not hurt it.
  15. Natural Killer Cells may only be attacking embryos because they are seen as foreign body as well and when they are there trying to kill of the diseases and issues causing inflammation in the body, they just happen to kill of any other foreign organism and inflammatory processes at the same time
  16. Again, to address natural Killer Cells, you need to address the inflammatory process as to why they are in high numbers in the first place
  17. The perception around Natural Killer Cells being this “thing” killing off embryos in the body is misguided and is actually not a true representation of what Natural Killer Cells actually do. It is purely often used to tug on the heartstrings of unsuspecting patients, who are highly emotive and clinics use these emotions to get them to pay for treatments that have never been fully proven to work.
  18. The name “Killer Cell” is too often exploited in the wrong context by many in the fertility world
  19. Blood tests cannot measure the number of Natural Killer Cells in the Uterus, Only a biopsy can do this.
  20. A Natural Killer Cell (uterine killer cells) Biopsy has to be done between the 24th and 28th day of your menstrual cycle to give the best results.
  21. Blood tests can only measure the circulating NK cells in the body and not the uterine killer cell activity, which can be the cause of recurrent miscarriage. So, if you have had a blood test, it is not measuring what is needed. Everyone will have circulating NK cells in their blood stream.
  22. The percentage of CD56+ NK cells in peripheral blood in normal healthy individuals varies from 5% to 29% (2)Despite this, more than 12% NK cells in women with infertility or miscarriage has been arbitrarily defined as abnormally raised and used as an indication for treatment (4)
  23. The percentage of NK cells in blood can be affected by many factors including sex, ethnicity, stress, and age too.
  24. There is now new evidence that shows that natural killer cells help with implantation and a healthy uterine environment, which now supersedes old outdated research.

Natural Killer cells (Uterine killer cells and other NK cells) are the main immune cell-type found in the uterus. Their numbers increase through the menstrual cycle to peak at the time of implantation. If an embryo does implant, NK cell numbers increase further to 70% of all cells.

Uterine NK numbers start to decrease at around the 20 week mark of pregnancy and are all but absent at the end of pregnancy.

Natural killer cells acquired their name as a result of the initial test used to identify them in vitro. Unlike T lymphocytes, NK cells are able to spontaneously kill cells in a non-MHC restricted manner.

Regrettably, this is a misleading name in reproduction, and the powerful image of maternal cells attacking the fetus is emotive and easily exploited. None the less, these NK cells can kill off the embryo at early stages of pregnancy, but there is nearly always a reason why. That reason is inflammation in the pelvic cavity and uterus. This needs to be addressed to regulate the number of NK cells, not some notion of killing off the “Killer Cells”.

Types of Inflammation causing high Natural Killer Cells (Uterine Killer Cells)

  • Endometriosis & Adenomyosis
  • PCOS/PCO
  • Fibroids, Myomas
  • Vaginal Infections & Bacteria
  • STI’s
  • Cancer, Trauma, Localised Lesions & Others
  • Stress

Yes, stress can lead to a compromised immune system, which then leads to high TNF (Tumor Necrosing Factor) and increase Natural Killer Cells, which then leads to prolonged increase activated T Cells, and this then causes reduced implantation of embryos.

This is also a reason why any inflammation in the uterus or pelvic cavity needs to be addressed to help fix this issue and one of the reasons why any woman having fertility issues needs to be investigated and treated properly.

This needs to involve proper differential diagnosis, proper pathology testing, genetic testing and surgical investigations such as laparoscopy prior to any further fertility treatment. A laparoscopy is the gold standard for addressing and treatment of issues in the uterine and pelvic cavity.

Natural Killer Cells (Uterine Killer Cells) may be a part of recurrent miscarriage, but we need to stop the misinformation and perception of them being some killer organism that isn’t meant to be in the body. They are meant to be in the body and the name is all too often exploited by many to offer unproven treatments and medications by clinics trying to increase profits.

If you want to regulate and treat natural killer cells (relating to recurrent miscarriage) properly, you need to find out what is causing them to be there in the first place. There is no magic pill to get rid of Natural Killer Cells.

You cannot rid the body of Natural Killer Cells anyway. They are meant to be there. You can only regulate the amount of killer cells doing their job and you need to find out why they are in higher numbers in the first place. This is usually because there is some sort of inflammation, infection, bacteria, or malignancy going on in the body that has not been investigated properly in the first place. Let’s not forget that stress, yes stress, increases the amount of Natural Killer Cells in the body too.

As part of my fertility program, I talk to couples about the facts about Natural Killer cells, and makes sure that proper investigations, testing and treatments are administered and managed properly. This can also be done alongside current medical protocols such as the Bondi protocol, or California protocol.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

-The International Fertility Experts

References

  1. Moffett-King A. Natural killer cells and pregnancy. Nat Rev Immuol 2002;2: 656-63.[CrossRef][Web of Science][Medline]
  2. Pijnenborg R, Vercruysse L, Hanssens M, Van Assche A. Incomplete trophoblast invasion: the evidence. In: Critchley H, MacLean A, Poston L, Walker J, eds. Pre-eclampsia. London: RCOG Press, 2003: 15-2615. Parham P. NK cells and trophoblasts: partners in pregnancy. J Exp Med 2004;200: 951-5.[Abstract/Free Full Text]
  3. Hiby SE, Walker JJ, O’Shaughnessy KM, Redman CWG, Carrington M, Trowsdale J, et al. Combinations of maternal and paternal innate immune genes influence the risk of pre-eclampsia. J Exp Med 2004;200: 957-65.[Abstract/Free Full Text]
  4. Aoki K, Kajiura S, Matsumoto Y, Ogasawara M, Okada S, Yagami Y, et al. Preconceptional natural-killer-cell activity as a predictor of miscarriage. Lancet 1995;345: 1340-2.[CrossRef][Web of Science][Medline]
  5. Ntrivalas EI, Kwak-Kim JY, Gilman-Sacchs A, Chung-Bang H, Ng SC, Beaman KD, et al. Status of peripheral blood natural killer cells in women with recurrent spontaneous abortions and infertility of unknown aetiology. Hum Reprod 2001;16: 855-61.[Abstract/Free Full Text]
  6. Bisset LR, Lung TL, Kaelin M, Ludwig E, Dubs RW. Reference values for peripheral blood lymphocyte phenotypes applicable to the healthy adult population in Switzerland. Eur J Haematol 2004;72: 203-12.[CrossRef][Web of Science][Medline]
  7. Kwak JY, Kwak FM, Gilman-Sachs A, Beaman KD, Cho DD, Beer AE, et al. Immunoglobulin G infusion treatment for women with recurrent spontaneous abortions and elevated CD56+ natural killer cells. Early Preg 2000;4: 154-64.
  8. RCOG Scientific Advisory Committee. Immunological testing and interventions for reproductive failure. London: RCOG, 2003. (Opinion paper 5.)
  9. Scott JR. Immunotherapy for recurrent miscarriage. Cochrane Database Syst Rev 2003;(1): CD000112.
  10. Daya S, Gunby J, Clark DA. Intravenous immunoglobulin therapy for recurrent spontaneous abortion: a meta-analysis. Am J Reprod Immunol 1998;39: 69-76.
Pain With Sex Dyspareunia

Do you suffer pain with sex? (dyspareunia)

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Pain with sex, Intercourse pain, or dyspareunia, can cause problems in a woman’s life and it can be a cause of problems in couple’s sexual relationship. In addition to the physically painful sex, there is also the possibility of negative emotional effects. Then even when a woman may feel aroused and wanting sex, the fear of the pain can cause the whole process of wanting sex to stop.

How many people get Pain with Sex

It is estimated that about 20%-25% of women suffer vaginal pain with foreplay or intercourse. Pain can be acute, intermittent or chronic and can stem from a wide variety of causes that will be covered shortly. Unfortunately when women complaining of pain during sex, they are often dismissed as being inhibited, having psychiatric issues, or merely just making it up to get out of having sex. Many men would like to boast that it is them being well endowed that is causing the problem (they wish) but in fact if your partner is in pain, then you need to actually stop and listen to the reasons why. The fact is most of the time, their symptoms are related to legitimate medical issues that need to be investigated and treated accordingly. So guys, get your hand of it and start listening to your partner if she says she is getting pain.

What causes pain with Sex (Dyspareunia)?

In many cases, a woman can experience painful sex if there is not sufficient vaginal lubrication. There could be many reasons for this and one that is commonly seen in menopause. When this occurs, the pain can be resolved if the female becomes more relaxed, if the amount of foreplay is increased, or if the couple uses a sexual lubricant. Issues like this can easily be overcome, but there are some medical and gynaecological issues that could be causing the pain and being very much overlooked.

So what are the other causes of Pain with Sex?

Endometriosis – This is a condition in which the endometrial like tissue (lesions) that lines the uterus grows outside the uterus. It can cause all sort of pain in the pelvis, bowel and rest of the body, but it can cause pain with sex. It is one of the leading conditions that does cause pain with sex. Many women with endometriosis may not have symptoms of it, or may only have one symptoms like pain with sex. Symptoms do not correlate to the extent of the disease either. Some people with small amounts get lots of pain, while others can have lots of it and have no pain. Endometriosis can only be properly diagnosed via surgery (laparoscopy)

Adenomyosis – is a condition which is very similar to endometriosis. It is a conditions in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). Adenomyosis can cause menstrual cramps, lower abdominal pressure etc, before the menses and can result in heavy periods.  It can also cause pain with sex. The condition can be located throughout the entire uterus, or localized in one spot

Vaginismus-  This is a common condition. It involves an involuntary spasm in the vaginal muscles, which closes up the vagina and prevents penetration from happens. It is sometimes caused by fear of being hurt.

Pelvic Floor Hypertonus– Pelvic floor hypertonus occurs when the muscles in the pelvic floor become too tight and are unable to relax. Many women with an overly tight and non-relaxing pelvic floor experience pelvic health issues such as constipation, painful sex, urinary urgency, bladder issues and pelvic pain.

Vaginal Infections-  These conditions are common and include yeast infections such as thrush and candida and these can cause inflammation to the vagina and cause pain with sex and also localized bleeding.

Vaginal skin conditions– Dermatitis around the vulva and also a condition called Lichen Sclerosis can all cause pain with sex due to the inflammation of the skin.

Atrophic Vaginitis – Atrophic vaginitis is a vaginal disorder that usually happens after menopause, but it can happen long before this time as well. When estrogen levels fall, the vaginal walls can become thin, dry, and inflamed. This then causes the surrounding tissue to lose its elasticity and become atrophied.

This can be uncomfortable and it can make sex uncomfortable, or extremely painful

Problems with the cervix (opening to the uterus) –In this case, the penis can reach the cervix at maximum penetration. So problems with the cervix (such as infections) can cause pain during deep penetration.

Problems with the uterus – These problems may include polyps, cysts, fibroids etc that can cause deep intercourse pain.

Problems with the ovaries – Problems might include cysts on the ovaries, or tubal disease.

Pelvic Inflammatory Disease (PID) – Often referred to as penis injected disease. With PID, the tissues deep inside become badly inflamed and the pressure of intercourse causes deep pain.

Ectopic Pregnancy – This is a pregnancy in which a fertilized egg develops outside the uterus, or into the tubes. It can cause immense pain and even death if not death with properly.

Menopause- With menopause, the vaginal lining can lose its normal moisture and tone and become dry. The vagina, uterus and surrounding organs can all suffer atrophy, which can cause bleeding and pain (see atrophic vaginitis above). It can also cause prolapse.

Intercourse too soon after childbirth, or surgery – Trying to have sex too soon after childbirth, or a surgery,  can cause pain during sex.

Sexually Transmitted Infections (STI’s) – These may include chlamydia, genital warts (HPV), genital herpes, or other STI’s.

Injury to the vulva or vagina- These injuries may include a tear from childbirth or from a cut (episiotomy) made in the area of skin between the vagina and anus during labor.

How Can Painful Sex In Women Be Treated?

Some treatments for painful sex in women do not require medical treatment. For example, painful sex after pregnancy can be addressed by waiting at least six weeks after childbirth before having intercourse, or when a women feels she is ready again. Make sure to practice gentleness and patience.

In cases in which there is vaginal dryness,  or a lack of lubrication,water-based lubricants will help. In the cases of some conditions such as menopause, topical estrogen creams may be needed to bring tone back into the vaginal wall, along with lubricants during sex.

Some of the conditions such as endometriosis, PID, fibroids, or trauma to the vagina and will require surgery and adjunct therapies such as hormones and other medications.

Other issues such as vaginal infections, bacterial infections, skin conditions, STI’s etc may just need medications such as antibiotics, antifungals, steroids and other medications for their treatment

Some conditions like vaginismus, or psychological traumas (sexual abuse), may require a person to see a counselor, psychologist, psychiatrist, or sex therapist.

There are also natural medicines such as Acupuncture, Chinese Herbal medicine,  herbal supplements etc which may assist with pain, either on their own, or in combination with medical treatments and talk therapy

Final Word

If you do have pain with sex, you need to go and speak to your healthcare provider, or seek the help of a gynaecologist, or women’s health expert.

Pain with sex is not normal, and you need to find out the cause of these issues and not put it off. Many times there are non-invasive and easy treatments to help.

If you need help in finding out how to manage pain with sex, and the causes, please give my friendly staff a call to find out how I can assist you.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicine

-The Women’s Health Experts

3d image of sperm cells

Facts About Sperm Health and Their Lifespan

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There is a lot of misinformation with regards to facts about sperm health and their lifespan.

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

It takes around 90-120 days for a sperm to become motile

From a tiny sperm cell it can take between 90-120 days before a sperm is fully mature. The sperm eventually develops a head and tail, so that its cells start to resemble the shape of a tadpole.

The head contains all of the DNA, or genetic material, and the sperm uses the tail to help it move. A sperm doesn’t reach full motility until it actually reaches the egg, where when touching the egg it creates a reactions that causes “super motility” to give it the final power to push inside the egg. This is called the acrosome reaction.

There has been lots of debate about the actual time it takes for a sperm to mature and become fully motile, but general consensus is that it will take somewhere between 90-120 days.

This is why it is important that men look after their health long prior to conception, because the sperm they ejaculate today was created around 90-120 days ago and what they did to their bodies at that time, will influence how healthy those sperm are.

A man’s lifestyle affects his sperm quality

So if a man had a poor diet, was drinking, smoking, had heaps of stress and goodness knows what, this can all have an impact of the maturing sperm and this can result in poor sperm quality and damage to the DNA of the sperm, which will then be carried onto his offspring, should the sperm be successful in fertilising an egg. This is why the couple need to be healthy prior to conception, not just the female.

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

What factors impact on sperm health?

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

Health and lifestyle factors

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

Environmental causes

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

Medical reasons

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

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

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

Sperm lifespan inside the female body

After ejaculation, sperm may be able live inside the female body for several days, but that is dependent on many varying factors once they enter a woman’s body.  To be honest, most of the 300-500 million sperm are dead with an hour. That is a fact.

The fluid in a woman’s reproductive tract, especially the fallopian tubes, has all of the nutrients that sperm need for their survival during that time. But while the woman’s body can help sperm on their way to meet the egg, it can also hinder it their survival as well.

An egg has 24 hours to be fertilised, otherwise it dies

But even so, sperm really only have about 24 hours to fertilise an egg once it is released. After 24 hours, if the egg isn’t fertilised it will die, so really, it doesn’t matter how long the sperm can survive for if the egg has already died.

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

Climax helps with getting sperm into the uterus

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

Only a small number is sperm survive the journey

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

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

All men should have there sperm quality tested

This is why all men need to have their sperm quality checked by a proper andrology lab and some men will need further testing of the DNA (DNA fragmentation analysis) and further genetic testing if the semen results are poor.

This should all be done prior to trying to conceive, as 50% of fertility issues are related to men. If a man has any of these risk factors, he should try to change them at least 3-4 months before trying to conceive, since that is how long it takes for sperm to fully mature. Some men may need longer than this, depending on what is causing their sperm to be of poor quality.

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

Regards

Dr Andrew Orr

-Women’s and Men’s Health Advocate

-No Stone Left Unturned

-The International Fertility Experts

How to deal with endometriosis

How to cope with endometriosis and manage it moving forward

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Endometriosis can be a challenging condition to deal with, both physically and emotionally. But with proper interventions and proper management and treatments after diagnosis, you can be shown how to deal with the associated symptoms of endometriosis and improve your quality of life. Please have a read of some of the best ways to cope with endometriosis.

What is Endometriosis?

Endometriosis can be painful disorder that is characterized by tissue that behaves like the lining of the uterus but that grows outside the uterus. Endometriosis is really normal tissue growing in abnormal places. This tissue can be found in various places, such as the ovaries, fallopian tubes, and pelvic lining, and even in or around the bladder and bowel.

Endometriosis affects around 1 in 10 women and girls and those are only the ones diagnosed. This mean these figures are grossly under-diagnosed and downplayed with many women not being diagnosed properly and those that do not even know they have the disease. Endometriosis can cause symptoms during the reproductive years, between the ages of 12 and 60, but it can show up in young girls under 10 years old too.  Many people with the condition remain undiagnosed and many more and missed and dismissed with many taking up to ten years or more to be diagnosed.

What are the symptoms of Endometriosis?

The main symptom of the condition is usually pelvic pain typically associated with the menstrual period. While women can experience some discomfort during their menstrual period, some of those with endometriosis describe pain that is worse than usual. For some it is actually unbearable.

There are also other symptoms such as painful periods, pelvic pain, ovulation pain, pain with sex, chronic fatigue, irritable bowel like symptoms, bladder issues and pain and bleeding on bowel movement. This is why all women need to know that period pain is not normal, because many times, period pain can actually be a sign that a woman has an underlining gynaecological conditions such as endometriosis.

We also need for everyone to know that endometriosis is not just about period pain. There are many other symptoms women face when dealing with endometriosis.

There is no cure, but there ways to manage Endometriosis

There is no cure for endometriosis (not yet anyway), but there are treatment options and lifestyle changes that can ease your symptoms so that the condition does not interfere with your day-to-day life.

The main thing with endometriosis is to manage the disease and try and create a quality of life moving forward. While there is no cure for endometriosis, it is possible for women to become asymptomatic (meaning having no symptoms) and this requires the right treatments and management of the disease and to see the right people from the beginning.

Again, it all gets back to who you are seeing and their experience with knowing about endometriosis. This is one the biggest issues women face when trying to get treatment. Many just do not know much about the disease at all and why women are left to deal with the horrible symptoms. But with the right treatment and management, women can have a better life and be able to cope with this horrible disease.

Before we look at proper management for women with endometriosis, it is important that all understand the facts because there is so much misinformation out there and this is part of the bigger issue for women with this disease.

Surgical intervention and medications alone are not enough

While surgical interventions are hormones/medications are needed for women with endometriosis, alone, or in combination are not enough. We know that despite the best surgical and medical intervention that women are still in pain and still having the associated symptoms of endometriosis. This is why women do need a multimodality/team approach, and a combination of different modalities to effectively manage endometriosis.

The problem for many is that once they have the surgery, they believe their endometriosis is gone, or that they don’t have to do anything else. This is where many go wrong and why they end up having to have multiples surgeries. Women need proper ongoing management after surgery, which includes medications, hormones, other therapies, counselling, physiotherapy, mindfulness, exercise, diet and lifestyle interventions and so much more. Without this, endometriosis cannot be effectively managed.

The Facts About Endometriosis

  1. Period Pain IS NOT Normal
  2. A significant portion of women with Endometriosis are asymptomatic
  3. Symptoms DO NOT correlate to the extent of the disease
  4. The only way to diagnose Endometriosis definitely is via surgical intervention
  5. There is NO cure for Endometriosis
  6. Having a baby will not cure endometriosis
  7. Endometriosis does not always cause infertility
  8. Endometriosis is Estrogen Driven and is not caused by Estrogen dominance
  9. The Pill, or Contraceptives DO NOT fix endometriosis
  10. You can have Endometriosis at a Young, or Older Age
  11. Hysterectomy does not cure endometriosis
  12. Endometriosis requires a multi-modality approach to be managed properly. You need a team for proper management
  13. Endometriosis IS NOT an autoimmune disease
  14. There Are Hereditary and Genetic links
  15. Endometriosis can cause many other issues in the body
  16. The first line approach for hormone therapy should be the use of progesterone only options
  17. Endometriosis needs to be excised (cut out) by an advanced laparoscopic surgeon, who has had extra years of specialised surgical training, and who specialised in the excision of the disease and specialised in the disease itself. Surgery should be performed by anyone other than an advanced laparoscopic surgeon and not by just a regular gynaecologist
  18. Not all women with endometriosis have suffered sexual abuse
What Women Can Do To Help Manage Endometriosis

1.Seeing the Right Specialist & Surgeon

First and foremost make sure you have seen someone who specialises in endometriosis and the management and treatments moving forward. You also need to make sure that your first surgery is your best surgery and that you have seen an advanced laparoscopic surgeon to ensure you have had the proper surgical intervention. This is many women’s biggest issue as they have not seen the proper surgeon initially and they aren’t seeing someone who specialises in the management of the disease moving forward.

2.Watch your diet

Eating the right foods may provide some protection from the symptoms of endometriosis. The role of diet in endometriosis has been investigated in recent years due to the influence of diet on some of the processes linked to the disease, such as inflammation, prostaglandin metabolism, and estrogen activity. Many of the so called endometriosis diets out there are now outdated and have outdated nutritional and dietary advice that don’t really help much at all. Women need to adopt an anti-inflammatory diet (grain free, non-refined food ) to help with settling any inflammation in the body and also helping the immune system. This also needs to include prebiotic and probiotic bacteria to help with digestive function, immunity and gut health.

Certain environmental estrogens such as preservatives, plastics, pesticides and insecticides that can be ingested through certain nutrients have been suggested as risk factors for exacerbating endometriosis too.

Excess body fat, now known as obestrogens (because it is estrogenic) needs to be controlled and managed through diet and exercise too. We know that estrogen drive endometriosis and that any estrogens (dietary, body fats, environmental etc) needs to be regulated and controlled.

3.Boost intake of omega-3 fatty acids

Researchers have also found that the type of fat included in your diet makes a difference in your risk of endometriosis. Studies have shown that people whose diets were heavily laden with trans fats increased their risk of the expression of endometriosis by 48 % when compared with individuals who ate the least of these. By comparison, women whose diets were rich in omega-3 oils lowered their risk of endometriosis by 22 % compared with those who consumed the least amount.

Eating foods high in omega-3 fatty acids, such as salmon, flaxseeds, almonds, and walnuts, may be helpful for endometriosis. Women should also be supplementing with Omega 3 oils too. Just remember, it is all about reducing inflammation.

4.Exercise

Often, people who experience pain fear exercising, in case it causes more problems for them. But over time, regular physical activity may decrease the pain and discomfort that you feel. High-intensity exercise and resistance training can help to reduce the symptoms of endometriosis.

Exercise may help those with endometriosis in many ways, including:

  • encouraging the circulation of blood to your organs
  • maintaining nutrients and oxygen flow to all your body systems
  • decreasing estrogen production
  • reducing stress
  • releasing endorphins in the brain, which are pain-relieving, “feel good” chemicals

Women who regularly exercise may be likely to have the symptoms associated with endometriosis. Research has shown that those who engage in frequent high-intensity physical activity have fewer symptoms of  endometriosis than women who do not participate in regular exercise. High-intensity physical activity, such as running, swimming, weight training etc, may be beneficial for reducing your symptoms.

Low-intensity exercise, including Yoga and Pilates may provide some relief in endometriosis, too. Yoga and Pilates can stretch and strengthen your muscles, help with core strength, help with circulation, which all may be beneficial for pelvic pain management and stress reduction.

5.Managing Stress Levels

Stress is a big factor in any disease and can make any disease worse. Not only can stress be exacerbated by endometriosis, but so can endometriosis symptoms be exacerbated by stress, in a never-ending cycle. Endometriosis could contribute to making your stress levels worse, due to the impact that the associated symptoms have on all aspects of your life, including family and personal relationships and work.

Stress management, Counselling, Mindfulness and Relaxation techniques can help to reduce stress that exacerbates endometriosis-related symptoms and pain.

Women with endometriosis need to manage stress by using mindfulness and relaxation techniques. These can help you to increase your awareness of your body, refocus on something calming, and reduce the activity of stress hormones and inflammation in the body. It is all about learning coping mechanisms and what works best for you, not what works best for others.

6.Try complementary medicine and therapies

Many women with Endometriosis find symptom relief from using a range of different complementary and alternative medicines. The Royal College of Obstetricians and Gynaecologists also recommends that women try natural medicines to help with the management of endometriosis and the associated symptoms. There is now some good research to support many natural medicines treatments such as acupuncture, Chinese herbal medicine, vitamins, omega 3 oils, probiotics, chiropractic/osteopathy, yoga, pilates and more, alongside medical interventions.

Acupuncture and Chinese medicines has some good research around period pain and pelvic pain and may be beneficial to those suffering this disease and its associated symptoms, alongside medical interventions.

Certain strains of prebiotics and probiotics have also been shown to help with the immune system, microbiome, bowel, and digestive associated symptoms of endometriosis. Probiotics have also been shown to not only help with digestive and immune function, but also with the psychological function as well. It does need to be specific strains of probiotics though.

Just like with medical treatments, when it comes to complementary medicines, it is important to find someone who is a qualified practitioner and who specialises in endometriosis. Just like in the medical model, this can also be hard to find.

7.Medications

Your endometriosis specialist can provide you with a list of treatment options for endometriosis and outline the risks and benefits of each. They will take into account your age, your symptoms, whether you want to become pregnant, and any treatments that you have had previously. It is important to manage pain and inflammation so that you can have a life and to be able to function daily.

You may need to use different forms of pain medications on script, as well as those that can be purchased over the counter. Please ensure you speak to your healthcare provider about setting up a pain management plan when using medications

You will also need to look at hormone therapy to help slow down the growth and expression of the disease and microscopic implants and also help with the associated symptoms of the disease. Hormones will usually be in the form of progesterone only medications and gonadotropin-releasing hormone antagonists and agonists. You may be prescribed other hormones depending on your individual case and symptoms.

Although all of these hormone therapies are effective at treating endometriosis, but,  they all have different side effects. You need to talk to your doctor and pharmacists about the side effects and risk factors of any medications and hormones that you are taking.

In Summary

It is important to know that women with endometriosis will need a multi-modality, or team approach to deal with this disease. The team you need and modalities that you will need will be dependent on your individual symptoms.

Try and find healthcare professionals that can offer you a multi-modality approach for ongoing care and support and who also have a team of other people who are experts in the disease too. Again, the approach that you and your healthcare profession choose to take will vary depending on your signs and symptoms, and whether or not you would like to become pregnant in the future.

Before starting any treatment, it is important to know all of your options and the potential outcomes of all of them and to know that the people that you are seeing are and expert in endometriosis and know how to manage the disease properly. That can often be the hardest thing to find and why you need to do your homework and see people who are experts in this area of medicine.

Regards

Andrew Orr

-No Stone Left Unturned

-Period Pain IS NOT Normal

-The Endometriosis Experts

Lichen Sclerosus

What Is Lichen Sclerosis?

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Lichen sclerosis is a long-term problem of the skin. It mostly affects the genital and anal areas. Sometimes, lichen sclerosis appears on the upper body, breasts, and upper arms.

For this article I am just going to talk about Lichen Sclerosis of the genital region (Vulva) and more around how this affects women and how it can be treated and managed.

Lichen sclerosis can cause itching, pain and scarring of the affected areas, but there are treatments available that can relieve symptoms and prevent and treat scarring.

Much of the information out there is also outdated and it all seems to be doom and gloom, so I wanted to do a post and put some positive options up for sufferers. With the right treatment and management, women with Lichen Sclerosis can get their lives back.

Who Does Lichen Sclerosis Affect?

Nobody knows exactly how many women are affected, but it is thought that as high as 1 in 30 women could suffer from Lichen Sclerosis. While anyone can get lichen sclerosis at any age, women after the menopause have the highest risk. In fact, it is about 10 times more common in women than in men. It is possible, but rare, for children to be affected.

What Are the Symptoms?

Early in the disease, small white spots appear on the skin. The spots are usually shiny and smooth. Later, the spots grow into bigger patches. The skin on the patches becomes thin and crinkled. The skin may also be inflamed and red or ulcerated from scratching.

Skin affected by lichen sclerosis can tear easily, and there may be tiny fissures (cracks in the skin). When severe, there may be bleeding and blistering.Sometimes, the skin becomes scarred. If the disease is a mild case, there may be no symptoms. 
Other symptoms are:

  • Itching (very common)
  • Discomfort or pain
  • Bleeding

Many women with lichen sclerosis are often misdiagnosed as having thrush because it too can also causes itchiness around the vulva.

Many women I see also have vaginal atrophy, which can be missed due to the focus on the lichen sclerosis. Women who have  vaginal atrophy can also have pain with intercourse, and atrophic vaginitis can also exacerbate the symptoms of lichen sclerosis. It can be a vicious cycle if it isn’t properly diagnosed.

Some women may have lichen sclerosis, atrophic vaginitis and thrush combined and this is why differential diagnosis is so important and women need to see someone who knows about how to diagnose these issues correctly.

Women need to see someone who specialises in this area and treats these conditions often. With correct treatment and management, women can live very normal lives.

Genital lichen sclerosis

Lichen sclerosis that affects the vulva usually feels intensely itchy. There may also be pain, stinging, burning or discomfort, especially during sex or when urinating.

Lichen sclerosis is a chronic, or ongoing, condition, and over time it can lead to scarring. If this affects the vulva, it may narrow the entrance to the vagina, interfering with sexual intercourse.

Women with severe lichen sclerosis in the genitals may not be able to have sex. The disease can cause scars that narrow the vagina. Also, sex can hurt and cause the patches to bleed.

However, treatment with creams or ointments can help. Women with severe scarring in the vagina may need surgery, but only after lichen sclerosis is controlled with medication. When the skin around the anus is affected, pain when emptying the bowels can lead to constipation.

Four out of 100 women will go onto develop cancer of the vulva and this is why early intervention and management is so important.

What Causes Lichen Sclerosis?

Doctors don’t know the exact cause of lichen sclerosis. Some doctors think a too active immune system and hormone problems may play a role. In women, lichen sclerosis also seems to be associated with autoimmune diseases (conditions where the immune system attacks the body), such as lupus , alopecia and thyroid disease.

It is also thought that people inherit the likelihood of getting the disease.

There may also be a hormonal involvement as It is also more common after menopause, when there is less oestrogen in the body. This is why careful differential diagnosis is so important, so that other conditions are not overlooked as well. This is something that I see happen to women often.

Lichen sclerosis is more likely to appear on skin that has been damaged or scarred from some other previous injury. Importantly, lichen sclerosis is not infectious and your partner cannot catch it during sex.

How Is It Diagnosed?

Lichen sclerosis can often be diagnosed from the appearance of the affected skin. It is important that your GP refer you to a pelvic floor/urodynamic specialist, or women’s health specialist that specialises in conditions affecting the female reproductive organs. Sometimes a referral to a dermatologist may also be needed also.

Besides visual diagnosis, a biopsy may be recommended to confirm the diagnosis. This involves taking a small sample of affected tissue for a pathologist to examine under a microscope. This allows specialists to make sure that it is not a different disease.

Treatment of lichen sclerosis

Treatment of lichen sclerosis is aimed at:

  • Relieving symptoms of itch and discomfort;
  • Healing the lesions (returning the affected skin to its normal colour and texture);
  • Preventing the development of scar tissue; and
  • Treating any scar tissue that has developed.

Medical Treatments for Lichen Sclerosis

Lichen sclerosis is usually treated by applying a strong steriod cream, or ointment to the affected area. This is usually applied daily for several weeks, or months, and then less frequently (once or twice per week) long-term to prevent a recurrence.

Corticosteroid ointment or cream should be applied only to the white patches and gently rubbed in. Try to avoid applying steroid to the normal surrounding skin to help prevent side effects.

Symptoms such as itch may improve within a couple of days of starting corticosteroid treatment. Healing of lesions generally takes longer.

Women with Lichen Sclerosis will need regular follow up consultations and management with their specialist while using these creams and ointments for a long time because they can cause the following

  • Thinning and redness of the skin
  • Stretch marks where the cream is applied
  • Genital yeast infections.

Sometimes, women just do not get better using this medication and there could be other things that could be stopping symptoms from clearing up. This could be from the following:

  • Low estrogen levels
  • Infection
  • Allergy to the medication.

Other treatments

If topical steroid treatment is not effective, your specialist may recommend other medications and treatments that target the immune system and help control inflammation.

  • Sometimes other medications such as Retinoids, or vitamin A-like drugs are used and your specialist may also recommend laser treatment.
  • If scarring has occurred, this does not usually improve with steroid treatment. Scarring in females that is affecting sexual intercourse or urination may be helped by surgery
  • There are also some new medical treatments that are presently being researched and providing some amazing results options and I will discuss at a later date. They are actually natural medicines that are being used as a medical treatments. All I can say is that I have seen the results of this new treatment option and I think it is going to help many people. At present on of my colleagues  is using this treatment to help women as part of a research project. I will update people when I am allowed to say more about this new treatment.

Natural Medicine Treatments

There are natural medicine treatments that may assist in the management of Lichen Sclerosis, alongside medical interventions.

Self-care measures for genital lichen sclerosis

The following self-care measures may help in the treatment of lichen sclerosis that affects the genital area.

  • Gently wash the area daily with warm water and pH neutral soap cleanser.
  • Try not to rub or scratch the area. This can sometimes be really hard when it is itchy and inflamed
  • Avoid tight clothing and any activities that may aggravate itching and discomfort, such as bike riding.
  • Your specialist may recommend you apply cream to gently moisturise and protect the area.
  • Women should use a mirror to become familiar with the location and appearance of their genital lesions, and to apply cream or ointment to the affected area of the vulva.

Complications and follow-up

If you have been diagnosed with lichen sclerosis then it is advisable to have regular follow-up appointments with your specialist every 6 to 12 months.

In addition, genital lichen sclerosis is associated with a small, but important, increase in the risk of cancer developing at the affected site. As mentioned before 4 out of 100 will go on to develop cancer of the vulva.

This is why frequent check-ups are important to detect any cancers early on, when they can be more easily treated. This is why I always say that early intervention and proper treatment and management of any disease and the same goes for lichen sclerosis.

I have helped and assisted many women with Lichen Sclerosis in my years in practice and I do find that a multimodality approach is the best way to assist and manage this disease effectively.

Sometimes you need to have a team to help treat this, just like many other diseases women endure.So many women are are at their wits end with this disease and all sorts of treatments that have not worked. The problem is that they have just seen the wrong people and haven’t been properly looked after.

Women with Lichen sclerosis can be helped if they see the right people and get the right help and proper clinical health care and management. You just need to find the right people who know about this disease and how to treat it properly.

I can say this, if this disease is treated and manage properly, it can give women their quality of life back. Instead of all the doom and gloom and negatives things, let’s get some positivity back and give women with this disease some hope. There always hope and you just need to know where to find it.

Take care

Regards

Andrew Orr

Women’s & Men’s Health Advocate

-“No Stone Left Unturned”

-The Women’s Health Experts

 

Copy of Endometriosis Facts There is no cure for endometriosis

Hysterectomy “DOES NOT” Cure Endometriosis

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Many women are led to believe that hysterectomy is a cure for endometriosis and this is probably one of the most non-factual statements that many healthcare professionals are guilty of telling women. This is because they lack the understanding of the disease and lack knowledge of how the disease can spread to other areas of the body outside the uterus.

For the record, and this is fact, Hysterectomy does not cure, never has cured, and never will be a cure for endometriosis.

Most endometriosis is found outside the uterus and can be found in the pouch of douglas, utero-sacral ligaments, ovaries, intestine, pelvic wall, bladder and it can even spread up into the diaphragm, thoracic cavity, liver, pericardium, rectum and other parts of the body. It has even been found in the brain and distal joints such as the fingers.

All women with endometriosis need to know that endometriosis will still stay in the places mentioned above, irrespective if the uterus is removed, or not.

Many women will often comment that hysterectomy has cured their endometriosis and this is because they have been led to believe what their doctor has told them, they lack the understanding of the disease and they may have had some relief of pain usually associated with their menstrual cycle.

All hysterectomy will do for a woman with endometriosis is stop their menstrual cycle and any associated symptoms and pain associated with her menstrual cycle. Some women are also just lucky to become asymptomatic after hysterectomy too.

The type of hysterectomy may also help to slow the progression of the disease too. What many people do not understand it they there are two types of hysterectomy. One is a full hysterectomy, where the uterus and ovaries are removed and the other is a partial hysterectomy, where only the uterus is removed and the ovaries are left behind. It may be possible that a full hysterectomy, where the ovaries are removed, may in fact reduce some of the estrogen that is driving the disease and make someone asymptomatic.

The other gynaecological issue that many healthcare practitioners misdiagnose and overlook is Adenomyosis. Adenomyosis is an inflammatory disease deep within the wall, muscle and tissues of the uterus. Many now believe that Adenomyosis and endometriosis are one in the same disease, except Adenomyosis is deep within the muscles and tissues, where as endometriosis tends to be more superficial.

Removal of the uterus will in fact help Adenomyosis and help with the associated symptoms, such as heavy bleeding and pain.

Many women actually have Endometriosis and Adenomyosis at the same time and many do not even know they have both diseases. Then when the uterus is removed, women experience less pain and symptoms, or no pain and symptoms, that was actually caused by the Adenomyosis rather than the endometriosis.

Then these women are led to believe that they have been cured of endometriosis due to the resulting levels of pain and symptoms that are now gone. But, while their Adenomyosis may be cured (and I use this term loosely due to context), their endometriosis still remains.

But if they are now asymptomatic, which many women are, they many not know that the endometriosis is actually still there. If you are one of these people I do need you to know that the hysterectomy has not cured your endometriosis at all and it is still there in your body. If a hysterectomy has cured your pain and associated symptoms is because of everything I have mentioned above. Again, hysterectomy DOES NOT cure endometriosis.

I also see the opposite of this in practice too. Many women whom have had a hysterectomy are still getting lots of abdominal pain, intestinal pain, bladder pain, rectal pain and others pains in the body. It is often hard for them to hear that their pain they are experiencing is actually from endometriosis, which they have been previously diagnosed with, yet believe has been cured due to the removal of the uterus and sometimes ovaries are well (partial, or full hysterectomy).

The only way that many will actually fully believe you is after they have had further surgery and the disease is found and excised and their symptoms are stopped, or reduced. It is not until then, that these women will know what you have said to be true and that they have been sold the biggest lie on the planet.

The reason I wanted to speak about this is because I see so many women believing that hysterectomy (partial or full) will cure their endometriosis and have been sold the lie.

Unfortunately many of these women are still suffering greatly and are often left wondering why, or are told it can’t be endometriosis as the uterus has been removed. It is so terrible to hear this and see this statement being spread as gospel by healthcare practitioners and even surgeons who know no better and do not understand endometriosis as a disease state.

It is also hard to hear other women tell their fellow sisters the same lie, even though it is not really their fault and they actually do not know any better. I am writing this so the truth is out there and we get to stop this misinformation from spreading any further.

I hope this has helped you with getting some of the facts and see why so many women are told the one of the biggest lies in healthcare.

Oh and remember one more thing….  Period Pain is not normal, no matter what anyone tells you!

Take care

Regards

Andrew Orr

-Women’s and Men’s Health Crusader

-“No Stone Left Unturned”

-Period Pain is not normal